Deep dry needling of the shoulder muscles

7 Deep dry needling of the shoulder muscles


Shoulder pain, shoulder complaints and shoulder disorders are frequently used terms and appear synonymous. It is clear from the definitions that there is a certain overlap between these terms. In this chapter, we will use the term shoulder pain.

Shoulder pain is a very common musculoskeletal disorder. In primary care, the yearly incidence is estimated to be 14.2 per 1000 people. The 1-year prevalence in the general population is estimated to be 20–50%. The estimates are strongly influenced by the definition of shoulder disorders, including or excluding criteria, including limited motion, age, gender, and anatomical areas. Thus, shoulder pain is widespread and imposes a considerable burden on the affected person and on society. Women are slightly more affected than men and the frequency of shoulder pain peaks between 46 and 64 years of age (Van der Windt et al. 1995). Shoulder pain tends to be persistent or recurrent despite medical treatment (Ginn & Cohen 2004). The pathophysiological mechanisms are poorly understood in spite of a growing body of knowledge of shoulder kinematics, shoulder injury mechanisms, and the technical improvement of medical imaging, including sonography, magnetic resonance imaging or more conventional techniques such as X-rays.

Most shoulder pains are caused by a small number of relatively common conditions. Although subacromial impingement is often suggested to be the most common potential source of shoulder pain (Neer 1972, Hawkins & Hobeika 1983), solid evidence is lacking (Bron 2008). This syndrome includes tendonitis or tendinopathy of the rotator cuff and the long head of the biceps brachii muscle, or subacromial or subdeltoid bursitis. In fact, calcifications, acromion spurs, subacromial fluid, or signs of tendon degeneration are equally prevalent in healthy subjects and in individuals with shoulder pain (Milgrom et al. 1995). Furthermore, physical examination tests of subacromial impingement are not reliable (Hegedus et al. 2007), and the results of imaging diagnostics do not correlate well with pain (Bradley et al. 2005). In addition, interventions targeting subacromial problems are, at best, only moderately effective at treating patients with shoulder complaints (Coghlan et al. 2008, Buchbinder et al. 2009, Dorrestijn et al. 2009). Other less common causes of shoulder pain are tumors, infections, and nerve related injuries.

Clinical relevance of myofascial trigger points (TrPs) in shoulder pain syndromes

Myofascial trigger points (TrPs) in patients with shoulder pain are most prevalent in the infraspinatus, upper trapezius and deltoid muscles and most of the time, multiple TrPs in more than one muscle are involved (Hsieh et al. 2007, Ge et al. 2008, Bron et al. 2011b). Ingber (2000) successfully treated the subscapularis muscle, which was thought to be the main cause of shoulder pain in three overhead athletes. Hidalgo-Lozano et al. (2010) found that the muscles most affected by active TrPs were the supraspinatus, infraspinatus and subscapularis in patients with shoulder pain with a medical diagnosis of shoulder impingement. A recent study of elite swimmers with shoulder pain showed similar findings (Hidalgo-Lozano et al. 2011a).

In an older study, Sola et al. (1955) concluded that the supraspinatus muscle was one of the least frequently involved shoulder girdle muscles both in patients and in young healthy adults. The supraspinatus muscle is rarely involved by itself, but usually appears in association with the infraspinatus or upper trapezius muscles (Bron et al. 2011b) or the subscapularis muscle (Hidalgo-Lozano et al. 2010), which very commonly harbor TrPs in patients with shoulder pain and dysfunction. In addition, other muscles, such as the levator scapulae, biceps brachii, deltoid, pectoralis minor, pectoralis major, scalene, latissimus dorsi, teres major and minor muscles may also be involved in shoulder pain. In fact, two studies demonstrated that TrPs in the latissimus dorsi and pectoralis major muscles reproduced axillary arm pain in women with breast cancer who had undergone mastectomies (Fernández-Lao et al. 2010, Torres-Lacomba et al. 2010)

Studies investigating the effect of TrP therapy in patients with shoulder pain are sparse. Recently, two randomized controlled trials showed promising results of manual TrP therapy in patients with shoulder pain (Hains et al. 2010, Bron et al. 2011a). More studies are in progress (Perez-Palomares et al. 2009). A multiple case study supported the idea that TrP dry needling may be effective in reducing shoulder pain and improving shoulder functioning in elite female volleyball players (Osborne & Gatt 2010). One study investigated the effects of TrP dry needling in patients with post-stroke shoulder pain and reported that patients in the intervention group reduced their analgesic medication use, improved their sleep and mood, and more effectively prepared them for their rehabilitation program than those in the control group (DiLorenzo 2004). Finally, a case series of patients with a diagnosis of shoulder impingement found that inactivation of TrPs in the shoulder musculature decreased shoulder pain and sensitization (Hidalgo-Lozano et al. 2011b)

Dry needling of the shoulder muscles

Subscapularis muscle

• Anatomy: The muscle originates from the subscapular fossa and inserts to the lesser tubercle and reinforces the transverse ligament that overlies the bicipital sulcus.

• Function: It is an internal rotator assisted by the pectoral major muscle. It stabilizes the humeral head together with the other rotator cuff muscles and prevents upward migration of the humeral head during all movements.

• Innervation: Subscapular nerve from the C5, C6, and C7 nerve roots.

• Referred pain: It is projected to the dorsal aspect of the shoulder extending to the dorsal aspect of the upper arm and around the wrist.

• Needling technique:

Aug 28, 2016 | Posted by in RHEUMATOLOGY | Comments Off on Deep dry needling of the shoulder muscles
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