title: Manipulative therapy in addition to usual medical care for patients with shoulder dysfunction and pain: a randomized, controlled trial.
abstract: BACKGROUND
  Dysfunction of the cervicothoracic spine and the adjacent ribs (also called the shoulder girdle) is considered to predict occurrence and poor outcome of shoulder symptoms. It can be treated with manipulative therapy, but scientific evidence for the effectiveness of such therapy is lacking.
  
  
  OBJECTIVE
  To study the effectiveness of manipulative therapy for the shoulder girdle in addition to usual medical care for relief of shoulder pain and dysfunction.
  
  
  METHODS
  Randomized, controlled trial.
  
  
  METHODS
  General practices in Groningen, the Netherlands.
  
  
  METHODS
  150 patients with shoulder symptoms and dysfunction of the shoulder girdle.
  
  
  METHODS
  All patients received usual medical care from their general practitioners. Only the intervention group received additional manipulative therapy, up to 6 treatment sessions in a 12-week period.
  
  
  METHODS
  Patient-perceived recovery, severity of the main complaint, shoulder pain, shoulder disability, and general health. Data were collected during and at the end of the treatment period (at 6 and 12 weeks) and during the follow-up period (at 26 and 52 weeks).
  
  
  RESULTS
  During treatment (6 weeks), no significant differences were found between study groups. After completion of treatment (12 weeks), 43% of the intervention group and 21% of the control group reported full recovery. After 52 weeks, approximately the same difference in recovery rate (17 percentage points) was seen between groups. During the intervention and follow-up periods, a consistent between-group difference in severity of the main complaint, shoulder pain and disability, and general health favored additional manipulative therapy.
  
  
  CONCLUSIONS
  The sample size was small, and assessment of end points was subjective.
  
  
  CONCLUSIONS
  Manipulative therapy for the shoulder girdle in addition to usual medical care accelerates recovery of shoulder symptoms.
authors.affiliation: University of Groningen and University Hospital of Groningen, Groningen, The Netherlands. g.j.d.bergman@med.rug.nl
authors.forename: Gert J D
authors.initials: GJ
authors.lastname: Bergman
authors.forename: Jan C
authors.initials: JC
authors.lastname: Winters
authors.forename: Klaas H
authors.initials: KH
authors.lastname: Groenier
authors.forename: Jan J M
authors.initials: JJ
authors.lastname: Pool
authors.forename: Betty
authors.initials: B
authors.lastname: Meyboom-de Jong
authors.forename: Klaas
authors.initials: K
authors.lastname: Postema
authors.forename: Geert J M G
authors.initials: GJ
authors.lastname: van der Heijden
mesh_terms: D000305:Adrenal Cortex Hormones / Q000627:therapeutic use; D000328:Adult; D000368:Aged; D003131:Combined Modality Therapy; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D026201:Musculoskeletal Manipulations; D026741:Physical Therapy Modalities; D011446:Prospective Studies; D012782:Shoulder / Q000503:physiopathology; D020069:Shoulder Pain / Q000503:physiopathology / Q000628:therapy*; D016896:Treatment Outcome
chemical_list: D000305:Adrenal Cortex Hormones