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Background: Implicit motor imagery performance is altered in a variety of chronic pain conditions, but it is not known whether this is the case in shoulder pain.Objectives: The aim of this study was to assess implicit motor imagery performance, using a valid and reliable shoulder left/right judgement task in people with shoulder pain.Design: Cross-sectional observational study.Methods: Participants with (n ¼ 369) and without (n ¼ 747) shoulder pain completed the shoulder left/right judgement task (LRJT). Response times (RT), accuracy were determined. Age, gender, hand dominance, current pain intensity, Shoulder Pain and Disability Index (SPADI) and pain duration recorded. Planned analysis included ANOVAs for current pain, RT and accuracy.Results: Gender and hand dominance distribution were similar between groups (p > 0.5). The shoulder pain participants were older, mean age (SD); 47(14)years, than the control group; 41(14)years, p < 0.01. Participants with shoulder pain were slower, mean RT(SD); 1809(746)ms than the controls; 1701(749)ms; p ¼ 0.02, but no different in accuracy, mean % (SD); 93.2(8.5)% to controls; 94.1(9.4)%; p ¼ 0.13. The differences in RT were resolved when age was entered as a covariate (p ¼0.83). Regression of the data from the shoulder pain group only found that current pain was positively related to RT (B ¼ 43.97) and negatively to accuracy (B ¼-0.70).Conclusions: Participants with shoulder pain do not demonstrate poorer implicit motor imagery performance than people who are pain-free. However, more intense shoulder pain is associated with poorer implicit motor imagery performance. We recommend further research utilising the LRJT in well-defined clinically homogenous groups, with verified pain severity, functional disability, and chronicity. Refereed/Peer-reviewed

Background: Disruption of cortically-held working body schema has been associated with a variety of pain conditions. A motor imagery technique - the left right judgement task (LRJT) - has been used as an indirect assessment of the integrity of the working body schema. To date there is no LRJT specifically designed to investigate the body schema of persons with shoulder pain. Objectives: To develop a shoulder specific LRJT and assess its validity and reliability. Design: Cross-sectional repeated measures. Methods: Shoulder images were developed representing the shoulder in a variety of postures of graded complexity/awkwardness and degree of rotation. These images were digitally mirrored to represent both left and right shoulders. Participants viewed the images on a computer and determined whether images were of a left or right shoulder. Results: 1413 participants were recruited worldwide and performed the shoulder LRJT (laterality judgement). Mean response time (SD) for the task was 1738(741) ms. Mean accuracy (SD) was 93.5(9.2)%. Chronbach's Alpha for shoulder image response times was 0.95. Participants were fastest responding to images of simple postures and slowest to images corresponding to the more awkward postures (mean difference 520 ms, 95%CI 469–570 ms). Participants were fastest responding to the least rotated images and slowest responding to inverted images, (mean difference 981 ms, 95%CI 919–1043 ms). Conclusions: The shoulder specific LRJT proved to be highly reliable. Response times increased with complexity and rotation of images, implying a motor imagery strategy was used to complete the task, validating the task as a measure of shoulder joint implicit motor imagery. Abnormal performance cut-offs for age were reported. This result will enable further research examining the relationship between shoulder pain and body schema. Refereed/Peer-reviewed