Thoracic Spine Thrust Manipulation Compared to Sham Manipulation in Individuals With Subacromial Pain Syndrome
Condition: Subacromial Impingement; Subacromial Impingement Syndrome
MeSH terms: Shoulder Impingement Syndrome; Syndrome
Study type: Interventional

Summary: 
      This study evaluates the immediate and short-term effects of a supine upper thoracic spine
      thrust manipulation, seated upper thoracic spine thrust manipulation, and sham manipulation
      for individuals with subacromial pain syndrome. The participants were randomized to receive
      one of the three interventions and baseline measures for the dependent variables were
      repeated immediately after the delivery of the intervention.
    

Detailed description: 
      Thoracic spine thrust manipulation has been shown to be effective in reducing pain and
      improving function in individuals with subacromial pain syndrome (subacromial impingement).
      It remains unknown if individuals respond differently to different manipulation techniques.
      This study examines the immediate effects on pain and short-term effects on pain and function
      using the Penn Shoulder Score (PSS) as well as the immediate effects on scapular kinematics
      (upward rotation and posterior tilt, specifically), pectoralis minor muscle length, and
      scapulothoracic muscle force production for the middle trapezius, lower trapezius, and
      serratus anterior.
    

Intervention name(s): Supine upper thoracic spine thrust manipulation; Seated upper thoracic spine thrust manipulation; Sham manipulation
Intervention type(s): Procedure; Procedure; Procedure
Intervention description(s): The supine thrust manipulation will target the upper thoracic spine and will be performed as previously described. The patient will be asked to lace his or her fingers behind the neck and bring his or her elbows close together in front of the chest. The therapist will place one hand just below the targeted upper thoracic region (at either the T3 or T4 level) using a pistol grip or loose fist to make contact with both transverse processes of the T3 or T4 vertebrae. The therapist will then use his or her body to push down through the patient's upper arms to provide a high-velocity, low-amplitude thrust in the anterior-to-posterior direction.; The seated thrust manipulation will target the cervicothoracic junction with the patient sitting with fingers laced behind the neck. The therapist will stand behind the patient and thread his or her arms through the patient's arms and clasp his or her hands near the C7-T1 level. The therapist will make contact with his or her chest against the patient's upper thoracic region to serve as a fulcrum. The patient will then be instructed to take a deep breath, and upon exhalation the therapist will apply a high-velocity, low-amplitude distraction thrust in a cephalad direction.; The sham manipulation will be performed with the patient and the examiner positioned in the same manner as for the seated manipulation, however the examiner will apply only minimal pressure to maintain physical contact and "skin lock" with the patient. The examiner will then move the patient through the same range of motion but deliver no manipulative thrust.
Other intervention name(s): C-T junction distraction manipulation
Allocation: Randomized
Intervention model: Parallel Assignment
Intervention model description: randomized controlled trial, 3 groups which includes a sham comparator
Masking: Single (Participant)
Primary purpose: Treatment
Keywords: scapular kinematics; thoracic spine; thrust manipulation