I have a patient that I was considering trying IDN with. The patient reported that she has 3 heart valves that are damaged and the doctors are watching. The patient reported that she is not currently needing surgery for valve replacements yet, they are watching the valves. She is on a blood thinner medication. She did also mention that when she goes to the dentist she has to take antibiotics prior due to her risk of infection. Would this patient be a candidate for dry needling?  

Have you dry needled her?

I would consider exploring her lumbar paraspinals, femoral nerve distribution including the quads. I would explore her lower extremity homeostatic as well. I would consider adding estim to her quadriceps. What are her hamstrings and adductors like?

As far as influencing the somatosensory system, have you tried vibration to facilitate the mechanorecptors? I would explore vibration to the extremity, both proximal and distal.  

Let us know!

SHW

In our facility, needles are required to be secured between two locked doors overnight. Currently, we store them in a cleaning caddy placed on a shelf within a locked room. The caddy contains a sharps container, box of 1/2", 1", 2", and 3" needles, alcohol preps and a trash receptacle. An ES-130 is stored nearby for easy access. Any additional needles are kept in a separate locked supply closet.

Good luck finding the right solution for your facility! 

SHW

I wondered if anyone had suggestions of smaller locked carts or cabinets that you like to use to store your dry needling supplies.  One of the offices I work at is ordering supplies and doesn't have a ton of space to house a huge cart.  It has to be locked, so I wondered if anyone had suggestions.

Thank you,

Lori 

I have a 70 year old female who had a knee replacement (hinged knee) in Jan of 2024.  She had PT at another clinic and reports good recovery post surgery.  In December 2024 she sustained an avulsion fracture to the inferior pole of the patella.  The ortho immobilized her in extension for 5 weeks and then she began PT to regain strength at another clinic.  She never lost the ability to fully extend the knee actively, however the patella on the involved side rests significantly higher than the uninvolved side. She also has a persistent quad lag with SLR that has not improved even as the MMT tested strength of the quads has shown improvement.   She came to me last fall with her primary complaint being the knee will buckle and cause her to fall where she will have to catch herself with an AD or furniture.  I have treated her for over 50 visits working on strengthening of the knee extensors, hips, static balance, dynamic balance and functional strength/balance (i.e. step ups unsupported).  Her strength and her level of function have improved however she still will have occasional knee buckling averaging 2x per week, placing her at a high risk of falling.  The MOI for the buckling varies, sometimes planted and twisting, sometimes standing in place, sometimes while walking.  

My question is has anyone treated something similar and can offer some additional ideas to incorporate?  Would there be any benefit from dry needling the surrounding homeostatics, and/or femoral n. distribution? 

Thank you all in advanced for any insights,

Dan 

Since this it is an immune driven inflammatory disease DN will not address the actual disease. 

However, DN could potentially help with secondary issues, such as: muscle guarding from fascial tightness, and pain modulation

I see important precautions:

   Since the inflamed fascia is the primary pathology, no aggressive needling (or any initially) into affected tissue bc it will aggravate  symptoms.

   Patients are often on strong immunosuppressive drugs so consideration needs to be made

    The skin and connective tissue may be fibrotic and less tolerant of needling so this is where the Neurologic approach is so beneficial because we can leverage the neurology of the Tibial nerve, sural, common Fib and saphenous so your thought to needle homeostatic points is correct and the safest and initially best patient tolerated approach.  

Hope that helps

Frank