BACKGROUND:Frozen Shoulder (FS) is a highly disabling glenohumeral condition marked by severe pain and restricted active and passive motion, typically without significant radiological changes. While conventionally viewed as a self-limiting and idiopathic disorder, recovery is often incomplete, suggesting that peripheral-only interventions are insufficient. OBJECTIVE:This manuscript reviews the contemporary understanding of FS etiopathogenesis, clarifying the underlying pain processing mechanisms, metabolic patterns, and psychological domains. Evidence about diagnostic tests and imaging for FS, and updated treatment strategies were also discussed. KEY FINDINGS:The latest evidence suggests FS is the musculoskeletal manifestation of systemic metabolic, inflammatory, and neuroendocrine dysregulation. Pain mechanisms extend beyond the periphery, showing links to sensitization and possible central involvement, though further clarity is needed. Moreover, FS significantly impacts mood, beliefs, and social well-being. Imaging remains a tool for diagnosis and differential ruling, and treatment should be "tailorized" from biopsychosocial perspective. Individualization involves the understanding of the individual's personal history, clinical characteristics, context, and goals in combination with tissue irritability. CONCLUSION:Clinicians must move beyond solely addressing FS as a "local" pathology. Modern research indicates that FS is a complex pathology involving an inflammatory phase followed by a fibrotic shift, fueled by metabolic, inflammatory, neuroendocrine, and psychological factors.

Introduction Self-efficacy and adherence to home exercises are fundamental to an effective treatment. Translating, culturally adapting, and evaluating the psychometric properties of a self-efficacy for home exercises scale will enable its use in clinical practice. Objectives To translate, culturally adapt, and evaluate the psychometric properties of the Self-Efficacy for Home Exercise Programs Scale (SEHEPS) in individuals with shoulder pain. Methods SEHEPS was translated from English to Brazilian Portuguese. Individuals aged 18 to 60 years with shoulder pain lasting at least 3 months were included. The test-retest reliability of the SEHEPS was verified through repeated applications by the same assessor. Construct validity was analyzed by correlation with the Chronic Pain Self-efficacy Scale (CPSS) and the Exercise Adherence Rating Scale (EARS). The responsiveness of the Brazilian Portuguese SEHEPS was assessed during a 12-week randomized clinical trial. The questionnaires were administered 4, 8, and 12 weeks after baseline. Results The Brazilian Portuguese SEHEPS demonstrated good reliability, with an intraclass correlation coefficient of 0.73 and Cronbach’s alpha of 0.93. Construct validity showed moderate correlations with CPSS (ρ = 0.45, p < 0.001) and EARS (ρ = 0.46, p < 0.001). Responsiveness analysis revealed that changes in SEHEPS scores were significantly correlated with CPSS scores (ρ = 0.42, p = 0.006), with an area under the curve (AUC) of 0.71. The tool showed no floor or ceiling effects. Conclusion The Brazilian Portuguese version of SEHEPS is a reliable, valid, and responsive instrument for assessing self-efficacy in home exercise programs among individuals with chronic shoulder pain.

Diabetes Mellitus (DM) is a major global health concern associated with serious complications, high healthcare costs, and reduced quality of life. Musculoskeletal pain is a common complication and contributes to limitations in daily activities and increased healthcare utilization. Pain is a multidimensional phenomenon typically classified as nociceptive, neuropathic, or nociplastic; however, evidence regarding pain mechanisms and phenotypes in people with DM remains limited. This review aimed to synthesize and critically review the literature on musculoskeletal pain in individuals with DM, focusing on pain mechanisms and phenotypes according to the International Association for the Study of Pain (IASP) classification. A narrative review with systematic search procedures examined the applicability of the seven clinical criteria proposed by the IASP for nociplastic pain to musculoskeletal pain phenotyping. Searches were conducted in PubMed and Web of Science from inception to December 2025. Evidence was analyzed according to the IASP nociplastic pain criteria to explore alignment with pain phenotyping approaches. Overall, the literature indicates that neuropathic pain mechanisms are relatively well documented and consistently reported in individuals with diabetes, while nociceptive musculoskeletal drivers are also described but with more limited and heterogeneous evidence. In contrast, evidence addressing hypersensitivity phenomena and other domains related to nociplastic pain remains scarce and is still emerging. This pattern suggests that current research on pain in people with DM remains focused on neuropathic mechanisms. Future research adopting standardized pain phenotyping frameworks is needed to support more precise and individualized pain management strategies in this population.

Objective:To explore potential mediators of treatment effect and moderators of scapular-focused interventions on shoulder disability at 12-week follow-up in patients with chronic shoulder pain. Design:Secondary analysis of a randomized controlled trial that compared the effects of scapular movement training with standardized exercises. Methods:Sixty-four participants with chronic shoulder pain were enrolled in the trial, of whom 58 completed the 12-week follow-up and were included in these analyses. Shoulder disability was assessed with Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire. Potential mediators were scapular upward rotation, kinesiophobia, and fear avoidance beliefs. Potential moderators were kinesiophobia, fear avoidance beliefs, and duration of symptoms. Results:Kinesiophobia, fear avoidance, and scapular upward rotation did not (p >0 .05) mediate the effects of scapular focused interventions on shoulder disability. Our sensitivity analyses indicated that the findings are likely to change because there were some small residual confounding factors between those mediators and the shoulder disability scores at 12 weeks. Kinesiophobia, fear avoidance, and duration of symptoms did not moderate the effects of the intervention on shoulder disability. Conclusions:Kinesiophobia, fear avoidance, duration of symptoms, and scapular upward rotation did not mediate or moderate the effects of scapular-focused interventions on shoulder disability at 12-week follow-up.

Introduction Musculoskeletal (MSK) pain is a common and disabling condition. In Brazil, the prevalence of MSK pain ranges from 21 % to 76 % with social and economic impacts. Mobile health (mHealth) applications (apps) have potential for aiding MSK pain treatment. Assessing their quality and usage is crucial to guarantee patient safety and intervention efficacy. The aim of this systematic review was to identify mHealth apps for self-management of MSK pain available in Brazilian online stores. The quality of the apps was also assessed. Methods Searches at App Store and Google Play were performed in December/2024. Apps in Portuguese, with no restrictions of price, involving self-management of MSK pain were included. The quality of apps was assessed with the Mobile Health App Rating Scale (MARS). Two reviewers conducted the search, screening and mHealth assessment. This systematic review was previously registered at PROSPERO (CRD42024626484). Results Of the 12,639 apps identified, 36 met the inclusion criteria (App Store = 5 and Google Play = 31). Among the included apps, 41.5 % approached exercises, 26.4 % education or counseling, 15.1 % symptom tracking and notes/logbook, and 1.9 % self-massage. The mean MARS score for the 36 apps was 3.87 ± 0.20 (ranging from 2.75 to 4.39 points). Conclusion This systematic review identified 36 apps with quality ranging from poor to excellent. The highest-scoring apps may be recommended for individuals with MSK pain with caution, as some do not provide all necessary resources for the assessment and follow-up in this population. Further studies are necessary to evaluate the efficacy and effectiveness of mHealth apps.

BACKGROUND:Fibromyalgia syndrome (FMS) is a complex condition characterized by numerous symptoms, especially long-lasting widespread pain. Available evidence suggests that the main causes of FMS are nociplastic pain mechanisms, but nociceptive and neuropathic pain components can also be involved, which would in these cases characterize FMS as a mixed-pain condition. In 2021, a comprehensive set of clinical criteria and grading systems was developed in accordance with the International Association for the Study of Pain. The establishment of these criteria is an important step toward precision pain medicine, with great potential for the assessment and treatment of FMS. OBJECTIVES:The aim of this study was to develop clinical recommendations for pain phenotyping, including the phenotyping of mixed pain, in patients with FMS. STUDY DESIGN:Narrative review. METHODS:Within this framework, an international and multidisciplinary group of pain specialists have developed clinical recommendations for integrating a mixed pain phenotype into the current framework of phenotyping FMS. A modified nominal group technique was used to develop the consensus recommendations. A manual is provided to allow clinicians to differentiate between predominant nociplastic pain and mixed pain when phenotyping FMS patients. RESULTS:A 7-step diagnostic approach, performed in 2 parts, is presented and illustrated using 3 case examples to enhance understanding and encourage effective implementation of this approach in research settings and clinical practice. LIMITATIONS:Studies examining the clinometric properties of these recommendations and this grading system for mixed pain in FMS are warranted. CONCLUSION:The current recommendations systematically summarize the methods that allow individuals with FMS to be classified into nociplastic or mixed pain phenotypes, based on potential nociceptive and neuropathic pain components.

Objective There is no established consensus for screening the spine in patients with shoulder pain. The aim of this study was to explore the role of the spine in shoulder pain and generate a set of recommendations for assessing the potential involvement of the spine in patients with shoulder pain.Methods A modified Delphi study was conducted through use of an international shoulder physical therapist's expert panel. Three domains (clinical reasoning, history, and physical examination) were evaluated using a Likert scale, with consensus defined as Aiken Validity Index >= 0.7.Results Twenty-two physical therapists participated. Consensus was reached on a total of 30 items: clinical reasoning (n = 9), history (n = 13), and physical examination (n = 8). The statement that spinal and shoulder disorders can coexist, sometimes influencing each other and at other times remaining independent issues, along with the concept of radiating pain as an explanatory phenomenon for the spine contribution to shoulder pain, achieved the highest degree of consensus.Conclusion International physical therapists shoulder experts reached consensus on key aspects when screening the spine in people with shoulder pain, including consideration of the distal location of symptoms relative to the shoulder, the presence or previous history of neck pain, the changes in symptoms related to neck movements, and the presence of neuropathic-like symptoms. They also acknowledged the importance of assessing active cervical or cervicothoracic movements and the usefulness of the Spurling test and symptom modification techniques applied to the spine.Impact This consensus holds implications for both clinical practice and research. In research, applying these considerations may ensure more homogenous samples, thereby enhancing the investigation of outcomes in shoulder pain populations. In clinical practice, determining the need for spine screening and its potential impact on prognosis and management could significantly influence patient care.

Background: Pectoralis minor (PM) shortening and posterior shoulder tightness (PST) are considered potential soft tissue alterations associated with rotator cuff related shoulder pain (RCRSP). Yet, their precise contribution to pain and disability remains unclear. Purpose: To explore the association between both PM length and PST and self-reported shoulder pain and disability in individuals with and without RCRSP. Demographic characteristics and shoulder active range of motion (AROM) were also considered for their potential contributions to RCRSP. Study Design: This was a cross-sectional study. Methods: Using Shoulder Pain and Disability Index (SPADI), 144 individuals were grouped by pain and disability severity: SPADI total score <= 20 and SPADI total score > 20. PM length was measured using a tape measure. PST, glenohumeral joint flexion, internal (IR) and external (ER) rotation AROM were quantified using an inclinometer. Demographic and AROM measurements were compared between groups and regression analyses identified SPADI predictors. Results: Age, PST, glenohumeral flexion, and ER AROM were associated with SPADI total score (p < 0.05). Higher age (odds ratio (OR [95%CI]): 1.07 [1.02-1.12]) and increased PST (OR: 1.16 [1.04-1.29]) were associated with higher self-reported shoulder pain and disability scores (SPADI score > 20). In contrast, increased flexion (OR: 0.93 [0.88-0.97]) and ER AROM (OR: 0.96 [0.93-0.99]) served as protective factors against increased levels of self-reported shoulder pain and disability. No other variables were associated with SPADI (p > 0.05). Conclusions: PST is associated with increased levels of self-reported shoulder pain and disability, as are age, while PM length and IR AROM were not significantly associated variables. Glenohumeral flexion and ER AROM prevented increased levels of self-reported shoulder pain and disability. (c) 2024 Elsevier Inc. All rights are reserved, including those for text and data mining, AI training, and similar

BACKGROUND:Rotator cuff-related shoulder pain (RCRSP) is a common musculoskeletal disorder. Chronic symptoms, high-level pain intensity, and disability are associated with high levels of pain catastrophizing in this condition. Although the Pain Catastrophizing Scale (PCS) is widely used to assess pain catastrophizing in individuals with chronic symptoms, its measurement properties are still unknown for assessing individuals with chronic RCRSP. OBJECTIVES:To assess construct validity, reliability, and responsiveness of the PCS in individuals with chronic RCRSP. METHODS:Eighty-three adult individuals with chronic RCRSP were included in this study. The assessment of construct validity was based on hypothesis testing. Spearman's rank correlation coefficient was used to verify the correlation of the total score and rumination, magnification, and helplessness subscales of the PCS with pain intensity, disability, and fear of movement. Test-retest reliability was analyzed with Intraclass Correlation Coefficient (ICC)(3,1) and internal consistency was analyzed with Cronbach's alpha. Responsiveness was analyzed by effect sizes and the area under the receiver operating characteristic curve (AUC). RESULTS:The PCS showed significant moderate correlation (rho ≥ 0.40) with fear of movement (95% confidence interval [CI]: 0.23, 0.70), pain intensity (95% CI: 0.14, 0.64), and disability (95% CI: 0.17, 0.66), except the rumination and magnification subscales, which showed significant weak correlation with pain intensity (95% CI: 0.14, 0.58) and disability (95% CI: 0.12, 0.56), respectively. PCS presented good reliability (ICC > 0.7, 95% CI: 0.63, 0.88), and adequate internal consistency (Cronbach alfa > 0.7) and responsiveness based on effect sizes and AUC. CONCLUSION:The PCS is a valid, reliable, and responsive instrument for assessing individuals with chronic RCRSP.

PURPOSE:To identify interactions among variables of the upper limbs, trunk, and hip joint associated with shoulder pain occurrence in asymptomatic overhead athletes. DESIGN:prospective cohort study. SETTING:Sports club facilities. PARTICIPANTS:Ninety-five adult asymptomatic overhead athletes from national first division teams, both sexes. MAIN OUTCOMES MEASURES:Isometric strength of the shoulder ER muscles, serratus anterior, lower trapezius and hip abductors, HipSIT, shoulder internal rotation (IR) range of motion (ROM), low flexion test, closed kinetic chain upper extremity stability test (CKCUEST), seat medicine ball test (SMB-T), upper seat shot put test (USSP-T), upper quarter Y balance test [UQYBT] and leg lateral reach test (LLRT). Shoulder pain occurrence was registered during a 6-month follow-up. RESULTS:The model correctly classified 77.4 % of the athletes who did not develop shoulder pain and 100.0 % of those who developed shoulder pain. The accuracy was 89 % (95 %CI:83 %,96 %). Athletes with UQYBT score under 88.5 %, and isometric strength of the shoulder ER muscles above 0.780 N/kg did not develop shoulder pain (RR:0.02, 95 %CI:0.001,0.44). Athletes with UQYBT score above 88.5 % and USSP-T performance above 3.175m developed shoulder pain (RR:14.09, 95 %CI: 3.27,60.56). CONCLUSION:Shoulder pain occurrence in overhead athletes was associated with interactions among UQYBT, isometric strength of the shoulder ER muscles, and USSP-T.

Background For evidence-based practice, clinicians and researchers can rely on well-conducted randomized clinical trials that exhibit good methodological quality, provide adequate intervention descriptions, and implementation fidelity. Objective To assess the description and implementation fidelity of exercise-based interventions in clinical trials for individuals with rotator cuff tears. Methods A systematic search was conducted in PubMed, Embase, CINAHL, LILACS, Cochrane Library, Web of Science, SCOPUS and SciELO. Randomized clinical trials that assessed individuals with rotator cuff tear confirmed by imaging exam were included. All individuals must have received an exercise-based treatment. The methodological quality was scored with the Physiotherapy Evidence Database (PEDro) scale. The Template for Intervention Description and Replication (TIDieR) checklist and the National Institutes of Health Behaviour Change Consortium (NIHBCC) were used to assess intervention description and implementation fidelity, respectively. Results A total of 13 studies were included. Despite their adequate methodological quality, the description of the intervention was poor with TIDieR scores ranging from 6 to 15 out of 24 total points. The TIDieR highest-scoring item was item 1 (brief name) that was reported in all studies. Considering fidelity, only one of the five domains of NIHBCC (i.e., treatment design) reached just over 50 %. Conclusion Exercise-based interventions used in studies for individuals with rotator cuff tears are poorly reported. The description and fidelity of the intervention need to be better reported to assist clinical decision-making and support evidence-based practice.

eHealth encompasses the use of information and communication technologies to support healthcare services. The World Health Organization endorses the use of eHealth strategies to enhance healthcare accessibility. Within eHealth, telerehabilitation is the use of digital technologies to provide rehabilitation services. It was especially relevant during the COVID-19 pandemic due to the need for remote healthcare delivery. Telerehabilitation is described in three modalities: synchronous, asynchronous, and hybrid, each with its own advantages and disadvantages. Evidence supports the use of telerehabilitation for various conditions, including musculoskeletal disorders. Frozen shoulder, a challenging and long-lasting condition, is identified as a suitable candidate for telerehabilitation, as a mean to enhance treatment adherence and alleviate the socioeconomic burden of frozen shoulder. The application of telerehabilitation in a clinical presentation-based approach for frozen shoulder is outlined in three steps: identifying the patient's profile, making shared decisions, and implementing telerehabilitation modalities with a focus on therapeutic exercises and patient education. Implementation requires clinicians to focus on patient-centered care, involving patients in therapeutic decisions and considering their preferences, digital literacy, and technology accessibility. Finally, clinicians and patients should identify and acknowledge potential barriers faced when implementing telerehabilitation.

Background: Chronic spinal pain (CSP) is a major public health problem worldwide, frequently related to sleep problems. Central sensitization (CS) may worsen the clinical picture of CSP patients with insomnia. The aim of this study was to compare self-reported and objectively measured clinical outcomes between insomniac CSP patients with comorbid insomnia with and without symptoms of CS. Methods: A case-control study on baseline self-reported sleep, functioning, and psychological distress through online questionnaires. Objective sleep and physical activity parameters and pressure pain thresholds (PPTs) were assessed through polysomnography, actigraphy, and digital algometry, respectively. Independent sample t-test and Mann–Whitney U tests were used to examine possible differences in the outcome measures between the groups. Results: Data from 123 participants were included and revealed no statistically significant group for objective sleep and physical activity parameters. The CS group, however, presented with worse self-reported sleep (quality sleep, insomnia severity, and dysfunctional beliefs about sleep), increased mental and physical fatigue, and higher psychological distress (anxiety and depressive symptoms), and reported lower PPTs. Conclusions: symptoms of CS may influence perceived sleep and affect functional health and well-being perception but do not seem to affect objective sleep and physical activity.

PURPOSE To link the items from shoulder-specific Patient Reported Outcome Measures (PROMs) to the International Classification of Functioning, Disability and Health (ICF) domains and categories, and to determine if the items fit into the ICF framework. MATERIALS AND METHODS The Brazilian versions of the Oxford Shoulder Score (OSS), Shoulder Pain and Disability Index (SPADI), Simple Shoulder Test (SST) and Western Ontario Rotator Cuff Index (WORC) were linked to the ICF by two researchers independently. Agreement between raters was determined by calculating the Kappa Index. RESULTS Fifty-eight items from the PROMs were linked to eight domains and 27 categories of ICF. The PROMs covered components of body functions, activities, and participation. Components of body structure and environmental factors were not covered by any of the PROMs. ​There was substantial agreement between raters when linking the OSS (Kappa index = 0.66), SPADI (Kappa index = 0.92), SST (Kappa index = 0.72) and WORC (Kappa index = 0.71). CONCLUSIONS WORC and SST were the PROMs that covered the highest number of ICF domains (seven and six, respectively). However, SST is short and may be less time consuming in a clinical assessment. Clinicians can benefit from this study to decide which shoulder-specific PROM may be more adequate according to the clinical demand.Implications For RehabilitationWestern Ontario Rotator Cuff Index was the shoulder-specific Patient Reported Outcome Measure (PROM) that best showed a broader view of functionality through the International Classification of Functioning, Disability and Health (ICF) domains that can influence shoulder pain and disability.Simple Shoulder Test seems to be the most recommended shoulder-specific PROM considering the number of domains covered by the ICF and the clinical evaluation time consumption.Shoulder Pain and Disability Index fails to provide a broader view of functioning through other ICF domains that may influence shoulder pain and disability.

Objective: To identify the association of trunk and lower limb factors with shoulder complaints and sport performance in overhead athletes.Methods: Search performed at PubMed/Medline, Embase, CINAHL, LILACS, Cochrane, Web of Science and SPORTDiscus for observational studies. Methodological quality and strength of the evidence was assessed with the Newcastle-Ottawa Scale and GRADE. Meta-analysis and effects sizes analysis were calculated when possible.Results: Sixty-five studies were included. Low to very-low evidence suggests no association of trunk/ lower limb strength, endurance, power, jump or balance with shoulder complaints and/or throwing performance. Athletes with shoulder complaints performed worse in trunk stability and endurance tests (mean difference:-6.83 (95%CI:-8.78,-4.88)). Athletes with high throwing performance presented better results in CMJ, horizontal jump, power measures and knee extension strength. For swimmers, there was no association of trunk/lower limb endurance with shoulder complaints (moderate evidence) and no association of balance and swimming performance (low evidence). Better trunk/lower limb strength, power and vertical jumps measures were associated with better swimming performance.Conclusions: In methodologically similar studies, some trunk/lower limb outcomes are associated with shoulder complaint or sport/swimming performance. Results should be considered with caution and future studies should use better methodologies.(c) 2023 Elsevier Ltd. All rights reserved.

Introduction: Constraint Induced Movement Therapy (CIMT) has been shown to be an effective rehabilitation technique in individuals with mild and moderate upper limb (UL) hemiparesis. The aim was to evaluate the effect the CIMT for improving paretic UL use and interjoint coordination with individuals in severe hemiparesis. Methods: Six individuals with severe chronic hemiparesis (mean age = 55 +/- 16 years) received a UL CIMT intervention for 2 weeks. UL clinical assessments were conducted five times: two assessments at pre-intervention and then, one assessment at post-intervention and 1-and 3-month follow-up using the Graded Motor Activity Log GMAL) and the Graded Wolf Motor Function Test (GWMFT). Scapula, humerus and trunk coordination vari-ability were assessed using the 3-D kinematics during arm elevation, combing hair, turning on the switch and grasp a washcloth. A paired t-test was used to check differences between coordination variability and a one-way ANOVA repeated measures was used to check differences between GMAL and GWMFT scores.Results: There were no differences in GMAL and GWMFT between the patient screening and the baseline data collection (p > 0.05). GMAL scores increased at post-intervention and at follow-ups (p < 0.02). GWMFT per-formance time score decreased at post-intervention and at 1-month follow-up (p < 0.04). Improvements in ki-nematic variability of the paretic UL at pre and post-intervention were observed in all tasks, except in the activity of turn on the light switch. Conclusion: Following the CIMT protocol, improvements in GMAL and GWMFT scores may reflect improvements in paretic UL performance, in real-life environment. Improvements in kinematic variability may reflect an improving of UL interjoint coordination for individuals with chronic severe hemiparesis.

Although beach handball is a popular sport worldwide, information about the functional profile in elite athletes are lacking. This study generate a descriptive profile of stability, performance and upper and lower extremities ROM in elite beach handball athletes. Secondary proposals were to compare these outcome measures between sexes and sides, and to report the frequency of athletes "at risk" according to cutoff values for shoulder ROM and dynamic postural stability of the lower extremities. Twenty-eight (n = 16 males, 28.7 & PLUSMN; 5.3 years; n = 12 fe -males, 27.5 & PLUSMN; 5.5 years) elite beach handball athletes were tested. Closed Kinetic Chain Upper Extremity Sta-bility Test (CKCUEST), single hop test, modified Star Excursion Balance Test (mSEBT) and passive shoulder, hip and ankle dorsiflexion ROM were assessed. Male athletes presented greater reach distance in the anterior di-rection [P < .0001; Mean Difference (MD): 36%] and lower reach distance in the posteromedial direction (P < .0001; MD:-29.7%) than female athletes in the mSEBT. Bilateral differences were observed for male athletes during the mSEBT, with the dominant stance limb obtaining a smaller reach distance in the anterior direction (P < .01; MD:-38.3%) and greater reach distance in the posteromedial direction (P < .0001; MD: 30.8%). Male athletes had less upper and lower extremities ROM and reached a smaller normalized single hop distance than female athletes. Most athletes presented mSEBT asymmetries and shoulder ROM deficits which have been shown to increase injury risk. Dynamic postural stability adaptations are present in elite beach handball athletes of both sexes, with more pronounced upper and lower extremity flexibility deficits in male athletes.

Background: The purpose of this study was to reach consensus on the most appropriate terminology and issues related to clinical reasoning, examination, and treatment of the kinetic chain (KC) in people with shoulder pain among an international panel of experts.Methods: A 3-round Delphi study that involved an international panel of experts with extensive clinical, teaching, and research experience in the study topic was conducted. A search equation of terms related to the KC in Web of Science and a manual search were used to find the experts. Participants were asked to rate items across 5 different domains (terminology, clinical reasoning, subjective examination, physical examination, and treatment) using a 5-point Likert-type scale. An Aiken coefficient of validity (V) >0.7 was considered indicative of group consensus.Results: The participation rate was 30.2% (n = 16), whereas the retention rate was high throughout the 3 rounds (100%, 93.8%, and 100%). A total of 15 experts from different fields and countries completed the study. After the 3 rounds, consensus was reached on 102 items: 3 items were included in the "terminology"domain; 17 items, in the "rationale and clinical reasoning"domain; 11 items, in the "subjective examination"domain; 44 items, in the "physical examination"domain; and 27 items, in the "treatment"domain. Terminology was the domain with the highest level of agreement, with 2 items achieving an Aiken V of 0.93, whereas the domains of physical examination and treatment of the KC were the 2 areas with less consensus. Together with the terminology items, 1 item from the treatment domain and 2 items from the rationale and clinical reasoning domain reached the highest level of agreement (V = 0.93 and V = 0.92, respectively).Conclusion: This study defined a list of 102 items across 5 different domains (terminology, rationale and clinical reasoning, subjective examination, physical examination, and treatment) regarding the KC in people with shoulder pain. The term "KC"was preferred and a agreement on a definition of this concept was reached. Dysfunction of a segment in the chain (ie, weak link) was agreed to result in altered performance or injury to distal segments. Experts considered it important to assess and treat the KC in particular in throwing or overhead athletes and agreed that no one-size-fits-all approach exists when implementing shoulder KC exercises within the rehabilitation process. Further research is now required to determine the validity of the identified items.Level of evidence: Consensus Development Study; Delphi Method & COPY; 2023 Journal of Shoulder and Elbow Surgery Board of Trustees. All rights reserved.

Objectives: To assess whether cervical sensitivity, range of motion (ROM) and strength are impaired in individuals with shoulder pain and how they interact with sociodemographic and clinical data. Methods: Forty-eight individuals with shoulder pain and 48 asymptomatic matched ones were included. Pressure pain thresholds (PPTs) in cervical region and tibialis anterior muscles, ROM of cervical flexion, extension, lateral flexions and rotations and cervical muscle strength of flexion, extension and lateral flexions were assessed. Between-groups comparisons and a logistic multiple regression model were performed. Results: The symptomatic group showed lower and not meaningful PPTs in trapezius of the unaffected/unmatched side, both sternocleidomastoid muscles, and tibialis anterior and reduced ROM in cervical extension (MD = - 9.00 degrees) when compared to the asymptomatic group. No differences were identified in muscle strength. Reduced PPT of the trapezius and reduced cervical extension ROM together accounted for 40.2% of the variance of the chance of presenting shoulder pain. Conclusion: Individuals with shoulder pain have more, but not clinically relevant, cervical sensitivity and lower cervical extension than asymptomatic individuals. The lower the PPT of the upper trapezius and the cervical extension ROM, the higher was the chance to present shoulder pain. Regional interdependence between cervical spine and shoulder may explain cervical physical function alterations in shoulder pain.