CPR for Cervicothoracic Manipulation and Shoulder Pain

Purpose

To identify prognostic factors for individuals with shoulder pain likely to experience improvements in pain and disability following the application of cervicothoracic spine thrust and nonthrust manipulation.

Rule

The following five criteria are considered predictors of improved short term shoulder pain prognosis following cervicothoracic manpulation:
1. Pain-free shoulder flexion < 120˚
2. Shoulder internal rotation < 53˚ @ 90˚ of abduction
3. Negative Neer’s Test
4. Not taking medications for their shoulder pain
5. Symptoms < 90 days

Diagnostic values of results (95% Confidence Intervals) are as follows:

Number of Positive Criteria	Sensitivity	Specificity	Positive Likelihood Ratio	Probability of Success(%)a
Met at least 1	1.0 (0.90, 1.0)	0.19 (0.08, 0.38)	1.0 (1.2, 1.5)	61
Met at least 2	0.90 (0.77, 0.96)	0.61 (0.42, 0.78)	2.3 (1.5, 3.6)	78
Met at least 3	0.51 (0.37, 0.65)	0.90 (0.73, 0.97)	5.3 (1.7, 16.0)	89
Met at least 4	0.27 (0.15, .41)	1.0 (0.86, 1.0)	∞	100
Met all 5	0.04 (0.01, 0.15)	1.0 (0.86, 1.0)	∞	100

Evidence

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Interventions

Manual Techniques for the Cervicothoracic Spine

References

Mintken PE, Cleland JA, Carpenter KJ, Bieniek ML, Keirns M, Whitman JM.  Some Factors Predict Short-Term Outcomes in Individuals with Shoulder Pain Receiving Cervicothoracic Manipulation:  A Single-Arm Trial.  Phys Ther.  2010; 90(1):  26-42.