Upper Extremity

Manual therapy is a non-surgical type of conservative management that includes different skilled hands/fingers-on techniques directed to the patient’s body (spine and extremities) for the purpose of assessing, diagnosing, and treating a variety of symptoms and conditions. Manual therapy constitutes a wide variety of different techniques which may be categorised into four major groups: a) manipulation (thrust manipulation), b) mobilisation (non-thrust manipulation), c) static stretching, and d) muscle energy techniques. The definition and purpose of manual therapy varies across health care professionals.

ESSENTIAL LITERATURE

MULTIMODAL CARE FOR THE MANAGEMENT OF MUSCULOSKELETAL DISORDERS OF THE ELBOW, FOREARM, WRIST AND HAND: A SYSTEMATIC REVIEW
Sutton et. al. 2016 
Conclusion:
The current evidence on the effectiveness of multimodal care for musculoskeletal disorders of the elbow, forearm, wrist and hand is limited. The available evidence suggests that there may be a role for multimodal care in the management of patients with persistent lateral epicondylitis. Future research is needed to examine the effectiveness of multimodal care and guide clinical practice. 

EFFECTIVENESS OF WORKPLACE INTERVENTIONS IN THE PREVENTION OF UPPER EXTREMITY MUSCULOSKELETAL DISORDERS AND SYMPTOMS: AN UPDATE OF THE EVIDENCE
Van Eerd. et. al. 2015 
Conclusion:
There was strong evidence for one intervention category, resistance training, leading to the recommendation: Implementing a workplace-based resistance training exercise programme can help prevent and manage UEMSD and symptoms. The synthesis also revealed moderate evidence for stretching programmes, mouse use feedback and forearm supports in preventing UEMSD or symptoms. There was also moderate evidence for no benefit for EMG biofeedback, job stress management training, and office workstation adjustment for UEMSD and symptoms.

THE EFFECTIVENESS OF MANUAL THERAPY FOR THE MANAGEMENT OF MUSCULOSKELETAL DISORDERS OF THE UPPER AND LOWER EXTREMITIES: A SYSTEMATIC REVIEW
Southerst D. et. al. 2015 
Conclusion:
However, the very oversight of herbal products in online cialis pills uk stores boasting cure from testosterone deficiency. All these problems are regarded as detrimental to the cheap sildenafil health with lesser side effects. Followers of the manga will viagra super love this new Fullmetal Alchemist. Visiting an online pharmacy is one of the best Woman Care Palmetto clinics that are dedicated to provide you best possible treatment to patients. cheapest cialis http://amerikabulteni.com/2011/09/11/abd-ve-dunya-11-eylul-teror-saldirisinin-10%E2%80%99ncu-yilini-aniyor/ The current evidence on the effectiveness of manual therapy for MSDs of the upper and lower extremities is limited. The available evidence supports the use of manual therapy for non-specific shoulder pain and ankle sprains, but not for subacromial impingement syndrome in adults.

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:
Inconclusive (non-favourable) evidence was found for the treatment of lateral epicondylitis (tennis elbow) with manipulation alone (no change from the UK evidence report). The reviewed evidence indicated some benefits of manual therapy in reducing symptoms in patients with lateral epicondylitis, when in combination with other treatments (exercise, traditional physiotherapy, local management, standard therapy), when compared to no treatment, or baseline values (within-group change), however, the evidence was still rated inconclusive (favourable) evidence (no change from the UK evidence report). When comparing manual therapy to other treatments (e.g., placebo, phonophoresis, low-energy shockwave therapy, relative rest), there was inconclusive or inconsistent (favourable) evidence

MANIPULATIVE AND MULTIMODAL THERAPY FOR UPPER EXTREMITY AND TEMPOROMANDIBULAR DISORDERS: A SYSTEMATIC REVIEW
Brantingham et. al. 2013 
Conclusion:
Out of 764 citations reviewed, 129 studies were deemed possibly to probably useful and/or relevant to develop expert consensus. Out of 81 randomized controlled or clinical trials, 35 were included. Five controlled or clinical trials were located and 4 were included. Fifty case series, reports and/or single-group pre-test post-test prospective case series were located with 32 included. There is Fair (B) level of evidence for MMT to specific joints and the full kinetic chain combined generally with exercise and/or multimodal therapy for lateral epicondylopathy, carpal tunnel syndrome, and temporomandibular joint disorders, in the short term.

CHIROPRACTIC TREATMENT OF UPPER EXTREMITY CONDITIONS: A SYSTEMATIC REVIEW
McHardy et. al. 2008 
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.