Dysfunction of the cervicothoracic spine and the adjacent ribs (ie, the shoulder girdle) is considered to be a predictor of the occurrence and poor outcome of shoulder symptoms. Shoulder disorders can be treated with various manual techniques, but there is a lack of scientific evidence to support the efficacy of such manipulation. 

A randomized, controlled trial was conducted at family medicine practices in Groningen, The Netherlands. Patients with shoulder symptoms and dysfunction of the shoulder girdle (N=150) were randomized into two study groups: those who received only traditional medical care (n=71) and those who received traditional medical care in addition to as many as six sessions of manual treatment (in a 12-week period) from physical therapists (n=79). 

The manual treatment provided to patients consisted of various techniques described by Cyriax, Greenman, and Lewit: manipulations (low-amplitude, high-velocity thrust) and mobilizations (high-amplitude, low-velocity thrust). 

After treatment for 6 weeks, no significant difference was observed between study groups. Following completion of treatment at 12 weeks, significantly more patients in the manipulation group (34 [43%]) than in the control group (15 [21%]) reported full recovery. 

At the 52-week follow-up, the two study groups continued to differ significantly in perceived recovery. During intervention and follow-up, consistent differences remained between the groups in severity of the main complaint, shoulder pain, disability, and general health. 

The results of the Groningen trial demonstrate that manipulation of the shoulder girdle is efficacious when combined with traditional medical care. Specifically, the trial found that these interventions improved overall joint function and decreased restrictions in movement at both single and multiple segmental levels in the cervical spine, upper thoracic spine, and adjacent ribs.