Dry Needling and Manipulation vs. Mobilization, Exercise and Interferential Electrotherapy for Shoulder Impingement (Subacromial Pain Syndrome)

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