Study of the Effect of Neck Treatment on Shoulder Impingement

Inclusion Criteria: 1. the complaint of pain in either the anterior, lateral, or posterior aspect of the upper arm in an area extending from the acromion to the deltoid tubercle or to a point equally distal on the humerus. 2. production or increase in pain in any of the area(s) above with one of the following: 1. active shoulder flexion or scaption (elevation in the scapular plane) 2. impingement sign as described by Neer (1983) 3. Hawkins-Kennedy impingement test (1980) 4. resisted supraspinatus, shoulder internal or external strength testing 3. patient is between 40 and 70 years of age Exclusion Criteria: 1. Any previous history of surgery or fracture in the cervical spine, upper thoracic spine, humerus, scapula, or clavicle 2. Any previous or current history of psychiatric or psychological treatment 3. Any medical condition that predisposes patients to shoulder pain such as past or current history of diabetes mellitus, fibromyalgia, adhesive capsulitis, rheumatoid arthritis, shoulder osteoarthritis, osteoporosis, ankylosing spondylitis, vertebrobasilar artery insufficiency, pregnancy, or shoulder instability 4. Any prolonged exposure to blood thinners or steroids 5. Constant lateral humeral pain that does not alter with movement, time of day, or position for the last 60 days 6. Subjects with an active worker's compensation claim related to the cervical spine, shoulder, or upper thoracic spine, or subjects with any impending or current litigation related to the same areas 7. A score of 11 or higher in the sensory plus affective dimensions of pain with the short-form of the McGill Pain Questionnaire 8. Any injections in the shoulder, cervical spine or upper thoracic spines in the last 6 months 9. Pain in the posterior shoulder, mid- and lower cervical spine, or upper thoracic spine that the patient wants treated 10. Onset of symptoms associated with trauma or trauma to the neck/shoulder area in the last 60 days