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Referred Pain Patterns Infraspinatus Muscle

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ClinicalTrials.gov Identifier: NCT02817269
Recruitment Status : Completed
First Posted : June 29, 2016
Last Update Posted : October 28, 2016
Sponsor:
Information provided by (Responsible Party):
Emilio-José Poveda-Pagán, Universidad Miguel Hernandez de Elche

Brief Summary:
The first aim of the study will be to identify the most common ReP pattern and compare its coincidence with that described by Travell and Simons. Second, the study aim will be to verify whether there are any significant differences by sex and types of technique used in regard to the ReP pattern of TrP 2 of the infraspinatus muscle, an area described as more sensitive.Finally, the third aim of the study will be to determine whether deep dry needling will evoke the LTR and ReP more easily than manual palpation.

Condition or disease Intervention/treatment Phase
Shoulder Pain Other: Manual palpation Other: Deep dry needling Not Applicable

Detailed Description:
Patients will be recruited from a university's employee and student population by advertising at the university. Patients with shoulder complaints (described as pain felt in the shoulder or upper arm) will be randomly assigned to either an manual palpation or deep dry needling group. Participants will be randomly divided into 2 groups, a deep dry needling group and manual palpation group. Visual analogue scale (VAS), referred pain (ReP) pattern and features of referred pain of the infraspinatus muscle will be all assessed post-technique.

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Study Type : Interventional  (Clinical Trial)
Actual Enrollment : 96 participants
Allocation: Randomized
Intervention Model: Crossover Assignment
Masking: Single (Investigator)
Primary Purpose: Diagnostic
Official Title: Referred Pain Patterns in Trigger Point 2 of the Infraspinatus Muscle in Patients With Shoulder Pain
Study Start Date : July 2016
Actual Primary Completion Date : August 2016
Actual Study Completion Date : September 2016

Arm Intervention/treatment
Experimental: Manual palpation group
For the manual palpation group, the reference position will be a lateral position, lying on the non affected shoulder while the affected side will be explored. The arm and elbow are flexed 90° resting on a pillow and legs placed with 90° hip and knee flexion to stabilize the body, with the head resting on a pillow to maintain body alignment. The physiotherapist will be in front of the participant and carried out the examination with flat palpation using the thumb to identify soreness taut band tried to elicit local twitch response and referred pain in the infraspinatus area. First, three attempts will be made to elicit an local twitch response (LTR) using snapping palpation if a response will be obtained. After LRT, referred pain could also be evoked by palpation.
Other: Manual palpation
The manual palpation level will kept constant by applying enough digital pressure to cause the finger nail bed to blanch. When the nail will be turn pale, the amount of pressure will be measured at approximately 3 4kg/cm2 and will be maintained for 5-10 seconds to evoke referred pain. A manual palpation referred pain will be present if the pain radiated far enough for the patient to feel more than just a local pain.

Experimental: Deep dry needling group
For the deep dry needling group, the reference position will be a lateral position, lying on the non affected shoulder while the affected side will be explored. The arm and elbow are flexed 90° resting on a pillow and legs placed with 90° hip and knee flexion to stabilize the body, with the head resting on a pillow to maintain body alignment. The physiotherapist will be in front of the participant and carried out the examination with flat palpation using the thumb to identify soreness taut before making the needle insertion. Sterile stainless steel needles (length 40mm/caliber 0.32 with a cylindrical plastic guide) will be used.
Other: Deep dry needling
Intramuscular needling will be carried out via deep dry needling into myofascial trigger point (MTrP) area without the introduction any substances. The aim is to elicit a local twitch response upon inserting the needle into the MTrP area and perform a neurological stimulation (by rotating the needle 360 degrees) to more easily evoke referred pain, holding for 10 seconds and then extracting the needle gently. The procedure will be followed by one minute of haemostatic compression.




Primary Outcome Measures :
  1. Mapping of Referred Pain Pattern [ Time Frame: One month ]
    The participants from both groups will ask to report whether ReP is evoked and to describe the ReP pattern using an anatomical map of the upper half of the human body divided into eighteen areas. Nine areas corresponded to the anterior part of the body and the other nine to the posterior part of the body.


Secondary Outcome Measures :
  1. Prevalence active trigger point [ Time Frame: One month ]
    Active trigger point is considered: Soreness taut band and familiar pain.

  2. Evocation of Local Twitch Response [ Time Frame: One month ]
    These were assigned a numerical value of 0 (yes) or 1 (no) for better statistical handling of the data.

  3. Subjective pain intensity: Visual Analogue Scale (VAS) [ Time Frame: One month ]
    The VAS for pain measures the amount of pain experienced by a subject on a continuum from 0 to 10, with 0 being no pain and 10 maximum pain.



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Ages Eligible for Study:   18 Years to 65 Years   (Adult, Older Adult)
Sexes Eligible for Study:   All
Accepts Healthy Volunteers:   No
Criteria

Inclusion Criteria:

  • Aged between 18 and 65 years.
  • To remain seated or in front of data visualization screens (tablets, computers or smartphones) for at least 4 hours a day.
  • Shoulder complaints in the last six weeks.

Exclusion Criteria:

  • Patients with evidence of serious medical illness.
  • Cognitive impairment.
  • Psychosocial disorders.
  • Bilateral affectation of shoulder pain.
  • Pregnancy.

Information from the National Library of Medicine

To learn more about this study, you or your doctor may contact the study research staff using the contact information provided by the sponsor.

Please refer to this study by its ClinicalTrials.gov identifier (NCT number): NCT02817269


Sponsors and Collaborators
Universidad Miguel Hernandez de Elche
Investigators
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Study Chair: José V Segura-Heras, PhD in math UNIVERSIDAD MIGUEL HERNÁNDEZ DE ELCHE (ALICANTE)

Publications of Results:
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Responsible Party: Emilio-José Poveda-Pagán, PhD, Universidad Miguel Hernandez de Elche
ClinicalTrials.gov Identifier: NCT02817269     History of Changes
Other Study ID Numbers: UniversidadMHE-1
First Posted: June 29, 2016    Key Record Dates
Last Update Posted: October 28, 2016
Last Verified: October 2016
Individual Participant Data (IPD) Sharing Statement:
Plan to Share IPD: Undecided

Keywords provided by Emilio-José Poveda-Pagán, Universidad Miguel Hernandez de Elche:
Shoulder pain
Trigger points
Referred pain
Visual analogue scale

Additional relevant MeSH terms:
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Shoulder Pain
Pain, Referred
Arthralgia
Joint Diseases
Musculoskeletal Diseases
Pain
Neurologic Manifestations
Signs and Symptoms