Physiotherapists commonly treat upper limb pain and disability, with about 70% of the population reporting pain in the upper quadrant at some point in their lives [Citation1,Citation2]. In this special issue, we present a series of articles related to interventions used to treat patients with upper extremity disorders and an article on examination of scapular dyskinesis.
Upper extremity functional impairments can have many causes and contributing factors, thus resulting in diversity among intervention approaches. In some cases, the spine may be a contributing factor to extremity pain or impairment [Citation3]; therefore, the spine becomes a target of intervention. In other cases, an approach directed specifically to the symptomatic region may be most appropriate. Clinical guidelines exist for some diagnoses and can be considered in intervention planning [Citation4,Citation5], while it has also been proposed that individual patient clinical presentation is the best strategy to guide intervention [Citation6].
Articles featured in this special issue present a variety of approaches to patient management that include manual therapy directed toward the spine for patients with upper extremity disorders, directed toward the shoulder for shoulder pain and directed toward the wrist and lymphatic system following distal radius fracture, neurodynamic intervention, and examination of scapular motor control [Citation7–11]. The issue contains three systematic reviews with meta-analyses, a narrative review, and a reliability study.
The first article in this special issue is a systematic review with meta-analysis investigating the effectiveness of manual physical therapy for the treatment of upper extremity musculoskeletal disorders. Specifically, authors evaluated the effects of cervicothoracic and thoracic spine thrust or non-thrust manipulation [Citation11]. These authors included 14 articles and concluded that cervicothoracic and thoracic manual therapy as a component of management for upper extremity pain conditions has limited evidence for reducing pain or improving function. Although there is some support for short-term effectiveness, there is little evidence for long-term effectiveness when compared to control/sham or other treatments.
The authors of the second systematic review with meta-analysis specifically investigated the effects of mobilization with movement (MWM) in patients with shoulder pain conditions [Citation10]. This review provides the most updated data on the effects of MWM and includes 21 clinical trials. The results show that the addition of MWM is effective for improving pain, range of motion, and related disability in individuals with frozen shoulder, shoulder pain, and movement dysfunction; however, the heterogeneity of the included studies should lead readers to use caution with interpretation of this conclusion.
The third and last systematic review with meta-analysis of this special issue covered the effects of manual therapy in patients with post-traumatic distal radius fracture [Citation8]. This review included eight trials and reported that adding MWM and manual lymphatic drainage showed positive effects on wrist range of motion and upper limb function; however, again the evidence was low. Results differed based on type of manual therapy. Authors concluded that there was a need for high-quality randomized clinical trials to determine the best approach.
Clinicians can conclude from the systematic reviews and meta-analyses in this special issue that the inclusion of manual therapy for the management of upper extremity conditions is still limited, but it seems that the inclusion of these interventions is more effective, at least at short- and mid-term than their non-inclusion.
The fourth article is a narrative review providing the most updated evidence-informed data on the effects of optimal tensile loading on peripheral nerve tissues and the use of tensioning (neurodynamics) interventions [Citation7]. This paper reviews in vivo, in vitro, animal and human evidence supporting the need for obtaining a tensile loading force on nerve tissue in order to obtain clinical effects on healthy or pathologic nerve tissue. Authors claimed that proper tensile loading force applied to the nerve tissue could be responsible for the positive effects observed in clinical practice [Citation12,Citation13].
The final study of this special issue is an original paper investigating the reliability of identifying scapular dyskinesis by video training [Citation8]. The results showed that using video training for identifying scapular motor control is an effective approach that permits proper identification. This is an interesting topic since the COVID-19 situation has increased the necessity of remote assessment and tele-rehabilitation by physical therapists.
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References
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- Guerrero-Henriquez J, Oyarce-Mella M, Reyes Rocabado J, et al. Inter-rater reliability of scapular dyskinesis classification in overhead athletes by entry-level physical therapy students [published online ahead of print, 2021 Aug 30]. J Man Manip Ther 2021 1–5. doi:https://doi.org/10.1080/10669817.2021.1972653
- Gutiérrez-Espinoza H, Araya-Quintanilla F, Olguín-Huerta C, et al. Effectiveness of manual therapy in patients with distal radius fracture: a systematic review and meta-analysis [published online ahead of print, 2021 Oct 20]. J Man Manip Ther. 2021;1–13. DOI:https://doi.org/10.1080/10669817.2021.1992090
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