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.