Scapular Kinematics Pre– and Post–Thoracic Thrust Manipulation in Individuals With and Without Shoulder Impingement Symptoms: A Randomized Controlled Study

Abstract

Shoulder pain is a common and debilitating condi tion, and its prevalence is second only to low back pain. 9,42,52,63 Shoulder im pingement syndrome (SIS) is the most frequently encountered shoulder condition and accounts for 44% to 65% of all shoulder pain. 63 A greater amount of scapular internal rotation, as well as a lesser amount of scapular upward rotation and posterior tilt during arm elevation, has previously been documented in individuals with symptoms of SIS compared to asymptomatic individuals. [35][36][37][38] These kinematic alterations have been associated with lesser activation of the middle and lower trapezius and serratus anterior muscles and excessive upper trapezius muscle activation. 37,51 Systematic literature reviews support the efficacy of therapeutic exercises for the rehabilitation of individuals with SIS, 29,43 and the results of randomized clinical trials suggest that providing manual therapy T T 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. T T 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. T T 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 randomly 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.

Immediate effects of cervical unilateral anterior-posterior mobilisation on shoulder pain and impairment in post-operative arthroscopy patients

“…Thrust manipulation techniques seemed to show immediate effect in studies not using a control intervention, [13,22,25,26], but were not superior when compared to sham manipulation [23,24]. Of these studies, only Mintken et al examined pain and shoulder ROM as outcomes.…”

“…Studies, using single or short interventions to the thoracic spine and the upper ribs show conflicting immediate- [22][23][24]26] and short-term results [13,25] in patients with shoulder pathology. Thrust manipulation techniques seemed to show immediate effect in studies not using a control intervention, [13,22,25,26], but were not superior when compared to sham manipulation [23,24].…”

“…Effects have been shown to extend remotely to influence the shoulder [11][12][13] and elbow [14][15][16][17]. In addition to intrinsic shoulder structures with causation for shoulder pain [18][19][20], extrinsic structures like the cervical [11,12,21] and thoracic spines [22][23][24][25], and upper ribs [26] have been implicated.…”

Systematic Review of Nondrug, Nonsurgical Treatment of Shoulder Conditions

“…However, in all 3 of these, only 1 SMT session was included and only short-term effects on pain were measured, with patients whose mean age was in the early 30s. [58][59][60] Only 1 of these trials 54 reported on adverse events, and in that case, there were none.…”

“…One of these was on LLLT 51 ; 1 on MT, specifically cervical mobilization 53 ; and 1 on spinal manipulation. 58 Engebretsen et al 55 reported that 2 patients in the ESWT group dropped out because of pain, with 1 crossing over to the supervised exercise group, and that 1 patient in the supervised exercise group reported increased pain. 55 Rhon et al 64 reported that in their trial of MT PT compared with CSIs, transient pain from the injection was the only adverse event reported.…”