Targeted Costotransverse Manipulation in Rotator Cuff Related Shoulder Pain: A Randomized Controlled Trial

Abstract

Background: Shoulder pain is a common musculoskeletal disorder typically associated with rotator cuff and can result in chronic pain, disability and limitation of shoulder movements. Central to conservative management is therapeutic exercise and an adjunct is often taken in the form of thoracic manual therapy. The extra advantage of the localized effect on the costotransverse joints is however, not clear. This research compared effect of costotransverse joint manipulation, when combined with thoracic spine manipulation and exercise on patients with rotator cuff-related shoulder pain and cervicothoracic dysfunction.

Methods: The trial was a parallel-group randomized controlled trial that was run in the physiotherapy units of the Jinnah Hospital Lahore, Services Hospital Lahore, and Shalamar Hospital Lahore in Pakistan. Convenience sampling was employed to select the participants who had should achy pain associated with the rotator cuff and cervicothoracic impairment, and assigned to an experimental or control group in a random manner. The experimental group was manipulated as far as the manipulation on costotransverse joints was used along with the manipulation of the thoracic spine and therapeutic exercise; the control group was manipulated with thoracic spine and the same exercise without the manipulation of the costotransverse joints. Measures were pain intensity (NNPRS) by measuring the pain, shoulder disability (SPADI) by evaluating the shoulder pain and disability index, shoulder range of motion, cervicothoracic mobility, posture alignment, and Global Rating of Change (GROC). Appropriate between- and within-group statistical tests were applied to analyze the data, reporting mean between and within group differences, 95% confidence interval, p-values, and the effect sizes.

Results: The experimental group showed more improvements than the control group in the intensity of pains, the disability of the shoulder, the shoulder range of motion, the cervicothoracic mobility range, the postural alignment, and the perceived recovery around the world. Post-treatment NPRS was 2.41 ± 0.91 in the experimental group compared with 3.47 ± 1.04 in the control group (p < 0.001). SPADI scores were also significantly lower in the experimental group (28.6 ± 7.9 vs. 38.7 ± 8.6; p < 0.001). There were greater between group differences in shoulder flexion, abduction, internal and external rotation, cervical and thoracic mobility (p < 0.05). The experimental group also demonstrated a greater GROC score (5.63 ± 1.14 vs. 4.31 ± 1.27; p < 0.001). There were moderate to large effect sizes on the major outcomes.

Conclusion: Adding costotransverse joint manipulation to thoracic spine manipulation and therapeutic exercise may provide additional benefits in reducing pain and disability and improving shoulder and cervicothoracic function in patients with rotator cuff–related shoulder pain and cervicothoracic dysfunction. Costotransverse manipulation can thus be viewed as used as a supplement to exercise-based rehabilitation in the right patients.