Shoulder ultrasonography in the diagnosis of polymyalgia rheumatica: a case-control study. Provocative cervical discography symptom mapping. Clinical predictors of a positive response to guided diagnostic block into the subacromial bursa. Mobilizations of the asymptomatic cervical spine can reduce signs of shoulder dysfunction in adults. Is ultrasound-guided injection more effective in chronic subacromial bursitis? The targeting accuracy of subacromial injection to the shoulder: an arthrographic evaluation. The subacromial impingement syndrome of the shoulder treated by conventional physiotherapy, self-training, and a shoulder brace: results of a prospective, randomized study. The accuracy of subacromial injections: a prospective randomized magnetic resonance imaging study. Subacromial impingement syndrome: the effect of changing posture on shoulder range of movement. The role of radiological subacromial distance measurements in the subacromial impingement syndrome Evaluating displacement of the coracoacromial ligament in painful shoulders of overhead athletes through dynamic ultrasonographic examination. Clinical and MRI findings after high dosage medical exercise therapy in patients with long lasting subacromial pain syndrome: a case series on six patients. Imaging-guided subacromial therapeutic injections: prospective study comparing abnormalities on conventional radiography with patient outcomes. Contributions of myofascial pain in diagnosis and treatment of shoulder pain. A randomized control trial Ultrasound-Guided Versus Blind Subacromial Corticosteroid Injections for Subacromial Impingement Syndrome Immediate changes in pressure pain sensitivity after thoracic spinal manipulative therapy in patients with subacromial impingement syndrome: A randomized controlled study. The effect of joint mobilization as a component of comprehensive treatment for primary shoulder impingement syndrome.
OBJECTIVE Magnetic resonance imaging ( MRI ) showed that subacromial/subdeltoid bursitis is the most frequent shoulder lesion in polymyalgia rheumatica ( PMR ) . We evaluated whether shoulder ultrasonography ( US ) was as effective as MRI in the detection of this lesion and assessed the sensitivity and specificity of bilateral subacromial/subdeltoid bursitis in the diagnosis of PMR . METHODS A case-control study of 57 consecutive case patients with untreated PMR and 114 controls seen over a 6 month period in 3 secondary referral rheumatology centers . Control patients consisted of the next 2 consecutive patients with bilateral shoulder aching and stiffness observed after the case patient . In all case and control patients the glenohumeral joint space , bursae , and long head biceps tendon were assessed by bilateral shoulder US . The first 24 case patients were also examined by bilateral shoulder MRI . RESULTS US showed subacromial/subdeltoid bursitis in 55/57 ( 96 % ) patients with PMR and in 25/114 ( 22 % ) controls ( p < 0.001 ) . The lesion was bilateral in 53/55 ( 96 % ) case patients and in 1/25 ( 4 % ) controls ( p < 0.001 ) . The frequency of glenohumeral joint synovitis and biceps tenosynovitis did not differ significantly between case patients and controls . In 100 % of case patients MRI showed subacromial/subdeltoid bursitis confirming US findings . The sonographic evidence of bilateral bursitis had a sensitivity of 92.9 % , specificity of 99 . 1 % , and positive predictive value of 98 . 1 % for the diagnosis of PMR . CONCLUSION US and MRI were equally effective in confirming bilateral subacromial and subdeltoid bursitis in PMR . This finding , in view of its high sensitivity and specificity , could be used as a new diagnostic criterion for PMR BACKGROUND CONTEXT In a small prospect i ve study assessing 10 symptomatic and 10 asymptomatic subjects , Schellhas et al. compared cervical discography to magnetic resonance imaging . Within that study he reported on the distribution of pain for the C3-C4 to C6-C7 levels . Four years later , Grubb and Ellis reported retrospective data from his 12-year experience using cervical discography from C2-C3 to C7-T1 in 173 patients . To date , no large prospect i ve study defining pain referral patterns for each cervical disc has been performed . PURPOSE To conduct a prospect i ve visual and statistical descriptive study of pain provocation of a cohort of subjects undergoing cervical discography .  STUDY DESIGN / SETTING Prospect i ve multicenter descriptive study . METHODS Pain referral maps were generated for each disc level from patients undergoing cervical discography with at least two levels assessed . If concordant pain was reproduced in a morphologically abnormal disc , the subject immediately completed a pain diagram . An independent observer interviewed the subject and recorded the location of provoked symptoms . Visual data were compiled using a body sector bit map , which consisted of 48 clinical ly relevant body regions . Visual maps with graduated color codes and frequencies of symptom location at each cervical disc level were generated . RESULTS A total of 101  symptom provocation maps  were recorded during cervical discography on 41 subjects . There were 10 at C2-C3 , 19 at C3-C4 , 27 at C4-C5 , 27 at C5-C6 , 16 at C6-C7 and 2 at C7-T1 . Predominantly unilateral symptoms were provoked just as often as bilateral symptoms . The C2-C3 disc referred pain to the neck , subocciput and face . The C3-C4 disc referred pain to the neck , subocciput , trapezius , anterior neck , face , shoulder , interscapular and limb . The C4-C5 disc referred pain to the neck , shoulder , interscapular , trapezius , extremity , face , chest and subocciput . The C5-C6 disc referred pain to the neck , trapezius , interscapular , suboccipital , anterior neck , chest and face . The C6-C7 disc referred pain to the neck , interscapular , trapezius , shoulder , extremity and subocciput . At C7-T1 we produced neck and interscapular pain . Visual maps with graduated color codes and frequencies of symptom location at each cervical disc level were generated . CONCLUSIONS In conclusion , these results confirm the observations of prior investigators that cervical internal disc disruption can elicit axial and peripheral symptoms . The particular patterns of pain generation allow the discographer to preprocedurally anticipate disc levels to assess . With these data , the number of disc punctures that are required can be limited rather than routinely assessing all cervical discs OBJECTIVE To compare the accuracy of combinations of clinical examination findings for predicting a positive response to injection of local anaesthetic into the subacromial bursa . DESIGN Prospect i ve , cohort , diagnostic validity design . SUBJECTS Consecutive patients with shoulder pain recruited from primary care physiotherapy and general medical practice s. METHODS All subjects underwent a st and ardised clinical examination ( index test ) followed by a diagnostic injection of xylocaineTM into the subacromial bursa ( reference st and ard test ) performed under ultrasound guidance . Clinical examination variables associated with a positive anaesthetic response ( ≥ 80 % post-injection reduction in pain intensity ) were identified ( p < 0.20 ) and diagnostic accuracy was calculated . RESULTS Of the 196 subjects who received a subacromial bursa injection , 66 subjects ( 34 % ) reported a positive anaesthetic response . Strain injury ( adjusted odds ratio ( AOR ) 2.3 ) , anterior shoulder pain ( AOR 2.3 ) and absence of pain with external rotation at 90º abduction ( AOR 3.9 ) were the strongest clinical predictors of positive anaesthetic response . Clinical prediction model variables demonstrated 100 % specificity ( 3 positive tests ) but low sensitivity ( maximum 40 % ) for a positive anaesthetic response . Combinations of 9 other clinical variables also demonstrated 100 % specificity ( 7 or more positive tests ) , and improved sensitivity ( 95 to 100 % ) for a PAR compared with clinical prediction model variables when less than two findings were present . CONCLUSION Combinations of these clinical tests may assist the clinician to differentiate subacromial pain from other shoulder conditions and guide selection of targeted pain management interventions . Additional diagnostic tests may be required when clinical criteria are not satisfied Generalized shoulder pain is a common problem that is difficult to treat and frequently recurrent . The asymptomatic cervical spine must be ruled out as a cause of any shoulder pain , as it can have a similar presentation to an isolated shoulder disorder . Previous studies have shown that lateral cervical glide mobilizations to the asymptomatic cervical spine at C5/6 can affect peripheral pain , but none have examined shoulder pain . A r and omized , blinded , placebo-controlled , cross-over trial was used to examine the immediate effects of cervical lateral glide mobilizations on pain intensity and shoulder abduction painful arc in subjects with shoulder pain . Twenty-one subjects received interventions of both cervical mobilization and placebo over two sessions . Pain intensity using a visual analog scale ( VAS ) and painful arc were assessed prior to and following application of cervical mobilization or placebo intervention . Evaluation of cervical mobilization revealed the shoulder abduction painful arc ( 12.5 degrees + /-15.6 degrees , p=0.002 ) and shoulder pain intensity ( 1.3+/-1.1 cm , p<0.001 ) were significantly decreased . The results of this study suggest that any immediate change in shoulder pain or active shoulder range of motion following cervical mobilizations indicate that treatment directed toward the asymptomatic cervical spine may expedite recovery PURPOSE Although ultrasound (US)-guided subacromial injection has shown increased accuracy in needle placement , whether US-guided injection produces better clinical outcome is still controversial . Therefore , this study aim ed to compare the efficacy of subacromial corticosteroid injection under US guidance with palpation-guided subacromial injection in patients with chronic subacromial bursitis . METHODS Patients with chronic subacromial bursitis were r and omized to a US-guided injection group and a palpation-guided injection group . The subjects in each group were injected with a mixture of 0.5 mL dexamethasone suspension and 3 mL lidocaine into the subacromial bursa . The primary outcome measures were the visual analog scale for pain and active and passive ranges of motion of the affected shoulder . Secondary outcome measures were the Shoulder Pain and Disability Index , the Shoulder Disability Question naire , and the 36-item Short-Form Health Survey ( SF-36 ) . The primary outcome measures were evaluated before , immediately , 1 wk , and 1 month after the injection ; the secondary outcome measures were evaluated before , 1 wk , and 1 month after the injection . RESULTS Of the 145 subjects screened , 46 in each group completed the study . Significantly greater improvement in passive shoulder abduction and in physical functioning and vitality scores on the SF-36 were observed in the US-guided group . The pre- and postinjection within-group comparison revealed significant improvement in the visual analog scale for pain and range of motion , as well as in the Shoulder Pain and Disability Index , Shoulder Disability Question naire , and SF-36 scores , in both groups . CONCLUSIONS The US-guided subacromial injection technique produced significantly greater improvements in passive shoulder abduction and in some items of the SF-36 . US is effective in guiding the needle into the subacromial bursa in patients with chronic subacromial bursitis PURPOSE The study goal was to examine the targeting accuracy of subacromial injection to the shoulder and the influence of the location of the injected structure . TYPE OF STUDY A prospect i ve nonr and omized study . METHODS Fifty-three patients ( 56 shoulders ; 34 women and 19 men ; mean age , 74.5 years ; range , 49 to 91 ) with impingement signs ( Neer , Hawkins ) of at least 2 months ' duration received a subacromial injection of a mixture of 0.5 mL ( 2.5 mg ) betamethasone acetate and 3 mL of radiographic contrast material ( iotrolan ) and 7 mL of 1 % lidocaine using a lateral approach . Radiographs of the shoulder joint were taken immediately after the injection to determine the structure reached by the injection . Details of pain expressed as Neer and Hawkins impingement signs were obtained before and 15 minutes after the injection , and subjectively assessed using a 4-point self-administered pain score . Pain reduction result ing from subacromial and intradeltoid injection was compared . RESULTS Thirty-nine of the 56 injections ( 70 % ) were judged to have reached the subacromial bursa . Twelve ( 21 % ) were seen to have entered the deltoid muscle ; 2 ( 4 % ) were in the glenohumeral joint ; and 3 ( 5 % ) were subcutaneous . A comparison of subacromial bursal with intradeltoid injection showed no significant differences in pain reduction expressed as impingement signs ( 1.5 vs 1.7 in the Neer impingement sign and 1.6 vs 1.6 in the Hawkins impingement sign , respectively ) . CONCLUSIONS This study showed that subacromial injection was a relatively difficult procedure . A high incidence of injections that missed the subacromial bursa would be a sufficient reason to refrain from repeated usage of corticosteroids . These results also suggest that pain relief could be attained whether the injected material reached the subacromial bursa or the deltoid muscle . Successful pain relief after intradeltoid injection seems to call into question the diagnostic value of a positive Neer impingement test This prospect i ve , r and omized trial was performed to compare the results of treating subacromial impingement syndrome of the shoulder by a guided self-training program with the treatment by conventional physiotherapy or a functional brace .  Sixty patients with the diagnosis of an outlet impingement syndrome of the shoulder ( Neer I and II ) were treated either by strengthening the depressors of the humeral head with a guided self-training program , by conventional physiotherapy , or by wearing a functional brace . The Constant-Murley score was assessed after 6 and 12 weeks . Shoulder pain was monitored with a visual analog scale . All three groups showed a significant improvement in shoulder function as well as a significant reduction in pain . There were no statistically significant differences among the groups . Guided self-training can lead to results similar to those of conventional physiotherapy . The comparable effect of the functional brace remains unclear and might be explained by an influence on proprioception PURPOSE To assess the accuracy of shoulder infiltrations in the subacromial bursa ( SAB ) by a posterior or an anteromedial approach . Magnetic resonance imaging ( MRI ) and clinical outcome were used for evaluation . TYPE OF STUDY A prospect i ve r and omized study . METHODS Thirty-three patients ( 22 women , 11 men ; average age , 46 years ; range , 25 to 64 years ) with clinical signs of subacromial impingement were infiltrated with a mixture of bupivacaine , methylprednisolone , and gadolinium-DTPA directly followed by MRI to determine the actual site of injection . The SAB was r and omly infiltrated posteriorly ( n = 17 ) or anteromedially ( n = 16 ) . Injection confidence of the surgeon and body-mass index of the patient were recorded . Follow-up consisted of the Constant Score , Simple Shoulder Test , and visual analog scale score for pain taken within 24 hours and 6 weeks after infiltration . RESULTS Thirteen injections ( 76 % ) were in the SAB with a posterior approach and 10 ( 69 % ) with an anteromedial approach . Many surrounding structures were hit as well , especially the rotator cuff . A positive correlation between the injection confidence of the orthopaedic surgeon and the MRI was found in 66 % . Only injection of the SAB alone result ed in a significant decrease of the pain ( P = .004 ) and an increase in the functional scores . Injection in the bursa and rotator cuff muscle showed a significant increase in pain ( P = .032 ) but no change in clinical scores . The body mass index had no influence on the scores . CONCLUSIONS Injections in the SAB are inaccurate , despite the confident feeling of the clinician . The finding that many different structures can be infiltrated with 1 injection can create both false-positive and -negative results . LEVEL OF EVIDENCE Level II STUDY DESIGN R and om allocation of subjects into a placebo-controlled , crossover study . OBJECTIVES To investigate the effect of changing thoracic and scapular posture on shoulder flexion and scapular plane abduction range of motion in asymptomatic subjects , and in subjects with subacromial impingement syndrome . BACKGROUND Changes in upper body posture and concomitant imbalance of the muscle system have been proposed as one of the etiological mechanisms leading to subacromial impingement syndrome . Although clinicians commonly assess posture and devise rehabilitation programs to correct posture , there is little evidence to support this practice . METHODS AND MATERIAL S Selected postural , range of movement , and pain measurements were investigated in 60 asymptomatic subjects and 60 subjects with subacromial impingement syndrome , prior to and following thoracic and scapular taping intended to change their posture .  RESULTS Changing posture had an effect on all components of posture measured ( P<.001 ) and these changes were associated with a significant increase ( P<.001 ) in the range of motion in shoulder flexion and abduction in the plane of the scapula . Changing posture was not found to have a significant effect on the intensity of pain experienced by the symptomatic subjects , although the point in the range of shoulder elevation at which they experienced their pain was significantly higher ( P<.001 ) . CONCLUSIONS The findings of this investigation suggest that changing 1 or more of the components of posture may have a positive effect on shoulder range of movement and the point at which pain is experienced Subacromial impingement is one of the most common causes of painful shoulder in the middle aged and elderly population . Since Neer ’s first description of the process , many investigators have research ed this condition in an effort to gain a better underst and ing of the disease etiology . The aim of this study was to investigate the relationship between the  radiological subacromial distance measurements  and the subacromial impingement syndrome in a series of patients from our institution . For this purpose , 44 patients scheduled for a unilateral shoulder arthroscopy were investigated prospect ively . The acromio-glenoid angle , supraspinatus-glenoid angle ( from coronal MR images ) and acromial index ( from true anterior-posterior shoulder X-ray images ) were measured as the implication s of the subacromial distance , and the degree of subacromial impingement was grade d according to intraoperative findings . Statistical data analysis revealed no significant correlations between the radiological measurements and the severity of subacromial impingement ( p > 0.05 ) . On the other h and , there was a significant correlation ( p = 0.0049 ) between the patient age and subacromial impingement . These results suggest that the radiological subacromial distance measurements do not have enough clinical significance as predictive markers in the subacromial impingement syndrome OBJECTIVE To evaluate displacement of the coracoacromial ligament ( CAL ) , using dynamic ultrasonography ( US ) , for detecting instability-related impingement caused by overhead activities . DESIGN Between-group survey . SETTING Department of Physical Medicine and Rehabilitation in a tertiary care center . PARTICIPANTS Volunteer high school volleyball players with unilateral shoulder pain ( n=10 ) and volunteer asymptomatic high school volleyball players with identical training activities as control subjects ( n=16 ) . INTERVENTIONS Not applicable . MAIN OUTCOME MEASURE The displacement of the CAL was measured during throwing simulation using dynamic US . Both shoulders of all subjects were evaluated . RESULTS During throwing simulation , the displacement of the CAL in the painful shoulders of overhead athletes increased significantly greater than the displacement in the asymptomatic shoulder ( 3.0+/-0.7 mm and 2.2+/-0.4 mm , respectively ; P=.017 ) . No difference was identified between the displacements of the CALs of bilateral shoulders of the control group subjects . CONCLUSIONS Dynamic US , by measuring the displacement of the CAL during simulation of throwing , may be helpful in detecting abnormal humeral head upward migration in overhead athletes UNLABELLED SUMMARY BACKGROUND AND PURPOSE : The primary aim of this case series was to investigate the effect of a high dosage medical exercise therapy program on shoulder pain in patients with subacromial pain syndrome . SUBJECTS Six subjects were assigned to a medical exercise therapy group . METHODS They received three treatments a week over three months . Outcome measures were descriptions of the subacromial space including supraspinatus tendon diameter , function , pain , and active range of motion in the shoulder girdle . RESULTS The subjects showed improvement posttest compared to pretest with respect to pain , function , range of motion , and isometric strength . An MRI demonstrated no change in tendon thickness after the treatment . Inflammatory signs such as fluid in the subacromial bursa decreased in some patients . DISCUSSION AND CONCLUSION In patients with uncomplicated subacromial pain syndrome , high dosage medical exercise therapy might be an efficient treatment approach . The clinical effects might be explained by morphological changes in the subacromial space OBJECTIVE The purpose of this study was to compare abnormalities detected on conventional shoulder radiography with improvement in pain and shoulder function after subacromial injections . SUBJECTS AND METHODS We conducted a prospect i ve outcomes study including 98 consecutive patients after fluoroscopy-guided subacromial injections who returned outcome question naires and who underwent routine shoulder radiography .  Numeric pain rating scale ( NRS ) data were collected before and , along with patient global impression of change ( PGIC ) data , at 1 week and 1 month after injection . Outcome differences were assessed using the Student t test and Mann-Whitney U test . Logistic regression analysis was done , including radiographic variables compared with the outcome improvement . The odds ratios with 95 % CIs were identified for the significant predictors . RESULTS A significant difference in overall improvement was found depending on the posterior acromial slope . Patients with a slope of more than 36 ° had significantly lower NRS and PGIC scores at 1 week and 1 month ( p < 0.025 ) compared with those with a slope of 36 ° or less , with 86.4 % of patients with a slope of more than 36 ° reporting significant improvement at 1 month . This was the only variable linked with improvement in the logistic regression analysis , with an odds ratio of 2.16 ( 95 % CI , 1.11 - 4.22 ) . Patients with calcific tendinitis had significantly lower NRS scores at both 1 week and 1 month ( p = 0.03 and 0.05 , respectively ) and PGIC scores at 1 week ( p = 0.05 ) . CONCLUSION A posterior acromial slope of more than 36 ° and the presence of calcific tendinitis on conventional shoulder radiography are associated with better outcomes . Patients with a slope of more than 36 ° showed the best improvement Background Rotator cuff tendinopathy and subacromial impingement syndrome present complex patomechanical situations , frequent difficulties in clinical diagnosis and lack of effectiveness in treatment . Based on clinical experience , we have therefore considered the existence of another pathological entity as the possible origin of pain and dysfunction . The hypothesis of this study is to relate subacromial impingement syndrome ( SIS ) with myofascial pain syndrome ( MPS ) , since myofascial trigger points ( MTrPs ) cause pain , functional limitation , lack of coordination and alterations in quality of movement , even prior to a tendinopathy . MTrPs can coexist with any degenerative subacromial condition . If they are not taken into consideration , they could perpetuate and aggravate the problem , hindering diagnosis and making the applied treatments ineffective . The aims and methods of this study are related with providing evidence of the relationship that may exist between this condition and MPS in the diagnosis and treatment of rotator cuff tendonitis and /or SIS . Method / design A descriptive transversal study will be made to find the correlation between the diagnosis of SIS and rotator cuff tendonitis , positive provocation test responses , the existence of active MTrPs and the results obtained with ultrasonography ( US ) and Magnetic Renonance Imaging ( MRI ) . A r and omized double blinded clinical trial will be carried out in experimental conditions : A Protocol ized treatment based on active and passive joint repositioning , stabilization exercises , stretching of the periarticular shoulder muscles and postural reeducation . B. The previously described protocol ized treatment , with the addition of dry needling applied to active MTrPs with the purpose of isolating the efficacy of dry needling in treatment . Discussion This study aims to provide a new vision of shoulder pain , from the perspective of MPS . This syndrome can , by itself , account for shoulder pain and dysfunction , although it can coexist with real conditions involving the tendons . Trail Registration IS RCT N Number : Background : Subacromial corticosteroid injections are frequently performed for impingement syndrome of the shoulder . To improve the accuracy of injections , ultrasound can be used . Purpose : To assess the clinical outcome of ultrasound-guided subacromial injections compared with blind subacromial injections for subacromial impingement syndrome . Study Design : R and omized controlled clinical trial ; Level of evidence , 1 . Methods : A total of 56 shoulders with subacromial impingement syndrome were r and omized into 2 groups : 28 shoulders received a subacromial corticosteroid injection with ultrasound guidance ( ultrasound group ) , and 28 shoulders received a subacromial corticosteroid injection without ultrasound guidance ( blind group ) . The visual analog scale ( VAS ) for pain with overhead activities and the American Shoulder and Elbow Surgeons ( ASES ) score were obtained before the injection and at 6 weeks after the injection . Results : The VAS score for pain with overhead activities decreased from 59 ± 5 mm ( mean ± SEM ) before the injection to 33 ± 6 mm at 6 weeks after the injection in the ultrasound group ( P < .001 ) and from 63 ± 4 mm to 39 ± 6 mm , respectively , in the blind group ( P < .001 ) . The decrease in the VAS score was not significantly different between the groups ( P > .999 ) . The ASES score increased from 57 ± 2 before the injection to 68 ± 3 at 6 weeks after the injection in the ultrasound group ( P < .01 ) and from 54 ± 3 before the injection to 65 ± 4 after the injection in the blind group ( P < .01 ) , with no significant difference between the groups ( P = .7 ) . Four shoulders ( 14 % ) in the ultrasound group and 6 shoulders ( 21 % ) in the blind group eventually needed surgery ( P = .7 ) . Conclusion : No significant differences were found in the clinical outcome when comparing ultrasound-guided subacromial injections to blind subacromial injections for subacromial impingement syndrome . Clinical Trial Registration : Australian New Zeal and Clinical Trials Registry : BACKGROUND Thoracic SMT can improve symptoms in patients with subacromial impingement syndrome . However , at this time the mechanisms of SMT are not well established . It is possible that changes in pain sensitivity may occur following SMT . OBJECTIVES To assess the immediate pain response in patients with shoulder pain following thoracic spinal manipulative therapy ( SMT )  using pressure pain threshold ( PPT ) , and to assess the relationship of change in pain sensitivity to patient-rated outcomes of pain and function following treatment . DESIGN R and omized Controlled Study . METHODS Subjects with unilateral subacromial impingement syndrome ( n = 45 ) were r and omly assigned to receive treatment with thoracic SMT or sham thoracic SMT . PPT was measured at the painful shoulder ( deltoid ) and unaffected regions ( contralateral deltoid and bilateral lower trapezius areas ) immediately pre- and post-treatment . Patient-rated outcomes were pain ( numeric pain rating scale - NPRS ) , function ( Pennsylvania Shoulder Score - Penn ) , and global rating of change ( GROC ) . RESULTS There were no significant differences between groups in pre-to post-treatment changes in PPT ( p ≥ 0.583 ) nor were there significant changes in PPT within either group ( p ≥ 0.372 ) following treatment . NPRS , Penn and GROC improved across both groups ( p < 0.001 ) , but there were no differences between the groups ( p ≥ 0.574 ) . CONCLUSION There were no differences in pressure pain sensitivity between participants receiving thoracic SMT versus sham thoracic SMT . Both groups had improved patient-rated pain and function within 24 - 48 h of treatment , but there was no difference in outcomes between the groups Primary shoulder impingement syndrome is a common shoulder problem which , if treated ineffectively , can lead to more serious pathology and expensive treatment . This study examined whether subjects receiving joint mobilization and comprehensive treatment ( hot packs , active range of motion , physiologic stretching , muscle strengthening , soft tissue mobilization , and patient education ) would have improved pain , mobility , and function compared with similar patients receiving comprehensive treatment alone . Subjects were eight men and six women ( mean age = 52.9 years ) with primary shoulder impingement syndrome ( superolateral shoulder pain , decreased active humeral elevation , limited overhead function ) . Following r and om assignment to experimental ( N = 7 ) and control groups ( N = 7 ) , three blinded evaluators tested 24-hour pain ( visual analog scale ) , pain with subacromial compression test ( visual analog scale ) , active range of motion ( goniometry ) , and function ( reaching forward , behind the head , and across the body in an overhead position ) before and after nine treatments . One-tailed analyses of covariance ( baseline values as covariates ) showed that the experimental group had less 24-hour pain and pain with subacromial compression test but no differences in range of motion and function ( Mann-Whitney U ) compared with controls . The experimental group improved on all variables , while the control group improved only on mobility and function ( one-tailed , paired t tests ; Wilcoxon matched pairs ) . Age , side of dominance , duration of symptoms , treatment attendance , exercise quality , and adherence had no effect on the outcomes . Results may be affected by inadequate sample size , minimal capsular tightness , insensitive functional scale , nonspecific motion measurements , position at which mobilization treatment was given , or a strong effect of comprehensive treatment . Mobilization decreased 24-hour pain and pain with subacromial compression test in patients with primary shoulder impingement syndrome , but larger replication studies are needed to assess more clearly mobilization 's influence on motion and function
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 .