title: Referred Pain Patterns of the Infraspinatus Muscle Elicited by Deep Dry Needling and Manual Palpation.
abstract: OBJECTIVE
  To identify the most common referred pain (ReP) pattern of the infraspinatus myofascial trigger point (MTrP) and compare its coincidence with the original ReP pattern, to verify whether there are any significant differences by sex and types of technique and to determine the observed signs and symptoms evoked by deep dry needling (DDN) and manual palpation (MPal).
  
  
  METHODS
  A cohort study of patients randomized to two different examination methods (July and August 2016).
  
  
  METHODS
  Students and staff recruited from Miguel Hernandez University (Southeast Spain).
  
  
  METHODS
  One hundred thirty-three participants (70.7% women) with shoulder complaints were randomly assigned to either an MPal (n = 67) or DDN group (n = 66).
  
  
  METHODS
  The same physiotherapist carried out the techniques on all participants, and the same protocol was followed for both the DDN and MPal groups. The physiotherapist did not ask participants about their pain features or other relevant issues.
  
  
  METHODS
  Local twitch response (LTR) and ReP assessed through a visual analogue scale and features of ReP of the infraspinatus muscle.
  
  
  RESULTS
  The areas with the highest percentage of ReP were the front (area 3; 27.1%) and back (area 11; 21.1%) of the arm, anterior (area 4; 36.1%) and posterior (area 12; 42.1%) shoulder, and infraspinatus muscle area. DDN proved to be significantly easier than MPal in evoking an LTR (p ≤ 0.001). There were significant differences between sexes in zone 2 (p = 0.041) and no statistically significant differences were found by technique.
  
  
  CONCLUSIONS
  The ReP pattern of the infraspinatus muscle coincides with the original pattern described by Travell and Simons, although the neck area should be questioned. The study found no significant differences in the ReP pattern by sex and when comparing MPal with DDN of MTrP of the infraspinatus muscle. DDN proved to be significantly easier than MPal in evoking an LTR.
authors.affiliation: 1 Physiotherapy Area, Pathology and Surgery Department, Centro de Investigación Traslacional en Fisioterapia, Miguel Hernandez University of Elche (UMH) , Alicante, Spain .
authors.forename: Emilio J
authors.initials: EJ
authors.lastname: Poveda-Pagán
authors.affiliation: 1 Physiotherapy Area, Pathology and Surgery Department, Centro de Investigación Traslacional en Fisioterapia, Miguel Hernandez University of Elche (UMH) , Alicante, Spain .
authors.forename: Carlos
authors.initials: C
authors.lastname: Lozano-Quijada
authors.affiliation: 2 Centro de Investigación Operativa, Miguel Hernandez University of Elche (UMH) , Alicante, Spain .
authors.forename: Jose V
authors.initials: JV
authors.lastname: Segura-Heras
authors.affiliation: 3 Physiotherapy Area, Pathology and Surgery Department, Miguel Hernandez University of Elche (UMH) , Alicante, Spain .
authors.forename: María
authors.initials: M
authors.lastname: Peral-Berna
authors.affiliation: 4 Department of Public Health, History of Science and Gynecology, Miguel Hernández University , CIBER en Epidemiología y Salud Pública, Alicante, Spain .
authors.forename: Blanca
authors.initials: B
authors.lastname: Lumbreras
mesh_terms: D015670:Acupuncture Therapy; D000293:Adolescent; D000328:Adult; D015331:Cohort Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D053591:Referred Pain / Q000175:diagnosis* / Q000503:physiopathology* / Q000517:prevention & control; D010173:Palpation; D011897:Random Allocation; D012782:Shoulder / Q000502:physiology / Q000503:physiopathology; D020069:Shoulder Pain / Q000503:physiopathology*; D061028:Trigger Points / Q000502:physiology*; D064232:Visual Analog Scale; D055815:Young Adult
keywords: dry needling; referred pain; shoulder pain; trigger points; visual analogue scale