Efficacy of Deep Dry Needling on Latent Myofascial Trigger Points in Older Adults With Nonspecific Shoulder Pain: A Randomized, Controlled Clinical Trial Pilot Study

Abstract

Background:Nonspecific shoulder pain has a high prevalence in older adults and causes functional alterations. Furthermore, there are difficulties in establishing a clinical diagnosis, effective treatments are lacking, and little evidence has been found regarding the use of invasive physical therapy techniques in this age group.Purpose:To determine the efficacy of a single physical therapy intervention with deep dry needling (DDN) on latent and active myofascial trigger points (MTrPs) in older adults with nonspecific shoulder pain.Methods:This pilot study is a single-blind, randomized, controlled clinical trial that included 20 participants, aged 65 years and older, who were diagnosed with nonspecific shoulder pain. The study was approved by the Clinical Research Ethics Committee of the area. Participants were recruited at their homes or at a care center and were randomly assigned into either an experimental group (n = 10), which received a session of DDN on 1 active and 1 latent MTrP of the infraspinatus muscle, or a control group (n = 10), which received a session of DDN on only 1 active MTrP. A blind examiner assessed the pain intensity, pain pressure threshold on the anterior deltoid, and extensor carpi radialis brevis muscles and grip strength before, immediately after, and 1 week after the intervention.Results:Statistically significant differences (P < .05) in the pressure pain thresholds (PPTs) of the extensor carpi radialis brevis were found in the experimental group in both posttreatment assessments. Moreover, the effect size values (d Cohen) varied from small for grip strength (0.017-0.36) to moderate for the pain intensity (0.46-0.78) and PPT in the anterior deltoid (0.49-0.66) and to large for the PPT in the extensor carpi radialis brevis (1.06-1.58).Conclusions:A single physical therapy intervention with DDN on 1 latent MTrP, in conjunction with 1 active MTrP, in the infraspinatus muscle may increase the PPT of the extensor carpi radialis brevis muscle area immediately following and 1 week after the intervention in older adults with nonspecific shoulder pain.

Comparison of hand grip strength and upper limb pressure pain threshold between older adults with or without non-specific shoulder pain

“…For the control group, these latent MTrPs were situated bilateral in both non-painful shoulders. Shoulder pain was considered if there was pain at rest and mainly located in the glenohumeral joint between the acromion, the insertion of the deltoid muscle, and the lateral region of the scapula (Calvo, Pacheco & Hita, 2015; Calvo-Lobo et al, 2016). Non-specific shoulder pain was considered if a previous diagnosis was not present in the medical record considering structural, neurological, visceral or red flag conditions (Mitchell et al, 2005).…”

“…A latent MTrP was diagnosed if there were palpable tender nodules in a taut band without the patient’s local or referred pain recognition. If there was more than one latent MTrP in the same muscle, then the MTrP most hyperalgesic to palpation was selected as the one that generated the highest pain intensity in the Numeric Rating Scale (NRS) under the same pressure (Calvo, Pacheco & Hita, 2015; Calvo-Lobo et al, 2016). The convention for PPT assessment in musculoskeletal conditions is the use of a designated site rather than the most painful MTrP (Coronado et al, 2014).…”

“…New treatments strategies for older adults with symptomatic shoulders are necessary (Burner et al, 2014). Therefore, non-specific shoulder pain is associated with myofascial pain syndrome (MPS), and treatment can reduce pain intensity, increase pressure pain threshold (PPT) and modify grip strength in the upper limbs of older adults (Calvo, Pacheco & Hita, 2015; Calvo-Lobo et al, 2016). …”

“…Active MTrPs produce spontaneous and recognized pain while latent MTrPs generate local or referred pain after stimulation (Ge & Arendt-Nielsen, 2011; Gerber et al, 2013). Indeed, the presence of latent MTrPs in the upper limb may influence the peripheral and central sensitization process and alter the strength and PPT in the upper limb of patients with shoulder pain (Calvo, Pacheco & Hita, 2015; Calvo-Lobo et al, 2016; Ge et al, 2008; Celik & Yeldan, 2011; Coronado et al, 2014). Nevertheless, the relationship between shoulder pain and PPT in the upper limb and grip strength should be more widely studied during aging.…”

“…The treatment of the latent MTrP associated with the key active MTrP of the infraspinatus muscle improves pain intensity and increases the PPT of the satellite latent MTrPs located in the referred pain area over the short term (Calvo, Pacheco & Hita, 2015; Calvo-Lobo et al, 2016). …”