Search Results (164)

Platelet-rich plasma (PRP) is widely used as a second-line treatment for chronic tendinopathy that persists despite structured conservative care, yet outcomes and imaging correlates remain heterogeneous. This review outlines PRP biology and preparation, summarises quantitative imaging techniques for monitoring tendon response, and presents the experience of a single centre integrating these methods into routine supraspinatus and lateral elbow PRP workflows. PRP is described as an autologous platelet concentrate with variable leukocyte and fibrin content, with leukocyte-rich formulations commonly selected for chronic tendinopathy. Quantitative approaches—including ultrasound shear-wave elastography and radiomics, MRI T2/T2* mapping, CT-based bone metrics, PET/CT, and optical techniques—offer numerical biomarkers of tendon structure, mechanics, and inflammation but are rarely implemented in PRP trials. At the authors’ centre, leukocyte-rich PRP is injected under ultrasound guidance after failed physiotherapy, and follow-up combines validated questionnaires with grey-level run-length matrix texture analysis of ultrasound and 3.0 T MRI T2 distribution profiling. A pilot ultrasound study in supraspinatus and common extensor tendinosis showed uniform short-term clinical improvement and significant changes in most texture features, with selected parameters correlating with symptom relief. A prospective supraspinatus cohort demonstrated significant six-month clinical gains in both tendinosis and small partial-thickness tears, whereas only the tendinosis group exhibited T2 profile convergence toward asymptomatic patterns. These data indicate that quantitative ultrasound radiomics and whole-length T2 profiling are feasible imaging biomarkers that capture PRP-induced tendon remodelling beyond qualitative imaging and may help tailor PRP protocols to specific tendon phenotypes. Full article

The in vivo effect of platelet-rich plasma (PRP) on supraspinatus tendon morphology and subacromial bursa cell gene expression in degenerative rotator cuff tears remains unclear. This randomized controlled trial evaluated the effect of preoperative leukocyte-poor PRP (LP-PRP) subacromial injection on supraspinatus tendon histology and subacromial bursa gene expression. Sixteen patients with full-thickness supraspinatus tears were randomized to receive an ultrasound-guided LP-PRP injection (n = 8) or no injection (n = 8) six weeks before arthroscopic repair. Tendon biopsies were assessed using the modified Movin score. Gene expression of collagen type I, II and III, metalloproteinase 3 and 13, and interleukin 1β and 6 genes from subacromial bursa cells was quantified using quantitative real-time PCR. The results of the two groups were compared to determine any statistically significant difference regarding all the examined parameters. The PRP group demonstrated a significantly lower total modified Movin score than controls (6.5 vs. 12.1, p = 0.002), with lower scores for fiber structure, fiber arrangement, nuclear rounding, inflammation and cell density (all p < 0.003), while angiogenesis did not differ (p = 0.149), indicating an architecture closer to that of normal tendon. No statistically significant differences in gene expression were observed (all p > 0.05), although collagen II and metalloproteinase 3 and 13 showed biologically relevant downregulation [fold change 0.23 (95%CI 0.05–1.09), 0.24 (95%CI 0.002–26.10), and 0.26 (95%CI 0.02–2.76), respectively]. The LP-PRP injection was associated with improved supraspinatus tendon histological characteristics and biologically relevant reductions in selected bursal genes, in the setting of supraspinatus tendon tear. Full article

Background/Objectives: Rotator cuff repair (RCR) is a common orthopedic procedure, with healing outcomes strongly influenced by patient-specific factors such as tissue quality, tear characteristics, and biological healing potential. Bioinductive collagen implants have shown great results in enhancing tendon healing and reducing retear rate. This study aimed to evaluate the clinical and imaging outcomes of RCR augmented with a xeno-derived collagen membrane over 24 months and to assess complications or implant failures. Methods: Patients underwent arthroscopic RCR using anchors (single or double-row) with additional xeno-derived matrix augmentation. The study included patients older than 40 years with full-thickness supraspinatus and/or infraspinatus tendon tears (DeOrio–Cofield grade 3–4) who were candidates for arthroscopic rotator cuff repair and provided informed consent. Clinical outcomes were assessed using the Constant–Murley Score (CMS), Disabilities of the Arm, Shoulder and Hand score (DASH), and Visual Analogue Score (VAS) at baseline, 3, 6, 12, and 24 months. MRI was performed preoperatively and at 24 months to assess tendon thickness. Results: All scores improved significantly. CMS increased from 16.3 ± 4.1 to 82.9 ± 5.8, VAS decreased from 7.8 ± 1.0 to 1.5 ± 0.8, and DASH improved from 70.3 ± 6.4 to 12.4 ± 4.5 (p < 0.05). Tendon thickness in the supraspinatus (T3) increased from 4.2 ± 0.9 mm to 6.8 ± 1.2 mm (p < 0.05). Retear rate was 7.55%, with no major complications. Conclusions: The bioinductive collagen implant showed notable results in improving tendon thickness, healing, and excellent clinical outcomes in RCR, without membrane-related complications. The study was designed as a prospective single-arm case series without a control group and that was the main limitation; The absence of adverse reactions in this cohort further supports the favorable safety profile of this implant in the present study population. Full article

Background/Objectives: This study aimed to characterize macro- and micro-morphological properties of the supraspinatus tendon (SST) in para swimmers during the chronic stage of rotator cuff tendinopathy, integrating ultrasound assessments of tendon thickness, peak spatial frequency radius (PSFR) for collagen organization, acromiohumeral distance (AHD), and occupation ratio to evaluate subacromial impingement risk. Methods: In a cross-sectional design, 43 elite para swimmers (aged 18–30 years, S7–S10 classes with lower extremity impairments) from Para Swimming Team Poland were divided into rotator cuff tendinopathy (RC; n = 22) and asymptomatic control (CON; n = 21) groups. Measurements on the dominant shoulder utilized B-mode ultrasound (Alpinion X-CUBE 90) to assess SST thickness at 5, 10, and 15 mm proximal to the greater tuberosity, PSFR via MATLAB-analyzed spatial frequency spectra, AHD, and occupation ratio. Two-way and one-way ANOVAs assessed group and measurement effects (p < 0.05); Pearson correlations examined the relationships between thickness and PSFR. Results: Para swimmers with tendinopathy exhibited greater SST thickness across sites (p < 0.001, η² = 0.63), higher PSFR at all intervals (p ≤ 0.009, η² = 0.53) peaking at 10 mm, wider AHD (p = 0.002, η² = 0.21), and lower occupation ratio (p < 0.001, η² = 0.44) versus controls. Strong positive correlations linked thickness and PSFR proximally (r = 0.75–0.79, p < 0.001). Conclusions: Chronic tendinopathy in para swimmers manifests as thickened SST with collagen disarray, altered subacromial space, and impingement risk, distinguishing pathological from healthy tendons. Integrated ultrasound metrics aid diagnosis and inform interventions for overhead athletes with locomotor disorders. Full article

Objectives: We aimed to evaluate Achilles tendon stiffness characteristics in asymptomatic patients with psoriatic arthritis (PsA) using shear wave elastography (SWE). Methods: In this prospective case–control study, 34 asymptomatic PsA patients and 34 age- and sex-matched healthy controls underwent bilateral Achilles tendon evaluation with grayscale ultrasonography and SWE. Tendon thickness was measured 3 cm proximal to the calcaneal insertion. Shear-wave velocity (m/s) and Young’s modulus (kPa) were obtained under standardized acquisition conditions, including five-star motion stability and ≥90% reliability. Results: Achilles tendon morphology and thickness did not differ between PsA patients and controls (p > 0.05). In contrast, SWE demonstrated higher tendon stiffness in the PsA group. Mean shear-wave velocity was significantly greater in PsA patients for both the left (4.89 ± 2.52 m/s vs. 3.23 ± 0.41 m/s; p < 0.001) and right tendons (4.88 ± 1.94 m/s vs. 3.12 ± 0.30 m/s; p < 0.001), with corresponding increases in Young’s modulus (all p < 0.001). SWE demonstrated good group discrimination, with shear-wave velocity achieving AUC values of up to 0.90 in differentiating PsA patients from healthy controls. Conclusions: SWE may reflect biomechanical tendon alterations in PsA, even in the absence of clinical symptoms, and may serve as a complementary imaging tool in the assessment of tendon involvement. Full article

Purpose: In this systematic review, we compare the effectiveness of high-intensity laser therapy (HILT) and extracorporeal shockwave therapy (ESWT) in treating lateral elbow tendinopathy (LET). Methods: A comprehensive search of PubMed, the Cochrane Library, and EMBASE was conducted from database inception to 23 June 2025 to identify randomized controlled trials (RCTs) comparing the two interventions. The primary outcome was pain intensity (visual analog scale or numeric rating scale). Secondary outcomes included upper-limb disability (qDASH), grip strength (pain-free or maximal), ultrasound-measured common extensor tendon thickness, and safety (adverse events and withdrawals). Two reviewers independently extracted data and assessed methodological quality using the Physiotherapy Evidence Database (PEDro) scale; the certainty of evidence was rated using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach. Effects were synthesized as SMD (95% CI) using random- or fixed-effects models based on heterogeneity (I²). Significance was set at p < 0.05. Results: Four RCTs met the inclusion criteria and 169 participants were included. Methodological quality was moderate, with moderate-quality evidence indicating a significant improvement in short-term and medium-term upper-limb function in favor of HILT (SMD = −0.42; 95% CI: −0.73 to −0.12 and SMD = −0.50; 95% CI: −0.94 to −0.06, respectively). Evidence ranging from low to moderate quality showed no significant differences between the HILT and ESWT groups in terms of short-term or medium-term resting pain (SMD = −0.50; 95% CI: −1.15 to 0.16 and SMD = −0.42; 95% CI: −1.06 to 0.22, respectively), short-term or medium-term activity pain (SMD = −0.38; 95% CI: −1.05 to 0.29 and SMD = −0.73; 95% CI: −1.65 to 0.19, respectively), short-term or medium-term grip strength (SMD = 0.24; 95% CI: −0.20 to 0.67 and SMD = 0.20; 95% CI: −0.16 to 0.55, respectively), or short-term or medium-term common extensor tendon thickness (SMD = 0.04; 95% CI: −0.50 to 0.59 and SMD = −0.00; 95% CI: −0.55 to 0.55, respectively). Conclusions: HILT appears to offer significant benefits in improving upper-limb function at short-term (<1 month) and medium-term (1–3 months) follow-up. Regarding pain, grip strength, and tendon thickness, the pooled effects did not show clear between-group differences. Evidence certainty ranged from low to moderate, demonstrating that trials with a follow-up period beyond 3 months are needed to evaluate long-term efficacy. Systematic review registration number: PROSPERO: CRD420251026387. Full article

To address the combined demands of lightweighting, modular construction, and durability in ultra-tall wind-turbine towers, a segmental prestressed concrete-filled steel-tube (PCFST) chord for lattice towers is investigated in this study. A finite-element approach is validated against published tests on CFST columns, showing close agreement in load–displacement response and failure modes. Based on this validation, a finite-element model of the segmental PCFST chord is developed to clarify load-bearing mechanisms and parameters under axial compression and tension. The results show that, in compression, the concrete core governs the response; after steel yielding, the tube undergoes multiaxial stress redistribution—rising hoop stress and falling axial stress—consistent with von Mises yielding and dilation of confined concrete. In tension, load sharing is dominated by the steel tube and tendons, with limited concrete contribution. Parametric analyses indicate that end stiffeners markedly improve tensile behavior: with eight stiffeners, initial stiffness and peak tensile load increase by 1.8 times and 1.3 times relative to no stiffener, while effects in compression are minor. Increasing initial prestress improves tensile performance but shows diminishing returns beyond a moderate level and reduces compressive yield capacity. Increasing flange thickness enhances tensile performance with negligible compressive effect, whereas greater tube thickness increases both capacities and the initial stiffness. Full article

Background: Greater trochanteric pain syndrome (GTPS) is associated with structural tendon alterations and functional impairment. Extracorporeal shockwave therapy (ESWT) is a common treatment, but objective monitoring of tendon remodeling and motor recovery remains limited. Objective: This study aimed to integrate shear-wave elastography (SWE) expressed in m/s and wearable inertial measurement unit (IMU) as biosensing tools for the quantitative assessment of tendon elasticity, morphology, and hip motion after ESWT in GTPS. Methods: In a prospective cohort of adults with chronic GTPS, shear wave elastography (SWE) quantified gluteus medius tendon (GMT) elasticity and thickness, while hip abduction range of motion (ROM) was measured using a triaxial inertial measurement unit. Clinical scores on the Visual Analogue Scale (VAS), Harris Hip Score (HHS), Low Extremity Functional Scale (LEFS), and Roles and Maudsley score (RM) were collected at baseline (T0) and at 6 months (T1). Results: Thirty-five patients completed follow-up. Pain and function improved significantly (VAS, HHS, LEFS, RM; all p < 0.05). SWE values of the affected GMT increased, while tendon thickness decreased yet remained greater than on the contralateral side. Hip abduction ROM increased significantly from T0 to T1 (p < 0.05). Correlation analysis showed a negative association between abduction and pain at T1 (r = −0.424; p = 0.011) and, at baseline, between abduction and VAS (r = −0.428; p = 0.010) and RM (r = −0.346; p = 0.042), and a positive association with LEFS (r = 0.366; p = 0.031). SWE correlated negatively with VAS at T1 (r = −0.600; p < 0.05) and positively with HHS at T1 (r = 0.400; p < 0.05). Conclusions: Integrating elastography with inertial sensor-based motion analysis provides complementary, quantitative insights into tendon remodeling and functional recovery after ESWT in GTPS. These findings support combined imaging and wearable motion measures to monitor treatment response over time. Full article

Background: Cardiovascular risk models, such as the Framingham and atherosclerotic cardiovascular disease (ASCVD) calculators, have improved risk prediction but often fail to identify individuals who experience ASCVD events despite low or intermediate predicted risk. This suggests that underrecognized, non-traditional risk factors may contribute significantly to the development of atherosclerosis. Objective: This narrative review synthesizes and summarizes recent evidence on high-yield non-traditional risk factors for atherosclerosis, with a focus on clinically significant, emerging, and applicable contributors beyond conventional frameworks. This review is distinct in that it aggregates a wide array of non-traditional risk factors while also consolidating recent data on ASCVD in more vulnerable populations. Unlike the existing literature, this manuscript integrates in a single comprehensive review various domains of non-traditional atherosclerotic risk factors, including inflammatory, metabolic, behavioral, environmental, and physical pathways. An additional unique highlight in the same manuscript is the discussion of non-traditional risk factors for atherosclerosis in more vulnerable populations, specifically South Asians. We also focus on clinically actionable factors that can guide treatment decisions for clinicians. Results: Key non-traditional risk factors identified include inflammation and biomarker-based risk factors such as C-reactive protein or interleukin-6 levels, metabolic and microbial risk factors, behavioral factors such as E-cigarette use, and environmental or infectious risk factors such as air and noise pollution. We explore certain physical exam findings associated with atherosclerotic burden, such as Frank’s sign and Achilles tendon thickness. Conclusions: Atherosclerosis is a multifactorial process influenced by diverse and often overlooked factors. Integrating non-traditional risks into clinical assessment may improve early detection, guide prevention and personalize care. Future risk prediction models should incorporate molecular, behavioral, and environmental data to reflect the complex nature of cardiovascular disease. Full article

Background/Objectives: Non-traumatic (degenerative) rotator cuff tendinopathy with partial supraspinatus tear (NT-RCTT) is a common source of shoulder pain and disability. Comparative evidence between radial extracorporeal shock wave therapy (rESWT) and multimodal physical therapy modalities (PTMs) remains scarce. Methods: In this single-center randomized controlled trial, 60 adults with MRI-confirmed NT-RCTT were assigned (1:1) to rESWT (one session weekly for six weeks; 2000 impulses per session, 2 bar air pressure, positive energy flux density 0.08 mJ/mm²; 8 impulses per second) or a multimodal PTM program (interferential current, shortwave diathermy and magnetothermal therapy; five sessions weekly for six weeks). All participants performed standardized home exercises. The primary outcome was the American Shoulder and Elbow Surgeons (ASES) total score; secondary outcomes included pain (visual analog scale, VAS), satisfaction, range of motion (ROM), supraspinatus tendon (ST) thickness and acromiohumeral distance (AHD). Assessments were conducted at baseline, and at week 6 (W6) and week 12 (W12) post-baseline. Results: Both interventions significantly improved all outcomes, but rESWT produced greater and faster effects. Mean ASES total scores increased by 31 ± 5 points with rESWT versus 26 ± 6 with PTMs (p < 0.05). VAS pain decreased from 5.2 ± 0.7 to 1.0 ± 0.7 with rESWT and from 5.2 ± 0.8 to 1.7 ± 0.8 with PTMs (p < 0.01). rESWT achieved higher satisfaction and larger gains in abduction, flexion and external rotation. Ultrasound showed reduced ST thickness and increased AHD after rESWT but not after PTMs. No serious adverse events occurred. Conclusions: rESWT yielded superior pain relief, functional recovery and tendon remodeling compared with a multimodal PTM program, with markedly lower treatment time and excellent tolerability. Full article

Background/Objectives: Specialized pro-resolving lipid mediators (SPMs), such as Resolvin E1 (RvE1) and Resolvin D1 (RvD1), play a critical role in the resolution phase of inflammation. However, their relevance to tendon pathology and tissue-specific degeneration in rotator cuff tears remains unclear. This study aimed to investigate the relation between serum RvE1 and RvD1 levels and the morphological severity of tendon retraction and muscle fatty degeneration in patients with full-thickness rotator cuff tears. Methods: A total of 70 participants were included: 35 patients with full-thickness rotator cuff tears determined by magnetic resonance imaging (MRI) and 35 healthy controls. Tendon retraction and muscle fatty degeneration were graded using Patte and Goutallier classifications, respectively. Serum RvE1 and RvD1 levels were measured using enzyme-linked immunosorbent assay (ELISA). Group comparisons were performed using Welch’s t-test, and correlations were analyzed with Spearman’s coefficient. Results: RvE1 and RvD1 levels were significantly lower in patients compared to controls (p < 0.001). RvE1 showed a moderate positive correlation with Patte score (ρ = 0.37, p = 0.027), while no significant correlation was observed with Goutallier classification (ρ = 0.19, p = 0.27). RvD1 levels demonstrated no significant relationship with either morphological parameter. Conclusions: These findings suggest that decreased serum RvE1 levels are associated with the severity of tendon retraction but not with muscle fatty degeneration. Therefore, RvE1 may serve as a potential biochemical biomarker reflecting tendon damage severity and the impaired resolution of inflammation in rotator cuff tears. Full article

Background/Objectives: Bioinductive bovine collagen implants (BCI) have been introduced to enhance tendon biology and promote tissue regeneration in rotator cuff (RC) repairs. This study aimed to assess the clinical and radiological outcomes of arthroscopic posterosuperior rotator cuff (psRC) repair with BCI augmentation in full-thickness tears at increased risk of retear. Methods: This case series analyzed 30 patients with psRC tears who were classified as being at high risk of failure according to a predefined set of parameters, including patient history, radiological findings and intraoperative assessments, and the presence of psRC retears. All patients subsequently underwent arthroscopic psRC repair with BCI augmentation, compromising 21 primary and 9 secondary repairs. Clinical outcomes were assessed using Subjective Shoulder Value (SSV), American Shoulder and Elbow Surgeons (ASES) shoulder score, and Constant score at 6 and 12 months postoperatively. Tendon integrity was assessed using the Sugaya classification. Results: At 12 months, magnetic resonance imaging revealed complete tendon healing in 56.7%, partial healing in 16.7%, and insufficient healing in 26.7%. Significant improvements in SSV (45.3 to 83.5), ASES (40.6 to 77.8), and Constant score (36.6 to 71.7) were observed at 12 months postoperatively, with all outcome measures exceeding their respective minimally clinically important differences. Two patients (6.7%) developed secondary shoulder stiffness, and 1 patient (3.3%) required revision surgery for bicipital groove pain. Conclusions: Augmentation with a BCI in arthroscopic repair of high-risk psRC tears demonstrate promising short-term results. Patients achieve significant improvements in pain and shoulder function, accompanied by satisfactory tendon healing on MRI. Full article

Background/Objectives: Enthesitis is a hallmark feature across the spondylarthritis spectrum, including psoriatic arthritis (PsA). In recent years, advanced imaging techniques, particularly musculoskeletal ultrasound (MSUS), have demonstrated higher sensitivity than clinical examination in detecting enthesitis. This study aimed to evaluate the inter-observer agreement for the diagnosis of Achilles enthesitis in a cohort of PsA patients. A secondary objective was to explore specific ultrasound diagnostic criteria for identifying active, inflammatory enthesitis in this population. Methods: Adult patients with PsA, all fulfilling CASPAR classification criteria, were recruited and underwent both clinical and ultrasonographic assessment of the bilateral Achilles tendons. Each patient was scanned by 4 rheumatologists in a direct study, followed by a blinded evaluation of static images of the same patients. The examiners assessed the presence of enthesitis components according to the OMERACT criteria. In addition, the images were subsequently evaluated by 10 MSUS-experienced rheumatologists who were asked to classify the enthesitis as inflammatory by selecting one of the following responses: “yes”, “no,” or “possible”. Results: Ten PsA patients, with a median age of 60 and a median DAPSA score of 21, were included. Both direct and image-based inter-observer studies showed high agreement values for enthesophytes (κ > 0.6), erosions (κ > 0.5), and entheseal thickness (κ > 0.5). In both, low agreement was observed for hypoechogenicity (κ between 0.1 and 0.4). Erosions and power Doppler (PD) signal in erosions showed statistically significant differences between the “possible” and definite (“yes”) inflammatory enthesitis groups. A PD signal of grade 2 or 3 within the enthesis or erosions was observed exclusively in cases classified as definite (“yes”) inflammatory enthesitis. Similarly, a grade 3 PD signal in the bursa was found only in patients with definite inflammatory enthesitis. This study proposes a novel ultrasound scoring system for defining inflammatory enthesitis. The score demonstrated overall good diagnostic performance, with a sensitivity of 67% and a specificity of 100%. Conclusions: The relatively low inter-observer agreement regarding hypoechogenicity and the presence of PD highlights the need for targeted educational interventions to improve interpretation in MSUS. Erosions and PD signal within erosions appear to be significant discriminatory features for identifying inflammatory enthesitis. Full article

Introduction and Objectives: The thickness of the plantar fat pad (PFP) beneath the metatarsal heads may play a protective role in preventing forefoot disorders such as metatarsalgia. However, reference values for plantar adipose tissue thickness in this region among healthy individuals are currently unavailable. Therefore, the aim of this study was to determine, by means of ultrasound imaging, the thickness of the PFP beneath the five metatarsal heads and to analyze its possible relationship with body mass index (BMI). Materials and Methods: Thirty-five young adults (17 males and 18 females) with neutral feet, free from deformities or pain, participated in the study. Using a VINNO E35 ultrasound device, the thickness of the PFP beneath each of the five metatarsal heads was quantified. A linear transducer was positioned longitudinally along the axis of each metatarsal. The distance between the dermis and the flexor tendon was measured from the second to the fifth metatarsal heads, and from the fibular sesamoid for the first metatarsal head. Results: The central forefoot showed the greatest PFP thickness (2nd metatarsal head, 7.1 ± 0.9 mm; 3rd metatarsal head, 6.9 ± 0.9 mm). No significant differences in PFP thickness were found between sexes. However, a positive correlation was observed between BMI and PFP thickness at the fourth metatarsal head (r = 0.358, p = 0.035). Conclusions: The study demonstrated greater PFP thickness beneath the second and third metatarsal heads, with no significant sex-related differences. These findings indicate a consistent anatomical pattern independent of sex in young, healthy individuals. Moreover, a moderate influence of BMI was identified at the fourth metatarsal head, which could represent a potential protective mechanism against forefoot overload. Full article

Background and Objectives: Subacromial pain syndrome (SAPS) is one of the most common musculoskeletal problems affecting the shoulder joint. In this study, we aimed to investigate the effectiveness of a rehabilitation program targeting humeral head depressor muscles on symptoms in individuals with SAPS. Materials and Methods: Participants were sequentially assigned to study and control groups in a quasi-randomized design. While the control group received standard physical therapy and rehabilitation, the study group underwent a combined progressive exercise program, including humeral head depressor strengthening, peri-articular muscle exercises, scapular stabilization, and proprioceptive training. Acromio–humeral distance (AHD) and tendon thickness measurements were evaluated via ultrasonography (USG), while pain intensity, upper-extremity disability, and kinesiophobia were measured using the VAS and McGill Pain Questionnaire, DASH-T, and the Fear Avoidance Beliefs Questionnaire, respectively. Results: Both the study and control groups showed statistically significant increments in AHD compared to the baseline. The first and final measurements changed from 7.92 mm to 10.54 mm and from 7.72 mm to 8.41 mm, respectively. However, the increase in AHD was greater in the study group relative to the control group, and the value was statistically significant. The study group showed significant improvements in pain and disability. Kinesiophobia levels, on the other hand, decreased in both groups, but a greater decrease was observed in the study group. Conclusions: In this study, both the study and control groups showed an increase in AHD, but the combined exercise program targeting humeral head depressor muscles resulted in a greater improvement. Reduced tendon thickness indicated the eased motion of the rotator cuff, supporting the improvements in pain and disability. The program had a positive impact on psychosocial parameters, including pain-related kinesiophobia. Given the limited literature on the effects of such exercises on AHD and tendon thickness, this study provides an original contribution. Clinical Trial Registration: ClinicalTrials.gov identifier: NCT07228455. Full article