(1) Background: The stiffness of the posterior shoulder muscles has been shown to be related to shoulder pain and range of motion (ROM) restriction in athletes. Specifically, the treatment of the teres major muscle showed promising results in previous studies. The aim of this study was to compare the effects of dry needling (DN) vs. diacutaneous fibrolysis (DF) to improve the stiffness and tone of the teres major muscle, pain intensity, shoulder ROM, and extensibility in the short-term and at one-week follow-up in handball athletes. (2) Methods: A randomized clinical trial with blinded examiners was carried out. Elite handball athletes with shoulder pain and glenohumeral internal rotation deficit (n = 30) were randomly allocated to the DN group or the DF group. Patients in both groups received a single treatment session directly applied to the teres major muscle. The primary outcome variables and instrument were mechanical properties of the teres major muscle (stiffness and tone) measured with myotonometry. The secondary outcome variables were intensity of shoulder pain evaluated with visual analogue scale and shoulder ROM and extensibility recorded with a digital inclinometer. (3) Results: No between-group differences were found after the intervention or at one-week follow-up in the mechanical properties of teres major muscle, pain intensity, shoulder ROM, or extensibility. (4) Conclusions: the DN and DF techniques showed similar results at both timepoints in elite handball athletes with shoulder pain and glenohumeral internal rotation deficits.
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