Thoughts of Death or Self-injury, Non-same-day ART Initiation, and 2-year Incidence of Disengagement from Care Among People Entering HIV Care in Cameroon.

Shoulder pain is prevalent across all ages and activity levels, with Subacromial Impingement Syndrome (SIS) being the most common cause. SIS is a common musculoskeletal disorder involving abnormalities of subacromial bursa and coracoacromial ligament, along with repeated impingement or abrasion of the rotator cuff or long head of the biceps beneath the anterior acromion [–]. Several studies in the literature support the association between SIS and cervical dysfunction and emphasize that the cervical and thoracic regions should not be overlooked during shoulder rehabilitation [, ]. The interaction between cervical dysfunction and subacromial impingement syndrome (SIS) is a bidirectional process occurring through both neurological and biomechanical pathways. Recent evidence further supports this relationship, demonstrating a significant association between shoulder dysfunction and concomitant neck disability, as well as a notable incidence of impingement syndrome in patients with cervical radiculopathy [, ]. However, findings remain inconsistent: while some report beneficial effects of cervicothoracic manual therapy others find no significant outcomes [–]. Therefore, the effectiveness of cervicothoracic manual therapy techniques in conjunction with exercise remains inconclusive. Previous studies investigating cervicothoracic manual therapy in patients with SIS have primarily reported short-term improvements in pain intensity, ROM, and functional outcomes; however, substantial heterogeneity exists in intervention protocols, targeted spinal regions, and outcome measures [–]. This heterogeneity limits the generalizability of existing findings. Moreover, only a limited number of studies have explored underlying sensory mechanisms, leaving a clear knowledge gap regarding the effects of cervical mobilization on sensory processing in SIS. From a mechanistic perspective, cervical mobilization may influence shoulder-related sensory and clinical outcomes through modulation of central pain processing mechanisms []. In individuals with chronic shoulder pain due to SIS, evidence of secondary hyperalgesia suggests the presence of central sensitization, characterized by an amplification of nociceptive signalling within the central nervous system [–]. Central sensitization is associated with lowered pain thresholds, enhanced responsiveness to both noxious and non-noxious stimuli, and pain hypersensitivity that extends beyond the site of tissue injury []. Altered afferent input from cervical spinal segments, which share convergent neural pathways with the shoulder region, may contribute to increased central excitability and persistent pain experiences. Cervical mobilization has been proposed to modulate spinal and supraspinal pain processing, potentially reducing central hypersensitivity and leading to improvements in sensory disturbances and pain perception at remote regions such as the shoulder. This supports a predominantly neurophysiological mechanism underlying the effects of cervical mobilization rather than a purely biomechanical explanation [–].