Rotator Cuff

There is moderate evidence for MMT of the shoulder, shoulder girdle when used in conjunction with a multimodal approach including exercise therapy for rotator cuff injuries/disorders, disease, or dysfunction. Therapeutic exercise is a particularly effective intervention for the treatment of painful shoulder conditions; however, the evidence for chiropractic management of shoulder pain is limited overall to evidence in the form of case reports, case series and small controlled trials. A trend was found favoring manual therapy for decreasing pain, but the effect on function and quality of life remains inconclusive. There is a need for more well-designed, trials investigating multi-modal chiropractic management for shoulder pain and dysfunction.

ESSENTIAL LITERATURE

REHABILITATION OF THE THROWING ATHLETE
Wilk KE et. al. 2015 
Conclusion:
The overhead athlete displays unique ROM, postural, strength, and joint laxity characteristics that occur as a result of physical adaptation to the imposed stresses and demands of repetitive throwing. As a result, there are distant pathologies in this patient population described in this article. The success of the rehabilitation program depends on an accurate recognition of the underlying cause of the pathology. An effective rehabilitation program focuses on re-establishing full ROM, dynamic rotator cuff stability, and implementing a progressive resistance exercise program to fully restore strength and local muscle endurance of the rotator cuff and scapular musculature. This program evolves to include sport-specific drills and functional activities to allow a return to sport and activity.

EFFECTIVENESS OF THE ECCENTRIC EXERCISE THERAPY IN PHYSICALLY ACTIVE ADULTS WITH SYMPTOMATIC SHOULDER IMPINGEMENT OR LATERAL EPICONDYLAR TENDINOPATHY: A SYSTEMATIC REVIEW
 Ortego-Castillo et. al. 2015 
Conclusion:
Eccentric exercise may reduce pain and improve strength in upper limb tendinopathies, but whether its effectiveness is much better than other forms of treatment remains questionable. Further investigations are needed, not only focused on shoulder impingement or epicondylar tendinopathy, but on tendinopathies in other areas of the upper limb.

CLINICAL EFFECTIVENESS OF MANUAL THERAPY FOR MANAGEMENT OF MUSCULOSKELETAL CONDITIONS
 Christine Clar et. al. 2014 
Conclusion:
The evidence suggests there are similar improvements in the manipulation and/or mobilisation intervention groups compared to active treatment, however, some trials also found no improvement in comparison to a control group

MANIPULATIVE THERAPY FOR SHOULDER PAIN AND DISORDERS: EXPANSION OF A SYSTEMATIC REVIEW
Brantingham et. al. 2011 
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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.

THE EFFECTIVENESS OF THERAPEUTIC EXERCISE FOR PAINFUL SHOULDER CONDITIONS: A META-ANALYSIS
Marinko et. al. 2011 
Conclusion:
Therapeutic exercise is an effective intervention for the treatment of painful shoulder conditions; however, subsequent research is necessary for translation into clinical practice.

A SYSTEMATIC REVIEW OF MANIPULATIVE THERAPY FOR THE TREATMENT OF SHOULDER PAIN
Pribicervic et. al. 2010 
Conclusion:
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.

EFFICACY OF STANDARDISED MANUAL THERAPY AND HOME EXERCISE PROGRAMME FOR CHRONIC ROTATOR CUFF DISEASE
Bennell et. al. 2010 
Conclusion:
A standardized program of manual therapy and home exercise did not confer additional immediate benefits for pain and function compared with a realistic placebo treatment that controlled for therapists’ contact in middle aged to older adults with chronic rotator cuff disease. However, greater improvements were apparent at follow-up, particularly in shoulder function and strength, suggesting that benefits with active treatment take longer to manifest.

EFFECTIVENESS OF MANUAL PHYSICAL THERAPY FOR PAINFUL SHOULDER CONDITIONS: A SYSTEMATIC REVIEW
Camarinos et. al. 2009 
Conclusion:
Seventeen related articles were found with seven fitting the inclusion criteria. The average PEDro score was 7.86, meeting the cutoff score for high quality. Significant heterogeneity in outcome measures prohibited meta-analysis. Five studies demonstrated benefits utilizing manual therapy for mobility, and four demonstrated a trend towards decreasing pain values. Functional outcomes and quality-of-life measures varied greatly among all studies. Manual therapy appears to increase either active or passive mobility of the shoulder. A trend was found favoring manual therapy for decreasing pain, but the effect on function and quality of life remains inconclusive. Future research utilizing consistent outcome measurements is necessary.

COMPARISON OF PHYSIOTHERAPY, MANIPULATION, AND CORTICOSTEROID INJECTION FOR TREATING SHOULDER COMPLAINTS IN GENERAL PRACTICE
Winters et. al. 1997 
Conclusion:
For treating shoulder girdle disorders, manipulation seems to be the preferred treatment. For the synovial disorders, corticosteroid injection seems the best treatment.