Comparison of IMES Versus DN on ATrPs of AC

Comparison of Intramuscular Electrical Stimulation Versus Dry Needling on Active Trigger Points of Adhesive Capsulitis

The aim of our study to compare DN and IMES for pressure pain threshold, ROM and the shoulder function in active trigger points with adhesive capsulitis. This study will add to the growing body of knowledge that if these two techniques yield comparable outcomes and if one technique is superior to the other, which should be the alternative of therapy. Moreover, it would add to the society as there are very limited researches done in Pakistan using needling for trigger points in adhesive capsulitis.

Study Overview

• Status: Completed
• Conditions: Shoulder Pain
• Intervention / Treatment: Other: intramusuar electrical stimulation; Other: Dry needling

Detailed Description

In literature review 2021, they were see the short-term effect of dry needling of myofascial trigger point in patient with adhesive capsulitis. They conclude MTrPs with DN technique were improve pain, ROM, disability, and PPT along with conventional physiotherapy management among patient with adhesive capsulitis In another study 2021, in their study they were see the effect of dry needling and muscle energy technique separately in patient suffering shoulder impingement syndrome on active trigger point of infraspinatus. In their study they conclude dry needling is an effective treatment to treat the active trigger point in patient suffering from shoulder impingement syndrome In another study 2023, in their study they see impact of dry needling with electrical stimulation on pain and disability in patient with musculoskeletal shoulder pain. They do the systemic review of 5 studies to see the beneficial effect of dry needling and IMES. They conclude that the significant improvement in pain, ROM, and functional disability in patient with musculoskeletal shoulder pain In 2021 study, in their study they were see the effect of Dry Needling with percutaneous electrical nerve stimulation in patient with Myofascial neck pain. They were applying the dry needling on myofascial trigger point present in upper trapezius in patient with Myofascial neck pain They conclude that electric nerve stimulation will improve disability and pain intensity in patient with myofascial neck pain In another study 2021, in their study they see the effect of intramuscular stimulation along with dry needling in patient with adhesive capsulitis. They target the shoulder girdle muscle and paraspinal muscle (C3 to C7). They conclude that IMES and dry needling were improve pain, ROM and functional disability in patient with adhesive capsulitis In another study 2021, in their study they were target the deltoid myofascial trigger point to improve pain they conclude that dry needling and IMES were enhance blood circulation and cervical and shoulder ROM in MTrPs patient IMES and dry needling according to literature review is an effective treatment to treat the trigger points present at various points in different musculoskeletal conditions. It reduces the shoulder pain severity and upper limb disability by deactivating the active MTrPs and improve the shoulder ROM in patient with adhesive capsulitis. Hence there is lack of evidence to allow conclusions to be drawn about the effectiveness of Dry needling when compared with intramuscular electrical stimulation for adhesive capsulitis in term of pressure pain threshold and shoulder function in active trigger points

• Study Type: Interventional
• Enrollment (Actual): 44
• Phase: Not Applicable

Contacts and Locations

Study Locations

• Pakistan
  • Punjab
    • Rawalpindi, Punjab, Pakistan, 46000
      • Railway general hopsital

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Adult
• Accepts Healthy Volunteers: No

Description

Inclusion Criteria:

• Age 40 to 60 year of both genders
• Diagnosed patients of stage 3 Adhesive capsulitis with type I and II diabetes
• Involvement of at least 3 shoulder girdle muscles in Active MTrPs (subscapularis, latissimus dorsi, deltoid (anterior, middle, posterior)
• Active MTrPs in shoulder girdle muscles (subscapularis, supraspinatus, deltoid (anterior, middle, posterior), teres minor, latissimus dorsi)
• Reproduction of the patient's symptoms at active trigger point, Taut band, Hypersensitive spot, Referred pain pattern, local twitch response
• Minimum 60 degrees of active/passive shoulder abduction range of movement.

Exclusion Criteria:

• Systemic inflammatory joint disease of shoulder joint (RA, OA polymyalgia rheumatic)
• Cerebral Vascular Accident
• Fibromyalgia, neurological deficits of upper limb (Nerve root entrapment, Cervical radiculopathy, Thoracic outlet syndrome)
• History of Fracture, Dislocation, Acute soft tissue injury, Acute bursitis
• Avascular necrosis of humeral head or visceral referred pain to shoulder
• Pregnancy, Hypothyroidism, skin infection
• Patients who are using Antiplatelet Therapy with in past 3 days of study
• Extreme fear of needles

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Treatment
• Allocation: Randomized
• Interventional Model: Parallel Assignment
• Masking: Single

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: Intramuscular Electrical stimulation; Myofascial trigger point would be targeted by direct intramuscular electrical stimulation by using direct electrode placement method, where anode pole and the cathode pole of the stimulator connected to the needles of the MTrPs of the shoulder girdle muscles using the alligator clip connector in which both electrodes are on the muscle belly in which anode pole at proximal end and cathode pole at the distal end along the musculotendinous junction. The special programmed comfy stim (a double channeled multipurpose electrical stimulator) was used to deliver electrical impulses with following parameters; pulse duration 80µs, frequency 100HZ, and time duration for 10 min	Other: intramusuar electrical stimulation; Myofascial trigger point would be targeted by direct intramuscular electrical stimulation by using direct electrode placement method, where anode pole and the cathode pole of the stimulator connected to the needles of the MTrPs of the shoulder girdle muscles .AROM 10 repetitions ×2 set×30 sec ,6days\week, Shoulder strengthening exercises: Isometric pain free (elastic Thera-band) 10 repetitions ×2 set×30 sec ,6days\week, Maitland mobilization grade 3 and 4 10 repetitions ×2 set×30 sec ,6days\week Total of 6 session were given each consisting of 30 min; Other Names: conventional treatment
Active Comparator: Dry Needling; DN for the MTrPs will be performed over the identified trigger points locations at a suitable angle. The needles of suitable length and thickness (30-mm), depending on the depth of the MTrPs location inserted into the shoulder girdle muscles to deactivate the active MTrPs. Subsequently, the inserted needles moved to-and-fro direction to elicit the local twitch responses, which further reaffirms the ideal placement of needle into the MTrPs. After the twitch response obtained, the dry needles were kept within the muscles approximately for 10 minutes. Dry needling was performed subscapularis, latissimus dorsi, supraspinatus, deltoid, teres minor.	Other: Dry needling; AROM 10 repetitions ×2 set×30 sec ,6days\week, Shoulder strengthening exercises: Isometric pain free (elastic Thera-band) 10 repetitions ×2 set×30 sec ,6days\week, Maitland mobilization grade 3 and 4 10 repetitions ×2 set×30 sec ,6days\week Total of 6 session were given each consisting of 30min; Other Names: conventional treatment

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Algometer (pressure pain threshold)	This tool can be used to assess the participant pressure pain at baseline ,2nd week,3rd week post assessment. Pressure pain threshold is measured at active trigger point at subscapularis, deltoid (ant, middle, post), latissimus dorsi, teres minor, supraspinatus. The PPT are measured by mean and standard deviation kg\cm2	3rd week

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
ROM Shoulder (Flexion)	Changes from baseline,2nd week,3rd week ROM range of motion of shoulder flexion was taken	3rd week
ROM Shoulder (Abduction)	Changes from baseline,2nd week,3rd week ROM range of motion of shoulder abduction was taken	3rd week
ROM Shoulder (External rotation)	Changes from baseline,2nd week,3rd week ROM range of motion of shoulder External rotation was taken with the help of Digital Goniometer	3rd week
ROM Shoulder (Internal Rotation)	Changes from baseline,2nd week,3rd week ROM range of motion of shoulder Internal rotation was taken with the help of Digital Goniometer	3rd week
American shoulder and elbow surgeons scale	Changes from baseline,2nd week,3rd week, American shoulder and elbow surgeons scale (ASES) Scale scoring was done at 2 level, pain questionnaire 5× (10-Q7 value), ADL Questionnaire (5× (raw score) divided by 3, final scoring is done by adding pain score and ADL score. A total 100-point scale Minimum score 0 which mean worst shoulder function and maximum score 100 which mean better shoulder function.	3rd week

Collaborators and Investigators

• Sponsor: Riphah International University
• Investigators: Principal Investigator: Aneela zia, MS-OMPT, Riphah International University

Study record dates

Study Major Dates

• Study Start (Actual): January 21, 2024
• Primary Completion (Actual): July 30, 2024
• Study Completion (Actual): July 30, 2024

Study Registration Dates

• First Submitted: March 4, 2024
• First Submitted That Met QC Criteria: March 4, 2024
• First Posted (Actual): March 12, 2024

Study Record Updates

• Last Update Posted (Actual): March 25, 2025
• Last Update Submitted That Met QC Criteria: January 28, 2025
• Last Verified: January 1, 2025

More Information

Terms related to this study

• Keywords: disability; trigger points; dry needling; range of motion
• Additional Relevant MeSH Terms: Pain; Neurologic Manifestations; Musculoskeletal Diseases; Joint Diseases; Arthralgia; Shoulder Pain
• Other Study ID Numbers: RiphahIU Shafia Anjum

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: NO

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No