Dry Needling for Shoulder Pain in Stroke Patients

Inclusion Criteria: * first-ever unilateral stroke; * hemiplegia resulting from stroke; * age between 30 and 60 years old; * presence of hypertonicity in the upper extremity; * pain symptoms in the shoulder * active trigger points in the shoulder muscles reproducing the shoulder pain symptoms Exclusion Criteria: * recurrent stroke; * absence of active trigger points in the shoulder muscles reproducing shoulder symptoms * previous treatment with nerve blocks, motor point injections with neurolytic agents for spasticity at any time; * previous treatment with botulinum toxin-A in the 6 months prior the study; * severe cognitive deficits; * other neurologic diseases, * underlying complex medical conditions, e.g., heart conditions, unstable hypertension, fracture * fear to needles; * any contraindication for deep dry needling, e.g., anticoagulants, infections, bleeding, or psychotic.