Patient case (clinical description): A 66-year-old woman comes to the office due to joint pain in the hands and periodic morning stiffness that lasts less than 15 minutes.  The pain is moderately severe and worsens with daily activity. The patient used Tylenol with minimal relief.  Past medical history is notable for hypertension and hypercholesteremia.  Physical examination shows firm nodules over the distal interphalangeal joints, bilaterally. The patient has pain in her knees as well. The knees are stiff in the morning for less than 30 minutes and become worse with climbing stairs. She has some sensation of bone friction during activity. X-ray shows narrowing of the joint space, subchondral bone sclerosis and osteophyte formation along the joints.

Patient's own account: I'm a 66-year-old woman and I went to my doctor's office because of a bloody joint pain in my hands that has been lasting for a while. The pain comes and go in the morning usually. I feel like a stiffness that last less than 15 minutes. The pain is moderately severe but it gets worse when I'm using my hands. I used Tylenol which helped a little. Apart from that, I suffer from hypertension and high cholesterol. The doctor made me notice that I have bumps around both of my hand joints. I also suffer from my knees and they are also stiff in the morning for around 30 min. It's even worse when I climb up the stairs! I also feel like my bones are rubbing against each other when I'm moving. The X-ray showed that I have narrow joint space, I have sclerosis, and abnormal growths of bone along my joints.

Clinical trial: Dry Needling Versus Conventional Physical Therapy in Patients With Knee Osteoarthritis

Eligibility criteria:
Inclusion Criteria:

          1. Report of knee pain of at least 2/10 per NPRS (0---10 scale) for >3 months

          2. Report of at least 3 of the following per Altman et al. (1986)

               -  Over 50 Years of age

               -  Less than 30 minutes of morning stiffness

               -  Crepitus on active motion

               -  Bony tenderness

               -  Bony enlargement

               -  No palpable warmth of synovium

        Exclusion Criteria:

          1. Report of red flags to manual physical therapy to include: hypertension, infection,
             diabetes, peripheral neuropathy, heart disease, stroke, chronic ischemia, edema,
             severe varicosities, tumor, metabolic disease, prolonged steroid use, fracture, RA,
             osteoporosis, severe vascular disease, malignancy, etc.

          2. History of previous surgery to the knee

          3. History of physical therapy, massage therapy, chiropractic treatment, or injections
             for knee pain in the last 4 weeks

          4. History of a surgical procedure on either lower extremity in last 6 months

          5. Two or more positive neurologic signs consistent with nerve root compression,
             including any two of the following:

               -  Weakness involving a major muscle group of the lower extremity.

               -  Diminished patella or achilles tendon reflex

               -  Diminished or absent sensation to pinprick in lower extremity dermatome

          6. Involvement in litigation or worker's compensation regarding knee pain.

          7. Any condition that might contraindicate the use of electro-needling

          8. The patient is pregnant.
No condition on gender to be admitted to the trial.
No healthy subjects accepted to join the trial.
Subject must be at least 18 Years old.


Eligibility (NLI label): Entailment