The Effects of Thoracic Spine Manipulation in Subjects With Signs of Rotator Cuff Tendinopathy

Abstract

Rotator cuff tendinopathy (RCT) is one of the most common causes of shoulder pain and dysfunction 5,26,48,73,74 and has been associated with symptoms of shoulder impingement. 15 While TSM may be beneficial in reducing shoulder pain and dysfunction, the mechanisms by which the manipulation might induce these changes are not well understood. Bialosky et al 3 suggested that the introduction of a manipulative force results in biomechanical as well as neurophysiologic responses. Biomechanical re-T T STUDY DESIGN: Controlled laboratory study. T T OBJECTIVES:To assess scapular kinematics and electromyographic signal amplitude of the shoulder musculature, before and after thoracic spine manipulation (TSM) in subjects with rotator cuff tendinopathy (RCT). Changes in range of motion, pain, and function were also assessed. T T BACKGROUND:There are various treatment techniques for RCT. Recent studies suggest that TSM may be a useful component in the management of pain and dysfunction associated with RCT. T T METHODS:Thirty subjects between 18 and 45 years of age, who showed signs of RCT, participated in this study. Changes in scapular kinematics and muscle activity, as well as changes in shoulder pain and function, were assessed pre-TSM and post-TSM using paired t tests and repeated-measures analyses of variance. T T RESULTS:TSM did not lead to changes in range of motion or scapular kinematics, with the exception of a small decrease in scapular upward rotation (P = .05). The only change in muscle activity was a small but significant increase in middle trapezius activity (P = .03). After TSM, subjects demonstrated decreased pain during performance of the Jobe empty-can (mean  SD change, 2.6  1.1), Neer (2.6  1.3), and Hawkins-Kennedy (2.8  1.3) tests (all, P<.001). Subjects also reported decreased pain with shoulder flexion (mean  SD change, 2.0  1.5; P<.001) and improved shoulder function (force production, 2.5  1.4 kg; Penn Shoulder Score, 7.7  9.4; sports/performing arts module of the Disabilities of the Arm, Shoulder and Hand questionnaire, 16.4  13.2) (all, P<.001). T T CONCLUSION: Immediate improvements inshoulder pain and function post-TSM are not likely explained by alterations in scapular kinematics or shoulder muscle activity. For people with pain associated with RCT, TSM may be an effective component of their treatment plan to improve pain and function. However, further randomized controlled studies are necessary to better validate this treatment approach. T T LEVEL OF EVIDENCE:Therapy, level 4.

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

“…There were 77 full-text articles screened (26 SRs and 51 RCTs). Eight were excluded as follows: 1 systematic review was outside the scope of this review (it did not include RCTs of shoulder conditions), 23 leaving 25 SRs; 5 articles designated as RCTs did not actually meet the definition of an RCT (did not test efficacy or did not test between-group differences) [24][25][26][27][28] ; and 2 were outside the scope of our review (1 did not measure patient-based outcomes, 29 and the other was a prognostic study 30 ), leaving 44 RCTs. The research question was clearly defined and the inclusion/exclusion criteria listed in the paper (if "no," then reject).…”

A Preliminary Randomized Clinical Trial on the Effect of Cervicothoracic Manipulation Plus Supervised Exercises vs a Home Exercise Program for the Treatment of Shoulder Impingement

“…6,7,16,17 In addition, recent studies have reported improvements in patient`s rated pain and function after a single treatment of thoracic SMT in patients with subacromial impingement syndrome, but they did not find mechanical changes in thoracic spine or shoulder mobility. 14,18 However, none of these studies included a symptomatic or asymptomatic control group for comparison in the controlled trials. Furthermore, no studies included cervicothoracic mobilization with and without impulse technique and exercise therapy in low cervical spine for the upper thoracic spinal dysfunction in SIS.…”