title: Manipulative therapy for shoulder pain and disorders: expansion of a systematic review.
abstract: OBJECTIVE
  The purpose of this study was to conduct a systematic review on manual and manipulative therapy (MMT) for common shoulder pain and disorders.
  
  
  METHODS
  A search of the literature was conducted using the Cumulative Index of Nursing Allied Health Literature; PubMed; Manual, Alternative, and Natural Therapy Index System; Physiotherapy Evidence Database; and Index to Chiropractic Literature dating from January 1983 to July 7, 2010. Search limits included the English language and human studies along with MeSH terms such as manipulation, chiropractic, osteopathic, orthopedic, musculoskeletal, physical therapies, shoulder, etc. Inclusion criteria required a shoulder peripheral diagnosis and MMT with/without multimodal therapy. Exclusion criteria included pain referred from spinal sites without a peripheral shoulder diagnosis. Articles were assessed primarily using the Physiotherapy Evidence Database scale in conjunction with modified guidelines and systems. After synthesis and considered judgment scoring were complete, with subsequent participant review and agreement, evidence grades of A, B, C, and I were applied.
  
  
  RESULTS
  A total of 211 citations were retrieved, and 35 articles were deemed useful. There is fair evidence (B) for the treatment of a variety of common rotator cuff disorders, shoulder disorders, adhesive capsulitis, and soft tissue disorders using MMT to the shoulder, shoulder girdle, and/or the full kinetic chain (FKC) combined with or without exercise and/or multimodal therapy. There is limited (C) and insufficient (I) evidence for MMT treatment of minor neurogenic shoulder pain and shoulder osteoarthritis, respectively.
  
  
  CONCLUSIONS
  This study found a level of B or fair evidence for MMT of the shoulder, shoulder girdle, and/or the FKC combined with multimodal or exercise therapy for rotator cuff injuries/disorders, disease, or dysfunction. There is a fair or B level of evidence for MMT of the shoulder/shoulder girdle and FKC combined with a multimodal treatment approach for shoulder complaints, dysfunction, disorders, and/or pain.
authors.affiliation: Department of Research, Cleveland Chiropractic College, Los Angeles, CA, USA. James.brantingham@cleveland.edu
authors.forename: James W
authors.initials: JW
authors.lastname: Brantingham
authors.forename: Tammy Kay
authors.initials: TK
authors.lastname: Cassa
authors.forename: Debra
authors.initials: D
authors.lastname: Bonnefin
authors.forename: Muffit
authors.initials: M
authors.lastname: Jensen
authors.forename: Gary
authors.initials: G
authors.lastname: Globe
authors.forename: Marian
authors.initials: M
authors.lastname: Hicks
authors.forename: Charmaine
authors.initials: C
authors.lastname: Korporaal
mesh_terms: D002062:Bursitis / Q000628:therapy; D018849:Controlled Clinical Trials as Topic; D006801:Humans; D007592:Joint Diseases / Q000628:therapy*; D026201:Musculoskeletal Manipulations; D010003:Osteoarthritis / Q000628:therapy; D017410:Practice Guidelines as Topic; D016032:Randomized Controlled Trials as Topic; D000070636:Rotator Cuff Injuries; D012782:Shoulder; D020069:Shoulder Pain / Q000628:therapy*