INTRODUCTION
Hemiplegic shoulder pain (HSP) is one of the most prevalent upper extremity complications after stroke.1 The incidence of HSP ranges from 16% to 84%.2 Mostly occurring from the second month after stroke, it can also occur in the first two weeks to a lesser extent.3 HSP accompanying the rehabilitation of hemiplegic patients is a significant problem since it limits daily activities, prolongs hospital stay, and adversely affects rehabilitation outcomes.1 Impaired motor control and tone changes (subluxation, scapular dyskinesia, spasticity), development of soft tissue lesions (shoulder impingement syndrome, rotator cuff tendinopathy, bicipital tendinopathy, adhesive capsulitis, myofascial pain syndrome), and changes in peripheral and central nervous system activity (entrapment neuropathies, complex regional pain syndrome, central post-stroke pain, central hypersensitivity, brachial plexopathy) play an important role in the etiology of HSP.4
Myofascial pain syndrome, which may play a role in the etiology of HSP, is a condition characterized by a taut band and trigger point, accompanied by sensory, motor, and autonomic symptoms.5 The formation of myofascial trigger point (MTrP) may be due to the deterioration of the biomechanics of the region as a result of a muscle imbalance in the shoulder girdle of the patients. It can also be due to structural changes caused by spasticity in the muscle tissue, asymmetric tension forces on the joint, and postural dysfunction due to the weakening of the muscles involved in trunk stabilization.6 Thorough physical examination of the shoulder girdle and adjacent musculature is essential in its diagnosis, and it is necessary to distinguish whether MTrP is active or latent.7 While pain is continuous in an active MTrP, there is no spontaneous pain in latent MTrP and is provoked by palpation.8 Medical treatments, physical therapy modalities, exercise approaches, and invasive interventions (dry needling, local anesthetic injection, botox) are available in the treatment options.9 Although there is no consensus in the literature on how many sessions and intervals these treatments should be performed, the general opinion is that invasive treatment approaches should be performed as sessions at regular intervals. Dry needling (DN) treatment is an increasingly popular, microinvasive, cost-effective treatment approach with a low risk of side effects in the treatment of MTrP.10
Numerous studies have been conducted on invasive treatment approaches, such as subacromial injection, glenohumeral injection, and suprascapular nerve block in HSP.11 Furthermore, some studies have used local anesthetic and DN for the treatment of MTrPs that cause HSP.12-14 There are limitations in these studies, such as the number of sessions and the muscles treated are not standardized, and the follow-up periods are short. The present study aims to show that DN treatment performed in addition to conventional rehabilitation practices provides additional improvement in patients’ pain, joint range of motion, and functionality parameters.