High prevalence of shoulder girdle muscles with myofascial trigger points in patients with shoulder pain Dry Needling on the Infraspinatus Latent and Active Myofascial Trigger Points in Older Adults With Nonspecific Shoulder Pain: A Randomized Clinical Trial Dry Needling to a Key Myofascial Trigger Point May Reduce the Irritability of Satellite MTrPs Dry Needling Alters Trigger Points in the Upper Trapezius Muscle and Reduces Pain in Subjects With Chronic Myofascial Pain. Bilateral Activation of Motor Unit Potentials with Unilateral Needle Stimulation of Active Myofascial Trigger Points Efficacy of Deep Dry Needling on Latent Myofascial Trigger Points in Older Adults With Nonspecific Shoulder Pain: A Randomized, Controlled Clinical Trial Pilot Study Contributions of myofascial pain in diagnosis and treatment of shoulder pain. A randomized control trial
Background Shoulder pain is reported to be highly prevalent and tends to be recurrent or persistent despite medical treatment . The pathophysiological mechanisms of shoulder pain are poorly understood . Furthermore , there is little evidence supporting the effectiveness of current treatment protocol s. Although myofascial trigger points ( MTrPs ) are rarely mentioned in relation to shoulder pain , they may present an alternative underlying mechanism , which would provide new treatment targets through MTrP inactivation . While previous research has demonstrated that trained physiotherapists can reliably identify MTrPs in patients with shoulder pain , the percentage of patients who actually have MTrPs remains unclear . The aim of this observational study was to assess the prevalence of muscles with MTrPs and the association between MTrPs and the severity of pain and functioning in patients with chronic non-traumatic unilateral shoulder pain . Methods An observational study was conducted . Subjects were recruited from patients participating in a controlled trial study ing the effectiveness of physical therapy on patients with unilateral non-traumatic shoulder pain .  Sociodemographic and patient-reported symptom scores , including the Disabilities of the Arm , Shoulder , and H and ( DASH ) Question naire , and Visual Analogue Scales for Pain were compared with other studies . To test for differences in age , gender distribution , and education level between the current study population and the population s from Dutch shoulder studies , the one sample T-test was used . One observer examined all subjects ( n = 72 ) for the presence of MTrPs . Frequency distributions , means , medians , st and ard deviations , and 95 % confidence intervals were calculated for descriptive purpose s. The Spearman 's rank-order correlation ( ρ ) was used to test for association between variables . Results MTrPs were identified in all subjects . The median number of muscles with MTrPs per subject was 6 ( active MTrPs ) and 4 ( latent MTrPs ) . Active MTrPs were most prevalent in the infraspinatus ( 77 % ) and the upper trapezius muscles ( 58 % ) , whereas latent MTrPs were most prevalent in the teres major ( 49 % ) and anterior deltoid muscles ( 38 % ) . The number of muscles with active MTrPs was only moderately correlated with the DASH score . Conclusion The prevalence of muscles containing active and latent MTrPs in a sample of patients with chronic non-traumatic shoulder pain was high Background and Purpose : Shoulder pain is a prevalent condition in older adults . Some authors associate nonspecific shoulder pain with myofascial trigger points ( MTrPs ) in the infraspinatus muscle . Dry needling is recommended to relieve the MTrP pain of shoulders in the short term ( < 9 days ) . Active MTrPs dry needling improves shoulder pain and the irritability of the satellite MTrPs in the referred pain area . Nociceptive activity at a latent MTrP may influence motor activity and the sensitivity of MTrPs in distant muscles at a similar segmental level . Therefore , this study aim ed to evaluate dry needling on 1 latent MTrP , in conjunction with 1 active MTrP , in the infraspinatus muscle of older adults with nonspecific shoulder pain . Methods : A single-center , r and omized , single-blinded , controlled study ( NCT02032602 ) was carried out . Sixty-six patients aged 65 years and older with trigger points in the ipsilateral infraspinatus of the painful shoulder were r and omly assigned to ( 1 ) of ( 2 ) treatment groups . A session of dry needling on the infraspinatus was performed in ( 1 ) the most hyperalgesic active and latent MTrP or ( 2 ) only the most hyperalgesic active MTrP. The Numeric Rating Scale , the pressure pain threshold ( primary outcome ) on the anterior deltoid and extensor carpi radialis brevis latent MTrPs , and grip strength were assessed before , after , and 1 week after the intervention . Results : Statistically significant differences in the reduction of pain intensity ( P ⩽ .001 ; & eegr;2 = 0.159 - 0.269 ; d = 1.017 - 1.219 ) and the increase of pressure pain threshold ( P < .001 ; & eegr;2 = 0.206 - 0.481 ; d = 0.870 - 1.924 ) were found for the ( 1 ) treatment group immediately and 1 week postintervention . Nevertheless , no statistical significant differences were found in grip strength ( P > . 05 ; & eegr;2 = 0.006 - 0.033 ; d = 0.158 - 0.368 ) . Conclusions : One dry needling intervention of the latent MTrP associated with the key active MTrP of the infraspinatus reduces pain intensity and the irritability of the satellite MTrPs located in the referred pain area in the short term in older adults with nonspecific shoulder pain Hsieh Y-L , Kao M-J , Kuan T-S , Chen S-M , Chen J-T , Hong C-Z : Dry needling to a key myofascial trigger point may reduce the irritability of satellite myofascial trigger points . Am J Phys Med Rehabil 2007;86:397–403 . Objective : To investigate the changes in pressure pain threshold of the secondary ( satellite ) myofascial trigger points ( MTrPs ) after dry needling of a primary ( key ) active MTrP. Design : Single blinded within-subject design , with the same subjects serving as their own controls ( r and omized ) . Fourteen patients with bilateral shoulder pain and active MTrPs in bilateral infraspinatus muscles were involved . An MTrP in the infraspinatus muscle on a r and omly selected side was dry needled , and the MTrP on the contralateral side was not ( control ) . Shoulder pain intensity , range of motion ( ROM ) of shoulder internal rotation , and pressure pain threshold of the MTrPs in the infraspinatus , anterior deltoid , and extensor carpi radialis longus muscles were measured in both sides before and immediately after dry needling . Results : Both active and passive ROM of shoulder internal rotation , and the pressure pain threshold of MTrPs on the treated side , were significantly increased ( P < 0.01 ) , and the pain intensity of the treated shoulder was significantly reduced ( P < 0.001 ) after dry needling . However , there were no significant changes in all parameters in the control ( untreated ) side . Percent changes in the data after needling were also analyzed . For every parameter , the percent change was significantly higher in the treated side than in the control side . Conclusions : This study provides evidence that dry needle – evoked inactivation of a primary ( key ) MTrP inhibits the activity in satellite MTrPs situated in its zone of pain referral . This supports the concept that activity in a primary MTrP leads to the development of activity in satellite MTrPs and the suggested spinal cord mechanism responsible for this phenomenon OBJECTIVE To determine whether dry needling of an active myofascial trigger point ( MTrP ) reduces pain and alters the status of the trigger point to either a non-spontaneously tender nodule or its resolution . DESIGN A prospect i ve , nonr and omized , controlled , interventional clinical study . SETTING University campus . PARTICIPANTS A total of 56 subjects with neck or shoulder girdle pain of more than 3 months duration and active MTrPs were recruited from a campus-wide volunteer sample . Of these , 52 completed the study ( 23 male and 33 female ) . Their mean age was 35.8 years . INTERVENTIONS Three weekly dry needling treatments of a single active MTrP. MAIN OUTCOME MEASURES PRIMARY OUTCOMES Baseline and posttreatment evaluations of pain using a verbal analogue scale , the Brief Pain Inventory , and the status of the MTrP as determined by digital palpation . Trigger points were rated as active ( spontaneously painful ) , latent ( requiring palpation to reproduce the characteristic pain ) , or resolved ( no palpable nodule ) . SECONDARY OUTCOMES Profile of Mood States , Oswestry Disability Index , and Short Form 36 scores , and cervical range of motion . RESULTS PRIMARY OUTCOMES A total of 41 subjects had a change in trigger point status from active to latent or resolved , and 11 subjects had no change ( P < .001 ) . Reduction in all pain scores was significant ( P < .001 ) . SECONDARY OUTCOMES Significant improvement in posttreatment cervical rotational asymmetry in subjects as follows : unilateral/bilateral MTrPs ( P = .001 and P = 21 , respectively ) ; in pain pressure threshold in subjects with unilateral/bilateral MTrPs , ( P = .006 and P = .012 , respectively ) ; improvement in the SF-36 mental health and physical functioning subscale scores ( P = .019 and P = .03 ) , respectively ; and a decrease in the Oswestry Disability Index score ( P = .003 ) . CONCLUSIONS Dry needling reduces pain and changes MTrP status . Change in trigger point status is associated with a statistically and clinical ly significant reduction in pain . Reduction of pain is associated with improved mood , function , and level of disability Audette JF , Wang F , Smith H : Bilateral activation of motor unit potentialswith  unilateral needle stimulation of active myofascial trigger points . Am J Phys Med Rehabil 2004;83:368–374 . Objective : The objective of this study was to determine if there are electromyographic differences between active and latent myofascial trigger points ( MTrPs ) during trigger point needling . Design : A total of 21 subjects were recruited prospect ively . The experimental group consisted of 13 subjects who had active myofascial pain in the neck for > 6 mos . The age-matched , control group consisted of eight subjects without neck pain but with taut b and s in the cervical musculature . The active MTrPs ( or latent MTrPs in the control group ) were identified in the trapezius or levator scapulae muscles , then needle electrodes were inserted ipsilaterally into the muscle with the MTrPs and into the same muscle on the contralateral side . Electromyographic activity was recorded bilaterally with a dual-channel electromyographic machine , and local twitch responses were obtainedusinganacupuncturedryneedlingtechniqueonlyonthesideoftheactiveMTrPs . Results : We demonstrated that in subjects with active MTrPs , bilateral motor unit activation could be obtained with unilateral needle stimulation of the trigger point . In contrast , in all the subjects with latent MTrPs , only unilateral motor unit activation could be obtained in the muscle on the same side of the needle stimulation . The motor unit potentials seen on the electromyograph were similar in morphology to a fasciculation potential but more complex . Conclusion : We demonstrated bilateral or mirror-image electromyographic activity associated with unilateral needle stimulation of active MTrPs . We have found no previous mention of this phenomenon in the literature . Our study supports the concept that the perpetuation of pain and muscle dysfunction in active MTrPs may be related to abnormal central nervous system processing of sensory input at the level of the spinal cord 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 , r and omized , 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 r and omly 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 assessment s. 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 Background Rotator cuff tendinopathy and subacromial impingement syndrome present complex patomechanical situations , frequent difficulties in clinical diagnosis and lack of effectiveness in treatment . Based on clinical experience , we have therefore considered the existence of another pathological entity as the possible origin of pain and dysfunction . The hypothesis of this study is to relate subacromial impingement syndrome ( SIS ) with myofascial pain syndrome ( MPS ) , since myofascial trigger points ( MTrPs ) cause pain , functional limitation , lack of coordination and alterations in quality of movement , even prior to a tendinopathy . MTrPs can coexist with any degenerative subacromial condition . If they are not taken into consideration , they could perpetuate and aggravate the problem , hindering diagnosis and making the applied treatments ineffective . The aims and methods of this study are related with providing evidence of the relationship that may exist between this condition and MPS in the diagnosis and treatment of rotator cuff tendonitis and /or SIS . Method / design A descriptive transversal study will be made to find the correlation between the diagnosis of SIS and rotator cuff tendonitis , positive provocation test responses , the existence of active MTrPs and the results obtained with ultrasonography ( US ) and Magnetic Renonance Imaging ( MRI ) . A r and omized double blinded clinical trial will be carried out in experimental conditions : A Protocol ized treatment based on active and passive joint repositioning , stabilization exercises , stretching of the periarticular shoulder muscles and postural reeducation . B. The previously described protocol ized treatment , with the addition of dry needling applied to active MTrPs with the purpose of isolating the efficacy of dry needling in treatment . Discussion This study aims to provide a new vision of shoulder pain , from the perspective of MPS . This syndrome can , by itself , account for shoulder pain and dysfunction , although it can coexist with real conditions involving the tendons . Trail Registration IS RCT N Number :
Findings revealed that active and latent MTrPs were prevalent throughout all disorders , however , latent MTrPs did not consistently have a higher prevalence compared to healthy controls .
Conclusions We found limited evidence supporting the high prevalence of active and latent MTrPs in patients with neck or shoulder disorders .
Background Neck and shoulder disorders may be linked to the presence of myofascial trigger points ( MTrPs ) .
These disorders can significantly impact a person ’s activities of daily living and ability to work .
MTrPs can be involved with pain sensitization , contributing to acute or chronic neck and shoulder musculoskeletal disorders .
The aim of this review was to synthesis e evidence on the prevalence of active and latent MTrPs in subjects with neck and shoulder disorders .