Effectiveness of Dry Needling and Physical Therapy Versus Physical Therapy Alone Following Shoulder Stabilization Repair
Condition: Shoulder Pain
MeSH terms: Shoulder Pain
Study type: Interventional

Summary: 
      The purpose of this single-blinded, randomized clinical trial is to determine the
      effectiveness of dry needling compared to a standard shoulder rehabilitation program on range
      of motion, functional movement, and pain in patients who have undergone shoulder
      stabilization surgery. Measurements of the aforementioned dependent variables will be taken
      at time intervals of four weeks, eight weeks, 12 weeks, and six months post-operatively. It
      is hypothesized that the inclusion of dry needling will result in an increase in range of
      motion, increase in functional movement, and decrease in pain at an accelerated rate when
      compared to rehabilitation alone.
    

Detailed description: 
      Methodology /Technical Approach 30-50 subjects at least four weeks after shoulder
      stabilization surgery will be randomized into two groups (one experimental group and one
      control group). Subjects in the experimental group will receive Trigger Point Dry Needling
      (TDN) intervention with standard rehabilitation protocol (Appendix A) while subjects in the
      control group will receive the same standard rehabilitation protocol without TDN. The
      experimental group will receive trigger point dry needling one time per week for four to six
      weeks in addition to the standard rehabilitation protocol. The control group will receive
      only the standard rehabilitation protocol. Baseline measurements will be taken at
      approximately four weeks post operatively, and subsequent measurements will be recorded at
      eight weeks, 12 weeks, and six months.

      All patients who have undergone a shoulder stabilization procedure will be invited to
      participate. Description of the study and informed consent will take place prior to
      randomization. Concealed randomization will take place 0-7 days post-operatively.

      At 4 weeks post-operatively, the following assessment tests will be undertaken: supine
      shoulder flexion, supine shoulder external rotation, supine shoulder internal rotation,
      functional movement testing, functional outcome measures, and the numeric pain rating scale.
      1,2,3 Those subjects in the 'experimental group' will receive manual palpation of all upper
      quarter muscles, including the cervical and thoracic spine region, to detect the presence of
      myofascial trigger points (TPs). Dry needling will be performed to all detected TPs by a
      provider trained and experienced in TDN.

      In addition to the TDN intervention, the experimental group subjects will undergo a
      rehabilitation program in accordance with a shoulder stabilization repair protocol which is
      the standard of care for this surgical procedure. Per the shoulder stabilization protocol,
      subjects will be instructed in a home exercise plan (HEP) that will reinforce the clinical
      treatment, will be provided with a handout of instructions, and will be required to
      demonstrate all exercises correctly.

      Subjects in the 'control group' will undergo a rehabilitation program as described above for
      the 'experimental group', except that they will not receive a TDN intervention.

      Objectives:

        1. To determine if the addition of upper quarter TDN to a rehabilitation protocol is more
           effective in improving range of motion and functional movement when compared to a
           rehabilitation protocol alone after shoulder stabilization surgery.

        2. To determine if the addition of upper quarter TDN to a rehabilitation protocol is more
           effective in decreasing pain than a rehabilitation protocol alone after shoulder
           stabilization surgery.
    

Intervention name(s): Rehabilitation and Dry Needling; Rehabilitation
Intervention type(s): Device; Device
Intervention description(s): Subjects will receive post-operative rehabilitation that is the standard of care for the surgical procedure they underwent. Rehabilitation will begin within one week after surgery and will continue for the duration of their recovery; two to three treatments a week for approximately 6-9 months. Subjects in this group will also receive dry needling as an adjunct intervention. Dry needling treatment will be performed one time a week for four weeks and will begin four weeks post-operative.; Subjects will receive post-operative rehabilitation that is the standard of care for the surgical procedure they underwent. Rehabilitation will begin within one week after surgery and will continue for the duration of their recovery; two to three treatments a week for approximately 6-9 months.
Allocation: Randomized
Intervention model: Factorial Assignment
Masking: Single (Outcomes Assessor)
Primary purpose: Treatment
Keywords: Dry Needling, Shoulder Stabilization