Journal of Novel Physiotherapies
Open Access

Dry needling; Musculoskeletal; Trigger points; Subacromial region; Exercise therapy

Introduction

One of the most prevalent musculoskeletal ailments is shoulder discomfort, which affects 7 to 27% of persons under the age of 70 [1,2]. One of the most prevalent causes of subacromial pain syndrome has been identified as a potential genesis for this condition [3]. This condition is described as a shoulder issue that is often unilateral, nontraumatic, and localised at the acromion. It is commonly made worse when patients raise their arms [4]. The rotator cuff tendons and the bursa of the subacromial region both degenerate as a result of this syndrome's many manifestations, although their pathophysiology is not fully understood [5]. This pathology has been implicated in a variety of etiological ideas. In this regard, several investigations have linked the pathology's aetiology to purely structural variables, such as modifications to the way the humeral head is positioned inside the glenoid cavity or the biomechanical interplay of the gleno-humeral and acromio-clavicular joints. Other research, however, disagree with the anatomical association shown in the aforementioned studies, and as a result, they view subacromial involvement or subacromial pain syndrome as a more direct means of elucidating this affliction. The most prevalent musculoskeletal condition that causes non-traumatic upper limb pain is shoulder discomfort, which has a yearly incidence of 20 to 50%. In 40 to 50 percent of patients, the symptoms last for 6 to 12 months [1,2], and it has a high chronicity and recurrence rate. The clinical definition of shoulder discomfort, however, is not standardised [3].

Due to the lack of consensus on diagnostic criteria, the lack of specificity in clinical evidence, the coexistence of various shoulder diseases, and the absence of any diagnostic test that is regarded as the "gold standard," clinical studies frequently refer to shoulder discomfort as nonspecific. The deltoid, forearm, and shoulder regions show the most frequent indications and symptoms, which include shoulder stiffness and reduced range of motion, which impair everyday activities [6].

Although shoulder impingement syndrome is the most often diagnosed condition in primary care, there is no conclusive evidence to support this theory. Furthermore, a diagnosis of shoulder pain alone would not explain the presence of symptoms because calcifications, acromial bone spurs, subacromial swelling, degenerative rupture of the rotator cuff, tendon inflammation, and signs of degeneration are common in both healthy subjects and subjects with shoulder pain [7].

Furthermore, it has been established that individuals with shoulder discomfort frequently have myofascial trigger points (MTrPs) in their shoulder muscles, which can be painful during muscular stretching, contraction, or compression. These MTrPs, which produce motor dysfunction and referred pain when compressed, are hyperirritable sites in tight bands of skeletal muscle.

Several writers have recently backed the association between myofascial trigger points (MTrPs) and shoulder discomfort. The highly irritable MTrPs are sensitive to pressure and are found in the tight bands of skeletal muscle. These sites cause spontaneous discomfort or pain upon compression, as well as motor impairment. In terms of biomechanics, the scapula is crucial to how the shoulder works. As a result, a muscular imbalance may disrupt the gleno-humeral region's typical arthrokinematics. Subacromial pain syndrome may result from the incapacity and discomfort brought on by MTrPs, which can change scapulohumeral rhythms. Although the theory of the trigger points is still up for debate, several studies have found that the subscapularis tendon and joint capsule contain high levels of inflammatory mediators and have high acetylcholine and nicotinic receptor activity, explaining how such conditions may result in a protracted and painful contraction.

However, the variety and ambiguity of this syndrome's treatments somewhat mirror the lack of clarity around its pathophysiology. The initial option for therapy has been suggested as being conservative tactics. In fact, several non-operative therapies, including exercise therapy, manual therapy, laser therapy, ultrasound therapy,extracorporeal shockwave therapy, and kinesio tapping, have been suggested to reduce the symptoms of shoulder pain syndrome. However, unless a thorough review of success has already been done, the diversity of different treatments does not always make the selection easier for doctors. Due to its clinical efficacy, cost-effectiveness, and other related health advantages, exercise therapy has been suggested in a recent summary of systematic reviews as the first-line treatment to reduce shoulder pain and functional impairment. Currently, there is an increasing trend toward using invasive methods, such as dry needling treatment, either by itself or in conjunction with exercise therapy, to treat symptoms associated with subacromial pain syndrome. A tiny needle is pushed throughout the skin during the minimally invasive procedure known as dry needling. This approach aims to alleviate pain and functional impairment by stimulating MTrPs, connective tissue, and muscles. It is yet unclear how all of these activities are produced via their various processes. Dry needling, however, has been found in multiple meta-analyses to be effective in lowering pain and may inactivate or eradicate MTrPs in the cases of shoulder pain, neck pain, spinal pain, and several musculoskeletal illnesses [8]. Numerous elements, including patient expectations, prior patient experiences, the placebo effect, declining nociceptive afferences, and biochemical changes, have been suggested as potential neurophysiological underpinnings of this syndrome. The efficacy of dry needling combined with physiotherapy for the rehabilitation of patients with subacromial pain syndrome was assessed in a systematic review by Blanco-Daz [9]. However, a meta-analysis was not conducted for this publication. This publication adds a thorough review of the efficiency of dry needling alone or in combination with exercise treatment for decreasing pain and functional handicap in patients with subacromial pain syndrome, thereby providing an evidence-based strategy. The impact of dry needling on MTrPs in nonspecific shoulder pain was reported in many investigations, including the meta-analysis carried out, which resulted in a temporary reduction in pain. Sánchez-Infante et al [8] further meta-analysis revealed that dry needling reduced the discomfort of many conditions. The purpose of this systematic review and meta-analysis was to examine the effects of dry needling treatment on pain and impairment in persons with subacromial pain syndrome, whether used alone or in conjunction with exercise therapy. We believe that both dry needling alone and in conjunction with therapeutic exercise may help to lessen subacromial syndrome-related pain and impairment.

Discussion

The best course of treatment might be challenging to determine since chronic shoulder pain is a complicated painful illness with no clear clinical description and high recurrence and duration of symptoms. Additionally, it has been demonstrated that there is a correlation between the existence of pain and the high prevalence of myofascial trigger points in the shoulder muscles, therefore these patients may benefit from a strategy that focuses on treating the muscles. Additionally, prior research has demonstrated the effectiveness of combining manual treatment methods with therapeutic exercise to treat shoulder discomfort, however the ideal frequency and dosage are yet unknown. Patients with Myofascial Pain Syndrome of the Upper Quadrant are advised to undergo dry needling, and cases of postsurgical shoulder pain have shown promise with a single session of dry needling in a multimodal programme.

Conclusion

Dry needling alone or in conjunction with exercise therapy may produce a small decrease in pain in the short- and mid-term. Evidence for the short- or medium-term effects of dry needling alone or in conjunction with exercise treatment is insufficient.

Acknowledgement

Not applicable.

Conflict of Interest

Author declares no conflict of interest.

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