QUESTION: What is the effectiveness and what are the adverse effects. DESIGN: Systematic review with meta-analysis. PARTICIPANTS: Patients with shoulder or upper extremity pain or dysfunction. INTERVENTION: Trigger point dry needling (TDN) compared to control, another intervention or another needling technique. OUTCOME MEASURES: Primary outcome measures included shoulder or upper limb pain, shoulder or upper limb dysfunction. RESULTS: Eleven randomized trials involving 496 participants were appraised. There was very low evidence that trigger point dry needling of the shoulder region is effective for reducing pain and improving function in the short term. There is some evidence that needling both active and latent trigger points is more effective than needling an active trigger point alone for pain immediately and 1-week after treatment (SMD -0.74, 95%CI -1.2 to -0.3; and SMD -1.0, 95%CI -1.52 to -0.59). CONCLUSION: There is very low evidence to support the use of TDN in the shoulder region for treating patients with upper extremity pain or dysfunction. Two studies reported adverse effects to TDN interventions. Most common adverse effects included bruising, bleeding, and pain during or after treatment. Future studies are likely to change the estimates of the effectiveness of TDN for patients with upper extremity pain or dysfunction. TRIAL REGISTRATION: CRD42016045639.

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