Needling Infraspinatus Helps Elderly Nonspecific Shoulder Pains

Came across a list of causes of shoulder pain causes and I found myself saying “where is the myofascial pain syndromes?”. As an example here is a cause of nonspecific shoulder pain in the elderly – the infraspinatus muscle and some results with just one needling on muscle:

Calvo-Lobo, César, et al.
Dry Needling on the Infraspinatus Latent and Active Myofascial Trigger Points in Older Adults With Nonspecific Shoulder Pain: A Randomized Clinical Trial.
Journal of geriatric physical therapy 41.1 (2018): 1-13.
https://europepmc.org/articles/pmc5728593
Infraspinatus is on the shoulder blade and can easily refer to shoulder:
infras_tp

 

  • Sixty-six patients aged 65 years and older with trigger points in the ipsilateral infraspinatus of the painful shoulder
  • Nonspecific shoulder pain was diagnosed if nothing else found on testing
  • Technique: – “Hong’s fast-in and fast-out technique with multiple rapid
    needle insertion”:
    -lie down with bad side up
    –  “A headless 0.32 × 40-mm needle (Stainless steel, Agupunt A1041P, 158 Caspe, Barcelona, Spain 08013) was fi xed between the fi ngers of the nondominant hand and inserted perpendicular to the scapula toward theMTrP.”
    – “By means of metacarpophalangeal flexion extension of the first to second fingers of the dominant hand, the area was probed in different directions until presence of 1-LTR, a pain response and, usually, the referred pain pattern of the MTrP were obtained”
    – multiple insertions over 1-2 minutes were done “until reaching LTR exhaustion.”
    – press on spot 1 minute to stop bleeding

My technique is different –

  • I find a good spot
  • I needle area until I get a good trigger response, then electrically stimulate with pulses from a pointer plus for the count of 120 times.(80 times will sometimes do it but 120 times consistently gets relief) – stimulation should be enough to move the muscle but not painful
  • Then move on to other satellites.
  • Infraspinatus triggers tend to be closer to  scapular spine and closer to shoulder.
  • Afterwards I work out all the remaining knots manually:
    – If you engageg infraspinatus transversely with your thumb either pushing cephalad (up towards head) or towards feet, you can quickly massage through it by thumping your thumb with a chripractic activator. Patient will complain it burns but it will be a good burn ( works well for upper trap and levator cscap too but that is another story)
    then rub the muscle 120 times and repeat sequence until muscle painfree.

They had 2 groups – half just had the active trigger point needled, other had the bad as well as more “latent treigger points done:

results:

infra_tp_rx

with just one treatment that is pretty good; usually triggers are done multiple times.

Comment – I will have to add this to my one-shot-wonder category because who in their right mind would only hit triggers once?

I would have them hit those triggers by rolling a lacrosse ball (A Canadian sport if you must know…) – Tennis ball may be too soft.

lacrosse

It is suggested to apply as much pressure while still staying fully relaxed.

They talked about satellite triggers in Anterior Deltoid and Exensor carpi radialis brevis. I find triggers in the anterior and posterior deltoid are manually tough to get out but with the activator may gradually relieve it – needling would make it easy though.

Just a point – elderly are not the only period who run into trouble with infraspinatus – computer operators who often end up with tingling in hands can come from infraspinatus triggers:

I wrote about it here:
What Causes Hand Tingling in Computer Terminal Operators – More Myofascial Than You Would Think
http://painmuse.org/?p=2720

TIP: – Infraspinatus trigger do not like to be stretched at night when shoulder is dragged across chest sleeping. So if bad side is up – have a pillow to hold arm up more as per pic:

infrasp_sleep

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