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 .
Scapular kinematics pre- and post-thoracic thrust manipulation in individuals with and without shoulder impingement symptoms: a randomized controlled study.
STUDY DESIGN R and omized controlled trial with immediate follow-up . OBJECTIVES To evaluate the immediate effects of a low-amplitude , high-velocity thrust thoracic spine manipulation ( TSM ) on pain and scapular kinematics during elevation and lowering of the arm in individuals with shoulder impingement syndrome ( SIS ) . The secondary objective was to evaluate the immediate effects of TSM on scapular kinematics during elevation and lowering of the arm in individuals without symptoms . BACKGROUND Considering the regional interdependence among the shoulder and the thoracic and cervical spines , TSM may improve pain and function in individuals with SIS . Comparing individuals with SIS to those without shoulder pathology may provide information on the effects of TSM specifically in those with SIS . METHODS Fifty subjects ( mean ± SD age , 31.8 ± 10.9 years ) with SIS and 47 subjects ( age , 25.8 ± 5.0 years ) asymptomatic for shoulder dysfunction were r and omly assigned to 1 of 2 interventions : TSM or a sham intervention . Scapular kinematics were analyzed during elevation and lowering of the arm in the sagittal plane , and a numeric pain rating scale was used to assess shoulder pain during arm movement at preintervention and postintervention . RESULTS For those in the SIS group , shoulder pain was reduced immediately after TSM and the sham intervention ( mean ± SD preintervention , 2.9 ± 2.5 ; postintervention , 2.3 ± 2.5 ; P<.01 ; moderate effect size [ Cohen d = 0.2 ] ) . Scapular internal rotation increased 0.5 ° ± 0.02 ° ( P = .04 ; small effect size [ Cohen d<0.1 ] ) during elevation of the arm after TSM and sham intervention in the SIS group only . Subjects with and without SIS who received TSM and asymptomatic subjects who received the sham intervention had a significant increase ( 1.6 ° ± 2.7 ° ) in scapular upward rotation postintervention ( P<.05 ; small effect size [ Cohen d<0.2 ] ) , which was not considered clinical ly significant . Scapular anterior tilt increased 1.0 ° ± 4.8 ° during elevation and lowering of the arm postmanipulation ( P<.05 ; small effect size [ Cohen d<0.2 ] ) in the asymptomatic subjects who received TSM . CONCLUSION Shoulder pain in individuals with SIS immediately decreased after a TSM . The observed changes in scapular kinematics following TSM were not considered clinical ly important . LEVEL OF EVIDENCE Therapy , level 4 . J Orthop Sports Phys Ther 2014;44(7):475 - 487 . Epub 22 May 2014 . doi:10.2519/jospt.2014.4760
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 .