Short-term Effects of Thoracic Manipulation in Shoulder Impingement

Short-term Effects of Thoracic Manipulation on Scapular Kinematics, Muscle Activity and Pain in Shoulder Impingement. A Randomized Controlled Trial

The hypothesis of this study is that thoracic spine manipulation would reduce pain in subjects with SIS and cause changes in scapular kinematics and muscle activity in subjects with impingement symptoms and in asymptomatic subjects. With this study, the investigators want to answer if possible changes in scapular motion and muscle activity following a TSM depend on the symptoms or if it is generic to individuals without shoulder dysfunction and not specific to subjects with shoulder impingement.

Subjects with shoulder impingement signs will be evaluated and will be compared with subjects asymptomatic for shoulder symptoms. Both subjects will be randomly assigned to one of two intervention groups: thoracic spinal manipulation (TSM) or sham intervention. We want to know if possible changes in scapular motion and muscle activity following a TSM depend on the symptoms or if it is generic to everyone. Also, we want to know if TSM reduces shoulder pain immediately and in a short-therm period.

Inclusion Criteria (symptomatic subjects): To present with at least 3 of the following findings:

• positive Neer impingement test,
• positive Hawkins impingement test,
• positive Jobe test,
• pain with passive or isometric resisted shoulder lateral rotation,
• pain with active shoulder elevation,
• pain with palpation of rotator cuff tendons,
• pain in the C5 or C6 dermatome region.

Exclusion Criteria (symptomatic subjects):

• signs of "red flags" for spinal manipulation (eg, fracture, osteoporosis, malignancy, infection, and active inflammatory process),
• pregnancy
• systemic illnesses
• if received physical therapy or manual therapy treatment within the 6 months prior to the evaluation
• signs of complete rotator cuff tear or acute inflammation
• cervical-thoracic spine related symptoms (ie, positive cervical compression test and excessive kyphosis)
• scoliosis
• glenohumeral instability (ie, positive apprehension, anterior drawer, or sulcus tests)
• previous upper extremity fracture or shoulder surgery.

Exclusion Criteria (asymptomatic subjects):

• any positive test for shoulder impingement
• signs of "red flags" for spinal manipulation (eg, fracture, osteoporosis, malignancy, infection, and active inflammatory process),
• pregnancy
• systemic illnesses
• if received physical therapy or manual therapy treatment within the 6 months prior to the evaluation
• signs of complete rotator cuff tear or acute inflammation
• cervical-thoracic spine related symptoms (ie, positive cervical compression test and excessive kyphosis)
• scoliosis
• glenohumeral instability (ie, positive apprehension, anterior drawer, or sulcus tests)
• previous upper extremity fracture or shoulder surgery.