# Cervical Spine Screening Based on Movement Strategies Improves Shoulder Physical Variables in Neck-Related Shoulder Pain Patients: A Secondary Analysis from an Observational Study

## TL;DR

Screening the cervical spine can improve shoulder movement in patients with neck-related shoulder pain, but it does not affect strength or self-reported function.

## Contribution

This study shows that cervical spine screening improves shoulder range of motion in patients with cervical contributions to shoulder pain.

## Key findings

- CSS improved shoulder flexion and abduction range of motion with medium effect sizes.
- CSS also improved internal and external rotation with small effect sizes.
- Self-reported shoulder function declined in patients without cervical contribution after CSS.

## Abstract

Background: It is important to consider the cervical spine as a potential contributor to shoulder pain, indicating the paramount importance of screening the cervical spine in patients with shoulder pain. Objectives: To study the immediate effects of cervical spine screening (CSS) on the shoulder active range of motion, isometric strength and self-reported function in patients with neck-related shoulder pain. Methods: A secondary analysis was conducted on data from a previous study. A cervical contribution was considered if a ≥30% shoulder symptom modification of pain intensity (Numeric Pain Rating Scales) was recorded during the most painful shoulder movement after CSS. Pre–post measurements of the shoulder active range of motion (inclinometer) and shoulder isometric strength (dynamometer) were recorded in a single session. Self-reported shoulder function (Shoulder Pain and Disability Index) was assessed at a 1-week follow-up. Results: Among 60 participants, statistically significant changes were found for those with a cervical contribution (n = 30) for shoulder flexion and the abduction range of motion (p < 0.001), with a medium size effect (r = 0.55), and in internal rotation (p = 0.02) and external rotation at 0° abduction (p = 0.008), with a small size effect (r = 0.3 and 0.34, respectively). The self-reported shoulder function in those without a cervical contribution significantly declined from the pre to post measurements (p = 0.002), with a small size effect (r = 0.4). No statistically significant changes were found for the isometric strength in either group. Conclusions: In patients with shoulder pain classified as having a cervical contribution, CSS produces intrasession improvements in the active shoulder range of motion but not in the shoulder isometric strength or self-reported shoulder function.