Non-traumatic Shoulder Pain Research Articles

Prevalence and associated factors of non-traumatic shoulder pain during spike and serve movements in male high school volleyball players: a cross-sectional study

BackgroundNontraumatic shoulder pain is a prevalent issue among male high school volleyball players, but its comprehensive assessment has been lacking in prior research, which often isolated specific aspects of shoulder function. This study aimed to identify contributing factors to shoulder pain in this population. HypothesisThe hypothesis posited that limited shoulder internal rotation (IR) range of motion (ROM), imbalance in rotator cuff muscle strength, intrinsic sensory disturbance, and joint stability are associated with shoulder pain in male high school volleyball players. Additionally, there was an anticipation that a substantial proportion of players would experience shoulder pain but refrain from reporting it to coaches. MethodsForty-nine male volleyball players aged 15-17 years were evaluated between February and June 2023. Questionnaires assessed the prevalence of shoulder pain during spiking and/or serving, as well as the frequency of reporting this pain to coaches. Various factors, including acromio-humeral distance, shoulder ROM, isometric strength, proprioception, joint stability (Upper Quarter Y-Balance Test), joint position sense, and upper extremity power (Seated Medicine Ball Throw Test; SMBT), were quantified. Logistic regression analyses was conducted to explore potential connections between these variables and shoulder pain. ResultsShoulder pain was reported by 39% of participants, but it was rarely communicated to coaches (95%). Jump serves (odds ratio 1.84, p=0.02) and reduced shoulder IR ROM (odds ratio 0.94, p=0.03) were associated with shoulder pain. ConclusionThis study provides crucial insights into the prevalence, severity, and associated factors of shoulder pain among male high school volleyball players. The findings underscore the importance of improving athlete-coach communication to facilitate early intervention and preventive measures. Significant associations were observed between the use of jump serves, reduced shoulder internal rotation range of motion, and shoulder pain, highlighting the relevance of specific volleyball techniques in injury prevention. These findings offer valuable guidance to coaches and trainers in developing interventions aimed at mitigating the risk of shoulder pain and enhancing player performance.

Effects of Intramuscular Electrical Stimulation for Treatment of Non-Traumatic Shoulder Pain

Non-traumatic shoulder pain is the third most common cause of consultations for musculoskeletal pain in primary health care. It is one of the common musculoskeletal conditions of the shoulder which may develop sensory-motor and autonomic dysfunctions at the various level of the neuromuscular system. The objective of the study to find out the Effects of Intramuscular Electrical Stimulation for Treatment of Non-Traumatic Shoulder Pain. The pain and dysfunction caused by NSP were primarily treated with physical therapy and pharmacological agents in order to achieve pain free movements. However, in recent years intramuscular electrical stimulation (IMES) with conventional electrode placement was used by researchers to maximize therapeutic values. But, in this study an inverse electrode placement was used to deliver electrical impulses intramuscularly to achieve neuro-modulation at the various level of the nervous system. Nine patients with NSP were treated with intramuscular electrode stimulation using inversely placed electrodes for a period of three weeks. All nine subjects recovered from their shoulder pain and disability within the few weeks of intervention. So, this IMES may be more appropriate for treatment approach for Non traumatic shoulder pain management.

Ultrasound Findings in Adult Patients with Chronic Shoulder Pain Having No History of Trauma

OBJECTIVE: To evaluate the frequency of non-traumatic chronic shoulder pain sonographically in the local population. METHODOLOGY: This cross-sectional study was conducted at the Department of Radiology, Combined Military Hospital Malir, from March to October 2020. A history of shoulder pain of more than one month duration was included. Patients with a History of shoulder dislocation, neurological, renal, hepatic and cardiac diseases were excluded. The sample size was 196. A non-probability consecutive sampling technique was employed. SPSS version 23 was used for statistical analysis. RESULTS: 196 patients (69.9% males and 30.1% females) with non-traumatic shoulder pain (56.4 % right side and 43.4% left) were scanned. The mean age was 42.80±11.20 years. Out of 196, 118(60.2%) were having complaints in dominant limbs (right 51.0% and left 9.2%); 78(39.8%) were having pain in non-dominant limbs (right 6.6% and left 33.2%). Significant findings were supraspinatus partial tear (46.9%), sub-acromial sub-deltoid bursitis(8.2%), and biceps tenosynovitis(6.1%), adhesive capsulitis, a complete tear of supraspinatus tendon, impingement syndrome, joint effusion, subscapularis tendon tear and tenosynovitis. 44(22.4%) patients had two pathologies, and 31 (15.8%) patients had three pathologies, respectively. Significant co-existent findings were biceps tenosynovitis (13.8%), Impingement syndrome (9.2%), bursitis (8.2%) and joint effusion (7.1%). Age and number of pathological were moderately positively correlated, r (194) = 0.46, p < 0.01 and keeping CI = 95%. CONCLUSION: Partial tears of the supraspinatus tendon were the most common pathology in non-traumatic shoulder myalgia, diagnosed on ultrasound, followed by sub-acromial sub-deltoid bursitis and biceps tenosynovitis, having moderate linear relation with age. KEYWORDS: Shoulder pain, Impingement syndrome, Rotator Cuff Tears, Tenosynovitis, Ultrasound Shoulder

Evaluation of the acromion variants in MRI and their association with rotator cuff injuries in non-traumatic patients

PurposeUnderstanding demographic and MRI parameters with determinant role in rotator cuff tearing (RCT) is required to predict outcomes and select more appropriate treatment in patients with non-traumatic shoulder pain. This study aimed to survey the association of rotator cuff tears with these factors. MethodsWe performed this cross-sectional study on patients referred to Kashani Hospital with non-traumatic shoulder pain suspected of rotator cuff injuries from April 2020 to February 2021. We obtained their demographic data and MRI from electronic hospital records. After that, two radiologists reviewed MRI and recorded data. We employed the SPSS 23 software to organize the obtained results and statistical evaluations. Results371 subjects, with the age of 48.61 ± 14.89 years, were included in our study, and 50% of them were male. The flat and down-sloping acromion and partial tearing of the supra and infraspinatus tendons were more frequent than the others. Gender could not consider as a determinant factor for the severity of tendon injuries, acromion types and variants. The relation of age to acromion morphology and the tendinopathy severity was significant. Remarkably, down-sloping acromion was higher at all the acromion shapes; however, it makes no difference in the level of supra and infraspinatus involvement. Moreover, we found that partial tearing was higher in all acromion types, except concave. This distribution was significant only for supraspinatus tears. ConclusionThe clinical decision is the most important step in patients with RCT and MRI prognostic factors, which are helpful to improve the management of the cases. RCT in older patients and down-slope acromion was more severe than the others. According to the previous studies, acromion morphology (as an important determinant factor) in RCT could be influenced by age, as well.

The single assessment numeric evaluation correlates with the western ontario rotator cuff score in non-traumatic shoulder disease

Patient-reported outcome measures (PROMs) are essential clinical instruments used for assessing patient function and assisting in clinical decision making. The Western Ontario Rotator Cuff (WORC) index is the PROM for shoulder pathology with the most psychometric properties but is very time consuming. The Single Assessment Numeric Evaluation (SANE) method is a PROM that takes less time to answer and to analyze. The aim of the study is to evaluate the intra- class correlation between these two outcome scores in establishing shoulder function in patients with non-traumatic rotator cuff pathologies. Fifty five subjects of both genders and different ages presenting with non-traumatic shoulder pain for more than 12 weeks had a physical examination and ultrasound as well as MRI arthrogram scan findings that were consistent of a non-traumatic rotator cuff (RC) based pathology. On the same moment a WORC index and a SANE score questionnaire were filled in by the subject. The intra class correlation of both PROMs was statistically analyzed. The WORC index score and the SANE score show a moderate correlation with an Intra Class Coefficient (ICC) of r = 0.60 (95% CI:0.40-0.75). This study demonstrates a moderate correlation between the WORC index score and the SANE score in rating the disability of patients with atraumatic RC disease. The SANE score is applicable in research and clinical practice and is for the patient and the researcher an almost no time consuming PROM.

A Case of a Curious Skin Lesion

Question: A 30-year-old previously healthy man presented as a transfer from an outside hospital for 2–3 weeks of bullous ankle rash and new migratory arthralgias, Three weeks before presentation, he developed severe nontraumatic left-side shoulder pain of unclear etiology. He denied any inciting triggers, though noted he had removed a tick of unknown duration from his leg a month earlier. There were no rashes noted at that time. His shoulder pain progressed, and he subsequently developed left ankle and back pain. Along with the progression of pain, he developed an erythematous raised rash above his left medial malleolus, which developed purple bullae (Figure A) and then ruptured into a large open wound with purulent discharge (Figure B). He developed another pustular lesion on the medial surface of his left thigh which increased in size before rupturing into a similar wound (Figure C). He developed associated fevers up to 104°F. He was subsequently admitted to the general medicine service.

Study of Role of Magnetic Resonance Imaging in Evaluation of Non-Traumatic Chronic Shoulder Pain in Adults

Study of Role of Magnetic Resonance Imaging in Evaluation of Non-Traumatic Chronic Shoulder Pain in Adults

Assessment of a painful non-traumatic shoulder by radiography paired to ultrasound: a series of 222 cases

Context and objective. Chronic shoulder pain is a common reason for outdoor parients in rheumatology. Magnetic Resonance Imaging (MRI), which is its main diagnosis tool, is not accessible for the majority of Congolese patients. The objective was to describe diseases that lead to non-traumatic shoulder pain (NTSP) using the radiography-ultrasound pair and to assess the performance of X-ray compared to that of ultrasound. Methods. This is a cases series of 222 patients for whom an X-ray and an ultrasound were carried out for an NTSP at the Gombe imaging center in Kinshasa and at the Intercommunal Hospital of Fécamp in France, during the period from January 2015 to October 2016. The variables of interest were demographic, clinical, radiographic and ultrasound data. Results. Two hundred and twenty-two patients were included in the study, including 113 women (50.9%) and 109 men (49.1 %). The mean age of the patients was 55.7 ± 14.3 years. A normal shoulder was observed in 122 patients (55 %) on the radiography versus 48 (21.6 %) on the ultrasound. Tendinopathies, calcifications and acromio-clavicular arthropathy were the most common forms of NTSP. The X-ray was more informative than ultrasound for the diagnosis of capsulitis and subacromial conflict. In all other cases it was less effective than ultrasound. The sensitivity and negative predictive value of X-ray were lower than that of ultrasounds. Conclusion. The coupling of X-ray with ultrasound helps to diagnose a greater number of entities than if we considered each examination in isolation. Ultrasound presented a better diagnosticu performance than standard radiography.

Immediate Effect of Dry Needling on the Viscoelastic Properties of a Trigger Point on the Infraspinatus Muscle Measured with MyotonPRO.

Purpose: This article investigates the immediate effects of a dry needling (DN) puncture on the viscoelastic properties (tone, stiffness, elasticity) of a trigger point (TP) in the infraspinatus muscle in non-traumatic chronic shoulder pain. Method: Forty-eight individuals with non-traumatic chronic shoulder pain were recruited. The presence of a TP in the infraspinatus muscle was confirmed by a standardized palpatory exam. The viscoelastic properties were measured with a MyotonPRO device at baseline (T1), immediately after DN (T2), and 30 minutes later (T3). A DN puncture was applied to the TP to obtain a local twitch response while performing the technique. Results: Analyses of variance showed significant decreases in tone (p <0.001) and stiffness (p=0.003) across time after the DN technique. Post hoc tests revealed a significant reduction in tone and stiffness from T1 to T2 (p ≤ 0.004) and no significant changes from T2 to T3 (p ≥ 0.10). At T3, only stiffness remained significantly lower compared to T1 (p=0.013). Conclusions: This study brings new insights on the immediate mechanical effect of DN on tone and stiffness of TPs. Whether these effects are associated with symptom improvement and long-term effects still needs to be verified.

The Effect of Acupuncture Using Specific Acupoints and Non-Acupoints in Non-Traumatic, Chronic Shoulder Pain: A Case Study

Chronic shoulder pain is one of the most common presentations of musculoskeletal pain in our community, which usually complicates or interferes with a person’s daily activities, social events, and overall quality of life. It is the leading cause of disability among middle-aged working individuals. It has been reported that until the present day, none of the conventional treatments has proved effective for chronic shoulder pain in the long term. Furthermore, there are considerable side effects, to varying degrees of these treatments. Acupuncture, as part of Traditional Chinese Medicine, has shown effective results in treating shoulder pain by minimizing the pain and improving range of motion and mobility. The present case involves four patients diagnosed with non-traumatic chronic shoulder pain. All the patients were given three acupuncture treatments per week, lasting 40 minutes for the duration of two weeks. Needling was inserted at six specific acupoints and five specific non-acupoints. Pain and mobility assessments were done before and twenty minutes after each treatment. The result shows positive effects of acupuncture using specific acupoints and specific non-acupoints in alleviating non-traumatic chronic shoulder pain. At the end of this study, their shoulder pain was greatly minimized, and their shoulder functionality improved remarkably. Although larger clinical intervention studies on the effect of acupuncture treatment on chronic shoulder pain due to non-traumatic injury are needed, the result of this case study indicates that acupuncture treatment using specific acupoints and specific non-acupoints can be an effective alternative therapy or treatment tool for patients with non-traumatic chronic shoulder pain.

Utility of lateral scapular radiographs in initial evaluation of nontraumatic shoulder conditions

Lateral scapular radiographs have been routinely included in the initial radiographic examination of both traumatic and nontraumatic shoulder conditions. With the advance of modern imaging modalities, the clinical utility of the lateral scapular view has become questionable. The purpose of the study was to assess the utilization of the lateral scapular view among the members of the American Shoulder and Elbow Surgeons (ASES) and to determine the clinical utility of the lateral scapular view in the initial evaluation of nontraumatic shoulder conditions. The study consisted of two parts. The first part involved an online survey of ASES members, which asked them 3 questions regarding their preference for radiographic evaluation of new patients with nontraumatic shoulder pain. The second part involved a clinical vignette-based survey, where 4 shoulder surgeons at our institution were given 50 clinical vignettes and asked to independently answer 4 questions regarding the most probable diagnosis, abnormal radiographic findings, further imaging studies, and treatment plan for each case. The survey was repeated twice; the first was given without a lateral scapular view, and the second given 4 weeks later with a lateral scapular view included. We obtained diagnostic accuracy and percent agreement of each surgeon over two surveys and intraobserver and interobserver reliability on each variable. Of a total of 235 ASES members who responded to the online survey, 193 (82.1%) indicated their routine use of a lateral scapular view. The most common reason for obtaining the view was better characterization of acromion morphology (75.4%). The clinical vignette-based survey showed substantial intrarater reliability (κ > 0.6) of the 4 surgeons between the two surveys for the most probable diagnosis, abnormal x-ray findings, and further imaging studies, while the intrarater reliability for treatment plan was moderate (κ= 0.548). The mean diagnostic accuracy of the 4 surgeons was almost equal (74% vs. 75%) between the surveys. Overall, each surgeon's percent agreement across the 2 surveys was over 70%. None of the 4 surgeons recommended a lateral scapular view for further imaging during the first survey; each wanted either advanced imaging (computed tomography, magnetic resonance imaging) or none. The addition of a lateral scapular radiograph in the presence of other orthogonal views does not appear to improve surgeons' diagnostic accuracy or affect their decision-making on the treatment plan in nontraumatic shoulder conditions. The clinical utility of the lateral scapular view may need to be reassessed in this setting.

MRI IN THE EVALUATION OF ROTATOR CUFF TENDONS IN CHRONIC SHOULDER PAIN

Background: Shoulder pain is the third most common cause of non- traumatic musculoskeletal pain with rotator cuff pathology being the most common cause. Magnetic Resonance Imaging (MRI) is the imaging modality of choice which helps in accurate diagnosis for making a treatment plan as wrong treatment strategy may lead to poor prognosis. Methods: A descriptive prospective study conducted in 100 individuals with non-traumatic chronic shoulder pain referred to referred to Department of Radiodiagnosis and Imaging, Dhulikhel Hospital, Kavre between 27th August 2020 to 29th August 2021. MRI images were acquired and analyzed by using IBM SPSS 21.0 version Pearson correlation coefficient, Spearman correlation and chi square tests were used for statistical analysis. Results: Rotator cuff pathology was most commonly encountered with supraspinatus being the most frequently involved tendon seen in 28(63.6%), followed by subscapularis 10(22.7%), infraspinatus 4(9%) and teres minor 2(4.5%).Similarly, MRI detected partial tear of supraspinatus in 23(52.2%),partial tear of subscapularis in 8(18.1%),partial tear of infraspinatus in 3(6.8%) and partial tear of teres minor in 2(4.5%) patients. Likewise, complete tear of supraspinatus was observed in 5(11.3%), complete tear of subscapularis in 2(4.5%) and complete tear of infraspinatus in 1(2.2%). Conclusions: Rotator cuff pathologies were the most common causes of chronic shoulder pain, predominantly partial tear of supraspinatus, followed by subscapularis, infraspinatus and teres minor. Magnetic resonance imaging has become the gold standard for diagnostic imaging of the shoulder related to soft tissue injury.

Relationship between Critical Shoulder Angle and Rotator Cuff Tears in Patients with Non-Traumatic Shoulder Pain

Relationship between Critical Shoulder Angle and Rotator Cuff Tears in Patients with Non-Traumatic Shoulder Pain

Content and consistency of clinical guidelines for diagnostic imaging of non-traumatic lower back, knee and shoulder pain: A scoping review

Purpose: For many patients with musculoskeletal (MSK) pain such as low back (LBP), knee and shoulder pain, there is clinical uncertainty about the role of diagnostic imaging. Given the aging population and the prevalence of structural changes in those with and without pain, the relevance of scan findings is often questionable. Despite this, the use of diagnostic imaging is increasing, and patients often perceive imaging results to be authoritative.

Neurophysiological and psychophysical effects of dry versus sham needling of the infraspinatus muscle in patients with chronic shoulder pain: a randomized feasibility study

BackgroundDry needling (DN) is increasingly used for treating myofascial trigger points (MTrPs) and has shown significant effects on pain and function. This study aimed to assess feasibility of conducting a randomized sham-controlled trial and to collect preliminary data on the effects of infraspinatus DN on corticospinal excitability and mechanical pain sensitivity.MethodThis randomized feasibility study included adults with chronic non-traumatic shoulder pain and a infraspinatus MTrP. Participants were randomized to receive real DN or sham DN in the infraspinatus MTrP. Feasibility outcomes included data pertaining to recruitment, retention of participants, completeness and safety of assessment procedures. Neurophysiological and psychophysical outcomes included corticospinal excitability and mechanical pain sensitivity measured by active motor threshold (aMT) and pressure pain threshold (PPT), respectively. They were assessed at baseline, immediately after and 24 h post-intervention.ResultsTwenty-one participants were recruited over a 6-month period. Nineteen participants completed the treatment and follow-up assessment. Motor evoked potential responses were discernible in all but 1 participant. Only 1 minor adverse event related to transcranial magnetic stimulation (mild headache) affected the measurements. No DN adverse effects were recorded in both groups. An overall completeness rate of 81% was reached, with 70% completeness in the DN group and 91% in the sham group. Data analysis revealed that real DN increased corticospinal excitability (reduced aMT) 24 h post-intervention (Mdn = − 5.96% MSO, IQR = 5.17, p = 0.04) and that sham DN triggered similar responses immediately after the intervention (Mdn = − 1.93% MSO, IQR = 1.11, p = 0.03). Increased mechanical pain sensitivity (reduced PPT) was significant only in the sham group, both immediately (Mdn = − 0.44 kg/cm2, IQR = 0.49, p = 0.01) and 24 h post-intervention (Mdn = − 0.52 kg/cm2, IQR = 1.02, p = 0.02). Changes in corticospinal excitability was positively correlated with changes in mechanical pain sensitivity in the DN group, both immediately (r = 0.77, p = 0.02) and 24 h post-intervention (r = 0.75, p = 0.05).ConclusionThe present study demonstrates the feasibility of quantifying the neurophysiological and psychophysical effects of DN, and provides recommendations and guidelines for future studies. Moreover, it provides preliminary evidence that DN may increase corticospinal excitability of the infraspinatus muscle in patients with chronic shoulder pain and that the relationship of neurophysiological and psychophysical effects is promising to better understand its mechanisms of action.Trial registrationNCT04316793; retrospectively registered November 3, 2020.

Two-point discrimination and judgment of laterality in individuals with chronic unilateral non-traumatic shoulder pain

BackgroundCortical representation of the painful body region may be disrupted in several chronic pain conditions. The two-point discrimination test (TPDT) and the Left/Right Judgement Task (LRJT) have been used to identify changes in the cortical body schema in several chronic pain conditions. However, it is unclear if these changes are present for all chronic pain mechanisms. ObjectivesTo investigate the integrity of the body schema of the painful shoulder in patients with chronic unilateral nociceptive shoulder pain. MethodsThe sample consisted of 52 individuals with chronic unilateral nociceptive shoulder pain. The TPDT was measured over the anterosuperior and lateral regions of both shoulders using a staircase method. Participants also performed judgment tests of shoulder and foot laterality. The comparison of the TPDT and LRJT was performed using the linear regression model with mixed effects. ResultsThere was no difference in TPDT in the anterosuperior and lateral regions when comparing the symptomatic and asymptomatic shoulders. There was no difference in the LRJT accuracy and response time between the symptomatic and asymptomatic shoulders. No differences were observed when comparing LRJT variables from symptomatic shoulder and foot. ConclusionTherefore, results do not provide clear evidence of altered body schema in chronic nociceptive unilateral shoulder pain. This suggest that alterations in body representations may depend on the primary pain mechanism.

Usefulness Of Lateral Scapular View In Initial Evaluation Of Patients With Nontraumatic Shoulder Pain

Traditional evaluation of non-traumatic shoulder pain (NTSP) involves four radiographic views of the joint: AP, Grashey (G), axillary (AX), and lateral scapular (LS). The LS view has historically been useful in diagnosing various glenohumeral injuries. However, some studies have questioned the clinical utility of the LS view. PURPOSE: To determine if including the LS view makes meaningful contribution to accurate diagnosis and treatment plan for NTSP. METHODS: Two sets of fifty clinical vignettes were developed based on patients who presented with NTSP. Each set included identical patient history and physical exam findings, but different radiographs. The first set included AP, G, and AX views. The second set included AP, G, AX, and LS views. Four independent raters initially evaluated the first set of vignettes and provided diagnoses, need for further imaging, and treatment recommendations. Each rater repeated the evaluation one month later with the second set of vignettes. Cohen’s kappa was used to assess intra-observer reliability across both sets of vignettes. A survey was also created and distributed to members of American Shoulder and Elbow Surgeons (ASES) to evaluate how often surgeons utilize the LS view, and for what reason. RESULTS: Cohen’s kappa demonstrated substantial intra-rater reliability between the two sets of vignettes for diagnosis (0.702), x-ray findings (0.645) and further studies (0.620). Percent agreement was calculated and showed that raters maintained the same diagnosis in 77.5% of cases across both sets of vignettes. Furthermore, none of the raters recommended further x-rays when evaluating the first set of vignettes, suggesting they did not feel a need for the LS view prior to developing a diagnosis and treatment plan. Of surgeons who responded to the ASES survey, 82.6% routinely order a LS radiograph to evaluate patients with NTSP. Indications included: better characterization of acromion morphology (75.4%), better appreciation of humeral head relative to glenoid (38.2%), and better evaluation of scapular morphology (28.1%). CONCLUSION: Most surgeons who responded to the ASES survey report routinely ordering a LS radiograph in the initial evaluation of NTSP. However, responses to clinical vignettes suggest that a LS view may not provide a meaningful contribution to diagnosis.

Association of Chiropractic Colleges Research Agenda Conference 2021 Abstracts of Proceedings.

Association of Chiropractic Colleges Research Agenda Conference 2021 Abstracts of Proceedings.

Physical Therapy Management of Nontraumatic Shoulder Problems Lacks High-Quality Clinical Practice Guidelines: A Systematic Review With Quality Assessment Using the AGREE II Checklist.

To appraise the quality of clinical practice guidelines (CPGs) for physical therapy management of nontraumatic shoulder pain disorders. Systematic review of CPGs. Two reviewers independently conducted a search of 7 databases and 7 gray literature sources. We included systematically developed CPGs for physical therapy management of nontraumatic musculoskeletal conditions of the shoulder in adults that were available in full text in the English language. We excluded CPGs for physical therapy management of surgically treated shoulder pain disorders. Three reviewers independently rated the quality of included CPGs using the Appraisal of Guidelines for Research and Evaluation II (AGREE II) instrument. Data were compiled into tables that displayed AGREE II domain scores for each CPG and mean item scores across the CPGs. We included 9 CPGs. Five CPGs focused on rotator cuff disorders, 2 focused on frozen shoulder, and 2 covered a range of soft tissue shoulder diagnoses. Three CPGs were judged as high quality (all were 5 or more years old) and 6 were judged as low quality. The quality domains in which CPGs were rated highest were "scope and purpose" (all CPGs scored greater than 50% and 4 scored greater than 80%) and "clarity of presentation" (all CPGs scored greater than 50% and 7 scored greater than 80%). The domains in which CPGs were rated most poorly were "applicability" (6 CPGs scored 40% or less) and "editorial independence" (4 CPGs scored less than 40%). There were no high-quality, contemporary CPGs to guide physical therapy management of nontraumatic shoulder pain. J Orthop Sports Phys Ther 2021;51(2):63-71. Epub 25 Dec 2020. doi:10.2519/jospt.2021.9397.

Effects of Trigger Point Dry Needling for Nontraumatic Shoulder Pain of Musculoskeletal Origin: A Systematic Review and Meta-Analysis.

The purpose of this study was to evaluate the effects of trigger point (TrP) dry needling alone or as an adjunct to other interventions on pain intensity and related disability in nontraumatic shoulder pain. Ten databases were searched from inception to January 2020 for randomized clinical trials in which at least 1 group received TrP dry needling for shoulder pain of musculoskeletal origin with outcomes collected on pain intensity and related disability. Data extraction including participant and therapist details, interventions, blinding strategy, blinding assessment outcomes, and results were extracted by 2 reviewers. The risk of bias (Cochrane Risk of Bias, Cochrane Guidelines), methodological quality (Physiotherapy Evidence Database score), and evidence level (Grading of Recommendations Assessment, Development, and Evaluation approach) were assessed. The search identified 551 publications with 6 trials eligible for inclusion. There was moderate-quality evidence that TrP dry needling reduces shoulder pain intensity with a small effect (mean difference=-0.49 points, 95% CI=-0.84 to -0.13; standardized mean difference =-0.25, 95% CI=-0.42 to -0.09) and low-quality evidence that TrP dry needling improves related disability with a large effect (mean difference=-9.99 points, 95% CI -15.97 to -4.01; standardized mean difference =-1.14, 95% CI -1.81 to -0.47) compared with a comparison group. The effects on pain were only found at short term. The Cochrane Risk of Bias was generally low, but the heterogenicity of the results downgraded the evidence level. Moderate- to low-quality evidence suggests positive effects of TrP dry needling for pain intensity (small effect) and pain-related disability (large effect) in nontraumatic shoulder pain of musculoskeletal origin, mostly at short term. Future clinical trials investigating long-term effects are needed. Dry needling is commonly used for the management of musculoskeletal pain. This is the first meta-analysis to examine the effects of dry needling on nontraumatic shoulder pain.