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 .
The comparative effects of spinal and peripheral thrust manipulation and exercise on pain sensitivity and the relation to clinical outcome: a mechanistic trial using a shoulder pain model.
STUDY DESIGN Single-blind r and omized trial . OBJECTIVES To compare the effects of cervical and shoulder thrust manipulation ( TM ) and exercise on pain sensitivity , and to explore associations with clinical outcomes in patients with shoulder pain . BACKGROUND Experimental studies indicate that spinal TM has an influence on central pain processes , supporting its application for treatment of extremity conditions . Direct comparison of spinal and peripheral TM on pain sensitivity has not been widely examined . METHODS Seventy-eight participants with shoulder pain ( 36 female ; mean ± SD age , 39.0 ± 14.5 years ) were r and omized  to receive 3 treatments of cervical TM ( n = 26 ) , shoulder TM ( n = 27 ) , or shoulder exercise ( n = 25 ) over 2 weeks . Twenty-five healthy participants ( 13 female ; mean ± SD age , 35.2 ± 11.1 years ) were assessed to compare pain sensitivity with that in clinical participants at baseline . Primary outcomes were changes in local ( eg , shoulder ) and remote ( eg , tibialis anterior ) pressure pain threshold and heat pain threshold occurring over 2 weeks . Secondary outcomes were shoulder pain intensity and patient-rated function at 4 , 8 , and 12 weeks . Analysis -of-variance models and partial-correlation analyses were conducted to examine comparative effects and the relationship between measures . RESULTS At baseline , clinical participants demonstrated lower local ( mean difference , - 1.63 kg ; 95 % confidence interval [ CI ] : -2.40 , -0.86 ) and remote pressure pain threshold ( mean difference , -1.96 kg ; 95 % CI : -3.09 , -0.82 ) and heat pain threshold ( mean difference , -1.15 ° C ; 95 % CI : -2.06 , -0.24 ) compared to controls , suggesting enhanced pain sensitivity . Following intervention , there were no between-group differences in pain sensitivity or clinical outcome ( P>.05 ) . However , improvements were noted , regardless of intervention , for pressure pain threshold ( range of mean differences , 0.22 - 0.32 kg ; 95 % CI : 0.03 , 0.43 ) , heat pain threshold ( range of mean differences , 0.30 - 0.58 ; 95 % CI : 0.06 , 0.96 ) , pain intensity ( range of mean differences , -1.79 to -1.45 ; 95 % CI : -2.34 , -0.94 ) , and function ( range of mean differences , 3.15 - 3.82 ; 95 % CI : 0.69 , 6.20 ) at all time points . We did not find an association between pain sensitivity changes and clinical outcome ( P>.05 ) . Conclusion Clinical participants showed enhanced pain sensitivity , but did not respond differently to cervical or peripheral TM . In fact , in this sample , cervical TM , shoulder TM , and shoulder exercise had similar pain sensitivity and clinical effects . The lack of association between pain sensitivity and clinical pain and function outcomes suggests different ( eg , nonspecific ) pain pathways for clinical benefit following TM or exercise . 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 .