Liberty University
This randomized controlled trial aims to investigate whether ultrasound-guided electrical dry needling with conventional physical therapy is more effective than conventional physical therapy alone in the following outcome measures: disability (Neck Disability Index and Upper Extremity Functional Index-20), average pain over the last 24 hours (Numeric Pain Rating Scale), paraspinal mechanosensitivity (pain-pressure threshold), cervical ipsilateral rotation range-of-motion, and medication intake.
Chronic cervical radiculopathy (CRAD) is a debilitating condition with often multi-year morbidity that may often appear recalcitrant to conservative management options, resulting in a high surgical rate and warranting further investigation of adjunct interventions in physical therapy (PT). Ultrasound-guided electrical dry needling (USEDN) is postulated to reduce pain and disability by reducing inflammatory cytokines and neuropeptide expression, improving the mechanochemical environment of the paraspinals, facilitating changes ion channel expression (e.g., P2X3), and improving central inhibitio…
Inclusion Criteria: 1. 18 years or older 2. Symptoms greater than three months 3. Neck and unilateral arm pain 4. A positive cluster of Wainner (4/4 tests; a clinical prediction rule to rule in cervical radiculopathy) 5. Cervical spine imaging confirming nerve root involvement Exclusion Criteria: 1. needle aversion 2. local or systemic infection 3. vascular disease 4. a compromised immune system 5. cognitive impairment 6. dyskinesia 7. bleeding disorders 8. uncontrolled diabetes 9. pregnancy 10. seizure history 11. presence of a pacemaker 12. presence of other polyneuropathies 13. presence…
With ultrasound guidance using sterile gel, between 40mm and 60mm by 0.30mm diameter J-SEIRIN needles will be inserted lateral to medial at a 45 to 60 degree angle to the laminas from C5 to T1. Needles will be angled inferiorly by 10 degrees secondary to the perched nature of the cervical vertebra. Needles (n=4) will be left in situ for 30 minutes with electrical stimulation at low frequency (2 Hz) and moderate pulse duration (250 microseconds) via an ITO ES-160 at the maximum tolerable intensity. Electrical stimulation will be coupled with manual manipulation via four clockwise 360-degree turns every five minutes as tolerated.
Classification of patients into high, moderate, and low severity and irritability groups will be done within the severity and irritability components of the SINSS protocol. Severity and irritability levels will be assessed at the start of each visit to guide CPT prescription. If these levels differ, then the allotted interventions will be the more conservative option. CPT will incorporate stretching, graded cervical and periscapular exercises, joint mobilization, and neural mobilization at different intensities per their respective severity and irritability.
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