Clinical Observation Of The Extracorporeal Shock Wave And Ultrasonic On The Treatment Of Shoulder-hand Syndrome

Background:Shoulder-hand syndrome (SHS) is a series of clinical syndrome after the attack of stroke, including ipsilateral shoulder pain, the patient's hand got edema, pain and skin color change, even the upper limb motor function limitation. If not ignored early and without effective treatment, hands and fingers deformation will arise. Under the worst of conditions, the patient's hand function would completely lost. Patients will lose the confidence for rehabilitation psychologically and abandon themselves. All of these will largely increase the patient's family care, social and health service burden. As a kind of mechanical wave, there must be no treated area and extracorporeal shock wave is needed during the treatment. Which can be solved by daubing coupling agent to close contact. During treatment, extracorporeal shock wave can get through the skin, fat, muscle and other tissues with various impedance and gradually get to the deep layer. When meet two different tissues with different impedance, Extracorporeal shock wave will perform physical effects on the surface of two groups:reflection, refraction, transmission and absorption, etc. Extracorporeal shock wave can perform directly tear effect and thermal effect, indirect cavitation effect and chemical effect in pain treatment. Dornier took the lead in applying extracorporeal shock wave in the treatment of urinary calculi in 1984. In recent years, the function of the extracorporeal shock wave was gradually developed by the researchers. Extracorporeal shock wave was found to promote bone healing and pain settling on muscle pain. The clinical treatment of bone and muscle is more adopted. But now. there are less clinical research on the extracorporeal shock wave treatment of SHS shoulder pain after stroke research.Objective:To observe and evaluate the therapeutic effect of extracorporeal shock wave treatment on SHS shoulder pain after stroke research.Methods:After diagnosis,60 patients with SHS shoulder pain after stroke were divided into two groups according to the random remainder grouping:experimental group was the extracorporeal shock wave treatment group, controlled group was ultrasonic treatment group, and 30 cases in each group. Routine rehabilitation training was given to both groups of patients, including physical therapy, occupational therapy, intermediate frequency electric pulse treatment, air pressure and acupuncture treatment. On the basis of conventional rehabilitation training, extracorporeal shock wave treatment mode was applied to experimental group. At the same time, Ultrasonic therapy was given to the controlled group on the basis of routine rehabilitation training. Visual analog scale (VAS), Fugl-Meyer assessment of upper extremity (FAM-UE) and total effective rate after 4-week treatment were respectively compared after 4 weeks of treatment with respect to the values of these three aspects before treatment, 1 week,2 weeks and 4 weeks after treatment of two groups of patients.Results:After treatment for 1 week,2 weeks, VAS scores of two groups of patients was compared the scores before treatment respectively, and there turned out to be no statistical difference between them. After 4 weeks'treatment, VAS scores of two groups of patients were significantly decreased (p< 0.001), and the VAS score of extracorporeal shock wave treatment group is lower than that of ultrasonic treatment group (p< 0.05). After 1 week's,2 weeks'treatment, Fugl-Meyer assessments of upper extremity (FAM-UE) of two groups of patients were compared with the values before treatment respectively, and there is no statistical difference. After 4 weeks' treatment, Fugl-Meyer assessments of upper extremity (FAM-UE) of two groups of patients were significantly increased (p< 0.001), and the Fugl-Meyer assessments of upper extremity (FAM-UE) of extracorporeal shock wave treatment group higher than that of ultrasonic treatment group (p< 0.05). Meanwhile, after 4 weeks' treatment, the total effective rate of extracorporeal shock wave treatment group is significantly higher than that of ultrasonic treatment group (93.3% vs.76.7%, p< 0.05).Conclusion:Extracorporeal shock wave treatment can improve the SHS shoulder pain in patients with cerebral apoplexy, promote patients with upper limb functional recovery, and the curative effect is superior to the ultrasonic treatment.