Lane Elizabeth, Clewley Derek, Koppenhaver Shane
J Orthop Sports Phys Ther. 2017 Apr;47(4):287-292. doi: 10.2519/jospt.2017.7055. Epub 2017 Mar 3.
Study Design Case report. Background Abnormal sensation, such as numbness or tingling, is traditionally thought to originate from neural compression. There is limited evidence to support reports of abnormal sensation arising from a trigger point. Case Description The patient was a 60-year-old woman with a primary complaint of right shoulder pain and secondary complaints of neck pain and right upper extremity numbness. Cervical spine neurological examination was unremarkable, and manual examination did not reproduce the patient's arm numbness or tingling symptoms. Compression of a trigger point in the infraspinatus and teres minor reproduced the patient's primary complaint of shoulder pain. The initial intervention included dry needling, which reproduced her upper extremity numbness. Subsequent treatment included manual therapy and exercise. Outcomes The patient was seen for a total of 3 visits, including the evaluation. Dry needling was utilized in 2 of her 3 visits. At discharge, she reported complete resolution of pain and altered sensation. Additionally, her scores on the Neck Disability Index, numeric pain-rating scale, and global rating of change exceeded the minimal clinically important difference. These outcomes were maintained at 2- and 12-month follow-up phone calls. Discussion This case report described the examination and use of dry needling in a case where the diagnosis was unclear. Clinicians may consider trigger point referral when examining patients with reports of abnormal sensation, especially when a more common cause cannot be identified. Level of Evidence Therapy, level 5. J Orthop Sports Phys Ther 2017;47(4):287-292. Epub 3 Mar 2017. doi:10.2519/jospt.2017.7055.
病例报告。背景：传统上认为异常感觉，如麻木或刺痛，源于神经受压。支持触发点引起异常感觉报告的证据有限。病例描述：患者为一名60岁女性，主要诉求为右肩疼痛，次要诉求为颈部疼痛和右上肢麻木。颈椎神经学检查无异常，手法检查未再现患者的手臂麻木或刺痛症状。对冈下肌和小圆肌触发点的按压再现了患者的主要诉求——肩痛。初始干预包括干针治疗，这再现了她的上肢麻木症状。后续治疗包括手法治疗和运动。结果：患者共就诊3次，包括评估那次。在她的3次就诊中有2次采用了干针治疗。出院时，她报告疼痛和异常感觉完全消失。此外，她在颈部功能障碍指数、数字疼痛评分量表和整体变化评分上的得分超过了最小临床重要差异。这些结果在2个月和12个月的随访电话中得以维持。讨论：本病例报告描述了在诊断不明确的情况下的检查和干针治疗的应用。临床医生在检查有异常感觉报告的患者时，尤其是在无法确定更常见病因时，可考虑触发点转诊。证据水平：治疗性，5级。《矫形与运动物理治疗杂志》2017年；47(4)：287 - 292。2017年3月3日在线发表。doi:10.2519/jospt.2017.7055 。
