The Effectiveness and Safety of Acupuncture for Shoulder Impingement Syndrome: A Systematic Review and Meta-analysis.

The Effectiveness and Safety of Acupuncture for Shoulder Impingement Syndrome: A Systematic Review and Meta-analysis.

Background:

Subacromial impingement syndrome (SIS) is considered as the most common cause of shoulder pain [1].

Conservative treatments for SIS include exercise therapy, manual therapy, physical therapy, steroid injections, laser therapy, ultrasound therapy, extracorporeal shockwave therapy, and electrical stimulation [2].

Dry needling (DN) is also commonly used as a non-surgical treatment.

DN is a minimal invasive treatment in which a small needle is inserted through the skin to stimulate connective tissue and muscles to reduce pain and functional disabilities. The mechanisms how DN produces these effects are not yet fully understood [3]. Several meta-analyses have shown that DN can effectively reduce pain in shoulder pain [4], neck pain [5], spinal pain [6], and various musculoskeletal disorders [7]. While DN is commonly used to treat SIS, the evidence has not been collected and systematically combined. Therefore, this systematic review and meta-analysis will examine the effectiveness and safety of DN on SIS.

Purpose/Objectives:

1. Upon completion, participant will be able to understand what subacromial impingement syndrome is.

2. Upon completion, participant will be able to confirm dry needling as a treatment for subacromial impingement syndrome.

3. Upon completion, participant will be able to verify the effectiveness and safety of dry needling as a treatment for subacromial impingement syndrome.

Method:

We conducted a search in Pubmed, Cochrane central, Embase, 1 Chinese database, and 5 Korean database. We searched for the combination of "Shoulder impingement syndrome“ OR ”SIS“ OR ”Chronic Shoulder pain“ OR ”Subacromial impingement syndrome" AND "Acupuncture“ OR ”Needling“ OR ”Acupoints". Only randomized controlled trials were included. The participants were patients diagnosed with SIS. The intervention included any treatment method named "Acupuncture" or "Dry needling". Two reviewers will independently conduct a risk of bias assessment for the selected systematic review. The risk of bias assessment for the literature review will use RoB, and the quality evaluation tool for randomized controlled trials is Cochrane's Risk of Bias tool. Pain scales will be the primary outcome, and range of motion and other secondary outcomes will also be assessed.

Results:

A total of 2378 studies were identified. Of these, 9 RCTs and 788 participants were included [8-16].

The assessment of bias and table for SR will be shown in the table.

The meta-analysis results are as follows:

No significant adverse effects were reported.

The Std. Mean Difference IV, Random, 95% Cl value for VAS and NRS was 0.53.

The Std. Mean Difference IV, Random, 95% Cl value for NPRS was 0.27.

Details will be shown in the table later.

Conclusions: We conducted a systematic review and meta-analysis with recently published articles to evaluate the effectiveness and safety of DN for SIS. We conducted systematic review and meta-analysis with 9 randomized controlled trials. RCTs were compared to other common non-surgical treatments in terms of pain scale improvement such as NRS, VAS, and NPRS.

None of the studies reported any adverse reactions, so there were no cases where the study was terminated due to participants' adverse reactions. Although statistically significant effects of DN compared to other common non-surgical treatments were not found, however, the results suggest that DN can be considered to be a safe optional treatment for shoulder impingement.

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