Leigh McCutcheon APA Presentation Oct

The following case report was presented during the APA Conference week held in Cairn’s in October, 2007 as part of the Musculoskeletal Physiotherapy Australia program.

CASE REPORT: Physiotherapy management incorporating direct acupuncture needling to a large intrasubstance supraspinatus tear.

McCutcheon LM^{1, 2}

¹Elanora and Robina Physiotherapy Clinics

²Combined Health Acupuncture and Dry Needling Education

A 64 year old woman presented with a two month old traumatic intrasubstance supraspinatus tear measuring 1.8 x 1.2cm. Four treatments consisting of taping, rotator cuff and scapular stabilising exercises, ultrasound and laser were implemented over a five week period with minimal effect on range and no effect on supraspinatus power or pain reduction. The therapy regime was supplemented with acupuncture consisting of threading the supraspinatus tendon from both an anterior (LI 15) and posterior (LI 16) approach with 40mm and 50mm needles respectively.

The aim of acupuncture tendon threading is to produce a local healing response due to the various chemicals and neuropeptides that are activated when a needle is inserted into damaged tissue. Disability of the Arm, Shoulder and Hand (DASH) questionnaire performed prior to the commencement of acupuncture depicted a 71.7 score. Eight acupuncture treatments were performed over a three month period with a reduction to 27.5 on the DASH scale. An additional three treatments were performed over a two month period with a further reduction on the DASH scale to 5. Another diagnostic ultrasound was performed following treatment depicting a small 3mm region of heterogeneity in the supraspinatus tendon which is a common phenomenon in asymptotic individuals within this age group. This study raises the possibility of an alternative to surgery in the case of a torn supraspinatus tendon. Results of this single case report support the need for randomised controlled trials to further investigate the effect of deep acupuncture needling on rotator cuff tears.

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