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* OBJECTIVES: To compare the effects of spinal thrust manipulation and electrical dry needling (TMEDN group) to those of nonthrust peripheral joint/Soft tissue mobilization, exercise, and interferential current (NTMEX group) on pain and disability in patients with subacromial pain syndrome (SAPS). * DESIGN: Randomized, single-blinded, multi-center parallel-group trial. * METHODS: Patients with SAPS were randomized into the TMEDN group (n = 73) or the NTMEX group (n = 72). Primary outcomes included the Shoulder Pain and Disability Index and the numeric pain-rating scale. Secondary outcomes included the global rating of change scale (GROC) and medication intake. The treatment period was 6 weeks, with follow-ups at 2 weeks, 4 weeks, and 3 months. * RESULTS: At 3 months, the TMEDN group experienced greater reductions in shoulder pain and disability (P<.001) compared to the NTMEX group. Effect sizes were large in favor of the TMEDN group. At 3 months, a greater proportion of patients within the TMEDN group achieved a successful outcome (GROC score of 5 or greater) and stopped taking medication (P<.001). * CONCLUSION: Cervicothoracic and upper-rib thrust manipulation combined with electrical dry needling resulted in greater reductions in pain, disability, and medication intake than nonthrust peripheral joint/soft tissue mobilization, exercise, and interferential current in patients with SAPS. The effects were maintained at 3 months. [ABSTRACT FROM AUTHOR]

* BACKGROUND: Patients with lateral elbow pain are often diagnosed with lateral epicondylalgia. Lateral elbow pain is often associated with dysfunction of the wrist extensor muscles; however, in some cases, it can also mimic signs and symptoms of radial nerve dysfunction. * CASE DESCRIPTION: In this case report, a 43-year-old man, who was originally referred with a diagnosis of lateral epicondylalgia as a result of playing table tennis and who previously responded favorably to manual therapy and exercise, presented to the clinic for treatment. An exacerbation while participating in a table tennis match resulted in a return of his lateral epicondylalgia symptoms, which did not respond favorably to the same interventions used in his prior course of therapy. Further examination revealed sensitization of the radial nerve, which was treated with 2 sessions of ultrasound-guided percutaneous electrical nerve stimulation and 4 weeks of a low-load, concentric/eccentric exercise program for the wrist extensors. * OUTCOMES: Following this intervention, the patient experienced clinically meaningful improvement in pain intensity (numeric pain-rating scale), function (Patient-Rated Tennis Elbow Evaluation), and related disability (Disabilities of the Arm, Shoulder and Hand questionnaire). The patient progressively exhibited complete resolution of pain and function, which was maintained at 2 years. * DISCUSSION: This case report demonstrates the outcomes of a patient with lateral elbow pain who did not respond to manual therapy and exercise. Once radial nerve trunk sensitivity was identified and the intervention, consisting of ultrasound-guided percutaneous electrical nerve stimulation targeting the radial nerve combined with a low-load exercise program, was applied, a full resolution of pain and function occurred rapidly. Future clinical trials should examine the effect of percutaneous electrical nerve stimulation in the management of nerve-related symptoms associated with musculoskeletal pain conditions. * LEVEL OF EVIDENCE: Therapy, level 5. [ABSTRACT FROM AUTHOR]

* BACKGROUND: Carpal tunnel syndrome (CTS) results in substantial societal costs and can be treated either by nonsurgical or surgical approaches. * OBJECTIVE: To evaluate differences in cost-effectiveness of manual physical therapy versus surgery in women with CTS. * METHODS: In this randomized clinical trial, 120 women with a clinical and an electromyographic diagnosis of CTS were randomized through concealed allocation to either manual physical therapy or surgery. Interventions consisted of 3 sessions of manual physical therapy, including desensitization maneuvers of the central nervous system, or decompression/release of the carpal tunnel. Societal costs and health-related quality of life (estimated by the European Quality of Life-5 Dimensions [EQ-5D] scale) over 1 year were used to generate incremental cost per quality-adjusted life year ratios for each treatment. * RESULTS: The analysis was possible for 118 patients (98%). Incremental quality-adjusted life years showed greater cost-effectiveness in favor of manual physical therapy (difference, 0.135; 95% confidence interval: 0.134,0.136). Manual therapy was significantly less costly than surgery (mean difference in cost per patient, €2576; P<.001). Patients in the surgical group received a greater number of other treatments and made more visits to medical doctors than those receiving manual physical therapy (P = .02). Absenteeism from paid work was significantly higher in the surgery group (P<.001). The major contributors to societal costs were the treatment protocol (surgery versus manual therapy mean difference, €106980) and absenteeism from paid work (surgery versus manual physical therapy mean difference, €42224). * CONCLUSION: Manual physical therapy, including desensitization maneuvers of the central nervous system, has been found to be equally effective but less costly (ie, more cost-effective) than surgery for women with CTS. From a cost-benefit perspective, the proposed CTS manual physical therapy intervention can be considered. * LEVEL OF EVIDENCE: Economic and decision analyses, level 1b. [ABSTRACT FROM AUTHOR]

This randomized clinical trial compared the effects of adding ultrasound (US)-guided percutaneouselectrolysis into a program consisting of manual therapy and exercise on pain, shoulder-related disability, function, and pressure sensitivity in subacromial pain syndrome. Fifty patients with subacromial pain syndrome were randomized into manual therapy and exercise or percutaneous electrolysis group. All patients received the same manual therapy and exercise program, 1 session per week for 5 consecutive weeks. Patients assigned to the electrolysis group also received the application of percutaneous electrolysis at each session. The primary outcome was assessed using the Disabilitiesof the Arm, Shoulder and Hand (DASH) questionnaire. Secondary outcomes included pain, function (Shoulder Pain and Disability Index [SPADI]) pressure pain thresholds (PPTs) and Global Ratingof Change (GROC). They were assessed at baseline, post-treatment, and 3 and 6 months after treatment. Both groups showed similar improvements in the primary outcome (DASH) at all follow-ups (P = .051). Subjects receiving manual therapy, exercise, and percutaneous electrolysis showed significantlygreater changes in shoulder pain (P < .001) and SPADI (P < .001) than did those receiving manual therapy and exercise alone at all follow-ups. Effect sizes were large (standardized mean difference >.91) for shoulder pain and function at 3 and 6 months in favor of the percutaneous electrolysis group. No between-group differences in PPT were found. The current clinical trial found that the inclusion of US-guided percutaneous electrolysis in combination with manual therapy and exercise resulted in no significant differences for related disability (DASH) compared with the application of manual therapy and exercise alone in patients with subacromial pain syndrome. Nevertheless, differences were reported for some secondary outcomes such as shoulder pain and function (SPADI). Whether these effects are reliable should be addressed in future studies.Perspective: This study found that the inclusion of US-guided percutaneous electrolysis into a manual therapy and exercise program resulted in no significant differences for disability and pressure pain sensitivity compared with the application of manual therapy and exercise alone in patients with subacromial pain syndrome. [ABSTRACT FROM AUTHOR]

Abstract Objective The purpose of the current randomized clinical trial was to examine the effects of cervical thrust manipulation or sham manipulation on cervicocephalic kinaesthetic sense, pain, pain-related disability, and pressure pain sensitivity in patients with mechanical neck pain. Methods Fifty-four individuals with neck pain were randomly assigned to receive either a cervical manipulation (right or left) or a sham manipulation. Immediate outcomes included cervical kinesthetic sense as assessed by joint position sense error (JPSE) and pressure pain thresholds (PPTs). At 1 week, neck pain intensity (numerical pain rate scale) and neck pain-related disability (Neck Disability Index [NDI]) outcomes were also collected. Results The mixed-model analysis of covariance revealed a significant group × time interaction in favor of the cervical thrust manipulation group for the JPSE on rotation and extension. There was also a significant interaction for changes in PPTs at C5 to C6 and tibialis anterior. At the 1-week follow-up, a significant interaction existed for neck-related disability but not for neck pain at rest, worst pain, or lowest pain experienced the preceding week. Conclusions Our results suggest that cervical spine thrust manipulation improves JPSE, PPT and NDI in participants with chronic mechanical neck pain. Furthermore, changes in JPSE and NDI were large and surpass published minimal detectable changes for these outcome measures. In addition, the effect sizes of PPTs were medium; however, only C5 to C6 zygapophyseal joint exceeded the minimal detectable change. In contrast, cervical thrust manipulation did not improve neck pain intensity at 1 week after the intervention. [ABSTRACT FROM AUTHOR]

STUDY DESIGN: Clinical measurement study. BACKGROUND: Achilles tendinopathy is a prevalent sport-related injury. The Victorian Institute of Sport Assessment-Achilles (VISA-A) questionnaire is a widely used patient-reported outcome to assess the severity of symptoms for this injury. OBJECTIVE: To adapt the VISA-A questionnaire into Spanish and to assess its psychometric properties. METHODS: Cross-cultural adaptation was conducted according to recommended guidelines. The Spanish VISA-A (VISA-A-Sp) questionnaire was administered to 210 subjects: 70 healthy students, 70 active at-risk subjects (participating in running and jumping), and 70 patients diagnosed with Achilles tendinopathy. Participants were assessed at baseline and after 3 to 5 days. The injured subjects were also evaluated with a quality-oflife questionnaire (Medical Outcomes Study 36-Item Short-Form Health Survey [SF-36]) and at discharge. The final VISA-A-Sp was evaluated for reliability, validity, and responsiveness. RESULTS: Cronbach alpha for the VISA-A-Sp was greater than .8. The intraclass correlation coefficient (model 2,1) was 0.993 (95% confidence interval: 0.991, 0.995; P<.05). In the confirmatory factor analysis, a 1-factor solution obtained a relatively good fit. Subjects with Achilles tendinopathy scored significantly lower than the other 2 groups (P<.001). The VISA-A-Sp score within the Achilles tendinopathy group showed significant correlations with SF-36 physical components (Spearman rho>0.5, P<.001). The standard error of the measurement was 2.53, and the minimal detectable change at the 95% confidence level was 7 points. The responsiveness indicators included an effect size of 2.16 and a standardized response mean of 1.92. CONCLUSION: The VISA-A-Sp showed satisfactory psychometric properties that were comparable to the original English-language version. Therefore, it can be recommended for use in clinical practice and research for assessing the severity of symptoms in Spanish-speaking athletes who suffer from Achilles tendinopathy. [ABSTRACT FROM AUTHOR]

Background: The application of dry needling usually is associated with postneedling-induced pain. A postneedling intervention to reduce this adverse event is needed.Objective: To determine the effectiveness of low-load exercise on reducing postneedling-induced pain after dry needling of active trigger points (TrPs) in the infraspinatus muscle in subacromial pain syndrome.Design: A 72-hour follow-up, single-blind randomized controlled trial.Setting: Urban hospitals.Participants: Individuals with subacromial pain syndrome (n = 90, 52% female, mean age: 35 ± 13 years) with active TrPs in the infraspinatus muscle.Interventions: All individuals received dry needling into the infraspinatus active TrP. Then, they were divided randomly into an experimental group, which received a single bout of low-load exercise of shoulder muscles; a placebo group, which received inactive ultrasound for 10 minutes; and a control group, which did not receive any intervention.Outcome Measures: Numerical Pain Rating Scale (0-10 point) was administered postneedling, immediately postintervention (2 minutes), and 24, 48, and 72 hours after needling. Shoulder pain (Numerical Pain Rating Scale, 0-10) and disability (Disabilities of the Arm, Shoulder and Hand; Shoulder Pain and Disability Index) were assessed before and 72 hour after needling.Results: The 5 × 3 analysis of covariance showed that the exercise group demonstrated a larger decrease in postneedling-induced pain immediately after (P = .001), 24 hours (P = .001), and 48 hours after (P = .006) than placebo or control groups. No differences were found at 72 hours (P = .03). Similar improvements in shoulder pain (P < .001) and related disability (Disabilities of the Arm, Shoulder and Hand: P < .001; Shoulder Pain and Disability Index: P < .001) were observed 72 hours after needling, irrespective of the treatment group.Conclusions: Low-load exercise was effective for reducing postneedling-induced pain on active TrPs in the infraspinatus muscle 24 and 48 hours after needling. The application of a postneedling intervention did not influence short-term pain and disability changes.Level Of Evidence: I. [ABSTRACT FROM AUTHOR]

This randomized clinical trial investigated the effectiveness of exercise versus exercise plus trigger point (TrP) dry needling (TrP-DN) in subacromial pain syndrome. A randomized parallel-group trial, with 1-year follow-up was conducted. Fifty subjects with subacromial pain syndrome were randomly allocated to receive exercise alone or exercise plus TrP-DN. Participants in both groups were asked to perform an exercise program of the rotator cuff muscles twice daily for 5 weeks. Further, patients allocated to the exercise plus TrP-DN group also received dry needling to active TrPs in the muscles reproducing shoulder symptoms during the second and fourth sessions. The primary outcome was pain-related disability assessed using the Disabilities of the Arm, Shoulder, and Hand questionnaire. Secondary outcomes included mean current pain and the worst pain experienced in the shoulder during the previous week. They were assessed at baseline, 1 week, and 3, 6, and 12 months after the end of treatment. Analysis was according to intention to treat with mixed analysis of covariance adjusted for baseline outcomes. At 12 months, 47 patients (94%) completed follow-up. Statistically larger improvements (all, P < .01) in shoulder disability was found for the exercise plus TrP-DN group at all follow-up periods (post: Δ -20.6 [95% confidence interval (CI) -23.8 to -17.4]; 3 months: Δ -23.2 [95% CI -28.3 to -18.1)]; 6 months: Δ -23.6 [95% CI -28.9 to -18.3]; 12 months: Δ -13.9 [95% CI -17.5 to -10.3]). Both groups exhibited similar improvements in shoulder pain outcomes at all follow-up periods. The inclusion of TrP-DN with an exercise program was effective for improving disability in subacromial pain syndrome. No greater improvements in shoulder pain were observed.Perspective: This study found that the inclusion of 2 sessions of TrP-DN into an exercise program was effective for improving shoulder pain-related disability at short-, medium-, and long-term; however, no greater improvement in shoulder pain was observed. [ABSTRACT FROM AUTHOR]

Objective: The purpose of this study was to evaluate the effects of including 1 session of trigger point dry needling (TrP-DN) into a multimodal physiotherapy treatment on pain and function in postoperative shoulder pain. Methods: Twenty patients (5 male; 15 female; age, 58 ± 12 years) with postoperative shoulder pain after either open reduction and internal fixation with Proximal Humeral Internal Locking System plate plate or rotator cuff tear repair were randomly divided into 2 groups: physiotherapy group (n = 10) who received best evidence physical therapy interventions and a physical therapy plus TrP-DN group (n = 10) who received the same intervention plus a single session of TrP-DN targeted at active TrPs. The Constant-Murley score was used to determine pain, activities of daily living, range of motion, and strength, which was captured at baseline and 1 week after by an assessor blinded to group assignment. Results: Analysis of variance showed that subjects receiving TrP-DN plus physical therapy exhibited greater improvement in the Constant-Murley total score (P < .001 ) and also activities of daily living (P < .001 ) and strength (P = .019) subscales than those receiving physical therapy alone. Between-group effect sizes were large in favor of the TrP-DN group (0.97 < SMD < 1.45). Both groups experienced similar improvements in pain (P < .001) and range of motion (P < .001 ). Conclusions: Our results suggest that including a single session of TrP-DN in the first week of a multimodal physical therapy approach may assist with faster increases in function in individuals with postoperative shoulder pain. [ABSTRACT FROM AUTHOR]