| Objective:Periarthritis of the shoulder joint, also known as shoulder coagulation disorder or frozen shoulder, is a chronic inflammatory disorder of the muscles, tendons, bursa and articular capsule around the shoulder. The clinical characteristics of frozen shoulder include pain and dysfunction of the shoulder joint caused by the formation of internal and external adhesions in the shoulder joint. This disease is more common in older adults, occurs more often in female patients and affects the left hand more often than the right hand. If the joint on one side is attacked and becomes immobile, the joint on the other side will undergo compensatory overload, which would make it more susceptible to future attacksIf not treated correctly, frozen shoulder can develop into disuse atrophy and result in Bi-syndrome, which includes arthralgia (joint pain) accompanied by a generalized soft tissue pain syndrome. Although periarthritis of the shoulder joint is a self-limiting disease prone to spontaneous healing, it can last for several years and affect the patient’s physical and mental health. Due to the chronic pain, frozen shoulder often alters the quality of patients’ daily lives by affecting their ability to perform routine activities such as combing hair, putting on clothes, lifting arms, and buckling belts. Pain relief, therefore, becomes a key factor in restoration of physical activity in patients with periarthritis of the shoulder joint.Traditional Chinese medicine has a long history. Ancient manuscripts have been found that describe detailed approaches to the treatment of both arthralgia and accompanying generalized soft tissue pain syndrome. Some of these therapeutic procedures, including nine stone needle massage and moxibustion, are particularly effective.Therefore, the main objective of this study was to test the clinical effectiveness of Chuan Cheng Tang massage and acupuncture at the Tiaokou (ST38) and Chengshan (BL57) points in patients with periarthritis of the shoulder joint. Patients with both shoulder pain and joint dysfunction were allocated to two treatment groups. One group was treated with acupuncture that involved needle insertion into Tiaokou in a way that it penetrated into Chengshan. The second group was treated with the combination of the above-described acupuncture method and massage therapy. The effects of the treatments on shoulder joint pain were compared using the FABER (Flexion-Abduction-External rotation-Extension) test.We hoped that after objective evaluation, our data would lead to the generation of new ideas and, therefore, development of new therapies for the treatment of periarthritis of the shoulder joint.MethodsThe study was conducted at the inheritance of Chuan Cheng Tang and Guang Ji Chinese medicine clinic in Taiwan during the period from July 2013 to July 2014. For the randomized, single-blind, controlled study,60 patients with periarthritis of the shoulder joint were divided into two groups:30 patients (treatment group) were treated with both acupuncture and massage, and the remaining 30 patients (control group) were treated with acupuncture only.The patients in the treatment group were treated with acupuncture combined with massage therapy as follows. Acupuncture was performed in either sitting or standing position. Acupoints on an ipsilateral lower limb were disinfected with 75% alcohol. The needle was first inserted into the Tiaokou acupoint, the tip was then aimed in the direction of Chengshan acupoint, and the needle was allowed to penetrate the latter acupoint as well. The arrival of Qi was indicated by changes in the patient’s behavior (e.g., the patient typically became agitated). The FABER test was then performed three times before the needle was removed. Massage therapy included thumb-kneading, rolling around the shoulder, and rubbing for approximately 1 minute. The following acupoints were then pressed in the distal contralateral body with the thumb for 30 seconds to 1 minute:Biguan (ST31), Futu (ST32), Yanglingquan (GB34), and Sanyinjiao (SP6). The patient’s range of motion was then measured using tests involving shoulder external rotation and forearm pronation (each movement was performed 5-8 times). The therapy was concluded with more rubbing and kneading to relax the muscles.The patients in the control group were treated with acupuncture as described above. The treatments were performed once a day and continued for five days. In addition, patients in both groups underwent physical therapy. After two courses of treatment, the results were analyzed.ResultsBefore the treatment, both groups of patients exhibited similar degrees of shoulder pain and similar range of motion changes. However, after the treatment, the group subjected to both acupuncture and Chuan Cheng Tang massage therapy demonstrated both statistically significant reduction in the shoulder pain and statistically significant improvement in the range of motion compared to the group treated with acupuncture alone (P< 0.05 for all comparisons).ConelusionsPeriarthritis of shoulder joint, a common life-altering illness that causes pain and shoulder joint dysfunction, can be treated with medications, orthopedic surgery, acupuncture, or moxibustion. However, oral medications often have a slow onset of action and cause undesirable side effects, while surgical treatment has a high rate of relapse. On the other hand, acupuncture and massage therapy have produced long-lasting curative effects.The goal of our study was, therefore, to test the hypothesis that the combination of Chuan Cheng Tang massage and acupuncture would provide superior efficacy to acupuncture alone for treating patients with periarthritis of the shoulder joint. Our results showed that the combination therapy did, in fact, produce a significant analgesic effect as well as a significant improvement in the shoulder joint mobility. The success of the treatment could be attributed to (a) an efficient stimulation of the Qi by the acupuncture method simultaneously involving two pressure points, Tiaokou and Chengshan, and (b) the massage-triggered increase in blood circulation that led to improved oxygen supply, metabolism acceleration, and subsequent reduction in both adhesion formation and local inflammation. We, therefore, concluded that the combination of acupuncture and massage therapy can alleviate pain and restore normal motion in the periarthritis-affected shoulder joint and, thus, markedly improve the quality of patient’s lives. |
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