| BackgroundAdhesive capsulitis(AC)of shoulder known as frozen shoulder(FS)is a common,painful and sometimes disabling condition that can last for months or years.It affects around 2%of adults.The characteristic symptoms are pain,stiffness,and limitation of active and passive shoulder movements(particularly external rotation of the joint).They maybe severe enough to interfere with everyday activity(e.g.driving,dressing,sleeping),and may prevent some patients from working.The cause of frozen shoulder is poorly understood.It is thought that scar tissue forms in the fibrous capsule surrounding the shoulder joint,causing it to thicken and contract,so restricting shoulder movement.Frozen shoulder is most common in people aged 40-60 years and,in up to 20%of those affected.Risk factors include female sex,older age,shoulder trauma and surgery,diabetes,and cardiovascular,cerebrovascular and thyroid disease.Common treatment approaches include simple analgesics(like acetaminophen),nonsteroidal anti-inflammatory drugs,local corticosteroid injections and physiotherapy.Acupuncture has had over 2000 years experience of treating shoulder pain.Acupuncture has a potential role in the treatment of frozen shoulder,particularly for those patients not responding well to conventional therapy.In TCM,frozen shoulder belongs to ’ Bi syndrome ’ and also referred to as ’wu shijian’ In the pathogenesis analysis of frozen shoulder the understanding of TCM is mostly believed to be wind,cold and dampness invade local meridians and collaterals and then pain occurs.Most of treatments are based on the principles of dispelling wind,cold and dampness,activating blood circulation and removing blood stasis,dredging collaterals and relieving pain.Current clinical studies in China show that acupuncture at ST38 by targeting to BL57 in frozen shoulder achieved statistically significant effects in improving the symptoms and percentage of clinical effectiveness.ObjectiveTo compare therapeutic effects of acupuncture at ST38 by targeting to BL57 and local shoulder acupoints in primary frozen shoulder patients.MethodsThis study is a randomized pilot clinical trial study in patients who referred to private clinic in Rash,Iran since July 2018 to September 2018.In first visit for all patients a complete physical exam(specially assessment of external rotation and vertical abduction)and history taking is done.A one week period of rest as wash-out period was determined for patients and emphasized that don’t receive any other treatments or medications.After one week,the patients completed the questionnaire(oxford shoulder score),physical exam is done,VAS and goniometry(active and passive)evaluated.All including and excluding criteria checked and final candidates divided randomly to two groups.To randomize the patients,30 numbers that is 1-30 were written on a piece of paper and placed in a container.To do this,each patient then took a number without looking at the paper from inside of the container.Patients with an Even number were placed to one group and the patients with Odd number were placed to other group,then a simple Head or Tail draw was done.It was planned that Head be named as group A(experimental group,ST38 to BL57 needling group)and Tail be named as group B(control group,local shoulder acupoints group).Intervention:For group A(ST38 to BL57 needling group),at first patient lied down in supine position,after routine disinfection by alcohol around the needle insertion site,according to the depth,needling is performed by using a sterile acupuncture needle(0.3mmx75mm,Zhongyan Taihe medical instrument company,Beijing,China),inserting it into the skin by targeting at BL57 from ST38 perpendicularly and slowly deep as much as 2.5～3 cun,same side as the affected shoulder,followed by rotating and thrusting(strong stimulus)to get de qi with a sensation of soreness and distention in the front of leg,radiating down to dorsum of foot and then the puncture is continued to the position of BL57.The final depth is determined based on qi arrival.The reducing technique(slow thrusting and rapid lifting)was used for all patients in this group.The needle was maneuvered every 10 minutes to maintain stimulus.Total needle retention time was 30 minutes.Patients were treated by this technique for 10 sessions(two times a week)and were advised to do stretching and strengthening exercises(such as pendulum stretch,finger walk and scapular retraction)between treatment sessions.For group B(local shoulder acupoints group),at first patient was placed in a sitting position,after routine disinfection by alcohol around the needle insertion site,needling is performed by using a sterile acupuncture needle(0.25mmx40mm,Zhongyan Taihe medical instrument company,Beijing,China),based on the location of joint capsule,acupoints Naoshu(SI10),Jianyu(LI15),Jianliao(SJ14)and extra-point Jianneiling(EX-UE)were needled in a way that the tip of needle touch articular capsule.After arrival of qi,needles remained for 30 minutes.Twirling method was done every 10 minutes for all patients in this group.Patients were treated for 10 sessions(two times a week)and they were advised,as in the group A,do stretching and strengthening exercises between treatment sessions.All the patients in both groups were evaluated by Visualized Analogue Scale(VAS)seven times:baseline,first session(before and after treatment),one week,two weeks,three weeks and five weeks after first session.OSS(oxford shoulder scale)questionnaire was evaluated six times:baseline,first session,one week,two weeks,three weeks and five weeks after first session.External rotation and vertical abduction ROM in both groups were evaluated five times:baseline,first session(before and after treatment),two weeks and five weeks after first session. Statistical analysis:SPSS version 22 statistics were used in this study and the significant statistic P-value was less than 0.05.ResultsTotally 30 primary frozen shoulder patients were enrolled in two groups(15 patients in each group),16(53.3%)of them were male and 14(46.7%)of them were female.In experimental group(group A)the mean age was 56.27±7.20(years old)and in control group(group B)the mean age was 51.20±5.24(years old).From total of 30 cases,19 cases had right shoulder involvement and the rest of 11 cases had left shoulder involvement.Comparing of VAS within groups in different sessions show that there is statistically significant decrease from baseline to five weeks for both experimental and control groups(P<0.001).Comparison of VAS between two groups show that there is no significant difference between two groups(P>0.05).Comparing of OSS within groups in different sessions show that there is statistically significant increase from baseline to five weeks for both experimental and control groups(P<0.001).Comparison of OSS between two groups show that there is no significant difference between two groups until three weeks(P>0.05).The changes of VAS and OSS values in the two groups suggest that acupuncture treatment methods in group A and group B can reduce shoulder pain and improve the quality of life of patients.External rotation and vertical abduction ROM(active and passive)were compared in two groups five times:baseline,"before and after first session"(for evaluating of immediate effect),"two weeks after first session" and "five weeks after first session"(for evaluating the change of activity before and after treatment.There was a statistically significant difference in improving of ROM in each group(P<0.05)for external rotation and vertical abduction(active and passive)movements.Between groups comparison of ROM show that there is no statistically significant difference between two therapeutic methods(P>0.05).ConclusionBoth methods of treatment,local shoulder acupoints and ST38 to BL57 needling group,can decrease shoulder pain and improve ROM in frozen shoulder patients,and the differences between two methods should be evaluated in future studies. |
PDF Full Text Request