Evidence supporting the use of physical modalities in the treatment of upper extremity musculoskeletal conditions.
OBJECTIVE
To evaluate recent trials and reviews of physical modalities and conservative treatments for selected upper extremity musculoskeletal conditions for evidence supporting their use.


RESULTS
Recent evidence suggests that many localized tendinopathies are related more to degenerative than inflammatory processes. With this realization, there is increased emphasis on finding new modalities to treat tendinopathies and other localized musculoskeletal conditions that rely on other than anti-inflammatory mechanisms. Although there is good evidence to support the short-term benefits of corticosteroid injections, convincing evidence in support of other conservative treatments and modalities is generally lacking. Extracorpal shock wave therapy may have significant clinical benefit for calcific tendinitis; however, it requires intravenous sedation in most cases and does not appear to be effective in lateral epicondylitis. The most consistent positive treatment effects for rotator cuff tendinitis were achieved by ultrasound-guided subacromial corticosteroid injection as well as manual therapy in conjunction with therapeutic exercise.


CONCLUSIONS
Although there is evidence supporting the use of several different physical modalities and conservative treatments for upper extremity musculoskeletal conditions, there is a strong need for larger, higher quality randomized controlled trials. Although most studies are able to demonstrate short-term benefits, there is a lack of high-quality data demonstrating that these conservative treatments have long-term benefits, particularly, with regard to functional outcomes.
Valen
Peter A
PA
Section on Rheumatology and Immunology, Wake Forest University School of Medicine, Winston Salem, North Carolina 27157, USA. pvalen@wfubmc.edu
Foxworth
Judy
J
D000305:Adrenal Cortex Hormones / Q000627:therapeutic use; D002349:Carpal Tunnel Syndrome / Q000628:therapy*; D006801:Humans; D007270:Injections, Intra-Articular; D026741:Physical Therapy Modalities; D016032:Randomized Controlled Trials as Topic; D052256:Tendinopathy / Q000628:therapy*; D013716:Tennis Elbow / Q000628:therapy*; D016896:Treatment Outcome
D000305:Adrenal Cortex Hormones