Author Names

Dunning, J; Mourad, F; Giovannico, G; Maselli, F; Perreault, T; Fernandez-de-las-Penas, C

Reviewer Name

Brenna Hammer, SPT, LAT, ATC

Reviewer Affiliation(s)

Duke University School of Medicine – Doctor of Physical Therapy

 

Paper 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 b .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. Conclusion: 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. (J Manipulative Physiol Ther 2015;38:382-394)

 

NIH Risk of Bias Tool

  1. Was the study question or objective clearly stated?
  • Yes
  1. Was the study population clearly and fully described, including a case definition?
  • Yes
  1. Were the cases consecutive?
  • Yes
  1. Were the subjects comparable?
  • Yes
  1. Was the intervention clearly described?
  • Yes
  1. Were the outcome measures clearly defined, valid, reliable, and implemented consistently across all study participants?
  • Yes
  1. Was the length of follow-up adequate?
  • Yes
  1. Were the statistical methods well-described?
  • Yes
  1. Were the results well-described?
  • Yes

 

Key Finding #1

Patients with shoulder pain secondary to second and third rib syndrome responded positively to thrust manipulation of the upper thoracic zygapophyseal joints.

Key Finding #2

Pain and disability index scores decreased 48 hours, 1 month, and 3 months after thrust manipulation in patients with shoulder pain secondary to second and third rib syndrome.

 

Please provide your summary of the paper

10 patients with shoulder pain secondary to first or second rib syndrome were treated with HVLA thrust manipulation to the upper thoracic zygapophyseal joints bilaterally and the costotransverse joints of the second and third rib on the symptomatic side. They returned 48 hours later and completed questionnaires and received the treatment again. SPADI, NPRS, and GROC were all used to measure the effect of the intervention. On average, there pain and disability decreased after intervention at 48 hours, 4 days, 1 month, and 3 months post intervention.

Please provide your clinical interpretation of this paper.  Include how this study may impact clinical practice and how the results can be implemented.

This paper indicates that thrust manipulation of the thoracic spine and costotransverse joints may be effective in treating pain and disability related to second or third rib syndrome. However, this study did have some limitations that are worth noting in clinical practice. First, the sample size was too small to make any causative conclusions. A randomized control trial would be effective in determining the true effect of this intervention. Second, follow up only lasted 3 months. A longer follow up time, such as 1 year, would be beneficial in determining long term benefits of this intervention, as well as giving appropriate time for any adverse effect. Third, this study does not take into effect any other treatments that are given in standard physical therapy practice and only examined HVLA thrust manipulation as a stand alone treatment, which decreases the external validity of the study as this is not how one would expect standard physical therapy to occur. However, despite various limitations, this study does show promise for thrust manipulation in treating shoulder pain secondary to second or third rib syndrome.