Comparison of Upper Trapezius and Infraspinatus Myofascial Trigger Point Therapy by Dry Needling in Overhead Athletes With Unilateral Shoulder Impingement Syndrome

upper trapezius muscle


Chronic musculoskeletal disorders in shoulder joint are often associated with myofascial trigger points (MTrP), particularly in the upper trapezius (UT) muscle. Dry needling (DN) is a treatment of choice for myofascial pain syndrome. However, local lesions and severe post-needle soreness sometimes hamper the direct application of DN in the UT. Therefore, finding an alternative point of treatment seems useful in this regard.


To compare the efficacy of UT versus infraspinatus (ISP) DN on pain and disability of subjects with shoulder pain. We hypothesized that ISP DN could be as effective as the direct application of DN in UT MTrP.


Single-blind randomized clinical trial.


Sports medicine physical therapy clinic.


40 overhead athletes (age 36±16 yo; 20 females, 20 males) with unilateral shoulder impingement syndrome were randomly assigned to the UT DN (n=21) and ISP DN (n=19) groups.


An acupuncture needle was directly inserted into the trigger point of UT muscle in the UT DN group and of ISP muscle in the ISP DN group. DN was applied in three sessions (2-day interval between sessions) for each group.


Pain intensity (visual analog scale), pain pressure threshold (PPT) and disability in the arm, hand and shoulder (DASH) were assessed before and after the interventions.


Pain and disability decreased significantly in both groups (P<0.001) and PPT increased significantly only in the ISP group (p=0.020). However, none of the outcome measures showed a significant inter-group difference after treatments (P>0.05).


Application of DN for active MTrPs in the ISP can be as effective as direct DN of active MTrPs in the UT in improving pain and disability in athletes with shoulder pain, and may be preferred due to greater patient comfort in comparison with direct UT needling.

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