The Effect of Dry Needling of the Trigger Points of Shoulder Muscles on Pain and Grip Strength in Patients with Lateral Epicondylitis: A Pilot Study

Abstract

Background: Lateral epicondylitis, also known as tennis elbow, is the most common overuse syndrome of the elbow. The severity of pain may not be directly caused by tendinopathy of wrist extensors since trigger points of the shoulder muscles have a referral zone in the arm and elbow. Therefore the aim of this study was to evaluate the effect of dry needling of shoulder myofascial trigger points on wrist extensors muscles pain and function.Methods: Fourteen female patients with tennis elbow (aged 20 - 45 years old) were recruited after primary evaluation by an orthopedist. They entered the study if they had pain in the lateral aspect of elbow of the dominant hand for more than 3 months along with the presence of myofascial trigger points in any muscles of supra spinatus, infra spinatus, sub scapularis or scalenes. Pain pressure threshold, maximal grip force and pain intensity of the hand extensors on lateral epicondyle of elbow were measured before and after treatment. Pain intensity was measured on a one to ten scale of visual analogue scale (VAS). A hand dynamometer used to measure the maximal grip force value of the affected hand in 0˚shoulder flexion/abduction, 90˚ elbow extension and mid-poison of forearm in sitting position .A pressure algometer was applied on hand extensor muscles to define their trigger point sensitivity. For the control group, treatment regimens consisted of routine physical therapy of tennis elbow. This regime was accompanied by dry needling of mentioned muscles for the intervention group. Wilcoxon and Mann-Whitney non-parametric tests were used for statistical analysis.Results: Comparison of the results after intervention showed that the patients’ pain significantly decreased in both groups (P <0.001); but the patient’s PPT and grip force significantly increased solely in the intervention group (P <0.05). Mann Whitney test showed significant pain differences in both groups (P = 0.001).The comparison of differences showed that the grip force and PPT statistically improved in the intervention group (P <0.05).Conclusion: Dry needling of affected shoulder muscles along with routine physical therapy has a more significant effect on improvement of pain, sensitivity and grip power of patient’s with tennis elbow syndrome.