Pain, function and peritendinous effusion improvement after dry needling in patients with long head of biceps brachii tendinopathy: a single-blind randomized clinical trial

Abstract

Introduction: Long head of biceps brachii tendinopathy, a frequent source of anterior shoulder pain, may lead to discomfort and diminished function. The objective of this study is to assess the efficacy of dry needling and transcutaneous electrical nerve stimulation in these patients.

Patients and methods: Thirty patients were randomized into dry needling and transcutaneous electrical nerve stimulation groups and assessed before treatment, 8 and 15 days after treatment using a visual analogue scale, shoulder pain and disability index, pressure pain threshold, tissue hardness, and biceps peritendinous effusion.

Results: Both treatments significantly reduced the visual analogue scale in immediate (p < 0.001), short-term (p < 0.01), and medium-term effects (p < 0.01). Dry needling outperformed transcutaneous electrical nerve stimulation for the pain (p < 0.01) and disability (p < 0.03) subscales of the shoulder pain and disability index in the short-term and medium-term effects, respectively. Pressure pain threshold increased after both treatments but didn't last beyond 8 days. Neither treatment showed any improvements in tissue hardness of the long head of biceps brachii muscle. Notably, only the dry needling group significantly reduced biceps peritendinous effusion in both short-term and medium-term effects (p < 0.01).

Conclusions: Dry needling showed non-inferior results to transcutaneous electrical nerve stimulation in reducing pain and disability and demonstrated even superior results in reducing biceps peritendinous effusion (see Graphical Abstract).

Trial registration: The Institutional Review Board of the China Medical University Hospital (CMUH107-REC2-101) approved this study, and it was registered with Identifier NCT03639454 on ClinicalTrials.gov.

Keywords: Shoulder pain; acupuncture; dry needling; myofascial trigger point; ultrasound.

Graphical abstract

Figure 1.

Study treatment and assessment timeline. VAS, PPT, and TH were measured before and, immediately after three times of each treatment (immediate effect), 8 days after treatment (short term effect), and 15 days after treatment (medium-term effect). SPADI and ultrasonographic evaluation of the BPE were collected before the first treatment, 8 days after treatment, and 15 days after treatment. Abbreviation: DN: dry needling; TENS: transcutaneous electrical nerve stimulation; VAS: visual analogue scale; PPT: pressure pain threshold; TH: tissue hardness; BPE: biceps peritendinous effusion; SPADI: shoulder pain and disability index.

Figure 2.

(a) Dry needling was performed on the MTrPs of the long head of the biceps brachii. Biceps peritendinous effusion was measured at the bicipital groove by ultrasound in short axis view; (b) TENS pads were placed on the MTrPs of the arm and forearm. Abbreviation: MTrPs: myofascial trigger points; TENS: transcutaneous electrical nerve stimulation.

Figure 3.

Flow diagram of this study. Abbreviation: TENS: transcutaneous electrical nerve stimulation; DN: dry needling; VAS: visual analogue scale; SPADI: shoulder pain and disability index; PPT: pressure pain threshold; BPE: biceps peritendinous effusion.

Figure 4.

Comparison of VAS, SPADI scores, PPT, tissue hardness, and BPE thickness between DN and TENS groups. (a) (b) The asterisk and the dagger indicate statistically significant differences, respectively. (c) (d) (e) No statistically significant difference was present in either group. (f) The asterisk indicates statistically significant differences in the DN group. However, no significant difference was present in the TENS group. Abbreviation: VAS: visual analogue scale; SPADI: shoulder pain and disability index; PPT: pressure pain threshold; TH: tissue hardness; LHBT: long head of biceps tendon; DN: dry needling; TENS: transcutaneous electrical nerve stimulation. BPE: bicipital peritendinous effusion.