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Subacromial pain syndrome (SPS) accounts for as much as 44% of shoulder pain encountered by physical therapists. Thoracic spine thrust manipulation (TSTM) is effective in the short term for improving pain and function in individuals with SPS, but its mechanisms remain elusive. Furthermore, it is unknown whether individuals with SPS respond differently based on the TSTM technique received.To compare the immediate effects of a supine TSTM, seated TSTM, and sham manipulation on the primary outcomes of self-reported pain, function, and satisfaction and secondary biomechanical impairments examined in individuals with SPS.Participants in this randomized clinical trial were randomized to receive a seated TSTM (n = 20), supine TSTM (n = 20), or sham manipulation (n = 20). The primary outcomes of self-reported pain, function, and satisfaction were measured via the Penn Shoulder Score. Secondary outcomes were changes in scapular upward rotation and posterior tilt; peak force generated in tests for the middle trapezius, lower trapezius, and serratus anterior; and pectoralis minor muscle length. Impairment measures were immediately reassessed, and the Penn Shoulder Score was reassessed after 48 hours.There were no significant between-group differences in immediate or short-term follow-up outcomes.Two TSTM techniques resulted in no differences in pain, satisfaction, and function when compared to a sham manipulation. Thoracic spine thrust manipulation did not have an immediate effect on the scapular impairments examined.Therapy, level 1.

Synopsis The available body of knowledge on shoulder ultrasound imaging has grown considerably within the past decade, and physical therapists are among the many health care professions currently exploring the potential clinical integration of this imaging technology and the knowledge derived from it. Therefore, the primary purpose of this commentary was to review the recent evidence and emerging uses of ultrasound imaging for the clinical evaluation of shoulder disorders. This includes a detailed description of common measurement techniques along with their known clinimetric properties. Specifically provided are critical appraisals of the existing measures used to estimate soft tissue and bony morphometry, muscle contractile states, and lean muscle density. These appraisals are intended to help clinicians clarify the scope of physical therapy practice for which these measurement techniques are effectively utilized and to highlight areas in need of further development. J Orthop Sports Phys Ther 2015;45(5)...

The Orthopaedic Section of the American Physical Therapy Association (APTA) has an ongoing effort to create evidence-based practice guidelines for orthopaedic physical therapy management of patients with musculoskeletal impairments described in the World Health Organization's International Classification of Functioning, Disability, and Health (ICF). The purpose of these clinical practice guidelines is to describe the peer-reviewed literature and make recommendations related to adhesive capsulitis. J Orthop Sports Phys Ther 2013;43(5):A1–A31. doi:10.2519/jospt.2013.0302

Controlled laboratory study.To examine the effects of altering posture on the subacromial space (SAS) in subjects with rotator cuff disease and subjects without shoulder pain.Poor upper quadrant posture has been linked to altered scapular mechanics, which has been theorized to excessively reduce SAS. However, no study has examined the direct effects of altering upper quadrant posture on SAS. We hypothesized that upright posture would increase and slouched posture would decrease the SAS, as compared to a normal posture, when measured both with the shoulder at rest along the side of the trunk and when maintained in 45° of active shoulder abduction.Participants included 2 groups: the subjects with shoulder pain and rotator cuff disease, as diagnosed via magnetic resonance imaging (n = 31), and control subjects without shoulder pain (n = 29). The SAS was imaged with ultrasound using a 7.5-MHz linear transducer placed in the coronal plane over the posterior to midportion of the acromion. The SAS was measured on ultrasound images using the acromiohumeral distance (AHD), defined as the shortest distance between the acromion and the humerus. The AHD was measured in 2 trials at 2 arm angles (at rest along the trunk and at 45° of active abduction) and across 3 postures (normal, slouched, and upright), and averaged for data analysis.Two mixed-model analyses of variance, 1 for each arm angle, were used to compare AHD across postures and between groups. There was no interaction between group and posture, and no significant main effect of group for either arm position. There was no significant main effect of posture for the arm at rest (P = .26); however, there was a significant main effect of posture on AHD at the 45° abduction arm angle (P = .0002), with a significantly greater AHD in upright posture (mean AHD, 9.8 mm), as compared to normal posture (mean AHD, 8.6 mm).The effect of posture on SAS, as measured by the 2-dimensional AHD using ultrasound of the posterior to middle aspect of the SAS, is small. The AHD increased with upright posture by 1.2 mm compared to normal posture, when the arm was in 45° active abduction.