Author (Year)	Intervention	Technique Details	Control Group
Thoracic manual therapy in isolation
Haik et al. (2017) [26]	Thoracic manipulation	Middle thoracic spine, patient seated with arms crossed over chest. The therapist was located behind the patient and performed a thrust technique with arms and chest around the thoracic region of the subject. Sham: Same position without performing thrust. The technique was applied twice in a period of 3 to 4 days apart. Sham technique was previously reported as a believable active treatment.	Sham manipulation
Grimes et al. (2019) A [29]	Thoracic manipulation	One of the three interventions was delivered between the levels of C7 and T4, and was performed two times on each participant based on methods used in previous studies. For the supine TSTM, examiner used his body to push down through the participant’s upper arms to provide a high-velocity, low-amplitude thrust in the anterior-to-posterior direction. Sham: Seated manipulation moving the participant through the same motion but delivering no manipulative thrust. This sham technique has been previously validated as a plausible treatment.	Sham manipulation
Grimes et al. (2019) B [29]	Thoracic manipulation	One of the three interventions was delivered between the levels of C7 and T4, and was performed two times on each participant based on methods used in previous studies. For the seated TSTM, examiner applied a high-velocity, low-amplitude distraction thrust in a cephalad direction Sham: Same seated sham manipulation	Sham manipulation
Hunter et al. (2022) A [27]	Muscle Energy Tecnhique (MET)	MET consisted of the application of lateral force to the spinous process of the thoracic vertebra until initial resistance with the vertebra below was noted.	MET
Hunter et al. (2022) B [27]	MET + Soft tissue massage (STM)	Same MET technique. STM was applied to the rotator cuff (subscapularis, infraspinatus, and teres minor) and the triceps muscle of the affected shoulder. The STM techniques included static compression and deep longitudinal stripping to the aforementioned muscles, with active engagement.	Placebo laser
Thoracic manual therapy combined with exercise
Haider et al. (2018) [30]	Non-thrust + 3 thrust manipulations	In thoracic group, thoracic manipulative therapy included one non-thrust mobilization and three different thrust manipulation techniques directed at thoracic spine and exercise therapy including hot or cold pack, mobility exercises (flexion and extension exercises with arms in front of the wall, shoulder flexion 90°, and exercises with shoulder circles) and strengthening exercises (resistance exercise with elbow flexion 90° and an elastic band, shoulder flexion with elbow extension holding bar (1–4 kg), body lift from a seated position with elbows extended, and resistance exercises for external rotation. In group 2, patients received conservative exercise therapy including hot or cold pack, mobility exercises and strengthening exercises.	Shoulder exercises
Park et al. (2020) A [28]	Thoracic mobilization	Thoracic spine joint mobilization consisted of oscillatory techniques performed in the prone position, with 30 repetitions per set, four sets in total, and a 1-min rest between sets. Central posterior–anterior mobilization was applied using a grade III large-amplitude rhythmic oscillation, targeting the joint sign segment (the most painful or stiffest level) identified through Maitland’s passive accessory intervertebral motion test. When a joint sign was not present, mobilization was applied at T6–T7. The mobilization session lasted 15 min. The exercise program aimed to enhance thoracic spine extension, trunk extensor strength, and trunk flexor flexibility. It included foam roll stretches as a warm-up, marching on a roller (2 sets of 10 repetitions), thoracic extension against a wall using bodyweight (2 sets of 10 repetitions), and a standing neck/chest stretch as a cool-down. Each exercise session lasted 15 min.	Shoulder exercises
Park et al. (2020) B [28]	Thoracic Mobilization + Shoulder exercises	The combination group received an intervention consisting of joint mobilization and an exercise program. Joint mobilization involved central posterior–anterior oscillations performed in the prone position for 30 repetitions, with a 1-min rest between 2 sets. The exercise program included foam roll stretches (warm-up), marching on a roller (1 set of 10 repetitions), thoracic extension against a wall using bodyweight (1 set of 10 repetitions), and a standing neck/chest stretch (cool-down). The total duration of the combined therapy was 15 min, equally divided between joint mobilization (7 min 30 s) and exercise (7 min 30 s).	Shoulder exercises
Abu El Kassem et al. (2024) [13]	SNAGs + Shoulder Exercises	SNAGs technique on the thoracic spine. The patient sat at the far end of the table, hands behind his neck, protracting the scapulae, and providing the therapist’s hand accessibility to the mid-thoracic spine. The therapist did stand on their most effective side for a centrally administered SNAG. Firstly, a restricted segment of the thoracic spine was detected. The therapist performed passive extension of the thoracic spine and at the same time made palpation of the thoracic spinous process to detect the restricted segment of the thoracic spine. The therapist’s mobilizing hand (ulnar border) was used to apply a cephalad glide in line with the facet joint plane of the involved spinal level, while the other arm held the thoracic wall above the level to be mobilized. The patient was then asked to perform thoracic extension while gliding was applied to the restricted thoracic segment to the end of the range. Traction was administered before glide, which was accomplished via the therapist’s knee extension. The technique was repeated for 6 to 10 times for 3–5 sets with rest in between. Shoulder exercises included pendulum exercises, shoulder range of motion exercises, stretching exercises, strengthening exercises and scapular stabilization exercises.	Shoulder Exercises
Michener et al. (2024) [11]	Thoracic + scapular manual therapy + Shoulder exercises	Manual therapy combined both thrust manipulation and non-thrust mobilization. The manual therapy techniques were aimed at three areas. Clinicians were instructed to apply manual techniques for a total duration of 10–15 min, ensuring the use of at least one technique in each of the following regions: thoracic spine, posterior shoulder, and glenohumeral joint. Practitioners could select low-grade techniques for those with moderate to high irritability, whereas high-grade techniques could be used for those with low irritability. Thoracic techniques were thoracic PA glides in prone, thoracic PA glides seated, thoracic thrust in prone (max 2 reps), thoracic thrust in supine (max 2 reps) and distraction thrust (max 2 reps). Shoulder exercises combined progressive resistance exercise with stretching. The program consisted of resistance exercises using body weight or exercise bands to target the shoulder muscles with particular emphasis on the scapular stabilizers and rotator cuff, complemented with flexibility exercises and postural training through chin tucks and scapular retraction. Strengthening exercises were performed using latex-free Thera-Bands, with 2 to 3 sets of 10 repetitions.	Shoulder exercises