Chiropractic treatment of upper extremity conditions: A systematic review

Objective: This study investigates the scope, type, and quality of chiropractic research conducted on the management of upper limb peripheral conditions. Method: A literature search regarding upper limb and chiropractic treatment was performed on CINAHL, MEDLINE, and MANTIS databases. Search terms included chiropractic, shoulder, elbow, wrist, hand, forearm, and arm, with MeSH terms for each region. For articles to be considered relevant, there had to be a peripheral diagnosis and chiropractic intervention. Papers were excluded if pain was referred from spinal sites. Duplicates, articles published in non-peer-reviewed literature, conference proceedings, grand rounds, and discussion papers where no treatment was actually rendered were also removed. The articles were then reviewed and assessed for quality using the Physiology Evidence Database (PEDro) scale. Results: There was a total of 64 articles found. There were 36 case reports for the shoulder, 8 case reports for the elbow, 14 case reports for the wrist/hand, and 6 clinical trials (3 shoulder, 1 elbow 2 wrist). For the PEDro score, 58 case reports scored 0, 1 clinical trial scored 7, 2 clinical trials scored 6, 2 clinical trials scored 4, and 1 clinical trial scored 0. 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.