No abstract

BACKGROUND: Median nerve neurodynamic testing is described in the literature with the scapula blocked and depressed and there are numerous descriptions of structural differentiation performed during testing. A better understanding of how these variables impact median nerve neurodynamic testing is warranted. PURPOSE: To compare the Upper Limb Tension Test A (ULTT A) with the scapula blocked and depressed to determine: the reliability of ULTT A with the scapula blocked and depressed; if there is a statistically significant difference between the left and right arms; and if there is a statistically significant difference for ULTT A with the scapula blocked or depressed. METHODS: This was a intertester and test-retest reliability and accuracy study. Elbow extension was measured with a standard goniometer. Sensory responses were captured with the Numeric Pain Rating Scale (NPRS). Subjects were randomly tested by Rater, side, and by test condition. RESULTS: The NPRS and end range elbow extension had moderate to good intertester reliability. There were poor to moderate findings for reliability of structural differentiation. There was no statistically significant difference ( p > 0.05) between the left and right arms except for structural differentiation. There was a statistically significant difference between the scapula blocked vs scapula depressed test conditions except for the NPRS on the left arm ( p = 0.08). CONCLUSIONS: ULTT A under the depressed scapula test condition is less reliable and more variable than the blocked scapula condition in the normal healthy population. Structural differentiation may not be a reliable or valid aspect of ULTT A.

No abstract

Background 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. Objectives 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. Methods 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. Results There were no significant between-group differences in immediate or short-term follow-up outcomes. Conclusion 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. Level of Evidence Therapy, level 1. J Orthop Sports Phys Ther 2019;49(10):716–724. Epub 12 Mar 2019. doi:10.2519/jospt.2019.8484

No abstract