Effectiveness of Cervicothoracic Manipulative Treatment in Unilateral Shoulder Impingement Syndrome: A Randomized Controlled Trial.

Design: Randomized Clinical Trial. Objective: to determine the effects of manipulative techniques for the ervicothoracic spine versus home exercises on pain, disability, and range of movement in patients with unilateral shoulder inmingement syndrome.

Methods and Measures: ninety-two subjects will be randomly assigned to one of two groups.

Intervention: For 5-weeks, the groups 1 will undergo tratment comprising manipulative protocol techniques for the cervicothoracic spine (2/week) and the group 2 will develop a home exercise (2/week).

Main Outcome Measures: Intensity of pain, disability, and range of motion data will be collected at baseline, and 24hr after the last therapy application. Mixed-model analyses of variance will be used to examine the effects of the treatment on each outcome measure.

Inclusion criteria

• Report of pain or dysfunction with overhead activities
• Demonstration of pain during active shoulder movements
• Demonstration of a positive Neer/Hawkins-Kennedy test
• Recent onset within the last 12 months
• Report of non-traumatic onset
• Demonstration of a painful arc of the arm from 60° to 120° of flexion
• Report of a baseline pain level of ≥2/10 on an 11 point numeric scale

Exclusion criteria

• The presence of any red flags
• A history of frozen shoulder
• Disorders of the acromioclavicular joint
• Degenerative arthritis of the glenohumeral joint
• Known calcifying tendonitis (if identified by radiograph)
• Shoulder instability
• Posttraumatic disorders
• Shoulder surgery and/or elbow, hand, wrist and blatantly misdiagnosed cervical spine disorders