Table 1.

Data extracted from the included studies

Study	Study Characteristics
	Sample Size	Participants	Diagnosis (Duration)	Intervention group (n) (SD)	Outcome Measure	Comparison group (n)		Follow up	Results	PEDro score
Kaya et al (2014)	n = 54	21 males; 33 females age (30–60)	Subacromial impingement syndrome 6 wk. treatment	Thoracic manual therapy with exercise (n = 26) Mean age 47.15 (±9.44)	VAS DASH US of tendon thickness	Kinesiotape with exercise (n = 28) Mean age 50.85	No		Significant differences in pain and DASH within groups; no difference in US thickness	6
Land et al (2017)	n = 60	30 males; 30 females; age 40–60	Subacromial shoulder impingement 12 wk. treatment	Upper thoracic mobilization (n = 20) Mean age 51 (±4.4) Shoulder massage, mobilization, stretching (n = 20) Mean age 51 (±4.4)	AROM shoulder Passive glenohumeral IR Pain Shoulder pain and function disability index Pain (SPADI)	Ultrasound (control) (n = 20) Mean age 51 (±4.4)		E-Mail follow up of pain and function (SPADI) Time frame	Outcomes significantly improved in the groups receiving upper thoracic treatment compared with the active control group and in the posterior shoulder treatment compared with the active control group with no differences detected between the shoulder treatment compared with the thoracic treatment	10
Kardouni et al (2015)	n = 45	23 females; 22 males; age 18–59	Subacromial impingement syndrome; 6 techniques during one session	Thoracic SMT (n = 24) Mean age 31.1 (±2.3)	NPRS; Penn shoulder score; GROC	Sham thoracic SMT (n = 21); Mean age 31.2 (±12.1)		No	There were no differences in pain sensitivity between groups. Both groups improved patient rated pain and function within 24–48 hrs.	9
Silva et al (2019)	n = 60	19 males; 41 females; age 20–70	Rotator cuff tendinopathy Two treatments	Thoracic manipulation group (n = 30) Mean age 46.06 (16.11); placebo group (n = 30) Mean age 44.46 (±12.14)	VAS; shoulder flexion, abduction range of motion	Placebo – therapist maintained minimal pressure on thoracic segments with patient in prone		No	Both groups demonstrated a reduction in pain, but there was no clinically significant improvement between groups. Both showed increased shoulder ROM, but only abduction of the painful shoulder in the MG reached the MDC.	8
Fernandez-Camero (2011)	n = 18	9 females; 8 males; age 18–60	Lateral epicondylalgia; 1 session	Thoracic manipulation (T5-8)	Pain pressure threshold; pain-free grip strength	Cervical manipulation (C5-6)		No	Cervical spine manipulation produced a greater increase of PPT in both sides compared with thoracic. For pain-free grip strength, no interaction between group and time existed	7
Riley et al (2015)	n = 88	54 females; 34 males Age 18–69	Patients with shoulder pain; 1 session	Thoracic HVLATM (n = 22); age 52.3 (±8.5): 13 females; nine males Scapular HVLATM (n = 22); age 45.9 (±13.2); 15 females; 7 males	NPRS; NPRS with impingement testing; SPADI	Thoracic neutral massage (n = 22); age 48.5 (±12.0); 14 females; 8 males Scapular neutral massage (n = 22); age 48.1 (±10.4); 12 females; 10 males		Outcome measures at 6–9 days post	Patients improved following the interventions. Neither the type of HVLATM nor the message conveyed had a significant effect on patient improvements	8
Park et al (2020)	n = 30	9 males; 21 females; age	Subacromial impingement syndrome 4 wk treatment, 12 sessions	Thoracic joint mobilization (n = 10); age 49.20 (±9.48) Ex group (n = 10); age 50.90 (±9.10)	Thoracic kyphosis; pec major and upper trap pain muscle tone and stiffness; affected side PROM; SPADI	Combination group (n = 10); age 50.20(±8.99)		No	All three groups had significant improvements in all variables. The combination group displayed a significant improvement in thoracic kyphosis and upper trapezius muscle tone as well as flexion, medial and lateral rotation ROM and SPADI compared to the mobilization and exercise groups.	8
Wright et al (2017)	n = 18	8 females; 10 males; >18 yo (mean 43.1)	Subacromial impingement syndrome; treatment 2x/week for 4 weeks	Cervicothoracic thrust/non-thrust plus shoulder manual therapy and exercise (n = 10); 5 males, 5 females; age 46.3 (±15.9)	NPRS; SPADI	Shoulder only manual therapy and exercise (n = 8); 4 males, 4 females; age 39.1 (±15.8)		DC assessment	Both groups showed statistically significant improvements in both pain and function at 2, 4 wks. and DC. Between group differences for changes in pain and physical function were not significant	7
Haider et al (2018)	n = 40;	22 females; 18 males; mean age 49.55 (±9.706)	Subacromial pain; 4 thoracic manipulations over 6 treatment session	Thoracic manual procedures, hot or cold pack, shoulder ROM and strengthening exercises (n = 20)	NPRS; SPADI	Hot or cold pack, shoulder ROM and strengthening exercises (n = 20)		1 week follow up	Pain intensity and function score improved to a greater extent in the experimental group	6
Haik et al (2017)	n = 61	38 males; 23 females	Shoulder impingement syndrome; 2 interventions over 1 week	Mid-thoracic manipulation (n = 20); Mean age 32.5(±12.0)	NPRS; DASH; Western Ontario Rotator Cuff Index	Sham thoracic manipulation group (n = 31); Mean age 31.3(±11.0)		Day 3 follow up	TSM increased scapular upward rotation during arm lowering. Did not influence activity of the scapular muscles and pain, function, scapular tilt and internal rotation were not conclusive	8
Bergman et al (2004)	n = 150	79 females; 71 males	Shoulder pain; 6 treatments over 12 weeks	Usual medical care plus cervical and thoracic manipulation (n = 79); 42 females, 37 males; mean age 48.4 (±12.4)	Patient-perceived recovery; severity of main complaint; shoulder disability; general health	Usual medical care (n = 71); 37 females, 43 males; mean age 47.8 (±11.8)		52 weeks follow up 87–94%	More patients from intervention group reported full recovery or very large improvement. The intervention and control groups differed significantly in perceived recovery and patients who reported feeling ‘cured’ at 52 weeks. The outcomes of shoulder pain and disability favored additional manipulative therapy; however, only shoulder disability received a sig difference at 26 wks.	8
Vinuesa- Montoya et al (2017)	n = 41	28 males; 13 females	Shoulder impingement syndrome; 10 sessions over 5 weeks (2 session/wk)	Cervicothoracic manipulation plus exercise; (n = 21); 15 males, 6 females; age 46.85(±8.02); 25–57	VAS; DASH; Shoulder disability questionnaire; Hawkins-Kennedy and Neer test; Shoulder AROM	Home exercise program; (n = 20); 13 males, 7 females; age 51.21(±5.29); 38–58		no	Between group differences in the DASH. No statistically significant differences for shoulder disability questionnaire and pain intensity. Both groups improved regarding disability and clinical tests for subacromial impingement syndrome	9
Grimes et al (2019)	n = 60	37 males, 23 females	Shoulder pain syndrome; 2 thoracic manipulative techniques	Seated thoracic manipulation (n = 20); 12 males, 8 females, age 35.6(±14.7) Supine thoracic manipulation (n = 20); 10 males, 10 females; age 37.6(±15.3)	Self-reported pain; Pain shoulder score; impairment measures	Sham manipulation (n = 20); 15 males, 5 females; age 36.5(±15.5)		no	No differences in pain, satisfaction and function compared to a sham manipulation. Thoracic spine manipulation did not have an immediate effect on the scapular impairments measured.	8
Mintken (2016)	n = 140; age 18–65	76 females; 64 males	Shoulder pain; 8 sessions of manual therapy with exercise or exercise alone	Thoracic manual therapy plus exercise (n = 70); 40 females, 30 males; age 40.5(±11.7)	SPADI; NPRS; QuickDASH; GROC; PASS	Exercise alone; (n = 70); 36 females, 34 males; age 44.8(±12.9)		6 mos. follow up	Adding two sessions of high dose cervicothoracic manual therapy to an exercise program did not improve pain or disability in patients with shoulder pain, but did improve patient-perceived success at 4 wks. and 6 mos. and acceptability of symptoms at 4 wks.	9