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    Central sensitization significantly deteriorates functionality and the interpretation of self-reported disease activity in primary Sjögren’s syndrome
    (Springer Science and Business Media Deutschland GmbH, 2024) Sariyildiz, Aylin; Coskun Benlidayi, Ilke; Yetişir, Ayşegül; Turk, Ipek; Zengin Acemoglu, Serife Seyda; Deniz, Volkan
    Background: Central sensitization has a major role in health-related parameters in musculoskeletal conditions. There is still a lack of understanding regarding the impact of central sensitization on the interpretation of disease activity and functional disability in primary Sjögren’s syndrome (pSS). Methods: The Central Sensitization Inventory (CSI) was used to screen for central sensitization. Disease-related parameters, including objective tests, medication use, the EULAR SS Patient Reported Index (ESSPRI), and the EULAR SS Disease Activity Index (ESSDAI), were assessed. Functionality, quality of life, sleep, and mental health were evaluated by the Health Assessment Questionnaire-Disability Index (HAQ-DI), Medical Outcomes Study 36-Item Short Form Health Survey (SF-36), Jenkins Sleep Evaluation Scale (JSS), and Hospital Anxiety and Depression Scale (HADS), respectively. The effect of central sensitization on functionality and disease activity measures was assessed by regression analyses. Results: The frequency of central sensitization was 65% in patients with pSS (n = 60). Patients with central sensitization had higher HAQ-DI, ESSPRI, HADS, and JSS and lower SF-36 subdomain scores (p < 0.05 for all). A significant positive correlation was observed between the CSI score and the ESSPRI, JSS, HAQ-DI, and HADS scores (Spearman’s rho ranging from 0.342 to 0.739). The multiple regression analysis indicated that CSI was independently associated with HAQ-DI (adjusted R2 = 0.19, B = 0.01) and ESSPRI (adjusted R2 = 0.45, B = 0.08) (p < 0.001 for all). Conclusion: This study confirms that central sensitization has a major impact on functionality and the interpretation of self-reported disease activity in pSS. When devising strategies for the management of patients with pSS, it is crucial to consider these close relationships. (Table presented.) © The Author(s), under exclusive licence to International League of Associations for Rheumatology (ILAR) 2024.
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    Comparison of the activation and mechanical properties of scapulothoracic muscles in young tennis players with and without scapular dyskinesis: an observational comparative study
    (Mosby-Elsevier, 2024) Deniz, Volkan; Sariyildiz, Aylin; Buyuktas, Bilgihan; Basaran, Sibel
    Background: In tennis athletes with scapular dyskinesis, the activation of the scapulothoracic muscles during serve is not known. Also, the mechanical properties (tone, elasticity, and stiffness) of the scapulothoracic muscles of the tennis athletes with scapular dyskinesis are likely to change. The study aimed to evaluate the activation of the scapulothoracic muscles while performing tennis serve and to determine the changes in the mechanical properties of the same muscles in young tennis athletes with scapular dyskinesis. Methods: Seventeen tennis athletes with scapular dyskinesis aged between 11 and 18 years (the scapular dyskinesis group) and age- and gender-matched 17 asymptomatic tennis athletes (the control group) were included in the study. Activation of scapulothoracic muscles (descending-transverse-ascending trapezius and serratus anterior) in the 3 phases (preparation, acceleration, and follow-through) of the serve was evaluated using surface electromyography, and the mechanical properties of the same muscles were measured at rest by myotonometry.Results: Ascending trapezius activation in the follow-through phase was lower in the scapular dyskinesis group compared with the control group (mean difference 95% confidence interval: -22.8 [-41.2 to -4.5]) (P = .017). The tone and stiffness of the transverse trapezius (P = .043 and P = .017, respectively) were higher, whereas the same parameters of the ascending trapezius were lower (P = .008 and P = .010, respectively) in the scapular dyskinesis group compared with the control group.Conclusions: Activation of the ascending trapezius and the tone and stiffness of the transverse-ascending trapezius were altered in tennis athletes with scapular dyskinesis. Implementations to improve these changes can be included in the rehabilitation or training programs of young tennis athletes with scapular dyskinesis.(c) 2023 Journal of Shoulder and Elbow Surgery Board of Trustees. All rights reserved.
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    Diagnostic utility of deep tendon reflex responses in rectus femoris and triceps brachii in fibromyalgia: a clinical and electrophysiological study
    (Springer Heidelberg, 2025) Benlidayi, Ilke Coskun; Deniz, Volkan; Ornek, Ceren; Sariyildiz, Aylin
    The aim of this study was to evaluate deep tendon reflex responses and associated electrophysiological parameters of the muscles in patients with fibromyalgia. This cross-sectional study included 38 patients with fibromyalgia and 32 age- and sex-matched controls. Deep tendon reflexes of the rectus femoris and triceps brachii were tested using a reflex hammer. Electromyographic (amplitude and duration of activation), inertial measurement unit (angular velocity, acceleration), and electromechanical (delay) analyses were performed using a surface electromyography (sEMG) device. Comparative analyses were carried out between patients and controls. Additionally, Receiver Operating Characteristic (ROC) analysis was performed to evaluate the ability of hyperreflexia in distinguishing fibromyalgia patients from controls. Hyperactive deep tendon reflexes in the right/left rectus femoris and/or triceps brachii were observed in more than 85% (ranging from 86.8 to 94.7%) of the fibromyalgia group. Patients with fibromyalgia exhibited significantly increased deep tendon reflex responses compared to controls (p < 0.001). Patients revealed significantly higher amplitude, longer duration of muscle activation, greater sagittal acceleration and angular velocity, and shorter electromechanical delay. Normalized muscle activation (right and left rectus femoris and right triceps brachii) in response to deep tendon reflex test showed acceptable ability in differentiating fibromyalgia patients from controls (Area under curve (AUC) = 0.890, 0.784 and 0.782, respectively). For the right rectus femoris, values <= 28.3 (clinically corresponding to normoactive/hypoactive deep tendon reflexes) appeared to rule-out fibromyalgia with 94.1% sensitivity and 61.3% specificity. Patients with fibromyalgia exhibit increased deep tendon reflex responses. Normal or decreased deep tendon reflex responses may probably be used as a rule-out criterion for fibromyalgia.
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    Effectiveness of corrective exercise program on alignment, muscle activation and biomechanical properties in forward head posture: A randomized controlled trial
    (Cukurova Univ, Fac Medicine, 2024) Sariyildiz, Aylin; Deniz, Volkan; Basaran, Sibel
    Purpose: The aim of this study was to investigate the effects of supervised corrective exercise program on craniovertebral angle (CVA), shoulder protraction angle (SPA), and activity/biomechanical properties of cervicothoracic muscles in medical students with forward head posture (FHP). Materials and Methods: Thirty-six medical students with FHP were allocated to an exercise group (n=18) or a control group (n=18). The participants in the exercise group followed an 8-week supervised corrective exercise program. CVA and SPA were evaluated with photogrammetry and activity and biomechanical chracteristics of the servicothoracic muscles were assessed with surface electromyography and myotonometry at baseline and after supervised exercise program. Results: Data of thirty-two participants (16 for both groups) were analyzed. A significant improvement of CVA [Mean Difference (MD) 95% Confidence Interval (CI): 7.8 (5.2 to 10.5)] and SPA [MD 95%CI: 3.7 (0.2 to 7.2)] was observed in the exercise group compared to the control group. Multiple regression analysis revealed that a reduction in right upper trapezius stiffness had a significant effect on CVA (B= 0.047, Adjusted R2= 0.61), and the change in the tone of the right lower trapezius (B= 2.85, Adjusted R2= 0.64) had a significant effect on SPA. Conclusion: An eight-week corrective exercise program improved cervicothoracic alignment in FHP. Streching exercises that reduce the stiffness of the upper trapezius and strengthening exercises that increase the tone of the lower trapezius can be prioritized in the management of FHP.
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    Evaluation of the segmental distribution of pain sensitivity among patients with central sensitization associated with chronic subacromial pain syndrome: A cross-sectional study
    (Elsevier, 2024) Deniz, Volkan; Sariyildiz, Aylin
    Introduction: Pain sensitivity is the main finding of central sensitization (CS) and can occur in patients with chronic shoulder pain. However, there is limited evidence concerning the distribution of pain sensitivity in shoulders, forearms, and legs in patients with CS associated with chronic shoulder pain. The present study aimed to determine the distribution of pain sensitivity in patients with CS associated with chronic subacromial pain syndrome (SPS). Method: This cross-sectional study included 58 patients with chronic SPS and CS (patient group) and 58 healthy participants (control group). The presence of CS was determined using the Central Sensitization Inventory (CSI). To determine the distribution of pain sensitivity, pressure pain threshold (PPT) measurements were performed from the shoulders, forearms, and legs. Results: There was no significant difference between the two groups in terms of sociodemographic data (p > 0.05). The patient group had a significantly higher CSI score (p < 0.001) and lower PPTs in all regions (p < 0.05) than the control group. Unlike the control group, the patient group had lower PPTs on the affected side for the shoulder [mean difference (MD) 95% confidence interval (CI): 1.2 (-1.7 to - 0.6)], forearm [MD 95% CI: 1.1 (-1.7 to - 0.6)], and leg [MD 95% CI: 0.9 (-1.4 to -0.3)] compared with the contralateral side (p < 0.001). Conclusion: Pain sensitivity is more pronounced in the affected shoulder and the forearm and leg located on this side than in those on the contralateral side in patients with CS associated with chronic SPS.
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    The relation of psychological status and type D personality with central sensitization in knee osteoarthritis: everything is in your mind!
    (Springer Heidelberg, 2023) Sariyildiz, Aylin; Coskun Benlidayi, Ilke; Olmez Engizek, Sila; Deniz, Volkan
    To evaluate the relation of psychosocial parameters and type D personality with central sensitization in knee osteoarthritis (OA). The study included 126 patients with knee OA according to the American College of Rheumatology criteria. Sociodemographic variables (age, gender, education, marital status, annual income), alcohol consumption/smoking, body mass index, comorbidities, and duration of symptoms were noted. Radiographic evaluation was performed according to the Kellgren-Lawrence grading system. The Western Ontario and McMaster Universities Osteoarthritis Index was used for clinical evaluation. Type D personality, negative affectivity, and social inhibition were evaluated using the type D Scale-14 (DS14). Central sensitization was assessed by the central sensitization inventory (CSI), while psychological status, quality of life, and sleep were assessed by the Hospital Anxiety and Depression Scale (HADS), an abbreviated version of the World Health Organization Quality of Life Instrument (WHOQOL-BREF), and the Jenkins Sleep Evaluation Scale (JSS), respectively. The effect of type D personality on study parameters including central sensitization, as well as the risk factors for the development of central sensitization were assessed by regression analyses. Patients with type D personality had higher CSI, HADS scores and lower WHOQOL-BREF scores for psychological health, social relationship, environment and general quality of life. Linear regression analysis showed that the DS14 total score has a significant positive relation with CSI (beta = 0.4, p < 0.05), HADS-depression (beta = 0.4, p < 0.05), HADS-anxiety (beta = 0.5, p < 0.05), and HADS-total scores (beta = 0.5, p < 0.05). It also had a significant negative effect on all domains of WHOQOL-BREF (p < 0.05 for all). Logistic regression analysis revealed that JSS [Odds ratio (OR) 0.83, 95% CI 0.73-0.94; p = 0.003] and negative affectivity (OR 0.78, 95% CI 0.65-0.94; p = 0.008) were independent risk factors for the development of central sensitization in knee OA. Type D personality has an impact on quality of life, central sensitization, and psychological health, with negative affectivity and sleep impairment serving as independent risk factors for central sensitization. While managing patients with knee OA, these intimate relationships should be taken into consideration.