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Öğe Aponeurotic Expansion as a Cause for Rotator Cuff Tears but Full Joint Movements in Patients: Magnetic Resonance Arthrography Images of Aponeurotic Expansion and the Clinical Situation(Springernature, 2024) Uludag, Veysel; Guclu, Derya; Karaduman, Zekeriya Okan; Ogul, HayriThis case report presents the detailed clinical and radiological findings of a 63-year-old male patient who presented with right shoulder pain. Magnetic resonance imaging (MRI) and magnetic resonance arthrography (MRA) revealed significant tears in most of the rotator cuff muscles. Despite these findings, the patient was able to perform full shoulder movements, suggesting that aponeurotic expansion may play a crucial role in this scenario. This case highlights important clinical findings that could lead to potential changes in shoulder surgery and rehabilitation approaches.Öğe The Characteristics and Outcomes of Contralateral Non-Concurrent Hip Fractures: A Retrospective Study in Geriatric Patients(Mdpi, 2024) Saglam, Sonmez; Arican, Mehmet; Karaduman, Zekeriya Okan; Yucel, Mucahid Osman; Degirmenci, Erdem; Uludag, VeyselBackground and Objectives: This study aimed to determine the relationship between non-simultaneous contralateral hip fractures, urban and rural differences, fracture localization, time between fractures, physiotherapy applications, comorbidity, and the second fracture outcomes. Materials and Methods: We retrospectively analyzed 107 patients aged 65 and older with proximal femur fractures (PFFs) who underwent surgery at D & uuml;zce University Medical Faculty between January 2010 and December 2022. High-energy fractures, pathological fractures, and patients with a history of old fractures were excluded. Results: The study included 66 females (61.7%) and 41 males (38.3%), with a mean age of 83.76 years. The mean interval between two fractures was 28.3 months. There was no statistical difference between the localization of the first and second fractures (p = 0.107). However, there was a significant difference in the first PFF localizations of patients living in rural areas (p = 0.023). Patients with heart failure, respiratory failure, osteoporosis, and cognitive impairment had shorter intervals between fractures (p < 0.001). Conclusions: This study shows that age, female gender, place of residence, comorbid diseases, and whether physical therapy is received after the first fracture are significant risk factors for a second hip fracture in patients over 65 years of age.Öğe Comparative evaluation of artificial intelligence models GPT-4 and GPT-3.5 in clinical decision-making in sports surgery and physiotherapy: a cross-sectional study(Bmc, 2025) Saglam, Soenmez; Uludag, Veysel; Karaduman, Zekeriya Okan; Arican, Mehmet; Yucel, Muecahid Osman; Dalaslan, Rasit EminBackground The integration of artificial intelligence (AI) in healthcare has rapidly expanded, particularly in clinical decision-making. Large language models (LLMs) such as GPT-4 and GPT-3.5 have shown potential in various medical applications, including diagnostics and treatment planning. However, their efficacy in specialized fields like sports surgery and physiotherapy remains underexplored. This study aims to compare the performance of GPT-4 and GPT-3.5 in clinical decision-making within these domains using a structured assessment approach. Methods This cross-sectional study included 56 professionals specializing in sports surgery and physiotherapy. Participants evaluated 10 standardized clinical scenarios generated by GPT-4 and GPT-3.5 using a 5-point Likert scale. The scenarios encompassed common musculoskeletal conditions, and assessments focused on diagnostic accuracy, treatment appropriateness, surgical technique detailing, and rehabilitation plan suitability. Data were collected anonymously via Google Forms. Statistical analysis included paired t-tests for direct model comparisons, one-way ANOVA to assess performance across multiple criteria, and Cronbach's alpha to evaluate inter-rater reliability. Results GPT-4 significantly outperformed GPT-3.5 across all evaluated criteria. Paired t-test results (t(55) = 10.45, p < 0.001) demonstrated that GPT-4 provided more accurate diagnoses, superior treatment plans, and more detailed surgical recommendations. ANOVA results confirmed the higher suitability of GPT-4 in treatment planning (F(1, 55) = 35.22, p < 0.001) and rehabilitation protocols (F(1, 55) = 32.10, p < 0.001). Cronbach's alpha values indicated higher internal consistency for GPT-4 (alpha = 0.478) compared to GPT-3.5 (alpha = 0.234), reflecting more reliable performance. Conclusions GPT-4 demonstrates superior performance compared to GPT-3.5 in clinical decision-making for sports surgery and physiotherapy. These findings suggest that advanced AI models can aid in diagnostic accuracy, treatment planning, and rehabilitation strategies. However, AI should function as a decision-support tool rather than a substitute for expert clinical judgment. Future studies should explore the integration of AI into real-world clinical workflows, validate findings using larger datasets, and compare additional AI models beyond the GPT series.Öğe The Effects of Phenyramidol and Diclofenac Treatment on Fracture Healing in Rats(Korean Orthopaedic Assoc, 2024) Celik, Mucahit; Karaduman, Zekeriya Okan; Turhan, Yalcin; Arican, Mehmet; Gamsizkan, Mehmet; Saglam, Sonmez; Uludag, VeyselBackground: Fracture healing or nonunion refers to a process in which many factors interact. In this study, we aimed to evaluate the radiological, histological, and biomechanical effects of phenyramidol and diclofenac, which are frequently used to treat post-fracture ture pain worldwide, on fracture healing and nonunion in a rat femur fracture model. Methods: In this study, 72 male Wistar-Albino rats aged 2-3 months and weighing 250 +/- 30 g were divided into 4 main groups. The rats were divided into 12 subgroups according to the early, middle, and late periods. A fracture model was created in rat femurs, and surgical fixation was performed. Postoperative analgesic treatment protocols included phenyramidol, diclofenac, phenyramidol + diclofenac, and the control group. The rats were sacrificed on the fifteenth, thirtieth, and forty-fifth days and were evaluated radiologically, histopathologically, and biomechanically. Results: Scoring was conducted independently by 2 orthopedists not involved in the study. When the results were analyzed statistically, no statistically significant difference was observed between the fifteenth and thirtieth day radiology score values of the control, diclofenac, phenyramidol, and Phenyramidol + diclofenac groups (p > 0.05), but there was a statistically significant difference (p < 0.05) between the forty-fifth day radiology score values of the control, diclofenac, phenyramidol, and phenyramidol + diclofenac groups. Conclusions: Our study shows that the use of diclofenac or phenyramidol alone negatively affects postoperative fracture healing. However, this effect was less pronounced in the combined treatment group. Histologic examination revealed that neither treatment had a significant effect on healing. There were statistical differences in biomechanical and radiologic properties between the phenyramidol and diclofenac groups; in particular, the diclofenac group had lower biomechanical properties.Öğe Glenohumeral Joint Volume Measurement in Patients with Shoulder Instability: A 3D Volumetric Magnetic Resonance Arthrographic Study(Mdpi, 2024) Gueclue, Derya; Unlu, Elif Nisa; Arican, Mehmet; Acar, Oguzhan; Uludag, Veysel; Ogul, HayriBackground and Objectives: This study aimed to compare capsular volume in patients with shoulder instability to that in control subjects without instability using magnetic resonance (MR) arthrography. The objective was to develop a reliable screening method with which to assess shoulder volume. Materials and Methods: In 21 patients with atraumatic shoulder instability and 21 controls, thin-slice 3D volumetric MR arthrography sequences were obtained. MR arthrography images were uploaded to 3D reconstruction, and 3D images were generated. From the 3D reconstructed images, volumetric measurements of rotator interval (RI), anterior and posterior capsular (AC, PC) recesses, biceps tendon sheath (BS), axillary recess (AR), and total glenohumeral joint (TGJ) were performed. Individuals with any extra-articular contrast leakage were also recorded. Results: A retrospective study analyzed a patient group of 21 individuals with shoulder instability (mean age 29.52 +/- 12.83 years) and a control group of 21 individuals without instability (mean age 35.71 +/- 12.77 years). No statistically significant differences were identified between the groups with regard to age, gender, or side distribution. The mean total joint volume was significantly higher in the instability group (29.85 +/- 6.40 cm3) compared to the control group (23.15 +/- 3.48 cm3, p = 0.0001). Additionally, the mean volumes of the RI, AC, PC, BS, and AR were all significantly greater in the patient group compared to the control group. Conclusions: 3D volumetric MR arthrographic measurements of the shoulder joint capacity can provide valuable insights for clinical follow-up and guide surgical treatment decisions in cases of atraumatic shoulder instability.Öğe Innovative approaches in the treatment of chronic plantar fasciitis: comparison of pulsed radiofrequency ablation and surgical intervention(Springer, 2024) Armagan, Celal; Karaduman, Zekeriya Okan; Arican, Mehmet; Turhan, Yalcin; Kaban, Ilyas; Uludag, VeyselPurpose This study aimed to compare the effectiveness of Pulsed Radiofrequency Ablation (PRFA) and surgery for treating chronic plantar fasciitis, focusing on pain relief and functional outcomes. Methods A prospective study involved 30 patients with chronic plantar fasciitis unresponsive to 12 months of conservative treatment. Patients were divided into PRFA (n = 17) and surgical (n = 13) groups. Clinical evaluations were conducted preoperatively and at three, six and 12 months postoperatively using VAS, AOFAS, FFI, and RMS scores. Radiological measurements assessed foot structure impact. Results Both PRFA and surgery significantly reduced pain and improved function. PRFA had a shorter operative time and quicker return to activities (p < 0.001). At 3 months, PRFA showed superior VAS, FFI, and RMS scores (p < 0.05). Long-term outcomes were similar. No major complications occurred, but minor complications were higher in the surgical group (p < 0.01). Conclusions PRFA is a minimally invasive, effective treatment for chronic plantar fasciitis with quicker recovery and lower complication rates compared to surgery. Both treatments offer comparable long-term benefits. Further studies are needed to confirm these findings.Öğe Investigation of the Relationship Between Cervical Disc Herniations and Shoulder Complex Pathologies(Duzce Univ, Fac Medicine, 2024) Tuncer, Cengiz; Kilic, Rabia Tugba; Kilic, Guven; Karaduman, Zekeriya Okan; Arican, Mehmet; Akbari, Pouriya; Uludag, VeyselObjective: The aim of our study was to investigate whether there is a relationship between shoulder complex pathologies and cervical disc herniations. Materials and Methods: This study retrospectively included 524 patients with both dominant extremity shoulder and neck magnetic resonance examinations obtained from the information processing unit of Duzce University Faculty of Medicine between 01.08.2009-01.08.2023. The results were compared in Statistical Package for Social Sciences (SPSS). Results: A total of 524 patients, 153 (29.2%) males and 371 (70.8%) females, with a mean age of 51.17 +/- 13.70 (range, 13-93) years, were included in the study. According to the statistical analysis of our study, 410 of the participants had supraspinatus pathology, 234 had infraspinatus pathology, 243 had subscapularis pathology and 11 had teres minor pathology. In addition, a statistically significant relationship was found between other shoulder pathologies and herniations at the C4 -C5 and C5 -C6 disc level (p<0.05). Conclusions: In conclusion, even if there is a significant relationship between cervical disc herniations and shoulder pathologies, different methods should be developed for treatment algorithms and pain management. Evaluation of the cervical region should not be neglected in patient groups with shoulder pathologies.Öğe Investıgatıon of the effects of treatment with enoxaparın sodıum and hyperbarıc oxygen therapy on the recovery of rats wıth achılles tendon rupture(Bmc, 2024) Aytekin, Cafer Erman; Turhan, Yalcin; Karaduman, Zekeriya Okan; Arican, Mehmet; Saglam, Sonmez; Coskun, Sinem Kantarcioglu; Uludag, VeyselPurpose In this study, we aimed to investigate the effects of hyperbaric oxygen therapy and enoxaparin sodium, which are known to accelerate bone tissue healing as well as tendon and soft tissue healing, on the healing of Achilles tendon rupture. Methods Thirty-six rats were used in the present study. All rats were divided into groups of nine. The groups were the enoxaparin sodium group, enoxaparin sodium and hyperbaric oxygen group, hyperbaric oxygen group and control group. After 21 days, the process was completed, and the rats were sacrificed. Achilles tendon samples were evaluated histopathologically. Results The groups were compared according to the results of statistical analysis based on the histopathological data. There was no significant difference between the groups in terms of acute inflammation (p = 0.785) or chronic inflammation (p = 0.827) scores, but there were significant differences in neovascularization (p = 0.009), proliferation (p < 0.001) and fibrosis (p = 0.006) scores. Conclusion Our study showed that the use of enoxaparin sodium and hyperbaric oxygen had a positive effect on the healing of the Achilles tendon. Based on these results, we believe that the use of enoxaparin sodium and hyperbaric oxygen therapy after Achilles tendon rupture will be beneficial for healing and preventing complications.Öğe Novel Conservative Therapies in Migraine Management: The Impact of Fascia Exercises in a Randomized Controlled Trial(Mdpi, 2025) Tekin, Rabia Tugba; Aslan, Hilal; Uludag, Veysel; Gumusyayla, Sadiye; Vural, GonulBackground/Objectives: Migraine is a complex neurological disorder often associated with autonomic nervous system (ANS) dysfunction. This study aimed to evaluate the effects of fascia exercises on migraine symptoms and explore their potential as a novel conservative treatment approach. Methods: A prospective, randomized controlled trial was conducted with 30 migraine patients who were randomly assigned to a treatment group (fascia exercises) or a control group (conventional physiotherapy). Both groups underwent a six-week intervention consisting of two sessions per week. Pain intensity, migraine-related disability, sleep quality, anxiety, depression, heart rate variability (HRV), and patient satisfaction were assessed before and after the intervention using validated scales. Results: Significant improvements in pain intensity, attack frequency and duration, migraine-related disability, sleep quality, and anxiety levels were observed in both groups (p < 0.05). However, the treatment group demonstrated a more pronounced reduction in depression scores compared to the control group (p < 0.05). While no significant changes in HRV parameters were detected in either group, patient satisfaction was significantly higher in the treatment group (p < 0.05). Conclusions: Fascia exercises represent a promising complementary therapy for migraine management, offering significant improvements in both physical and psychological symptoms. While immediate effects on HRV were not evident, the potential to modulate autonomic balance and address migraine pathophysiology warrants further exploration. These findings highlight the value of fascia exercises as a low-cost, non-invasive approach, emphasizing the need for further research to confirm their long-term clinical benefits and integration into migraine treatment protocols.Öğe The relationship between resting heart rate variability and sportive performance, sleep and body awareness in soccer players(Bmc, 2025) Tekin, Rabia Tugba; Kudas, Savas; Buran, Melike Mese; Cabuk, Salih; Akbasli, Oguzhan; Uludag, Veysel; Yosmaoglu, Hayri BaranBackgroundHeart rate variability (HRV) is a key marker of autonomic nervous system function and has been proposed as a tool for monitoring training adaptations. However, its relationship with performance beyond aerobic capacity remains unclear in football players. This study aimed to examine the associations between resting HRV and aerobic capacity, agility, neuromuscular coordination, sleep quality, and body awareness.MethodsTwenty-five male football players (mean age 20 +/- 3 years) underwent HRV assessment via the Polar H10 system. Performance tests included the 20 m Shuttle Test (VO2max), Illinois Agility Test, Hexagon Test (neuromuscular coordination), and Vertical Jump Tests (muscular strength). Sleep quality and body awareness were assessed using the Pittsburgh Sleep Quality Index and Body Awareness Questionnaire.ResultsHRV Score was positively correlated with VO2max (r = 0.4, p = 0.04), while LF/HF ratio showed a negative correlation with shuttle test distance (rs=-0.52, p = 0.007). Mean RR correlated with neuromuscular coordination (r = 0.56, p = 0.004), sleep quality (r = 0.45, p = 0.024), and body awareness (rs = 0.46, p = 0.019). No significant correlations were found with muscular strength.ConclusionsResting HRV is associated with key performance indicators in football players, supporting its potential use in monitoring physiological readiness and training adaptations. Future research should establish reference values and evaluate HRV-based interventions for performance enhancement.Öğe Relationship between SLAP Lesions and Shoulder Joint Capsule Thickness: An MR Arthrographic Study(Mdpi, 2024) Guclu, Derya; Uludag, Veysel; Arican, Mehmet; Unlu, Elif Nisa; Ogul, HayriBackground and Objectives: This study aimed to evaluate the relationship between SLAP lesions and the shoulder joint capsule thickness via MR arthrography. Understanding the relationship between SLAP lesions and the joint capsule thickness is important because an increased capsule thickness may indicate chronic inflammation and contribute to persistent pain and dysfunction. These findings have significant clinical implications for the diagnosis, management, and treatment strategies of shoulder joint pathologies. Materials and Methods: We retrospectively analyzed the MR arthrography results of 78 patients who underwent shoulder imaging at D & uuml;zce University Medical Faculty between October 2021 and November 2024. The study included patients diagnosed with SLAP lesions and compared them with a control group without such pathology. Data on joint capsule thickness at the level of the axillary recess, SLAP lesion type, cuff pathology, and demographic information were collected and analyzed. Results: The study included 32 patients with SLAP lesions and 46 control subjects. The mean age of the patients was 44.75 +/- 14.18 years, whereas the control group had a mean age of 38.76 +/- 13 years. The patient group presented a significantly greater mean anterior capsule thickness (3.13 +/- 1.28 mm vs. 1.72 +/- 0.7 mm, p = 0.0001), posterior capsule thickness (3.35 +/- 1.32 mm vs. 1.95 +/- 1.06 mm, p = 0.0001), and maximum capsule thickness (3.6 +/- 1.32 mm vs. 2.06 +/- 1.01 mm, p = 0.0001) in the axillary recess. SLAP type 2 lesions were the most common type (43.76%) in the patient group. Conclusions: This study revealed a significant association between SLAP lesions and an increased shoulder joint capsule thickness. These findings suggest that MR arthrography is an effective tool for assessing the joint capsule changes associated with labral tears, contributing to the better diagnosis and management of shoulder joint pathologies in clinical practice.Öğe The role of tranexamic acid and cryotherapy on acute postoperative pain and blood loss: a randomized controlled study following total knee arthroplasty(Springernature, 2025) Saglam, Soenmez; Karaduman, Zekeriya Okan; Arican, Mehmet; Yucel, Muecahid Osman; Dalaslan, Rasit Emin; Cangur, Sengul; Uludag, VeyselPurpose Blood loss and pain management are significant concerns in total knee arthroplasty (TKA). Tranexamic acid (TA) and cryotherapy have been used separately to address these issues, but their comparative effectiveness is not well studied. This study aimed to evaluate the efficacy of intravenous TA and cryotherapy in reducing blood loss and improving clinical outcomes after TKA. Methods A randomized controlled trial with 76 patients assigned to three groups: Group 1 received pre- and postoperative cryotherapy, Group 2 received intravenous tranexamic acid (TA), and Group 3 (control) received a standard cold pack. Hemoglobin (Hb), hematocrit (Hct), prothrombin time, international normalized ratio (INR), knee flexion and extension angles, and visual analog scale (VAS) pain scores were monitored preoperatively and postoperatively at 6, 24, and 48 h. Results The mean age of patients was 65 +/- 7 years. The tranexamic acid group showed significantly lower blood loss compared to the control group (p < 0.001). Knee flexion and extension angles were significantly better in the cryotherapy group compared to the control group (p < 0.001). VAS pain scores were significantly lower in the cryotherapy group at all time points compared to both the tranexamic acid and control groups (p < 0.001). Conclusion Both tranexamic acid and cryotherapy are effective in reducing blood loss and improving clinical outcomes following TKA. Tranexamic acid significantly reduces blood loss, while cryotherapy effectively manages postoperative pain and range of motion. These methods can enhance patient recovery after TKA.
