Author Names

Rick Heiser, Virginia H. O’Brien, and Deborah A. Schwartz

Reviewer Name

Adrienne Maniktala, LAT, ATC, SPT

Reviewer Affiliation(s)

Duke University School of Medicine, Doctor of Physical Therapy Division

 

Paper Abstract

Study design: Systematic review. Introduction: Joint mobilizations are used as an intervention for improving range of motion (ROM), decreasing pain and ultimately improving function in patients with a wide variety of upper extremity diagnoses. However, there are only a limited number of studies describing this treatment for conditions affecting the elbow, wrist, and hand. Furthermore, it is unclear as to the most effective joint mobilization technique utilized and the most beneficial functional outcomes gained. Purpose: Examine the current evidence describing joint mobilizations for treatment of conditions of the elbow, wrist and hand, and offer informative practical clinical guidance. Methods: Twenty-two studies dated between 1980 and 2011 were included in the systematic review for analysis. Results: The current evidence provides moderate support for the inclusion of joint mobilizations in the treatment of lateral epicondylalgia (LE). In particular, mobilization with movement (MWM) as described by Mulligan is supported with evidence from nine randomized clinical trials as an effective technique for the treatment of pain. Other described techniques include those known as Kaltenborn, Cyriax physical therapy, and Maitland, but the evidence for these techniques is limited. There is also limited evidence for the joint mobilizations in the treatment of wrist and hand conditions. Conclusions: The current literature offers limited support for joint mobilizations of the wrist and hand, and moderate support for joint mobilizations of the elbow for LE. There is moderate support for mobilization with movement.

 

NIH Risk of Bias Tool

Quality Assessment of Systematic Reviews and Meta-Analyses

  1. Is the review based on a focused question that is adequately formulated and described?
  • Yes
  1. Were eligibility criteria for included and excluded studies predefined and specified?
  • Yes
  1. Did the literature search strategy use a comprehensive, systematic approach?
  • Yes
  1. Were titles, abstracts, and full-text articles dually and independently reviewed for inclusion and exclusion to minimize bias?
  • Yes
  1. Was the quality of each included study rated independently by two or more reviewers using a standard method to appraise its internal validity?
  1. Were the included studies listed along with important characteristics and results of each study?
  • Yes
  1. Was publication bias assessed?
  • Cannot Determine, Not Reported, Not Applicable
  1. Was heterogeneity assessed? (This question applies only to meta-analyses.)
  • Cannot Determine, Not Reported, Not Applicable

 

Key Finding #1

For patients with lateral epicondylalgia there is moderate evidence for the following: MWM will decrease pain and improve strength, elbow joint mobilizations will improve ROM, that mobilization is just as beneficial as injections long-term, and that mobilizations have a positive impact on short and long-term function.

Key Finding #2

In distal radius fractures, moderate evidence demonstrates MWM has been shown for pain relief and Maitland has been beneficial for ROM change.

Key Finding #3

There is limited evidence for carpal tunnel syndrome, limited ROM in MCP and 1st CMC OA that mobilizations improve ROM or decrease pain.

 

Please provide your summary of the paper

The authors of this study compiled 22 pieces of literature on joint mobilizations for the distal upper extremities. The authors note that there is still limited evidence on these areas and state that further research is needed on the short and long-term effects of mobilizations in this part of the body. They were able to find research on elbow mobilizations, wrist mobilizations and hand mobilizations. Although the studies suggest joint mobilization of the upper extremity can have improvement with range of motion and strength, they were all completed along with exercise indicating that manual therapy on its own is not as beneficial. The strongest evidence in this systematic review was found in the elbow and wrist joint mobilizations, indicating that there is positive improvement in pain, strength, and range of motion in short term assessments. Only the studies looking at elbow joint mobilizations were able to find evidence of long-term function assessment.

Please provide your clinical interpretation of this paper.  Include how this study may impact clinical practice and how the results can be implemented.

The information in this study can be correlated to clinical practice because the research in this article can help clinicians determine the best course of treatment for their patients with distal upper extremity injuries. This article also can help clinical practice by encouraging clinicians to develop their practical skills in areas where it may not be used as commonly.