CPR for Shoulder Pain but Responds Well After C/S or T/S Manipulation

Boyles et al.³⁸ demonstrated that thoracic manipulation resulted in a statistically significant decrease in self-reported pain and disability in patients with shoulder impingement syndrome at 48 hours follow-up. Finally, Mintken et al.³⁹ were able to develop a CPR for patients with a primary complaint of shoulder pain who demonstrated rapid improvement in pain and disability following cervical and thoracic spine manipulation. The prospective single-arm trial found if three out of five prognostic variables were present

1. Pain-free Shoulder flexion <127°
2. Shoulder internal rotation <53° at 90° of abduction
3. Negative Neer test
4. No medication use for their shoulder pain
5. Symptoms <90 days),

The chance of experiencing rapid improvement following manipulation improved from 61 to 89% (positive likelihood ratio = 5.3).³⁹