Behandling av myofasciella triggerpunkter med ”dry needling” hos personer med impingement i axelleden : En prospektiv randomiserad interventionsstudie

Sammanfattning: Abstract Aim: The aim of this study was to investigate if treatment with “dry needling” in myofascial triggerpoints (MTrPs) in the rotatorcuff muscles may affect impingement symptoms such as pain during provocative tests, shoulder mobility, and function. The research questions were: Does the value of pain change on the Visual Analog Pain Scale (VAS) between before and after treatment? Do the positive provocative tests for impingement change between before and after treatment? Does the active shoulder mobility change between before and after treatment? Does the self-rated function change between before and after treatment? Method: The study was a prospective randomized intervention study and 19 persons with impingement symptoms (mean ± standard deviation; 58 ± 18 years, and shoulder pain duration 3.9 ± 1.6 months) were randomized into two groups. The groups were tested before, directly after and 3 weeks after treatment. The intervention group was treated twice, with a week in between, with “dry needling” in MTrPs. The control group was also treated on two occasions but was instead given a superficial needle in the infraspinatus muscle. All subjects were treated by the same physiotherapist. Pain was evaluated on the VAS when subjects performed active shoulder flexion before and after treatment. Provocative tests for shoulder impingement (Neer sign, Hawkins-Kennedy test and Jobe test) as well as range of motion tests were performed before, after and three weeks after treatment. The frequencies of positive/negative provocative tests were presented. Shoulder function was evaluated with the QuickDASH questionnaire. Significance level p≤0.05 was used in the study and a tendency was identified between 0.05 ≤ p < 0.1. Results: There was a tendency (p=0.086) with decreased pain (VAS) in the intervention group after the treatment. Among the impingement tests only significant improved results was observed for Neer sign test three weeks after the treatment (p=0.025) No significant difference could be seen on the active shoulder mobility between before and after the treatment. The perceived function in the intervention group, measured with the Quick DASH questionnaire, showed a tendency (p=0.086) towards a better function. Conclusions: The study showed a tendency towards that”dry needling”  in MTrPs may affect impingement symptoms such as pain and function. The provocative tests for shoulder impingement, Neer sign, showed a significant decrease in pain after treatment. More studies with larger population is needed to make a statement about the effect of “dry needling” in MTrPs as a treatment for shoulder impingement symptoms.