title: Changes in shoulder pain and disability after thrust manipulation in subjects presenting with second and third rib syndrome.
abstract: OBJECTIVE
  The purpose of this preliminary study was to investigate changes in shoulder pain, disability, and perceived level of recovery after 2 sessions of upper thoracic and upper rib high-velocity low-amplitude (HVLA) thrust manipulation in patients with shoulder pain secondary to second and third rib syndrome.
  
  
  METHODS
  This exploratory study evaluated 10 consecutive individuals with shoulder pain, with or without brachial pain, and a negative Neer impingement test, who completed the Shoulder Pain and Disability Index (SPADI), the numeric pain rating scale (NPRS), and the global rating of change. Patients received 2 sessions of HVLA thrust manipulation targeting the upper thoracic spine bilaterally and the second and third ribs on the symptomatic side. Outcome measures were completed after the first treatment session, at 48 hours, 1 month, and 3 months.
  
  
  RESULTS
  Patients showed a significant decrease in SPADI (F = 59.997; P = .001) and significant decrease in resting shoulder NPRS (F = 63.439; P = .001). For both NPRS and SPADI, there were significant differences between the pretreatment scores and each of the postintervention scores through 3-month follow-up (P < .05). Large within-group effect sizes (Cohen's d ≥ 0.8) were found between preintervention data and all postintervention assessments in both outcomes. Mean global rating of change scores (+6.8 at 3 months) indicated "a very great deal better" outcome at long-term follow-up.
  
  
  CONCLUSIONS
  This group of patients with shoulder pain secondary to second and third rib syndrome who received upper thoracic and upper rib HVLA thrust manipulations showed significant reductions in pain and disability and improvement in perceived level of recovery.
authors.affiliation: PhD Student, College of Health Care Sciences, Nova Southeastern University, Ft. Lauderdale, FL. Electronic address: jamesdunning@hotmail.com.
authors.forename: James
authors.initials: J
authors.lastname: Dunning
authors.affiliation: PhD Student, Department of Physical Therapy, Universidad Rey Juan Carlos, Alcorcòn, Madrid, Spain.
authors.forename: Firas
authors.initials: F
authors.lastname: Mourad
authors.affiliation: Lecturer, Department of Physiotherapy, Università di Padova, Padova, Italy.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Giovannico
authors.affiliation: Lecturer, Department of Physiotherapy, Università di Genova, Genova, Italy.
authors.forename: Filippo
authors.initials: F
authors.lastname: Maselli
authors.affiliation: Senior Physical Therapist, Portsmouth Physical Therapy, Portsmouth, NH.
authors.forename: Thomas
authors.initials: T
authors.lastname: Perreault
authors.affiliation: Professor, Department of Physical Therapy, Occupational Therapy, Rehabilitation and Physical Medicine, Universidad Rey Juan Carlos, Alcorcòn, Madrid, Spain.
authors.forename: César
authors.initials: C
authors.lastname: Fernández-de-Las-Peñas
mesh_terms: D000293:Adolescent; D000328:Adult; D000704:Analysis of Variance; D015331:Cohort Studies; D004185:Disability Evaluation; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D020393:Manipulation, Spinal / Q000379:methods*; D008875:Middle Aged; D010147:Pain Measurement; D017060:Patient Satisfaction / Q000706:statistics & numerical data; D012189:Retrospective Studies; D012272:Ribs / Q000503:physiopathology*; D012720:Severity of Illness Index; D020069:Shoulder Pain / Q000175:diagnosis / Q000534:rehabilitation*; D013577:Syndrome; D013904:Thoracic Vertebrae; D016896:Treatment Outcome; D055815:Young Adult
keywords: Manipulation; Manual Therapy; Ribs; Shoulder Pain; Spinal; Thoracic Vertebrae