In many instances , no or minimal attempts to screen were undertaken or reported .
Background Subacromial shoulder pain is a common clinical presentation with much diagnostic uncertainty .
Some of this uncertainty relates to the involvement of the cervical spine as a source or contribution to subacromial shoulder pain .
Currently , there is no accepted method of screening of the cervical spine in the presence of subacromial shoulder pain , which risks patients receiving misguided and /or ineffective interventions .
Objective To evaluate approaches used to screen the cervical spine in patients with subacromial shoulder pain .
Thoracic Spine Manipulation in Individuals With Subacromial Impingement Syndrome Does Not Immediately Alter Thoracic Spine Kinematics, Thoracic Excursion, or Scapular Kinematics: A Randomized Controlled Trial.
STUDY DESIGN R and omized controlled trial . OBJECTIVES To determine if thoracic spinal manipulative therapy ( SMT ) alters thoracic kinematics , thoracic excursion , and scapular kinematics compared to a sham SMT in individuals with subacromial impingement syndrome , and also to compare changes in patient-reported outcomes between treatment groups . BACKGROUND Prior studies indicate that thoracic SMT can improve pain and disability in individuals with subacromial impingment syndrome . However , the mechanisms underlying these benefits are not well understood . METHODS Participants with shoulder impingement symptoms ( n = 52 ) were r and omly assigned to receive a single session of thoracic SMT or sham SMT . Thoracic and scapular kinematics during active arm elevation and overall thoracic excursion were measured before and after the intervention . Patient-reported outcomes measured were pain ( numeric pain-rating scale ) , function ( Penn Shoulder Score ) , and global rating of change . RESULTS Following the intervention , there were no significant differences in changes between groups for thoracic kinematics or excursion , scapular kinematics , and patient-reported outcomes ( P>.05 ) . Both groups showed an increase in scapular internal rotation during arm raising ( mean , 0.9 ° ; 95 % confidence interval [ CI ] : 0.3 ° , 1.6 ° ; P = .003 ) and lowering ( 0.8 ° ; 95 % CI : 0.0 ° , 1.5 ° ; P = .041 ) , as well as improved pain reported on the numeric pain-rating scale ( 1.2 points ; 95 % CI : 0.3 , 1.8 ; P<.001 ) and function on the Penn Shoulder Score ( 9.1 points ; 95 % CI : 6.5 , 11.7 ; P<.001 ) . CONCLUSION Thoracic spine extension and excursion did not change significantly following thoracic SMT . There were small but likely not clinical ly meaningful changes in scapular internal rotation in both groups . Patient-reported pain and function improved in both groups ; however , there were no significant differences in the changes between the SMT and the sham SMT groups . Overall , patient-reported outcomes improved in both groups without meaningful changes to thoracic or scapular motion . LEVEL OF EVIDENCE Therapy , level 1b-
In many instances , no or minimal attempts to screen were undertaken or reported .
Background Subacromial shoulder pain is a common clinical presentation with much diagnostic uncertainty .
Some of this uncertainty relates to the involvement of the cervical spine as a source or contribution to subacromial shoulder pain .
Currently , there is no accepted method of screening of the cervical spine in the presence of subacromial shoulder pain , which risks patients receiving misguided and /or ineffective interventions .
Objective To evaluate approaches used to screen the cervical spine in patients with subacromial shoulder pain .