Osteolysis of the Distal Clavicle: Serial Improvement and Normalization of Acromioclavicular Joint Space with Conservative Care

A systematic review of manipulative therapy for the treatment of shoulder pain

OBJECTIVE

The purpose of this systematic review is to discuss the evidence for manipulative methods of management of shoulder pain and chiropractic management techniques used within the literature.

METHODS

A literature search of MEDLINE, CINAHL, MANTIS, the Cochrane Musculoskeletal Group trials register and the Cochrane Controlled Trials Register was conducted. Search terms included chiropractic or manipulative therapy and shoulder pain, impingement, rotator cuff, shoulder instability, shoulder joint, treatment or rehabilitation exercises. Publications were included if they contained shoulder pain or contained a specific clinical diagnosis of a shoulder pain syndrome in the title; a detailed description of the treatment intervention which was typical of the profession; treatment performed by a registered practitioner and outcome measures were included in the studies. Exclusion criteria included the diagnosis of adhesive capsultis or referred/pathological pain. The articles were reviewed and clinical trials ranked on the Physiotherapy Evidence Database scale.

RESULTS

From a total of 913 retrieved publications, 22 case reports, 4 case series and 4 randomized, controlled trials met the inclusion and exclusion criteria for this review.

CONCLUSIONS

The literature contains 2 articles of reasonably sound methodology. The evidence for chiropractic management of shoulder pain is limited to low level evidence in the form of case reports and case series and 1 small controlled trial. There is a need for more well-designed, trials investigating multi-modal chiropractic management for shoulder pain.

Chiropractic treatment of upper extremity conditions: a systematic review

OBJECTIVE

This study investigates the scope, type, and quality of chiropractic research conducted on the management of upper limb peripheral conditions.

METHOD

A literature search regarding upper limb and chiropractic treatment was performed on CINAHL, MEDLINE, and MANTIS databases. Search terms included chiropractic, shoulder, elbow, wrist, hand, forearm, and arm, with MeSH terms for each region. For articles to be considered relevant, there had to be a peripheral diagnosis and chiropractic intervention. Papers were excluded if pain was referred from spinal sites. Duplicates, articles published in non-peer-reviewed literature, conference proceedings, grand rounds, and discussion papers where no treatment was actually rendered were also removed. The articles were then reviewed and assessed for quality using the Physiology Evidence Database (PEDro) scale.

RESULTS

There was a total of 64 articles found. There were 36 case reports for the shoulder, 8 case reports for the elbow, 14 case reports for the wrist/hand, and 6 clinical trials (3 shoulder, 1 elbow 2 wrist). For the PEDro score, 58 case reports scored 0, 1 clinical trial scored 7, 2 clinical trials scored 6, 2 clinical trials scored 4, and 1 clinical trial scored 0.

CONCLUSION

There is a small amount of chiropractic research into upper limb conditions that is comprised mostly of case studies (level 4 evidence) and a small number of higher-level publications (level 1-3 evidence). Most treatments are multimodal in nature, which address both spinal and peripheral structures, with joint and soft tissue methods. There is a need for future research to be directed at higher-level evidence, in particular, randomized controlled trials for the chiropractic treatment of upper limb conditions.