Dry Needling Plus Manual Therapy and Exercise for Subacromial Pain Syndrome: A Sham-Controlled Randomized Clinical Trial

<b>OBJECTIVE:</b> To determine the effect on Shoulder Pain and Disability Index (SPADI) scores of adding dry needling to a program of exercise and manual therapy in individuals with subacromial pain syndrome (SAPS). <b>DESIGN:</b> Three-arm randomized trial involving 121 participants with SAPS. <b>METHODS:</b> Participants were randomized to physical therapy (PT) treatment (PT Only), PT and sham dry needling (PT+SDN), or PT and dry needling (PT+DN) groups. The primary outcome was the SPADI at 1 year. Secondary measures included the Physical Function and Pain Interference subscales from the PROMIS-57, the Patient Acceptable Symptom State (PASS), and self-reported shoulder-related health care use. Linear marginal models and generalized estimating equations were used to identify differences between groups at each follow-up. Logistic regression was used to determine differences in health care use between groups at 1 year. <b>RESULTS:</b> Differences (95% confidence interval) in SPADI scores at 1 year between the PT+DN and PT Only (-7.51 [-16.57, 1.54]) and the PT+DN and PT+SDN (-9.85 [-18.98, 0.73]) groups did not reach statistical significance. Differences in the percentage of "yes" responses to the PASS were significant at 6 months between the PT+DN and PT Only groups (34% [14%-55%]) and the PT+DN and PT+SDN groups (24% [4%-45%]) and at 1 year between the PT+DN and PT+SDN groups (28% [7%-49%]). Participants in the PT+DN group were less likely to receive additional care for their shoulder in the year following enrollment (<i>OR</i> = 0.35 [0.13, 0.95]). <b>CONCLUSION:</b> Adding dry needling to a standard PT program did not result in greater improvements in SPADI scores at 1 year. Improvements in secondary outcomes and patient-perceived symptom acceptability may suggest potential clinical value. <i>J Orthop Sports Phys Ther 2026;56(1):50-63. Epub 19 November 2025. doi:10.2519/jospt.2025.13460</i>.