Background/Purpose: Upper quarter pain and dysfunction is commonly seen in the outpatient orthopedic setting. It can include impairments and functional limitations of the neck, shoulder, arm, and thorax. There are numerous physical therapy interventions available to treat these dysfunctions, including manual therapy and therapeutic exercises. The purpose of this paper is to determine the efficacy of dry needling, which is a skilled manual intervention that utilizes acupuncture needles to penetrate and release trigger points within the muscle belly. More specifically, this literature review aims to answer the following question: In patients with upper quarter pain and dysfunction, how effective is dry needling compared to other treatments in promoting functional outcomes? Case Description: Patient is a 58 year old female who was referred to the outpatient orthopedic clinic for a rotator cuff tear. This injury had occurred approximately eight months prior to her initial visit, and she had not yet undergone any conservative or surgical treatments. Upon evaluation she exhibited left shoulder joint stiffness, decreased range of motion (ROM), decreased strength, difficulty with dressing independent activities of daily living (IADLs), and work related lifting. Dry needling was utilized in the patients plan of care during four separate visits, along with other manual therapy techniques, therapeutic exercise, and modalities. Outcomes: She was discharged after 9 visits over an 8 week span. She met all of her goals - regained full shoulder active range of motion (AROM) and strength and reported 0/10 pain for all motions. She was able to dress and lift 30 pounds overhead with proper body mechanics with no pain. Discussion: The reviewed literature demonstrated that dry needling is both statistically and clinically effective in promoting functional outcomes in patients with upper quarter pain and dysfunction in the short term compared to other treatments (including sham/placebo and lidocaine injections). Outcomes included improvements in pain intensity, pressure pain threshold, range of motion, disability, and other quality of life measures. Dry needling has similar efficacy when compared to trigger point compression technique, which is a commonly used physical therapy intervention. Early introduction of dry needling is seemingly most effective to reduce pain and regain range of motion; thus allowing incorporation of other physical therapy interventions to further promote functional outcomes. Physical therapy often includes a multimodal approach and dry needling is a safe, effective, and quick method that should be considered for patients with upper quarter impairments.
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Dry needling, upper quarter, pain, dysfunction, functional outcomes
Clark, Jael. "Dry Needling for Upper Quarter Pain and Dysfunction." (2015). http://digitalrepository.unm.edu/dpt/107
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