title: The effects of thoracic spine manipulation in subjects with signs of rotator cuff tendinopathy.
abstract: METHODS
  Controlled laboratory study.
  
  
  OBJECTIVE
  To assess scapular kinematics and electromyographic signal amplitude of the shoulder musculature, before and after thoracic spine manipulation (TSM) in subjects with rotator cuff tendinopathy (RCT). Changes in range of motion, pain, and function were also assessed.
  
  
  BACKGROUND
  There are various treatment techniques for RCT. Recent studies suggest that TSM may be a useful component in the management of pain and dysfunction associated with RCT.
  
  
  METHODS
  Thirty subjects between 18 and 45 years of age, who showed signs of RCT, participated in this study. Changes in scapular kinematics and muscle activity, as well as changes in shoulder pain and function, were assessed pre-TSM and post-TSM using paired t tests and repeated-measures analyses of variance.
  
  
  RESULTS
  TSM did not lead to changes in range of motion or scapular kinematics, with the exception of a small decrease in scapular upward rotation (P = .05). The only change in muscle activity was a small but significant increase in middle trapezius activity (P = .03). After TSM, subjects demonstrated decreased pain during performance of the Jobe empty-can (mean ± SD change, 2.6 ± 1.1), Neer (2.6 ± 1.3), and Hawkins-Kennedy (2.8 ± 1.3) tests (all, P<.001). Subjects also reported decreased pain with shoulder flexion (mean ± SD change, 2.0 ± 1.5; P<.001) and improved shoulder function (force production, 2.5 ± 1.4 kg; Penn Shoulder Score, 7.7 ± 9.4; sports/performing arts module of the Disabilities of the Arm, Shoulder and Hand questionnaire, 16.4 ± 13.2) (all, P<.001).
  
  
  CONCLUSIONS
  Immediate improvements in shoulder pain and function post-TSM are not likely explained by alterations in scapular kinematics or shoulder muscle activity. For people with pain associated with RCT, TSM may be an effective component of their treatment plan to improve pain and function. However, further randomized controlled studies are necessary to better validate this treatment approach.
  
  
  METHODS
  Therapy, level 4.
authors.affiliation: University of Medicine and Dentistry of New Jersey, 40 East Laurel Road, UEC Suite 2105, Stratford, NJ 08084, USA. muthst@umdnj.edu
authors.forename: Stephanie
authors.initials: S
authors.lastname: Muth
authors.forename: Mary F
authors.initials: MF
authors.lastname: Barbe
authors.forename: Richard
authors.initials: R
authors.lastname: Lauer
authors.forename: Philip W
authors.initials: PW
authors.lastname: McClure
mesh_terms: D000328:Adult; D001696:Biomechanical Phenomena; D005260:Female; D006801:Humans; D008297:Male; D020393:Manipulation, Spinal; D017006:Rotator Cuff / Q000502:physiology*; D020069:Shoulder Pain / Q000628:therapy*; D052256:Tendinopathy / Q000628:therapy*; D013904:Thoracic Vertebrae / Q000502:physiology*; D016896:Treatment Outcome; D055815:Young Adult