How many of you start your shoulder examination with a look at the cervical and thoracic spine? In the absence of trauma it makes the most sense to do a cervical and thoracic scan during the initial evaluation. The scapula is part of the shoulder girdle. A lot of the muscles that attach to the scapula are innervated by the cervical spine. If the patient presents with a cervical dysfunction they can wind up with altered muscle length of muscles that attach to the scapula. This can lead to altered scapula positioning at rest and with motion. If the patient has altered scapula movement it can lead to shoulder impingement during shoulder girdle movements.
The article below demonstrates that patients presenting with shoulder pain who received a thoracic manipulation experienced significant reduction in their shoulder pain and improved function. So don't forget to widen your focus and include the thoracic spine!
Non-specific shoulder pain (NSSP) is often persistent and disabling leading to high socioeconomic costs. Cervical manipulation has demonstrated improvements in patients with NSSP, although risks associated with thrust techniques are documented. Thoracic manual therapy (TMT) may utilise similar neurophysiological effects with less risk. The current evidence for TMT in treating NSSP is limited to systematic reviews of manual therapy (MT) applied to the upper quadrant. These reviews included trials that used shoulder girdle manual therapy (SG-MT) in the TMT group. This limits the scope of their conclusions with regard to the exclusive effectiveness of TMT for NSSP. Read Methods and Results here.
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**Abstract of the week shared by NAIOMT Instructor Stacy Soappman, PT, DSc, COMT, FAAOMPT.