Evidence-Based Upper Extremity Thrust Manipulation

Evidence Summary Table

Author (Year)	Level of Evidence	Pathology	Upper Extremity Manipulation(s) Performed
Struijs et al. (2003)	1b	Lateral Epicondylitis	Wrist manipulated from neutral position to maximal extension
Nagrale et al. (2009)	1b	Lateral Epicondylitis	Mill's manipulation
Goyal et al. (2013)	1b	Lateral Epicondylitis	Wrist manipulation (Scaphoid)
Kearns et al. (2012)	4	Cubital Tunnel Syndrome	Lateral thrust manipulation of humeral ulnar joint Palmar thrust manipulation of triquetrum on hamate
Sucher BM (1994)	1b	Carpal Tunnel Syndrome	Opponens roll
Siu et al. (2012)	5	Carpal Tunnel Syndrome	Opponens roll Carpal bone HVLA Metacarophalangeal joint HVLA Carpometacarpal joint HVLA Posterior radial head HVLA

Lateral Epicondylitis

Struijs et al. (2003)

• Manipulation Performed

+ Wrist manipulated from neutral position to maximal extension

• Results
  

+ Following 3 weeks of treatment

- 62% of thrust manipulation patients reported being "much improved or "completely improved"

- Only 20% of the control group achieved these outcomes

Nagral et al. (2009)

• Treatment

+ Cyriax physiotherapy (deep tendon massage + Mill's manipulation) vs. Phonophoresis

• Results

+ Following 4 weeks of treatment

- 26% increase in function on the Tennis Elbow Function Scale

Carpal Tunnel Syndrome

Siu et al. (2012)

• Opponens roll maneuver—This maneuver involves lateral and axial rotation of the thumb, which creates substantial traction on the attachment of the opponens pollicis muscle. The muscle originates from the transverse carpal ligament and tubercle of the trapezium bone. This maneuver stretches the muscle and transverse carpal ligament, releasing pressure within the carpal tunnel and unloading pressure on the median nerve.
• The physician performs this technique by grasping the hypothenar region of the patient and then using his or her other hand to grasp the patient's thenar area. The physician gradually pulls the patient's thenar area laterally while simultaneously moving the thumb into extension to create traction. In addition, the abductor pollicis brevis is extended and abducted. A progressive phase of stretch further extends and abducts the opponens and abductor muscles.
• This technique is especially useful as patients can be educated on how to self-perform the opponens roll maneuver by using the contralateral hand to grasp and extend the thumb.
  

References

1. Struijs P, Damen PJ, Bakker E, Blankevoort L, Assendelft W, Dijk CN. Manipulation of the Wrist for Management of Lateral Epicondylitis: A Randomized Pilot Study. Phys Ther 2003; 83(7):608-616.

2. Nagrale AV, Herd CR, Ganvir S, Remteke G. Cyriax physiotherapy versus phonophoresis with supervised exercises in subjects with lateral epicondylagia: a randomized clinical trial. J Man Manip Ther. 2009; 17(3): 171-8.

3. Goyal M, Kumar A, Monga M, Moitra M. Effect of Wrist Manipulation & Cyriax Physiotherapy Training on Pain & Grip Strength in Lateral Epicondylitis Patients. J Ex Sci Physiother. 2003; 9(1): 17-22.

4. Kearns G, Sharon W. Medical diagnosis of cubital tunnel syndrome ameliorated with thrust manipulation of the elbow and carpals. J Man Manip Ther. 2012; 20(2): 90-95.

5. Sucher BM. Palpatory diagnosis and manipulative management of carpal tunnel syndrome. J Am Osteopath Assoc. 1994; 94(8): 647-63.

6. Siu G, Jaffe JD, Rafique M, Weinik MM. Osteopathic Manipulative Medicine for Carpal Tunnel Syndrome. J Am Osteopath Assoc. 2012; 112(3): 127-139.