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2019 Literature Review part 2: shoulder, wrist, and hand pain

We distribute newsletters every week to educate you—our patients—on some of the most common injuries and conditions that we treat, and to explain why we always recommend seeing a physical therapist first when dealing with any type of pain. In working towards this goal, we also regularly summarize research studies that show how physical therapy typically leads to the best possible outcomes, and how it helps patients avoid surgery and other costly or unnecessary treatments in the process.

With the end of the year approaching, we’d like to look back at some of our favorite study summaries of 2019 in a four—part newsletter series with each one focusing on a different topic or region of the body. In part 2, we review research on physical therapy for wrist pain, hand pain, and shoulder pain.

Wrist and hand pain

Pain in the wrist or hands can result from a number of different causes. Some conditions (like carpal tunnel syndrome) develop from performing the same movements over and over, while others (like rheumatoid arthritis) are based on a more complex process that is largely uncontrollable. Injuries like wrist sprains and broken fingers are also fairly common, especially in athletes and active individuals.

Is manual therapy based on neurodynamic techniques effective in the treatment of carpal tunnel syndrome? A randomized controlled trial (2019)

  • Background: carpal tunnel syndrome (CTS) is a common condition caused by a pinched nerve in the wrist, which usually leads to numbness, tingling and weakness in their affected hand; it can be treated either surgically or non—surgically with interventions like physical and manual (hands—on) therapy
  • How the study was conducted: 103 patients with mild or moderate CTS underwent either a manual therapy program or no treatment (control group) for 10 weeks
  • What the results showed: the manual therapy group experienced significantly greater improvements than the control group in several outcomes, with lower pain scores, reduced symptoms, and better functional status
  • Take—home message: patients with CTS should seek out care from a physical therapist first to receive manual therapy, as it may lead to notable improvements and help them avoid surgery

Hand exercises for patients with rheumatoid arthritis: an extended follow—up of the SARAH randomised controlled trial (2017)

  • Background: rheumatoid arthritis (RA) is a debilitating long—term disease that often leads to pain, fatigue, and less mobility, especially in the hands; physical therapy with stretching and strengthening exercises is often suggested as an effective intervention for these patients
  • How the study was conducted: a follow—up analysis was performed on an original study of 490 RA patients that received either a personalized exercise program—consisting of strengthening and stretching exercises—or no treatment (control); the original study identified improvements from this program, and the follow—up was intended to see if these improvements lasted in the long term
  • What the results showed: even though patients gradually performed fewer exercises (which they were instructed to complete regularly), they still showed better hand function scores compared to the control group for up to two years
  • Take—home message: a strengthening and stretching exercise program can lead to long—term improvements in RA, so patients with this condition are advised to visit a physical therapist to begin treatment

Shoulder pain

The shoulder is a complex ball—and—socket made up of two joints. It is extremely mobile and allows the arm to rotate almost 360°, but this comes at a cost, as it’s also one of the most commonly injured areas of the body. Up to 26% of the general population is dealing with shoulder pain at any given point in time, with a higher concentration in those who regularly perform overhead movements (like painters, baseball players, and tennis players). Shoulder pain can come about immediately or develop gradually, with certain conditions being more likely to arise in older age.


  • Background: the rotator cuff is a group of muscles and tendons in the shoulder that allows arm motion, and it’s often injured or torn in overhead sports like baseball; it’s not completely clear if surgery or non—surgical treatments like physical therapy and exercise are better for complete—or full—thickness—tears
  • How the study was conducted: a systematic review was performed, which collects and analyzes all related research on a single topic; 35 studies—including nine high—quality studies called randomized—controlled trials (RCTs)—were included in this review, all of which evaluated the effectiveness of exercise for treating full—thickness rotator cuff tears
  • Results: all of the RCTs showed that exercise was effective, as it led to an 86% reduction in pain, an 83% improvement in range of motion, an 89% improvement in strength, and an 85% improvement in function
  • Take—home message: patients with rotator cuff tears should attempt a course of physical therapy first before considering the option of surgery, as an exercise—based intervention can lead to various improvements

In our next newsletter, we review our top summaries on studies that cover knee pain, ankle pain, and foot pain.

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