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 .
Comparison of conservative treatment with and without manual physical therapy for patients with shoulder impingement syndrome: a prospective, randomized clinical trial
The aim of this prospect i ve , r and omized clinical study was to compare the effectiveness of two physical therapy treatment approaches for impingement syndrome , either by joint and soft tissue mobilization techniques or by a self-training program .  Thirty patients ( Group 1 , n = 15 ; Group 2 , n = 15 ) with the diagnosis of an outlet impingement syndrome of the shoulder were treated either by strengthening the depressors of the humeral head with a guided self-training program  ( Group 1 , age 49.5 ± 7.9 years ) , or by joint and soft tissue mobilization techniques  ( Group 2 , age 48.1 ± 7.5 years ) . Group 1 was instructed with the active range of motion ( ROM ) , stretching and strengthening exercise program including rotator cuff muscles , rhomboids , levator scapulae and serratus anterior with an elastic b and at home at least seven times a week for 10–15 min and Group 2 received a prescription for 12 sessions of joint and soft tissue mobilization techniques , ice application , stretching and strengthening exercise programs and patient education in clinic for three times per week . All patients were tested with visual analog scale ( VAS ) for pain level , goniometric measurement for ROM and algometry for the pain threshold . Function was measured with a functional assessment question naire . The VAS ( 10 cm ) used to measure pain with functional activities and the functional assessment question naire ( Neer ) were also measured 3 months after the initiation of treatment . Subjects in both groups experienced significant decreases in pain and increases in shoulder function , but there was significantly more improvement in the manual therapy group compared to the exercise group . For example , pain in the manual therapy group was reduced from a pre-treatment mean ( ±SD ) of 6.7 ( ±0.3 ) to a post-treatment mean of 2.0 ( ±2.0 ) . In contrast , pain in the exercise group was reduced from a pre-treatment mean of 6.6 ( ±1.4 ) to a post-treatment mean of 3.0 ( ±1.8 ) . ROM at flexion , abduction and external rotation in the manual therapy group improved significantly while ROM in the exercise group did not . There were statistically differences among the groups in function ( P > 0.05 ) . Group 2 showed significantly greater improvements in the Neer Question naire score and shoulder satisfaction score than Group 1 . The patients treated with manual physical therapy applied by experienced physical therapists combined with supervised exercise in a brief clinical trial showed improvement of symptoms including increasing strength , decreasing pain and improving function earlier than with exercise program
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 .