Dry Needling and Manipulation vs. Manual Therapy, Exercise and Electrothermal Modalities for Shoulder Impingement

Patients with shoulder impingement will be randomized to receive 2 treatment sessions per
week for up to 6 weeks (up to 12 sessions total) of either: (1) electric dry needling and
spinal manipulation or (2) impairment-based manual therapy, exercise and electrothermal
modalities.

Inclusion Criteria:

1. Adult over the age of 18 years old that is able to read, write and speak English

2. Primary complaint of anterolateral shoulder pain lasting longer than 6 weeks secondary
to shoulder impingement. (Shoulder Impingement is defined as a spectrum of alterations
of the subacromial space and may affect the supraspinatus tendon, subacromial bursa,
tendon of the long head of the biceps, and shoulder capsule (isolated or combined.)

3. Diagnosis of shoulder impingement, as indicated by ONE or more of the following
special tests:

1. Positive Neer Impingement test—i.e. pain with passive overpressure at full
shoulder flexion with the scapula stabilized.

2. Positive Hawkins-Kennedy test—i.e. pain with passive internal rotation at 90° of
shoulder and elbow flexion

4. Pain with ONE or more of the following active movements and resisted isometric tests

1. Pain with active shoulder elevation

2. Pain with resisted shoulder external rotation at 90 deg of abduction

3. Pain with resisted shoulder abduction in Empty Can Test positon - i.e. 90 deg of
shoulder abduction, 30 deg of horizontal adduction (i.e. in scapular plane) and
full internal rotation (i.e. thumb down)

Exclusion Criteria:

1. Report of red flags to manual physical therapy to include: severe hypertension,
infection, uncontrolled diabetes, peripheral neuropathy, heart disease, stroke,
chronic ischemia, edema, severe varicosities, tumor, metabolic disease, prolonged
steroid use, fracture, RA, osteoporosis, severe vascular disease, malignancy, etc.

2. History of shoulder injection within the past 3 months.

3. History of shoulder dislocation, subluxation, fracture, adhesive capsulitis, or
cervical, thoracic or shoulder surgery.

4. Isolated acromioclavicular joint pathology (i.e. the only location of symptoms is
localized specifically with one finger directly over the acromioclavicular joint and
nowhere else, and reproduced only with acromioclavicular palpation by the examiner.)

5. Evidence of cervical radiculopathy, radiculitis or referred pain from the c-spine

6. Full-thickness rotator cuff tears (evidenced by MRI and/or positive lag signs)

7. Baseline SPADI of not less than 20%

8. History of breast cancer on involved side.

9. Prior treatments (eg. Acupuncture, physical therapy, chiropractic, dry needling,
massage therapy, injections) to the involved limb over past 3 months.

10. Pending litigation for an injury.

11. Psychiatric disorders or cognitively impaired

12. Pregnancy