The Somatic Connection  |   July 2018
Effects of Adding Cervicothoracic Treatments to Shoulder Mobilization in Subacromial Impingement Syndrome
Author Notes
  • Western University of Health Sciences College of Osteopathic Medicine of the Pacific, Pomona, California 
Article Information
The Somatic Connection   |   July 2018
Effects of Adding Cervicothoracic Treatments to Shoulder Mobilization in Subacromial Impingement Syndrome
The Journal of the American Osteopathic Association, July 2018, Vol. 118, 484-485. doi:
The Journal of the American Osteopathic Association, July 2018, Vol. 118, 484-485. doi:
Wright AA, Donaldson M, Wassinger CA, Emerson-Kavchak. Subacute effects of cervicothoracic spinal thrust/non-thrust in addition to shoulder manual therapy plus exercise intervention in individuals with subacromial impingement syndrome: a prospective, randomized controlled clinical trial pilot study. J Man Manip Ther. 2016;25(4):190-200. doi:10.1080/10669817.2016.1251377 
Shoulder pain is a common reason for musculoskeletal office visits in the United States, with a yearly prevalence greater than 50% in the general population.1 The department of physical therapy at High Point University in North Carolina published a pilot randomized controlled trial to determine the subacute effects of cervicothoracic spinal thrust/nonthrust in addition to shoulder nonthrust plus exercise in patients with subacromial impingement syndrome. 
Participants were selected from a population of patients who received care at a physiotherapy outpatient or academic physiotherapy setting. Patients were included if they met at least 2 of the following 3 criteria: (1) Hawkins-Kennedy impingement sign; (2) painful arc sign; and (3) weakness in external rotation of the arm at the side. Patients with previous shoulder surgery, fractures, current steroid use, analgesic injection in the past 3 months, cervicothoracic joint referral, neurologic symptoms, sinister pathology, or misdiagnosed shoulder pathology were excluded. 
Eighteen patients (9 men, 9 women; mean [SD] age, 43.5 [15.8] years) were randomly assigned to 1 of 2 groups: 10 to shoulder treatment plus cervicothoracic spinal thrust/nonthrust (CT) and 8 to shoulder treatment only (SO). The physical therapists participated in consensus training for assessing range of motion and standardizing manual therapy. The therapists individualized each treatment to the findings on physical examination to simulate a patient encounter. The SO group received shoulder mobilization techniques (eg, shoulder glide techniques, capsule mobilization, scapulothoracic joint mobilization). The CT group received the shoulder mobilization techniques and cervicothoracic techniques (eg, distraction manipulation, supine thrust manipulation, thoracic thrust manipulation). 
The addition of cervicothoracic spinal thrust/nonthrust to shoulder treatment did not significantly change outcomes in patients with subacromial impingement syndrome. Both groups showed statistically significant mean (95% CI) improvement on both the numeric pain rating scale (SO group: −2.50 [−4.00, −1.00]; CT group: −3.50 [−5.25, −1.75]) and the Shoulder Pain and Disability Index (SO group: −38.85 [−61.32, −16.37]; CT group: −36.00 [−52.01, −19.99]). No adverse events occurred. 
Of note, a true control, which would have provided a baseline to compare the effectiveness of each treatment plan, was not used in this study. Another limitation of this study was the low number of patients, which could be addressed by expanding inclusion criteria, as patients with contributing factors, such as cervical spine symptoms, were excluded. The types of injuries present in each experimental group can also confound the data; in this study, 50% of the SO group and 70% of the CT group had a chronic shoulder injury. The osteopathic manipulative treatment approach to shoulder pain is similar to the CT approach provided in the experimental group by treating the shoulder and adjacent regions. Similar research should be conducted to assess the effectiveness of the osteopathic approach vs shoulder mobilization only. 
van der Heijden GJ. Shoulder disorders: a state-of-the-art review. Baillieres Best Pract Res Clin Rheumatol. 1999;13(2):287-309. [CrossRef] [PubMed]