Calvo-Lobo César, Pacheco-da-Costa Soraya, Martínez-Martínez Jorge, Rodríguez-Sanz David, Cuesta-Álvaro Pedro, López-López Daniel
Physiotherapy Department, Faculty of Health, Exercise and Sport, European University of Madrid, Villaviciosa de Odón, Madrid, Spain.
Nursing and Physiotherapy Department, Physiotherapy Teaching Unit, University of Alcalá, Alcalá de Henares, Madrid, Spain.
J Geriatr Phys Ther. 2018 Jan/Mar;41(1):1-13. doi: 10.1519/JPT.0000000000000079.
Shoulder pain is a prevalent condition in older adults. Some authors associate nonspecific shoulder pain with myofascial trigger points (MTrPs) in the infraspinatus muscle. Dry needling is recommended to relieve the MTrP pain of shoulders in the short term (<9 days). Active MTrPs dry needling improves shoulder pain and the irritability of the satellite MTrPs in the referred pain area. Nociceptive activity at a latent MTrP may influence motor activity and the sensitivity of MTrPs in distant muscles at a similar segmental level. Therefore, this study aimed to evaluate dry needling on 1 latent MTrP, in conjunction with 1 active MTrP, in the infraspinatus muscle of older adults with nonspecific shoulder pain.
A single-center, randomized, single-blinded, controlled study (NCT02032602) was carried out. Sixty-six patients aged 65 years and older with trigger points in the ipsilateral infraspinatus of the painful shoulder were randomly assigned to (1) of (2) treatment groups. A session of dry needling on the infraspinatus was performed in (1) the most hyperalgesic active and latent MTrP or (2) only the most hyperalgesic active MTrP. The Numeric Rating Scale, the pressure pain threshold (primary outcome) on the anterior deltoid and extensor carpi radialis brevis latent MTrPs, and grip strength were assessed before, after, and 1 week after the intervention.
Statistically significant differences in the reduction of pain intensity (P ≤ .001; η = 0.159-0.269; d = 1.017-1.219) and the increase of pressure pain threshold (P < .001; η = 0.206-0.481; d = 0.870-1.924) were found for the (1) treatment group immediately and 1 week postintervention. Nevertheless, no statistical significant differences were found in grip strength (P >. 05; η = 0.006-0.033; d = 0.158-0.368).
One dry needling intervention of the latent MTrP associated with the key active MTrP of the infraspinatus reduces pain intensity and the irritability of the satellite MTrPs located in the referred pain area in the short term in older adults with nonspecific shoulder pain.
肩痛在老年人中很常见。一些作者将非特异性肩痛与冈下肌的肌筋膜触发点（MTrP）联系起来。建议采用干针疗法在短期内（<9天）缓解肩部MTrP疼痛。对活跃的MTrP进行干针治疗可改善肩部疼痛以及牵涉痛区域卫星MTrP的激惹性。潜在MTrP处的伤害性活动可能会影响运动活动以及相似节段水平远处肌肉中MTrP的敏感性。因此，本研究旨在评估对患有非特异性肩痛的老年人冈下肌中的1个潜在MTrP联合1个活跃MTrP进行干针治疗的效果。
开展了一项单中心、随机、单盲、对照研究（NCT02032602）。66名年龄在65岁及以上、患侧肩部冈下肌有触发点的患者被随机分配到（1）或（2）治疗组。在（1）最痛的活跃和潜在MTrP处或（2）仅在最痛的活跃MTrP处对冈下肌进行一次干针治疗。在干预前、干预后及干预后1周评估数字评分量表、三角肌前部和桡侧腕短伸肌潜在MTrP处的压痛阈值（主要结局）以及握力。
在干预后即刻及干预后1周，（1）治疗组在疼痛强度降低（P≤.001；η=0.159 - 0.269；d = 1.017 - 1.219）和压痛阈值升高（P<.001；η=0.206 - 0.481；d = 0.870 - 1.924）方面存在统计学显著差异。然而，在握力方面未发现统计学显著差异（P>.05；η=0.006 - 0.033；d = 0.158 - 0.368）。
对患有非特异性肩痛的老年人，对与冈下肌关键活跃MTrP相关的潜在MTrP进行一次干针干预可在短期内降低疼痛强度，并降低位于牵涉痛区域的卫星MTrP的激惹性。
