Keele Research Repository

Background
Sub-acromial shoulder pain (SASP) is a common clinical presentation with much diagnostic uncertainty. Some of this uncertainty relates to the involvement of the cervical spine as a source or contribution to SASP. Currently, there is no accepted method of screening of the cervical spine in the presence of SASP, which risks patients receiving misguided and/or ineffective interventions.

Objective
To evaluate approaches used to screen the cervical spine in patients with SASP.

Design
Systematic review of randomized controlled trials (RCTs).

Methods
Electronic searches of PEDro and MEDLINE to December 2016 were conducted. RCTs evaluating the effectiveness of interventions within the current scope of physiotherapy comprising of adult patients complaining of SASP were included. Data relating to the method of cervical spine screening was extracted and synthesized categorically.

Results
102 studies were included. 26 (25.5%) were categorized as “No method of screening undertaken or reported”, 49 (48.0%) were categorized as “Localized cervical spine symptoms and/or radiculopathy/radicular pain”, 9 (8.8%) were categorized as “Cervical examination”, 2 (2.0%) were categorized as “Manual testing”, 2 (2.0%) were categorized as ‘History of cervical surgery”, and 14 (13.7%) were categorized as using “Combined approaches”

Conclusion
Examination of the cervical spine in patients with SASP is variable in RCTs. In many instances, no or minimal attempts to screen were made/reported. This has potential research and management implications and further research is indicated to facilitate development of this aspect of examination.