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Abstract
This randomised controlled trial was undertaken to evaluate the effectiveness of acupuncture as a treatment for frozen shoulder. Thirty-five patients with a diagnosis of frozen shoulder were randomly allocated to an exercise group or an exercise plus acupuncture group and treated for a period of 6 weeks. Functional mobility, power, and pain were assessed by a blinded assessor using the Constant Shoulder Assessment, at baseline, 6 weeks and 20 weeks. Analysis was based on the intention-to-treat principle. Compared with the exercise group, the exercise plus acupuncture group experienced significantly greater improvement with treatment. Improvements in scores by 39.8% (standard deviation, 27.1) and 76.4% (55.0) were seen for the exercise and the exercise plus acupuncture groups, respectively at 6 weeks (P=0.048), and were sustained at the 20-week re-assessment (40.3% [26.7] and 77.2% [54.0], respectively; P=0.025). We conclude that the combination of acupuncture with shoulder exercise may offer effective treatment for frozen shoulder.
... Chronic shoulder pain is considered to be one of the symptoms most amenable to acupuncture treatment. Several randomised controlled trials (RCTs) have investigated the effects of acupuncture for the treatment of shoulder pain, with different combinations of acupuncture points, treatment protocols and methods of needle stimulation, [4][5][6][7][8][9][10][11][12][13][14] all of which potentially influence the therapeutic outcome of acupuncture treatment. [15][16][17][18][19] While most acupuncture trials have involved acupuncture needling close to the site of pathology, with or without addition of distal or contralateral acupuncture points, many Chinese medical practitioners purely use acupuncture points contralateral to the site of pain to treat unilateral limb pain, such as that arising from the shoulder or leg. ...
... Patients recruited in the present study had a mean VAS score of 63.9 and mean pain duration of 8.4 months, both of which are typical of chronic shoulder pain and comparable to previous studies. [4][5][6][7][8][9][10][11][12][13][14] Based on both traditional Chinese medical literature 20 and clinical practice, the acupuncture protocol consisted of a set of acupuncture points located on the opposite side of the body to the pain. This is very different from previous acupuncture trials on shoulder pain, which have used acupuncture points close to the shoulder 8-10 or a combination of local and distal/contralateral acupuncture points. ...
... The therapeutic effects reported in the present study are comparable to the outcomes of other studies using acupuncture alone or acupuncture as an adjunct to physiotherapy. [4][5][6][7][8][9][10][11][12][13][14] However, we are ultimately unable to determine whether contralateral acupuncture is superior or equivalent to ipsilateral acupuncture with this design. Future RCTs comparing local and contralateral acupuncture would help answer this question and a valid sham intervention would additionally be required to completely control for the potential placebo effects. ...
Objective To explore the effects of contralateral manual acupuncture (MA) on patients with chronic shoulder pain.
Methods Eighty patients with chronic shoulder pain were randomly allocated to receive contralateral MA (n=38) for 4 weeks or to remain on a waiting list while receiving conventional orthopaedic therapy (n=42). Visual analogue scale (VAS) scores were taken as the primary outcome measure and used for a priori power calculation. Secondary outcome measures for the assessment of shoulder mobility and quality of life included the Jobe test, the Constant-Murley (CM) score, the Disabilities of the Arm, Shoulder and Hand (DASH) score, and the 36 item Short Form Health Survey (SF-36).
Results Intention-to-treat (ITT) analysis demonstrated significant pain relief with contralateral acupuncture, with mean differences in VAS scores compared to the waiting list group of −19.4 (−28.0 to −10.8) at 2 weeks, −40.4 (−49.0 to −31.8) at 4 weeks, −41.1 (−49.7 to −32.5) at 8 weeks, and −40.9 (−49.5 to −32.3) at 16 weeks. CM and DASH scores were also improved at all time points (p<0.01). Shoulder mobility, physical functioning, social functioning and mental health components of the SF-36 were also improved by contralateral acupuncture at 8 weeks. No significant adverse effects were observed.
Conclusions These results demonstrate beneficial effects of contralateral acupuncture in the treatment of chronic shoulder pain, both in terms of pain and function. Future research is required to compare directly the effects of local and contralateral acupuncture and to quantify the specific and non-specific effects.
Trial registration number NCT01733914.
... There are many studies (Hansen 1997;He et al. 2004) of varying methodological quality that have found that acupuncture is beneficial in the treatment of either soft-tissue disorders or general shoulder pain. A few papers by Chinese authors have investigated the specific influence of acupuncture on CS, and they have reported very promising results (Lin et al. 1994;Sun et al. 2001;Ma et al. 2006). ...
... To the present authors' knowledge, no previous studies have directly compared acupuncture with corticosteroid injection in the management of primary CS. While there are some relevant papers that have analysed the contributory factors of corticosteroid injection (Bulgen et al. 1984;Van der Windt et al. 1998;Arslan & Celiker 2001;Carette et al. 2003;Ryans et al. 2005) in comparison to various forms of physiotherapy, there are only a few studies (Sun et al. 2001;Ma et al. 2006;Cheing et al. 2008) that have conducted trials with of the use of acupuncture in the management of primary CS. The absence of research evidence to justify the use of acupuncture delayed its acceptance in the field of physiotherapy. ...
... In the present study, the positive outcomes of acupuncture observed in shoulder pain, movement and function were comparable to similar previous studies (Tukmachi 1999;Sun et al. 2001;Ma et al. 2006). Both Sun et al. (2001) and Ma et al. (2006) also assessed the effect of acupuncture in combination with physiotherapy. ...
The aim of this study was to investigate the effects of acupuncture, corticosteroid injection and
a home-based exercise regime in the management of primary contracted (frozen) shoulder
(CS). Twenty patients (mean age=58.7 years) diagnosed with primary CS (mean duration of
symptoms=7.6 months) were evaluated in a single-blinded controlled trial. The participants
were consecutively allocated into three groups: (I) home-based exercise programme; (II)
corticosteroid injection with home-based exercises; and (III) acupuncture with home-based
exercises. The groups were assessed at baseline and at 6 weeks. A visual analogue scale (VAS)
was used to evaluate pain at rest and during activity. Shoulder function was assessed with the
Oxford Shoulder Score (OSS) using the original scoring system of 12–60, with 12 being the
best outcome. Range of motion (ROM) was measured with a standard goniometer. At the end
of the 6 weeks, descriptive analysis showed improvements in pain, function and ROM in all
groups. The participants who had received corticosteroid injections (group II) showed a trend
towards a greater improvement in VAS scores at rest (d=0.92, a large effect). Those who had
received acupuncture (group III) exhibited a trend towards a bigger improvement in VAS
scores on movement (d=1.18, a very large effect). Abduction was least improved in all groups
(group II: d=0.14; group III: d=0.04; negligible effects). Cohen’s d showed large to very large
effect sizes in VAS and OSS scores in both the corticosteroid injection and acupuncture groups,
as well as a medium-sized effect in flexion and external rotation in the acupuncture group. This
study suggests that both acupuncture and corticosteroid injection are more beneficial than
home-based exercises alone for short-term pain relief, movement and functional improvement.
Although the corticosteroid injection group had better results for reduction in pain at rest, the
acupuncture group demonstrated a greater reduction in pain on movement.
Keywords: acupuncture, adhesive capsulitis, corticosteroid injection, exercise, frozen shoulder.
... -CPM application has no superiority over PT on shoulder ROM, functional ability The presence of 2 intervention categories -"joint mobilization and mobility" and "exercise" increased the odds of a successful outcome in the BP and HF models, respectively -Use of iontophoresis, phonophoresis, ultrasound, or massage re- Average length of supervised physiotherapy -3.5 ± 0.5 weeks three studies were case series, and four studies were case reports. Five studies [39][40][41][42][43][44][45][46][47][48][49][50][51][52] were assigned level I because of the randomized design and large number of subjects included. Twenty four studies [26,28,[43][44][45][46][47][48]50,51,[53][54][55][56][57][58][59][60] which were randomized trials with small sample sizes (less than or equal to 30 per group) were classified at level II. ...
... Five studies [39][40][41][42][43][44][45][46][47][48][49][50][51][52] were assigned level I because of the randomized design and large number of subjects included. Twenty four studies [26,28,[43][44][45][46][47][48]50,51,[53][54][55][56][57][58][59][60] which were randomized trials with small sample sizes (less than or equal to 30 per group) were classified at level II. Eight studies [25,[29][30][31][32][61][62][63] were assigned level III because of their nonrandomized design (cohort design). ...
... The results of the qualitative review are summarized in Table 4. Overall, the results of the quality review were good. Of the 39 studies included based on the 8 criteria, six studies each met 7 [39,44,45,50,56,58], 6 [27,33,42,51,55,57], and 5 [35,38,40,48,49,59] of Sackett's critical appraisal criteria, respectively. Nine studies [26,28,29,41,43,46,54,60,62] met 4, six studies [6,18,25,30,31,37,61] met 3, four studies [32,34,36,53] met 2, and two studies [47,63] met 1 of Sackett's critical appraisal criteria, respectively (Fig. 2). ...
Frozen shoulder is a common condition, yet its treatment remains challenging. In this review, the current best evidence for the use of physical therapy interventions (PTI) is evaluated.METHOD: MEDLINE, CINAHL, Cochrane, PEDro, ProQuest, Science Direct, and Sport Discus were searched for studies published in English since 2000.
39 articles describing the PTI were analyzed using Sackett's levels of evidence and were examined for scientific rigor. The PTI were given grades of recommendation that ranged from A to C.
Therapeutic exercises and mobilization are strongly recommended for reducing pain, improving range of motion (ROM) and function in patients with stages 2 and 3 of frozen shoulder. Low-level laser therapy is strongly suggested for pain relief and moderately suggested for improving function but not recommended for improving ROM. Corticosteroid injections can be used for stage 1 frozen shoulder. Acupuncture with therapeutic exercises is moderately recommended for pain relief, improving ROM and function. Electro- therapy can help in providing short-term pain relief. Continuous passive motion is recommended for short-term pain relief but not for improving ROM or function. Deep heat can be used for pain relief and improving ROM. Ultrasound for pain relief, improving ROM or function is not recommended.
... One study compared two different MA methods [24]. Seven studies compared acupuncture to PT [18,19,22,23,26,27,30]. Five studies examined the effectiveness of EA [18,23,25,28,29]. ...
... In the segment of random sequence generation, two studies were rated high risk of bias due to no randomization [23,28] and six studies did not report the randomization clearly [18-20, 26, 27, 29]. In terms of allocation concealment, three studies did not conceal patients' allocation [23,27,28], and most of the studies did not describe clearly their concealment methods [18][19][20][22][23][24][25][26][27][28][29][30]. For participants blinding, only three studies properly blind participants [21,28,30]. ...
... In terms of allocation concealment, three studies did not conceal patients' allocation [23,27,28], and most of the studies did not describe clearly their concealment methods [18][19][20][22][23][24][25][26][27][28][29][30]. For participants blinding, only three studies properly blind participants [21,28,30]. Most studies did not blind study personnel, due to the difficulty in blinding acupuncturist [18][19][20][22][23][24][25][26][27][28][29]. ...
Background:
Frozen shoulder (FS) is associated with pain, reduced range of motion (ROM), and shoulder function. The condition occurs in 2-5% of the population, and it is especially common around the age of 50 years. FS symptoms will recover after 1-4 years. Many patients turn to acupuncture in order to alleviate the FS symptoms.
Objective:
In this review, we will investigate the efficiency of acupuncture as a FS treatment.
Methods:
A literature search of acupuncture and FS-related keywords was performed in the following databases: PubMed, Cochrane Library, Embase, and Web of Science. Thirteen publications were included for a systematic review, and a meta-analysis was done using the following measurements: visual analogue scale (VAS) for pain, Constant-Murley Shoulder Outcome Score (CMS) for shoulder function, and active shoulder ROM including flexion, abduction, and external rotation. The Cochrane Collaboration's risk of bias tool and quality of evidence GRADE recommendations and STRICTA 2010 were used to grade the included publications.
Results:
A meta-analysis on VAS pain score showed significant pain reduction, restoring CMS shoulder function, and flexion ROM in favor of acupuncture versus the control. In external rotation and abduction ROM, a meta-analysis was not significant. The most used acupoints are Jian Yu (LI15) and Jian Liao (TB14).
Conclusions:
The results indicate that acupuncture could be safe and effective for pain reduction, restoring shoulder function, and restoring flexion ROM for FS patients in the short term and midterm. However, the level of evidence was very low. More high-quality and longer studies are needed in order to robust the evidence.
... Estudos recentes [20][21][22][23][24] confirmam que a eficiência da Acupuntura isolada nos DME é superior a da Fisioterapia, principalmente em relação à dor; embora ainda permaneça inconclusivo quando se trata de reabilitação funcional osteoarticular [8]. Contudo, já existem trabalhos [25][26][27] que apóiam a integração destes dois procedimentos no tratamento daquelas patologias. ...
... Há relato na literatura [25,26,27] de tratamentos de Acupuntura associado aleatoriamente à Fisioterapia, não existindo nenhum estudo apoiando um método sistemático de tratamento de Acupuntura associada à Cinesioterapia como este ora aqui descrito. ...
The aim of this paper is to introduce the concept of Kinesthetic Acupuncture as a treatment based on the use of acupuncture during rehabilitation associated to kinesiotherapy. It is a multidisciplinary therapeutic approach offering the advantage of synchronizing two treatment procedures which take place simultaneously though divided into three phases considering the patient’s capacity for movement at the time. The needles are inserted in systemic, microsystemic and locomotor points (local, segmentary, distal or somatotopic points) with the objective of: preparing (adapting the structure for kinesthetic stimulation by interrupting pain-spasm cycle in the pre-kinesthetic phase); promoting (promoting synergism for the restoration of movement through the use of acupuncture during kinesthetic stimulation in the per-kinesthetic phase) and maintaining (maintaining long acting acupuncture stimulation through the insertion of needles or taping of seeds in specific points, which may be kept in place for days or weeks, in the pos-kinesthetic phase), in order to promote a better functioning of musculoskeletal and facial neuromuscular systems of the through the cessation of pain, the elimination of fibrotic blocking and the reintegration of the neuromotor system. It has been used in 305 patients with locomotor disorders, of which 122 were men and 183 were women, with ages ranging from 07-80 years. The parameters for evaluation were: Pain, Range of Movement, Tonus, Gait, Coordination and Balance. The degree of improvement ranged from 50 to 100%, in much less time than what would normally occur in conventional rehabilitation treatment. Acupuncture has proved to be an excellent treatment in the pre-kinesthetic phase in Physiotherapy for being able to interrupt the spasm-pain cycle. In this way, Acupuncture enhances the results of Kinesiotherapy leading to a more efficient rehabilitation.
RESUMO
Este trabalho visa á apresentação do conceito Acupuntura Cinética ou ( Cinesioacupuntura) como um método terapêutico que associa a aplicação da Acupuntura à Cinesioterapia durante a reabilitação. È uma conduta multidisciplinar que tem, como vantagem, a aplicação sincronizada de dois procedimentos terapêuticos em uma só sessão, sendo dividida em três fases respeitando o momento cinético do paciente. A inserção das agulhas é feita em pontos sistêmicos, microssistêmicos e locomotores (sejam eles loco-regionais, segmentares á distância, ou somatotópicos) e tem como princípios: a preparação pre-cinética, adaptando a estrutura para o recebimento do estímulo fisioterápico pela inibição do ciclo espasmo-dor; a promoção per-cinética, promovendo com sinergismo a recuperação do movimento; e a manutenção pós-cinética, mantendo o estímulo acupuntural de ação prolongada através de inserção de agulhas ou sementes em pontos específicos que pode durar dias ou semanas; que visa a melhora do complexo músculo-esquelético e neuromusculares da face mediante a debelação do quadro algico, do bloqueio fibrótico e a reintegração do sistema neuromotor. Foram tratados 305 pacientes portadores de distúrbios locomotores sendo 122 homens e 183 mulheres, sendo a faixa etária compreendida entre 7 a 80 anos. Os parâmetros de avaliação foram: dor, amplitude articular, tônus, marcha, coordenação motora e equilíbrio. O percentual de melhora dos quadros ficou em torno de 50 a 100 por cento para um tempo de recuperaçâo muito abaixo da media de um tratamento convencional de reabilitação. Foi observado que a acupuntura é um excelente recurso pre-cinético na fisioterapia por apresentar quesitos favoráveis á inibição do ciclo espasmo-dor. Assim, a acupuntura potencializa a ação da cinesioterapia levando a uma reabilitação mais eficaz.
... Patients were introduced to this trial by their doctors. The eligibility criteria for participants included the inclusion and exclusion criteria that were referred to in Sun et al. 's study [16] and listed as follows. ...
... The difference in treatment effect observed in 4 weeks between acupuncture and control group may reflect the strength and importance of sharp-hook acupuncture. The result of this study is consistent with a previous study reporting that acupuncture plus shoulder exercise experienced significant improvement after treatment compared with exercise only [16]. In their study, they observed that the effect of acupuncture added to exercise sustained from 6 weeks after randomization to 20 weeks, suggesting a long-term effect of acupuncture. ...
The Feng Gou Zhen (sharp-hook acupuncture) as a traditional form of ancient acupuncture is said to be particularly effective for managing periarthritis of shoulder. We conducted this randomized controlled trial to evaluate the effectiveness of Feng Gou Zhen as an add-on compared to conventional analgesics for patients with PAS. 132 patients were randomly assigned in a 1 : 1 ratio to either a acupuncture group receiving sharp-hook acupuncture plus acupoint injection with conventional analgesics or a control group. Patients from both groups were evaluated at week 0 (baseline), week 1, and week 4. The primary outcome measure was the change from baseline shoulder pain, measured by Visual Analogue Scale at 7 days after treatment. Secondary outcome measures include the (i) function of shoulder joint and (ii) McGill pain questionnaire. The results showed that patients in acupuncture group had better pain relief and function recovery compared with control group (< 0.05) at 1 week after treatment. Moreover, there were statistical differences between two groups in VAS and shoulder joint function and McGill pain questionnaire at 4 weeks after treatment (< 0.05). Therefore, the sharp-hook acupuncture helps to relieve the pain and restore the shoulder function for patients with periarthritis of shoulder.
... Patients were introduced to this trial by their doctors. The eligibility criteria for participants included the inclusion and exclusion criteria that were referred to in Sun et al. 's study [16] and listed as follows. ...
... The difference in treatment effect observed in 4 weeks between acupuncture and control group may reflect the strength and importance of sharp-hook acupuncture. The result of this study is consistent with a previous study reporting that acupuncture plus shoulder exercise experienced significant improvement after treatment compared with exercise only [16]. In their study, they observed that the effect of acupuncture added to exercise sustained from 6 weeks after randomization to 20 weeks, suggesting a long-term effect of acupuncture. ...
The
Feng Gou Zhen
(sharp-hook acupuncture) as a traditional form of ancient acupuncture is said to be particularly effective for managing periarthritis of shoulder. We conducted this randomized controlled trial to evaluate the effectiveness of
Feng Gou Zhen
as an add-on compared to conventional analgesics for patients with PAS. 132 patients were randomly assigned in a 1 : 1 ratio to either a acupuncture group receiving sharp-hook acupuncture plus acupoint injection with conventional analgesics or a control group. Patients from both groups were evaluated at week 0 (baseline), week 1, and week 4. The primary outcome measure was the change from baseline shoulder pain, measured by Visual Analogue Scale at 7 days after treatment. Secondary outcome measures include the (i) function of shoulder joint and (ii) McGill pain questionnaire. The results showed that patients in acupuncture group had better pain relief and function recovery compared with control group (
P
<
0.05
) at 1 week after treatment. Moreover, there were statistical differences between two groups in VAS and shoulder joint function and McGill pain questionnaire at 4 weeks after treatment (
P
<
0.05
). Therefore, the sharp-hook acupuncture helps to relieve the pain and restore the shoulder function for patients with periarthritis of shoulder.
... Review and meta-analysis articles have not reported any privilege about any of these approaches. Therefore, still in the new studies, the influence of different therapies on healing frozen shoulder is being surveyed, and one of them is acupuncture (9). Acupuncture is an approach used from 5000 years ago to heal disorders; and since it is safer than medical treatments and has less side effects, is being used nowadays to cure many types of diseases in the modern medicine, specifically to remedy of chronic joint pains. ...
... There are reports from WHO, National Center for Complementary and Integrative Health (NCCIH), and American Medical Association (AMA) that all declare effectiveness of acupuncture for treating many types of diseases (11). Many studies had been implemented in order to evaluation of effectiveness and pain-relief strength of acupuncture, such as a study by Ko Sun et al in 2001 in Hong Kong, in which they concluded that acupuncture accompanied by shoulder exercises is more effective to cure frozen shoulder (9). In another study in 2008 by Amanda Tiffany, she declared that acupuncture has effective results to cure chronic pains of frozen shoulder (12). ...
Background:
Adhesive capsulitis is a common disease that causes pain and reduced range of motion, but vague on the shoulder. Woman are affected fewer than men, but there is no known racial or genetic tendency. Most patients with adhesive capsulitis will improve with nonsurgical treatment. Acetaminophen and nonsteroidal anti-inflammatory drugs for pain relief in patients without contraindication are first-line options. Acupuncture considered being safe and effective in reducing pain. The aim of this study was to Investigation of the effectiveness of acupuncture in the treatment of frozen shoulder.
Materials and Methods:
In a controlled clinical trial, patients referred to the Baqiatallah clinic in 91 years with shoulder pain, frozen shoulder diagnosed based on history and physical exam, they have been enrolled. Indicators measured in the study was included the involved joint pain, range of motion and quality of life. Patients, first at baseline, one and a half months later (end of session) and then 3 months after the examination information about each individual entered in the from of questionnaires were pre-determined and data were analyzed by SPSS 17 software.
Results:
In this clinical trial study total 40 patients with frozen shoulder (20 interference with the acupuncture and 20 people control) study that patients average age 55/54. Age maximum 71 years and minimum 44 years. Acupuncture in the treatment of frozen shoulder with the results achieved in the general case acupuncture may improve shoulder motion in patients. VAS index at three months after treatment compared with the control group had a greater improvement.
Conclusion:
In the case of acupuncture and ultimately improve the overall look of all the movement of flexion and adduction of the shoulder, but the movement has been further improved, VAS index at three months after treatment compared with the control group had a greater improvement and finally, we perform acupuncture as a way to improve shoulder motion in patients with frozen shoulder offered.
... CSA: both statistically significant SPADI: both statistically significant VAS: both statistically significant Sun et al. 2001. none ...
... not mentioned none 15min stainless steel needle (0.3mm×40mm) Nam et al. 2007. 5 not mentioned none 15min stainless steel needle (0.3mm×40mm) Sun et al. 2001. ...
Objectives : This study aims to review randomized controlled trials on acupuncture for shoulder pain according to Jadad Scale and revised STRICTA. Methods : Seven electronic databases including PUBMED, SCOPUS, RISS were searched for randomized controlled trials (RCT) of acupuncture for shoulder pain. Results : 16 RCTs were included: 14 were published in English and 2 were published in Korean. According to Jadad scale, 15 RCTs had high quality. However, most of the studies could not meet the double blindness criteria. All RCTs meet 12.9 items on average in STRICTA. Conclusions : This systematic review shows four conclusions as follows. Traditional Chinese Medicine is often used in style of acupuncture. Spots of LI15, TE14, GB21 and LI11, stainless steel needle(), 20 retention time, manual stimulation, , and 2 times a week treatment (total 12) are often used. Double-blinded clinical trials needs to be conducted. It is controversial to use minimal acupunctures on controlled groups of RCTs on acupuncture for shoulder pain. Description about practitioner's background needs clarifying.
... Several treatment approaches for frozen shoulder have been published in the literature, including oral medicine, corticosteroid injections, exercises, joint mobilization, acupuncture, manipulation, nerve blocks, and surgery [4,9]. In addition, physiotherapy interventions such as thermal therapy, therapeutic modalities such as interferential therapy, ultrasound therapy, therapeutic exercises, stretching, graded mobilization, and manipulative techniques such as high thrust velocity, low amplitude, end-range-mid-range mobilization, Spencer's technique with muscle energy technique, and mobilization with movement in the shoulder, are used to treat adhesive capsulitis [10]. Among these techniques, intensive mobilization techniques play a significant role in managing the FS [11]. ...
Introduction. Physical therapy plays a significant role in managing frozen shoulder (FS), and it includes applying manual mobilization techniques to reduce pain, restore the extensibility of the shoulder capsule and increase range of motion (ROM). Objective: To compare the effectiveness of Gong's mobilization (GM) and Spencer technique (ST) in reducing pain, functional disability, and improving shoulder ROM on FS patients. Methods. A pre-and-post-test experimental study design was adopted, where thirty patients (n = 30) diagnosed with unilateral FS were selected and randomized into two groups of 15 using a simple random technique. Subjects in experimental group 1(EG-I) received ST technique and ultrasound therapy (US), with Codman's pendular exercise (CPE). Whereas experimental group II (EG-II) received GM technique and US, with CPE. The intervention lasted five days and consisted of one session every day. Three variables were assessed to study the treatment effectiveness both at the pre-intervention and at the end of the first week: (i) pain intensity as measured by the Visual Analogue Scale; (ii) shoulder ROM as measured by a goniometer (abduction, flexion, and medial rotation (MR)); and (iii) functional disability as measured by SPADI (Shoulder Pain Disability Index). Results. The EG-II showed a better reduction in pain intensity (mean difference (MD) of 0.87), SPADI (MD of 7), and increase in shoulder ROM (MD: 'abduction': 15.76; 'Flexion': 15.67; 'MR': 10.33) than the EG-I at 0.05 levels of significance. Conclusions. Gong's mobilization was found to be more effective than Spencer's technique with ultrasound therapy and CPE in treating patients with FS.
... The disease occurs mainly in middle aged individuals and is usually self-limiting but the duration and severity may vary greatly. 3 Most studies have suggested a self limiting condition lasting an average of two to three years, although significant numbers of people have residual clinically detectable restriction of movement beyond three years and smaller numbers have residual disability. 1 Frozen shoulder was first described as periarthritis by Duplay in 1872. Codman coined the termed as 'frozen shoulder 'in 1934. ...
... 13,17,18 Clinical randomized trials demonstrated the efficacy of acupuncture for neck and shoulder pain, attributed to etiologies not related to malignancy or its treatment. [19][20][21][22][23][24] Moreover, a recent case report showed its efficacy in the management of first bite syndrome following surgery of the parapharyngeal space. 25 We report the results of our pilot study of acupuncture versus conventional care in the management of postoperative shoulder pain and dysfunction after neck dissection. ...
Objectives/HypothesisThe efficacy of conventional physiotherapy and antiinflammatory/analgesic drugs in the management of shoulder pain and functional disability following neck dissection is often disappointing. Acupuncture is a safe and well-tolerated method. We report the results regarding our pilot trial of acupuncture versus conventional care in the management of postoperative shoulder pain and dysfunction after neck dissection. Study DesignPilot study. Methods
Patients at a tertiary university center with chronic pain or dysfunction attributed to neck dissection were randomly assigned to either weekly acupuncture or usual care (eg., physical therapy, analgesia, and/or antiinflammatory drugs) for 5 consecutive weeks. The Constant-Murley score, a composite measure of pain, function, and activities of daily living, was the primary outcome measure. As secondary end point, The Neck Dissection Impairment Index (NDII) was used to quantify site-specific, self-reported quality of life (QOL). ResultsAfter randomization, 48 patients completed the study (23 and 25 patients on acupuncture and control arms, respectively). Constant-Murley scores improved more in the acupuncture group (gain difference between groups 13.6, P < 0.01), a statistically significant improvement in site-specific QOL was also recorded at NDII (gain difference between groups 11.5, P < 0.01). Conclusion
Acupuncture is safe and effective; it should be introduced and offered to patients suffering from neck pain and dysfunction related to neck dissection.
... Acupuncture therapy has been widely used to treat a variety of conditions, such as allergic rhinitis, 10 stroke, 11 insomnia, 12 migraine, 13 low back pain, 14 frozen shoulder, 15 pressure ulcer 16 and neck pain 17 . In addition, the evidenced-based potential for effective use of acupuncture therapy for stiff neck patients with acute neck pain has been suggested in China. ...
The use of acupuncture has been suggested for the treatment of acute neck pain caused by stiff neck in China. However, current evidence is insufficient to draw any conclusions about its efficacy. Therefore this pilot study was designed to evaluate the feasibility and efficacy of acupuncture at the Houxi (SI3) acupoint for treatment of acute neck pain.
This pilot study will be a two-parallel-group, assessor-blinded, randomised controlled trial. Thirty-six stiff neck participants with acute neck pain will be recruited and randomly divided into two groups in a 1:1 ratio. Participants in the control group will receive massage on the local neck region (5 min each session, three times a day for 3 days). In addition to massage, patients in the treatment group will receive acupuncture (one session a day for 3 days). Measures will be taken at 0, 3 and 15 days. The primary outcome is the Northwick Park Neck Pain Questionnaire (NPQ). The secondary outcome is the Short Form of the McGill Pain Questionnaire (SF-MPQ).
The protocol for this pilot randomised clinical trial has undergone ethics scrutiny and been approved by the ethics review boards of the First Affiliated Hospital of Heilongjiang University of Traditional Chinese Medicine (Permission number: HZYLL201303502). The findings of this study will provide important clinical evidence on the feasibility and efficacy of acupuncture treatment for stiff neck patients with acute neck pain. In addition, it will explore the feasibility of further acupuncture research.
ChiCTR-TRC-13003911.
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... Responses to stimuli occur both locally ( 126 ) and remotely, through sensory neurons up to the CNS ( 127 ). Therefore, the result is the activation of pathways affecting various physiological systems in the central and peripheral nervous system( 128,129,130 ).Anecdotal reports and animal studies suggest that acupuncture may inhibit convulsions ( 131 ). It has been observed that electro-acupuncture can theoretically affect epilepsy by stimulating the inhibitory neurotransmitters ( 131, 132 ), such as serotonin, GABA, or opioid peptides. ...
Introduction:
Antiseizure medications (ASMs) are the primary treatment option for epilepsies of wide etiologies, however, about 10-20% of children do not gain sustained seizure control and in this case, it is worth investigating "alternative" therapeutic approaches aside from ASMs. Nowadays, non-pharmacological strategies for epilepsy treatment encompass dietary interventions, neurostimulation-based techniques, and biobehavioral approaches.
Areas covered:
A search on PubMed database was conducted. Experimental and clinical studies, as well as meta-analysis and structured reviews on the latest non-pharmacological treatments for drug-resistant epilepsy (DRE) in children, were included. Special attention is given to the efficacy and tolerability outcomes, trying to infer the role novel approaches may have in the future.
Expert opinion:
The large heterogeneity of primary clinical outcomes and the unavoidable subjective response of each patient to treatments prevents Researchers from the identification of a single, reliable, approach to treat DRE. The understanding of fine pathophysiologic processes is giving the way to the use of alternative therapies, such as the well-known ketogenic diet, in a "personalized" view of treatment. The goal is to apply the non-pharmacological treatment most suitable for the patient's sake.
... However, more effective and safer therapies are still looked for. [4] Acupuncture therapy has been widely used to treat a variety of conditions, such as stroke, [5][6][7][8] insomnia, [9] migraine, [10,11] knee pain, [12][13][14] neck pain, [15,16] frozen shoulder, [17] pressure ulcer, [18,19] irritable bowel syndrome, [20] chronic pelvic pain syndrome, [21] cancer care, [22] Alzheimer disease, [23] and COPD. [24][25][26] Specifically, acupuncture therapy has been suggested and used to treat patients with COPD in China. ...
Background
Acupuncture has been suggested to treat chronic obstructive pulmonary disease (COPD) in China. However, current evidence is insufficient to draw a firm conclusion regarding the effectiveness of acupuncture in COPD. Therefore, this multicenter, randomized, sham-controlled study was designed to evaluate the efficacy of acupuncture for treating patients with COPD.
Methods
This is a two-arm, parallel group, multicenter, randomized, sham-controlled trial with concealed allocation, and participants, assessor, and analyst blinding. Seventy-two participants with COPD were recruited and randomly divided into 2 groups (real acupuncture group and sham acupuncture group) in a 1:1 ratio. Patients received either real or sham needling at the same acupoints 3 times weekly for 8 weeks. The primary outcome was dyspnea on exertion evaluated using the 6-minute walk test. In addition, health-related quality of life was also evaluated. Measurements were obtained at baseline and after 8 weeks of treatment.
Results
Six-minute walking distance measurements and health-related quality of life were significantly better in the real acupuncture group than that in the sham acupuncture group.
Conclusion
The findings suggest that acupuncture can be used as an adjunctive therapy to reduce dyspnea in patients with COPD.
... Both the number and diversity of treatments, which have been recommended, reflect the extremely general nature of the physiotherapy treatment for frozen shoulder. Therefore, there is yet no definitive agreement on the most effective form of treatment [46]. Physiotherapy management aims to relieve pain, promote healing, reduce muscle spasm, increase joint range of motion and strengthen weakened muscles and ultimately to prevent and treat functional impairment [41]. ...
... Quantitative analysis of the research results as they pertained to various levels of evidence was difficult to establish given that the outcomes used in those studies were not consistent. Because quantitative analysis can be difficult to perform in some cases, the results of the research on each individual outcome were classified by each qualitative analysis in order to assign a level of evidence; a quantitative level of evidence was assigned based on the individual outcomes research of three trials using the Constant Murley Score (CMS), which is a measure of functional assessment [27][28][29][30][31]. ...
Introduction Shoulder pain is a common musculoskeletal problem and one of the highest health expenditures in Korea. This article describes the development of evidence-based Korean medicine (KM) clinical practice guidelines (CPGs) for manual acupuncture for the management of shoulder pain. Methods The CPG-KM Developing Committee was provided with 12 clinical questions on manual acupuncture for the management of shoulder pain. A literature search was then conducted on seven databases (PubMed, Medline, the Cochrane Library, three Korean medical databases and one Chinese medical database). Results The final recommendations were developed by reaching official agreement on the draft using the Delphi method and the CPG-KM for shoulder pain which was approved by The Society of Korean Medicine Rehabilitation. Twelve clinical questions and eleven of the recommendations (grade A (2), B (5), C (2) and GPP (2)) were primarily related to manual acupuncture methods. A manual acupuncture treatment is recommended as grade A, to alleviate pain and improve the range of motion and shoulder joint function of an adult shoulder pain patient. An acupuncture treatment for shoulder pain should simultaneously consider local and distal acupoints. Conclusion The CPG KM for shoulder pain provides a standard procedure for the treatment process to ensure that a high quality medical service is provided globally to all patients for traditional KM, thereby supporting international traditional medicine research methodology. If additional clinical research is conducted in the future, this CPG can be updated to reflect the most up-to-date evidence.
... As a result, acupuncture has drawn a considerable scholarly attention. Many of the studies focus on acupuncture's clinical effects (e.g., Chen and Hsieh, 2012;Ernst et al., 2007;Kaptchuk, 2002;Lee et al., 2004;Sun et al., 2001;Yeung et al., 2009;Vickers, et al., 2012), and most social science research treats acupuncture as a form of complementary or alternative medicine. Very few studies focus on acupuncture per se. ...
Purpose
– This paper aims at describing and exploring how consumers perceive acupuncture as a medical treatment in relation to biomedicine.
Design/methodology/approach
– Data were collected through an online survey using quota sampling. The attitudes of 879 Hong Kong residents aged 20 or above were surveyed. Questions were generated from a previous focus group study.
Findings
– Factor analysis found that attitude toward acupuncture consisted of five underlying dimensions, including trust in biomedicine, risks versus benefits, cure and effectiveness, qualification and skills of acupuncturists, side effects and costs and severe aftereffects. Lack of trust in acupuncturists and perceived inferiority of acupuncture to biomedicine were the major barriers of public acceptance of acupuncture. Perceived strengths of acupuncture identified were not involving taking medicine, fewer side effects and being good for preventive care.
Research limitations/implications
– This study used a convenience sample recruited through personal networks, so the findings cannot automatically be generalized to the rest of the population.
Practical implications
– There is a need to build trust in the therapy and the reputation of acupuncturists through better communication of the profession’s qualification and accreditation system, as well as dissemination of clinical evidence on a long-term basis. Consumers need to be better educated about the sensations to be expected during acupuncture and the criteria for selecting an acupuncturist.
Originality/value
– This has been the first quantitative study focusing on Hong Kong consumers’ perceptions of acupuncture.
... The authors had initially considered using bilateral LR3 and LI4 points to form "Four Gates" and relieve supraspinal pain; however, safety consideration in ''Four Gates'' acupuncture in Ms X was limited by her left lower limb poststroke sensation loss. Contralateral acupuncture can prove effective in treating post-stroke shoulder pain, which in turn excites the meridians over the affected left shoulder while considering hypoesthesia effect of stroke [6]. In this case the Zhong ping point was applied to replace left LR3 [7] as it is an influential point to relax shoulder tendons over right leg. ...
The present case study illustrates the case of a 47-year-old female (Ms X) with primary progressive Multiple Sclerosis (MS) who presented with central post-stroke pain (CPSP) over her left shoulder and underwent acupuncture treatment (AT) since she appeared irresponsive to conventional treatment. The aim of this case study is to explore the effectiveness of acupuncture as a complimentary treatment in improving central neurogenic pain in MS patients affected by CPSP. AT lasted six weeks, some modification of the conventional AT points was required to ensure continuity and safety of the treatment plan. In fact, Ms X suffered from gingivitis that led to hypersensitivity of her left upper limb (UL) to acupuncture needling; moreover, she experienced sensation loss in her legs as a result of post-stroke complications. The outcome showed that the subject’s shoulder range of motion (ROM), Disabilities of the Arm, Shoulder and Hand (DASH) score and pain improved remarkably, enabling Ms X to resume post-stroke rehabilitation and reduce her analgesic intake.
... Many studies have been performed to evaluate the effectiveness of acupuncture for FS, including its ability to relieve pain. [4,5] Electroacupuncture is based on acupuncture. Specifically, a small current passes between pairs of acupuncture needles. ...
Background:
Electroacupuncture has been reported to successfully control pain. Currently, no systematic reviews of the effects of electroacupuncture on frozen shoulder patients have been performed. This review aims to provide current evidence on the efficacy of electroacupuncture for the management of pain in frozen shoulder.
Methods and analyses:
Eleven databases will be searched from their inception: PubMed, AMED, EMBASE, the Cochrane Library, 6 Korean medical databases, and 1 Chinese medical database. Study selection, data extraction, and assessment will be performed independently by 2 researchers. Risk of bias will be assessed using the Cochrane risk of bias assessment tool.
Ethics and dissemination:
Ethical approvals and patient consent are not required because the meta-analysis will be based on published research. This systematic review will be published in a peer-reviewed journal and disseminated both electronically and in print. The review will be updated to inform and guide health care practice and policy.
Trial registration number:
PROSPERO 2021 CRD42021247090.
... There are many intervention options available for PAS, such as anti-inflammatory agents, intra-articular corticosteroid injections [9], capsular distension injections [10], bupivacaine suprascapular nerve blocks [11],manipulation under anesthesia [12], arthroscopic release and repair [13]. Most of the patients may also choose complementary therapies like physiotherapy [14], exercise therapy, electrotherapy, hydrotherapy and acupuncture for the management of pain and to progress Range of motion (ROM) of the affected joint [15,16]. ...
Background: In accordance with the meridian theory of Traditional Chinese Medicine (TCM), meridian phenomena are observed along the course of a meridian following acupuncture. Their visible anifestations include alterations in the color (reddening or whitening) of the skin as well as papule and vesicle formation.
Objectives: The aim of the present work is to report a series of visible meridian phenomena manifested in human subjects and to correlate them to TCM concepts. A total of 1,200 patients, on whom classical acupuncture (with standard single-use needles without electrostimulation or moxibustion) was applied, were carefully оbserved and documented.
Methods: Visible meridian phenomena were photographed using standard photographical equipment and compared to classical acupuncture channels used by TCM.
Results: Ten patients (5 male, 5 female) exhibited visible meridian phenomena. Lines, concurring with the meridians, were observed: white lines in seven cases and red lines
in three cases. The duration of the two kinds of phenomena was different. White lines remained visible for a shorter period (10-15 min), whereas red lines were seen for up to one hour after needle removal.
Conclusion: These observations indicate that visible meridian phenomena following acupuncture are objective, albeit rare, findings that coincide with the acupuncture channels described in the classical works of TCM. The presence of such phenomena provides a new insight into the concept of meridians and explains the development of the idea in its historical context.
... The advantage of acupuncture for CSP is the lower incidence of adverse effects compared to pharmacy treatment [10]. Clinical randomized trials demonstrated that acupuncture has a short-term effect regarding pain and improving function for CSP [11][12][13][14]. ...
Chronic shoulder pain (CSP) is the third most common musculoskeletal problem. For maximum treatment effectiveness, most acupuncturists usually choose acupoint in the nonpainful side, to alleviate pain or improve shoulder function. This method is named opposite needling, which means acupuncture points on the right side are selected for diseases on the left side and vice versa. However, the underlying neural mechanisms related to treatment are currently unclear. The purpose of this study was to determine whether different mechanisms were observed with contralateral and ipsilateral acupuncture at Tiaokou (ST 38) in patients with unilateral CSP. Twenty-four patients were randomized to the contralateral acupuncture group (contra-group) and the ipsilateral acupuncture group (ipsi-group). The patients received one acupuncture treatment session at ST 38 on the nonpainful or painful sides, respectively. Before and after acupuncture treatment, they underwent functional magnetic resonance scanning. The treatment-related changes in degree centrality (DC) maps were compared between the two groups. We found alleviated pain and improved shoulder function in both groups, but better shoulder functional improvement was observed in the contra-group. Increased DC in the anterior/paracingulate cortex and decreased DC in bilateral postcentral gyri were found in the contra-group, while decreased DC in the bilateral cerebellum and right thalamus was observed in the ipsi-group. Furthermore, the DC value in the bilateral anterior/paracingulate cortex was positively correlated with the treatment-related change in the Constant–Murley score. The current study reveals different changes of DC patterns after acupuncture at contralateral or ipsilateral ST 38 in patients with CSP. Our findings support the hypothesis of acupoint specificity and provide the evidence for acupuncturists to select acupoints for CSP.
... There is evidence that acupuncture, when added to exercise is more effective in increasing ROM and decreasing pain in patients with adhesive capsulitis when compared with acupuncture alone. 60 Acupuncture was equivalent to ultrasonography treatment for pain relief in patients with impingement. 61 For nonspecific shoulder pain, acupuncture showed statistically, but not clinically notable reduction in pain after 3 months of treatment. ...
There are a number of nonsurgical modalities used by athletes in attempts to improve performance or prevent, treat, and rehabilitate musculoskeletal injuries. A concise review of available evidence on common nonsurgical modalities used today is necessary so that practitioners may appropriately counsel patients.
Methods:
A comprehensive review of relevant publications regarding Kinesio taping, sports massage therapy, and acupuncture from 2006 through 2019 was completed using PubMed and Google Scholar.
Results:
There have been numerous investigations evaluating the efficacy of nonsurgical modalities for a myriad of musculoskeletal conditions. There is some low level evidence to suggest the use of Kinesio tape for athletes with acute shoulder symptoms and acupuncture for carpal tunnel syndrome and as an adjunct treatment for low back pain. There is a need for higher quality research to better elucidate the effect of sports massage therapy on sports performance, recovery, and musculoskeletal conditions in general.
Conclusions:
Nonsurgical modalities are low-cost treatment strategies with very few reported adverse outcomes that will likely continue to increase in popularity. High-quality studies are needed to effectively evaluate these treatments, so that care providers can provide appropriate guidance based on evidence-based medicine.
... In a randomized control trial, it is found that motion style acupuncture treatment is more effective than conventional acupuncture treatment (6) . A comparative study of exercise group with acupuncture plus exercise group showed that exercise plus acupuncture group experienced significantly greater improvement with treatment (7) . A Systematic review and metaanalysis of randomized controlled trials found encouraging evidence for the effectiveness of acupuncture at Tiaokou (ST 38) for shoulder adhesive capsulitis (8) . ...
... 5e7 Many studies have been performed to evaluate the effectiveness of acupuncture for frozen shoulder pain including its strength to relieve pain. 8,9 It is believed that acupuncture mediates its effects by releasing endogenous opioids in the body that relieve pain, by overriding pain signals in the nerves, or by allowing energy (qi) or blood to flow freely through the body. 10 Electroacupuncture (EA), the delivery of a pulsed electric current via acupuncture needles, is considered to further enhance the effectiveness of acupuncture analgesia. ...
Purpose:
Frozen shoulder syndrome (FSS) causes pain and reduces the range of motion in the shoulder joint. To investigate the short and medium-term effects of electroacupuncture in people with FSS, we evaluated the therapeutic effects of true and sham electroacupuncture on pain relief and improvement of shoulder function.
Methods:
In this randomized, single-blind controlled clinical trial, 21 subjects with FSS were randomly assigned to two groups: a true electroacupuncture group (TEAG) and a sham electroacupuncture group (SEAG). The two groups underwent 18 sessions of treatment over approximately 6-9 weeks and were then followed up at 1, 3, and 6 months. Their effectiveness for alleviating the intensity of shoulder pain was evaluated with a visual analog scale (VAS), while improved shoulder mobility was evaluated by the active range of motion (AROM) and passive range of motion (PROM), and shoulder functional ability was evaluated using the Shoulder Pain and Disability Index (SPADI).
Results:
It demonstrated that the TEAG or SEAG showed lasting effects at 1, 3, and 6 months, although with no significant difference between these two groups in the shoulder functional ability outcomes. However, the decline in the VAS occurred earlier in the TEAG than the SEAG. Also, there was much more improvement in AROM for flexion and abduction in the TEAG than the SEAG. An increase in the abduction angle after electroacupuncture and manual rehabilitation was also apparent.
Conclusion:
These results suggest that electroacupuncture plus rehabilitation may provide earlier pain relief for patients with FSS and could be applied clinically.
... Significant differences between the control and study group size weakens one RCT comparing exercises alone to shoulder exercises combined with leg point acupuncture. 19 extra shoulder movements during the study group acupuncture sessions introduce further bias. Other acupuncture studies have allowed analgesic medications. ...
In our literature review we find the evidence in both conventional and complementary therapies does not reliably inform us of the effectiveness of treatments for frozen shoulder (FS). Physiotherapy, non-steroidal anti-inflammatory drugs, glucocorticosteroid injections, capsular stretching, exercises and surgery demonstrated limited evidence of efficacy. Similarly, studies varied greatly regarding the effectiveness of acupuncture treatment for shoulder injury. In the following case study we discuss acupuncture treatment of a FS resulting from traumatic injury. However in this case, traditional acupuncture intervention markedly improved the patient's symptoms. After eight treatments the pain level was significantly reduced and stabilised. Furthermore, full range of motion was regained. MRI findings two months post-injury and two months post-acupuncture treatment also provide evidence of anatomical improvement during the course of treatment. We suggest future acupuncture research trials would be more clinically relevant, and likely show more clinically significant results, if subjects were treated according to their presenting TCM diagnosis and neuro-anatomical presentations.
Frozen shoulder is a poorly understood condition that typically involves substantial pain, movement restriction, and considerable morbidity. Although function improves overtime, full and pain free range, may not be restored in everyone. Frozen shoulder is also known as adhesive capsulitis, however the evidence for capsular adhesions is refuted and arguably, this term should be abandoned. The aim of this Masterclass is to synthesise evidence to provide a framework for assessment and management for Frozen Shoulder. Although used in the treatment of this condition, manipulation under anaesthetic has been associated with joint damage and may be no more effective than physiotherapy. Capsular release is another surgical procedure that is supported by expert opinion and published case series, but currently high quality research is not available. Recommendations that supervised neglect is preferable to physiotherapy have been based on a quasi-experimental study associated with a high risk of bias. Physiotherapists in the United Kingdom have developed dedicated care pathways that provide; assessment, referral for imaging, education, health screening, ultrasound guided corticosteroid and hydro-distension injections, embedded within physiotherapy rehabilitation. The entire pathway is provided by physiotherapists and evidence exists to support each stage of the pathway. Substantial on-going research is required to better understand; epidemiology, patho-aetiology, assessment, best management, health economics, patient satisfaction and if possible prevention.
Objective:
An earlier randomized controlled trial (RCT) study showed that bee venom acupuncture (BVA) in combination with physiotherapy can be more effective in functional improvement and pain reduction in patients with adhesive capsulitis (AC). The objective of the current study was to examine the long-term effect of BVA in combination with physiotherapy on AC of the shoulder.
Design:
Retrospective 1-year follow-up analysis of a previous RCT using a telephone interview method.
Setting:
Outpatient joint center at the Gang Dong Kyung Hee University Hospital of Seoul, Republic of Korea.
Patients:
A total of 192 patients had been enrolled in the previous study, and 124 of these were excluded from the current study. Sixty-eight patients who had been treated with combined BVA and physiotherapy for AC of the shoulder for 2 months were interviewed at approximately 1 year after treatment by telephone.
Intervention:
Sixty of 68 patients were included in the follow-up analysis. Twenty received BV 1 treatment (1:10,000 concentration BVA plus physiotherapy), 22 received BV 2 treatment (1:30,000 concentration BVA plus physiotherapy), and 18 received control treatment (normal saline injection plus physiotherapy).
Outcome measures:
The primary outcome measure was Shoulder Pain And Disability Index (SPADI) score. Secondary outcome measure was score on verbal rating scale for pain and patient satisfaction.
Results:
Baseline characteristics of the groups did not significantly differ. SPADI scores at 1 year significantly differed between the BV 1 group and the control group (p=0.043). No significant differences were found in pain verbal rating scores after 1 year. Treatment satisfaction with therapy was also assessed, and the BV 1 and BV 2 groups showed significantly greater satisfaction compared with the control group.
Conclusions:
BVA combined with physiotherapy remains clinically effective 1 year after treatment and may help improve long-term quality of life in patients with AC of the shoulder.
Gestational trophoblastic diseases (GTD) are a spectrum of tumors with a various of biological behavior and potential for metastases. It consists of hydatiform mole, invasive mole, choriocarcinoma and placental site trophoblastic tumor. Choriocarcinoma presents a very aggressive tumor with high malignant potential.
We presented the two cases of choriocarcinoma with brain metastases. The first one was manifested by neurological deterioration as the first sign of metastasis, while the second patient had firstly metrorrhagia and in the further couse neurological disturbances that suggested the presence of brain tumor. In both cases we applied a combined treatment of surgery, chemotherapy and radiation therapy. Both patient survived with high quality of life.
A successful outcome of brain metastases of choriocarcinoma was obtained by the use of a combined treatment of surgery, chemotherapy and radiation therapy. In cases of young women with brain metastases, gynecological malignancy should be always considered.
CONTEXTUALIZAÇÃO: Desde o relatório final da VIII Conferência Nacional de Saúde em 1986, busca-se a introdução de práticas alternativas de assistência à saúde no âmbito dos serviços públicos de saúde. Porém, apenas em 2006, por meio da Política Nacional de Práticas Integrativas e Complementares, os profissionais não-médicos puderam atuar como acupunturistas no Sistema Único de Saúde (SUS). OBJETIVOS: Descrever a evolução da acupuntura no SUS bem como a inclusão de novos acupunturistas não-médicos. MÉTODOS: Efetuou-se um estudo exploratório e descritivo cuja fonte de dados foi o Sistema de Informações Ambulatoriais (SIA) do SUS, disponibilizado pelo banco de dados do Ministério da Saúde, relativo às consultas em acupuntura realizadas por médicos e não-médicos entre 1999 e 2007, distribuindo-se os atendimentos segundo cidades e ano do atendimento. Para a análise da tendência temporal do número de atendimentos de acupuntura, foi utilizado o modelo de regressão linear simples, utilizando-se nível de significância de 5%. RESULTADOS: A análise da tendência temporal revelou um aumento significativo (p>0,001) de 1,1 consultas em acupuntura por 100 mil atendimentos ambulatoriais anualmente registrados entre os anos de 1999 e 2007. Foi observado um expressivo incremento no último ano do período estudado. Em 2007, 28% das consultas de acupuntura foram registradas por profissionais não-médicos em 41 cidades. CONCLUSÕES: Há expansão das consultas e do número de cidades que registram acupuntura no SUS no período do estudo.
Background
Although acupuncture is widely used for chronic pain, there remains considerable controversy as to its value. We aimed to determine the effect size of acupuncture for 4 chronic pain conditions: back and neck pain, osteoarthritis, chronic headache, and shoulder pain.
Methods
We conducted a systematic review to identify randomized controlled trials (RCTs) of acupuncture for chronic pain in which allocation concealment was determined unambiguously to be adequate. Individual patient data meta-analyses were conducted using data from 29 of 31 eligible RCTs, with a total of 17 922 patients analyzed.
Results
In the primary analysis, including all eligible RCTs, acupuncture was superior to both sham and no-acupuncture control for each pain condition (P < .001 for all comparisons). After exclusion of an outlying set of RCTs that strongly favored acupuncture, the effect sizes were similar across pain conditions. Patients receiving acupuncture had less pain, with scores that were 0.23 (95% CI, 0.13–0.33), 0.16 (95% CI, 0.07–0.25), and 0.15 (95% CI, 0.07–0.24) SDs lower than sham controls for back and neck pain, osteoarthritis, and chronic headache, respectively; the effect sizes in comparison to no-acupuncture controls were 0.55 (95% CI, 0.51–0.58), 0.57 (95% CI, 0.50–0.64), and 0.42 (95% CI, 0.37–0.46) SDs. These results were robust to a variety of sensitivity analyses, including those related to publication bias.
Conclusions
Acupuncture is effective for the treatment of chronic pain and is therefore a reasonable referral option. Significant differences between true and sham acupuncture indicate that acupuncture is more than a placebo. However, these differences are relatively modest, suggesting that factors in addition to the specific effects of needling are important contributors to the therapeutic effects of acupuncture.
Frozen shoulder, which is characterized by shoulder pain and limitation of the range of motion (ROM), is a common disorder. High-intensity laser therapy (HILT) was recently introduced in the musculoskeletal therapeutic field.
The objective of this study is to evaluate the clinical efficacy of HILT in patients with frozen shoulder.
A prospective randomized controlled study.
Patients with frozen shoulder were randomly divided into 2 groups: a HILT group (n = 33) and a placebo group (n = 33). The treatment was administered 3 times per week on alternate days for 3 weeks. For all patients, the visual analog scale (VAS) for pain, VAS for satisfaction, and passive ROM were measured at baseline and 3, 8, and 12 weeks after the treatment.
The HILT group had a lower pain VAS score at 3 weeks (3.2 ± 1.7 vs. 4.3 ± 2.2, p = 0.033) and 8 weeks (2.2 ± 2.0 vs. 3.4 ± 2.7, p = 0.042), however, no statistically significant difference in the pain VAS was observed between the two groups at the final follow-up (12 weeks). No statistical difference in the ROM and the satisfaction VAS was observed between the 2 groups at serial follow-ups.
In management of frozen shoulder, HILT provided significant pain relief at 3 and 8 weeks, but not at the final follow-up time point. HILT is a noninvasive adjuvant treatment that can reduce pain in frozen shoulders. Further study is needed in order to optimize the dose and duration of HILT.
Copyright © 2015 Elsevier Ltd. All rights reserved.
Frozen shoulder is a painful, debilitating condition with a duration that ranges from several months to several years. A significant proportion of sufferers may be left with long-term shoulder impairment. Arthroscopic surgery has improved the understanding of the macroscopic pathoanatomy, whilst further work has advanced our understanding of the genetic and molecular level pathology, driving the natural history of the disease. This review looks at the identification, diagnosis and classification of the disease. It brings together published trials and systematic reviews of current treatment options for frozen shoulder in order to help guide a pragmatic approach to managing patients with frozen shoulder and to identify areas for further research.
Background: Among many interventions for subjects with frozen shoulder, mobilization techniques are the important techniques of intervention. However the opinions about efficacy of mobilization techniques differ. Hence, the purpose of this study to compare the effectiveness of Mulligan’s mobilization with movement with that of Spencer technique on improving pain, abduction and external rotation ROM and functional disability in subjects with frozen shoulder.
Method: An experimental study design, 40 subjects with unilateral frozen shoulder were randomized into 2 groups with 20 subjects each in Mulligan and in Spencer group. Subjects in Mulligan group received Mulligan mobilization with movement (MWM) and subjects in Spencer group received Spencer technique and conventional exercises was given for both the groups. The duration of intervention was one treatment sessions per day for five days. Outcome measurements such as pain using VAS, shoulder abduction and external rotation ROM using goniometer and functional disability using SPADI were measured before and after five days of intervention.
Results: Analysis using paired ‘t’ test and wilcoxon signed rank test found that there is a statistically significant improvement (p
Kinetic Acupuncture (KA): Acupuncture combined with physiotherapy as a systematic treatment of 205 cases of musculoskeletal disorders Abstract This paper introduces the concept of Kinetic Acupuncture (KA), a treatment that combines both acupuncture and physiotherapy. KA is a multidisciplinary therapy that synchronizes two simultaneous procedures, divided into 3 phases: (1) In the PreKinetic phase, acupuncture needling is used at systemic, microsystemic or locomotor points. It aims to prepare musculoskeletal structures for physiotherapy by interrupting the pain spasmpain cycle. (2) In the Kinetic phase physiotherapy is used during acupuncture stimulation of relevant scalp points. It aims to promote synergism to restore mobility. (3) In the PostKinetic phase, mustard seeds are taped over ear acupoints of greatest pressure sensitivity. It aims to maintain prolonged stimulation for pain improvement. KA was used to treat patients (n=205; 147 women and 58 men, aged 1696 years) with musculoskeletal disorders (MSD). The overall pain improvement (PI) was 18.8±15.8mm on a 100mm Visual Analogue Scale score. Functional mobility improvement (FMI) was 77.0±0.15%; therapeutic satisfaction related to the return to daily activities was 90.0%. On a 4point scale, clinical improvement averaged 1.08. Most patients (76.6%) had "remarkable improvement". The results suggest strongly that KA is an effective method, and it may have a worthwhile role in the treatment of chronic conditions such as MSD in rehabilitation in order to improve pain intensity, functional mobility and performance of daily living activities, which is important for patients' quality of life.
Infektionen am Schultergelenk sind den Angaben der Literatur zufolge eher selten. Dennoch sind eine Reihe von schwerwiegenden, sogar letalen Komplikationen beschrieben [Ambacher et al., 2002], die in erster Linie durch die zu späte Diagnosestellung, verzögert einsetzende Therapie und die topografische Nähe zum Rumpf bedingt sind.
In dit artikel worden de epidemiologie en de klinische kenmerken van de frozen shoulder beschreven. Tevens wordt een overzicht gegeven van de evidentie die er is voor effectiviteit van de fysiotherapeutische behandeling van de frozen shoulder. Vervolgens wordt deze evidentie afgezet tegen de mening om juist geen behandeling te adviseren.
Die Orthopädie umfasst in der Volksrepublik China grundsätzlich auch die Traumatologie. Orthopädie und Traumatologie sind im Verlauf der Differenzierung der einzelnen Fachgebiete auch in der traditionellen chinesischen Medizin zu einem eigenen Fachgebiet geworden. Die Orthopädie der chinesischen Medizin zeigt eine eigene fachspezifische Profilierung, die sich historisch erschließen lässt, aber auch mit der Rolle der Träger ihrer Tradition verbunden ist. Im Mittelpunkt steht das Bewegungssystem und der Orthopäde als ein Arzt mit Bewegungserfahrung. Seine Tradition fußt besonders in der Volksmedizin, dem Kampfsport und der Traumatologie des Kampfsports und letztlich auch der Kriegsmedizin. Im Gegensatz zur „Inneren Medizin“ ist die Schrifttradition in der traditionellen chinesischen Orthopädie weniger reichhaltig, die traditionelle Hochschule war kaum Ort der medizinischen Tradition.
Adhesive capsulitis is often referred to as frozen shoulder, among other terms, and has long been a topic of debate and interest in orthopaedic surgery. Despite descriptions and research on the condition dating back to the first half of the nineteenth century, much about this disease remains unknown. Patients with frozen shoulder present with limited motion, particularly external rotation, substantial pain, and decreased function. Most cases are self-limited and improve with conservative measures, but an increasing body of work identifies a subset of patients with frozen shoulder who endure long-term sequelae, and who may also benefit from earlier or more aggressive interventions. Once these patients have exhausted conservative management, arthroscopic and other surgical options become the only means of treatment. Specific medical interventions are lacking, largely due to our limited understanding of the underlying pathophysiology. This disorder is strongly associated with trauma, diabetes, thyroid disease and other conditions. Understanding these associations may bring greater insight into the fundamental pathophysiology of frozen shoulder. Here we will review the history, epidemiology, diagnosis, pathophysiology, evidence-based treatments, and outcomes associated with this complex and burdensome disease.
A acupuntura é um recurso terapêutico do sistema médico conhecido no mundo ocidental como Medicina Tradicional Chinesa (MTC) Ela visa visa à terapia e à cura das doenças através da aplicação de agulhas e moxas, além de outras técnicas. Atualmente, tem sido utilizada para o tratamento de dores crônicas e agudas de diversas origens, para controle da dor durante alguns procedimentos cirúrgicos, prevenção e tratamento de doenças., dores musculoesqueléticas, promover a normalização funcional do organismo e tem sido utilizada por atletas, profissionais e amadores para modular o bem-estar físico, para o alcance de um nível mais alto de performance competitiva e para um melhor treinamento. Apesar de ser uma área ainda pouco explorada e estudada, os resultados dos presentes estudos, já justificam o uso da acupuntura como parte integrante de uma rotina atlética de condicionamento físico, e um acupunturista desportivo já deveria estar presente nas equipes desportivas de alto rendimento, a fim de melhorar a performance final dos atletas.
Objective
To compare the immediate effect of acupuncture at the contralateral versus ipsilateral Tiaokou (ST38) in patients with Chronic shoulder pain (CSP).
Method
Altogether, 38 patients with unilateral CSP were randomly assigned to a contralateral ST38 group (Contra group) or ipsilateral ST38 group (Ipsi group). Each underwent 20 min of manual acupuncture: Contra group at the contralateral ST38, Ipsi group at the ipsilateral ST38. Primary outcome measure was the visual analog scale (VAS) score. Secondary outcome measure for assessing shoulder mobility was the Constant-Murley (CM) score, which included pain level, activities of daily living (ADL), and shoulder range of motion (ROM). These factors were assessed before and immediately after acupuncture. A value of P < .05 indicated significance.
Results
VAS scores decreased immediately after treatment in both groups, but the effect was significantly greater in the Contra group (P = .043). CM scores also improved in both groups, but the Contra group improved significantly more (P = .002). The CM's pain and ADL scores were similar in the two groups (P = .055 and P = .193, respectively), but ROM and strength scores were better in the Contra group than in the Ipsi group (P = .003 and P = .037, respectively). No adverse effects were reported.
Conclusion
The immediate effect of acupuncture at the contralateral ST38 may be superior to that at the ipsilateral ST38 in CSP patients.
Objective
This retrospective propensity score–matched cohort study aimed to examine the frequency of acromioplasty among patients with shoulder disorders receiving and not receiving acupuncture, based on Korea National Health Insurance Service-National Sample Cohort (NHIS-NSC) data.
Methods
We included cases of high-frequency shoulder disorders—adhesive capsulitis, rotator cuff syndrome, shoulder impingement syndrome, and sprain and strain of the shoulder joint—stratified from the Korea NHIS-NSC database between 2002 and 2013; cases were classified into two groups based on a history of acupuncture treatment performed at least twice within 6 weeks (acupuncture group: n = 111,561; control group: n = 71,340). We examined propensity scores and hazard ratios (HRs) for the frequency of acromioplasty, within 2 years of the first treatment or first examination in the acupuncture and control groups, respectively; cumulative survival rates were estimated using Kaplan–Meier survival analysis.
Results
Following propensity score matching, no differences were observed between the acupuncture and control groups for variables including sex, age, income and the Charlson comorbidity index. In addition, the incidence rates of acromioplasty within 2 years were lower in the acupuncture group than in the control group (HR 0.264; 95% confidence interval 0.224–0.311). Based on differences in sensitivity analyses for the numbers of acupuncture sessions and treatment duration, the frequency of acromioplasty within 2 years was lower in the acupuncture group than in the control group.
Conclusion
This study found that the frequency of acromioplasty was reduced in patients with shoulder disorders who had been treated with acupuncture. Although the findings need to be verified by prospective randomized clinical trials, these results imply that acupuncture may be effective at reducing the incidence rate of shoulder surgery.
Importance
There are a myriad of available treatment options for patients with frozen shoulder, which can be overwhelming to the treating health care professional.
Objective
To assess and compare the effectiveness of available treatment options for frozen shoulder to guide musculoskeletal practitioners and inform guidelines.
Data Sources
Medline, EMBASE, Scopus, and CINHAL were searched in February 2020.
Study Selection
Studies with a randomized design of any type that compared treatment modalities for frozen shoulder with other modalities, placebo, or no treatment were included.
Data Extraction and Synthesis
Data were independently extracted by 2 individuals. This study followed the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) reporting guideline. Random-effects models were used.
Main Outcomes and Measures
Pain and function were the primary outcomes, and external rotation range of movement (ER ROM) was the secondary outcome. Results of pairwise meta-analyses were presented as mean differences (MDs) for pain and ER ROM and standardized mean differences (SMDs) for function. Length of follow-up was divided into short-term (≤12 weeks), mid-term (>12 weeks to ≤12 months), and long-term (>12 months) follow-up.
Results
From a total of 65 eligible studies with 4097 participants that were included in the systematic review, 34 studies with 2402 participants were included in pairwise meta-analyses and 39 studies with 2736 participants in network meta-analyses. Despite several statistically significant results in pairwise meta-analyses, only the administration of intra-articular (IA) corticosteroid was associated with statistical and clinical superiority compared with other interventions in the short-term for pain (vs no treatment or placebo: MD, −1.0 visual analog scale [VAS] point; 95% CI, −1.5 to −0.5 VAS points; P < .001; vs physiotherapy: MD, −1.1 VAS points; 95% CI, −1.7 to −0.5 VAS points; P < .001) and function (vs no treatment or placebo: SMD, 0.6; 95% CI, 0.3 to 0.9; P < .001; vs physiotherapy: SMD 0.5; 95% CI, 0.2 to 0.7; P < .001). Subgroup analyses and the network meta-analysis demonstrated that the addition of a home exercise program with simple exercises and stretches and physiotherapy (electrotherapy and/or mobilizations) to IA corticosteroid may be associated with added benefits in the mid-term (eg, pain for IA coritocosteriod with home exercise vs no treatment or placebo: MD, −1.4 VAS points; 95% CI, −1.8 to −1.1 VAS points; P < .001).
Conclusions and Relevance
The findings of this study suggest that the early use of IA corticosteroid in patients with frozen shoulder of less than 1-year duration is associated with better outcomes. This treatment should be accompanied by a home exercise program to maximize the chance of recovery.
Background : : Periarthritis of shoulder is a painful condition of the shoulder, affecting 2-3% of the general population and 20% of diabetic patients. Acupuncture is a widely practiced traditional Chinese medicine. Recent evidence shows that it alleviates shoulder pain with different needling techniques. Objectives: The present study is to compare the efficacy of remote and local points on PAS. Methods : : 60 subjects were randomly assigned into two groups, remote acupuncture group (n = 30) and local acupuncture group (n = 30). Both groups were assessed at baseline and at the end of 12 sessions. Shoulder pain and its disability index (SPADI) and (ROM) were measured using goniometer. The intervention was given weekly thrice on alternate days for four weeks with 20 min for each session. Results : : The result shows that both remote and local acupuncture points were beneficial in the pain management and rage of motion when compared within the group. The effects of acupuncture at remote acupoints were better than those at local acupoints in SPADI and ROM when compared between two groups. Conclusion : : In treatment of periarthritis of shoulder remote acupuncture points may have higher therapeutic value when compared to local points.
Patients with chronic neck and/or shoulder pain were sequentially allocated into two groups to be treated with acupuncture using the same needle positions and depth, but with varying time of stimulation. One group (15 patients) had treatment sessions lasting 20min, and the second group (13 patients) had treatment for only 5min. A visual analogue score (VAS) was used to measure the levels of pain before treatment, at the end of a ten week course of weekly acupuncture treatments and again after 6 months.
The results showed that patients in both groups had a good response, both short and long term, to acupuncture, and that there was no significant difference in benefit between the groups at the end of their course of treatment or after 6 months. However, this may not necessarily mean that the shorter time of stimulation can be used in preference to the more traditional longer treatment sessions, as there was an imbalance between groups in the pre-treatment VAS and the trial size was inadequate to give a reliable result.
There was good clinical tolerance and most patients were able to continue working during the course of treatment. There thus seems no benefit to be gained by advising patients to take sick leave during acupuncture treatment for neck and shoulder pain.
Patel M (Route de Saint-Loup 4, 1290 Versoix, Switzerland), Gutzwiller F, Paccaud F and Marazzi A. A meta-analysis of acupuncture
for chronic pain. International Journal of Epidemiology 1989, 18: 900–906.
Results of 14 randomized controlled trials of acupuncture for chronic pain were pooled in a meta-analysis and analysed in
three subgroups according to site of pain; and in two subgroups each according to type to trial, type of treatment, type of
control, ‘blindness’ of participating agents, trial size, and type of journal in which results were published. While few individual
trials had statistically significant results, pooled results of many subgroups attained statistical significance in favour
of acupuncture. Various potential sources of bias, including problems with blindness, precluded a conclusive finding although
most results apparently favoured acupuncture.
Cost effective treatment is needed for common self limiting rheumatological conditions. Periarthritis of the shoulder is an example. There is no consensus for one type of treatment, though local steroids or physiotherapy are conventionally used. Their cost and efficacy were compared in a prospective randomised observer-blind trial--in essence a medical audit of the treatment of a common rheumatological problem. Sixty two consecutive patients presenting with a painful stiff shoulder were studied. Patients with coexistent diseases like cervical spondylosis or a stroke were excluded. They were randomly allocated to receive local steroids, six weeks' physiotherapy, or both. The three groups were of similar age, sex, and disease severity. Assessments of pain and shoulder movement were made initially, at six weeks, and at six months by a 'blinded' observer. Physiotherapy was given by one therapist and injections by one physician. All three groups showed significant improvements by six weeks, with further improvement at six months. Improvements were identical in all three groups. No treatment gave complications. The costs of treatment varied: an injection of triamcinolone cost 2.10 pounds; a six week course of physiotherapy cost 48.50 pounds; combination treatment cost 50.60 pounds. Patients expect treatment for a painful stiff shoulder. The results show that local steroid injections are as effective as physiotherapy alone or a combination. They provide rapid treatment and are less expensive. In the uncomplicated case a local steroid injection is the most cost effective treatment.
Several methods have been devised to estimate shoulder function, none of which is entirely satisfactory. The method described in this article is applicable irrespective of the details of the diagnostic or radiologic abnormalities caused by disease or injury. The method records individual parameters and provides an overall clinical functional assessment. It is accurately reproducible by different observers and is sufficiently sensitive to reveal even small changes in function. The method is easy to perform and requires a minimal amount of time for evaluation of large population groups.
We have analysed the Constant-Murley (1987) assessment for 25 patients with shoulder pathology. We found the score easy to use, with low inter- and intraobserver errors, but sufficiently imprecise in repeated measurements to give concern in its use for clinical follow-up of patients.
We have calculated 95% confidence limits for a single assessment to be within 16 to 20 points in most cases. In addition, we found that all our subjects with instability as their main problem scored within five points of the maximum; this suggests that the scoring method may need to be revised for use on these patients.
To review the efficacy of common interventions for shoulder pain.
All randomised controlled trials of non-steroidal anti-inflammatory drugs, intra-articular and subacromial glucocorticosteroid injection, oral glucocorticosteroid treatment, physiotherapy, manipulation under anaesthesia, hydrodilatation, and surgery for shoulder pain that were identified by computerised and hand searches of the literature and had a blinded assessment of outcome were included.
Methodological quality (score out of 40), selection criteria, and outcome measures. Effect sizes were calculated and combined in a pooled analysis if study population, end point, and intervention were comparable.
Thirty one trials met inclusion criteria. Mean methodological quality score was 16.8 (9.5-22). Selection criteria varied widely, even for the same diagnostic label. There was no uniformity in the outcome measures used, and their measurement properties were rarely reported. Effect sizes for individual trials were small (range -1.4 to 3.0). The results of only three studies investigating "rotator cuff tendinitis" could be pooled. The only positive finding was that subacromial steroid injection is better than placebo in improving the range of abduction (weighted difference between means 35 degrees (95% confidence interval 14 to 55)).
There is little evidence to support or refute the efficacy of common interventions for shoulder pain. As well as the need for further well designed clinical trials, more research is needed to establish a uniform method of defining shoulder disorders and developing outcome measures which are valid, reliable, and responsive in affected people.
In most of the painful chronic movement disorders of the shoulder it is necessary to treat for a longer period. In daily practice there are only rare cases with acute resolution of symptoms. According to new original Chinese and Ceylonese acupuncture literature, Stomach 38 (Tiaokou) is named as a distal point in acute conditions of frozen shoulder. This point is situated on the Stomach meridian which intersects with the Large Intestine meridian crossing the shoulder. This connection is known as Yang Ming in the ancient Chinese literature. Using the point ST-38 (Tiaokou) in clinical treatment, 85% of patients in this series between 20 and 72 yr suffering from frozen shoulder were promptly cured. These results show that ST-38 (Tiaokou) is one of the most important distal points in treating shoulder diseases, it should be used before attempting any other treatment. The response of homolateral deep insertion of the needle (producing a 'chi' sensation) follows the rule of 'all-or-nothing' and gives us an important hint on how to treat further. Non-responders to needling may present problems, these can only be solved by a longer period of treatment or by surgery.
Pain is the major complaint of the estimated one million U.S. consumers who use acupuncture each year. Although acupuncture is widely available in chronic pain clinics, the effectiveness of acupuncture for chronic pain remains in question. Our aim was to assess the effectiveness of acupuncture as a treatment for chronic pain within the context of the methodological quality of the studies. MEDLINE (1966-99), two complementary medicine databases, 69 conference proceedings, and the bibliographies of other articles and reviews were searched. Trials were included if they were randomized, had populations with pain longer than three months, used needles rather than surface electrodes, and were in English. Data were extracted by two independent reviewers using a validated instrument. Interrater disagreements were resolved by discussion. Fifty one studies met inclusion criteria. Clinical heterogeneity precluded statistical pooling. Results were positive in 21 studies, negative in 3 and neutral in 27. Three fourths of the studies received a low-quality score and low-quality trials were significantly associated with positive results (p = 0.05). High-quality studies clustered in designs using sham acupuncture as the control group, where the risk of false negative (type II) errors is high due to large sample size requirements. Six or more acupuncture treatments were significantly associated with positive outcomes (p = 0.03) even after adjusting for study quality. We conclude there is limited evidence that acupuncture is more effective than no treatment for chronic pain; and inconclusive evidence that acupuncture is more effective than placebo, sham acupuncture or standard care. However, we have found an important relationship between the methodology of the studies and their results that should guide future research.
This paper reviews some of the recent randomised trials on acupuncture published in the literature, with particular reference to the definition of placebo (control), sham acupuncture and real acupuncture. Response rates of 30, 50 and 70% of placebo, sham and real acupuncture respectively, are suggested for the groups of patients studied. The statistical methodology necessary in the design of acupuncture trials, in order to detect differences of this order of magnitude, is discussed. If the postulated response rate had been envisaged at the onset of the trials here reviewed, then the majority of these trials have very low power at a conventional 5% level of significance. It is emphasised that one cannot necessarily conclude from trials which produce statistically non-significant results that acupuncture (when compared with placebo for example) is ineffective. The paper suggests that meaningful comparisons between alternative treatments may be made by using ‘pain free intervals’ with subsequent analysis using life table techniques. Tables are provided for determining appropriate patient numbers.
Two cases of drug resistant osteoarthritis were effectively treated using acupuncture. Sessions of up to 40min twice a week for 3 to 5 weeks were required to induce remission of pain, joint swelling and stiffness. Benefits were still seen at the six month follow-up.
A pilot study using acupuncture in the treatment of 31 patients with frozen shoulder showed marked improvement in 24 and improvement in 6. Patients with idiopathic or arthritic frozen shoulder responded better than those with post-traumatic aetiology. There was no relationship between response to acupuncture and age.
Although this study involved no control group, the high level of improvement together with the author’s clinical experience suggests that acupuncture should be considered an effective option in the treatment of frozen shoulder; the more so since conventional medical therapy has a low expectation of benefit. Aetiology pathology and clinical management are described in both Western medical and traditional Chinese terms and details of acupuncture treatment methods are given.
Acupuncture has gained increasing attention in the treatment of chronic pain. The lack of a satisfying placebo method has made it impossible to show whether needling is an important part of the method or whether the improvement felt by the patient is due to the therapeutic setting and psychological phenomena. Also, the effectiveness of acupuncture has not been demonstrated sufficiently. We treated 52 sportsmen with rotator cuff tendinitis in a randomised single-blind clinical trial using a new placebo-needle as control. Patients were treated for 4 weeks. The primary endpoint of the trial was the change in the modified Constant-Murley-score from the baseline. Assessment of the treatment outcome was made by experienced orthopaedists not informed of the treatment allocation. Acupuncture with penetration of the skin was shown to be more effective than a similar therapeutic setting with placebo needling in the treatment of pain. The acupuncture-group improved 19.2 Constant-Murley-score points (SD 16.1, range from −13 to 50), the control-group improved 8.37 points (SD 14.56, range from −20 to 41), (P=0.014; C.I. 2.3;19.4). This study showed that needling is an important part of the acupuncture effect in the treatment of chronic shoulder pain in athletes. No conclusions can be derived from this study concerning the importance of choosing points and the rules of Traditional Chinese Medicine. Using the new placebo method as control for other ailments could improve the evidence of specific acupuncture effects beyond pain treatment.
55 patients with 60 shoulders painful at rest, and with limitation of all ranges of movement, were treated with multiple injections of methylprednisolone acetate into the subacromial space and glenohumeral joint cavity. Pain was abolished in 80%, two weeks after starting therapy and 95% were pain-free four weeks after the first injection. Maximum functional recovery (at least 150 degrees abduction, 80 degrees internal rotation, and 45 degrees external rotation), was achieved in 90% of patients eight weeks after starting treatment. It is suggested that the "frozen" shoulder--i.e., pain-free shoulder with severe limitation of all movement--is the end result of a neglected painful shoulder and it is essential that painful shoulders be treated as early as possible if normal function is to be preserved.
One half of 42 subjects treated for painful shoulders received classic acupuncture, and one half received a placebo in which the needles did not penetrate the skin. Half of each of these groups was treated in a positive setting to encourage the subject, and half in a negative setting designed to keep encouragement at a minimum. All patients were independently rated for susceptibility to hypnosis. Although range of motion did not improve, the majority of patients reported significant improvement in shoulder discomfort to a blind evaluator after treatment; placebo and acupuncture groups did not differ in this respect, however. The positive and negative settings did not affect treatment outcome. In all groups, those who were not rated as highly susceptible to hypnosis tended to fail to achieve the highest levels of relief, but such differences were not statistically significant.
A prospective study has been made of 49 patients with the frozen shoulder syndrome (as distinct from tendinitis, calcific deposits and frozen shoulders occurring after coronary infarction or with pulmonary tuberculosis) of whom forty-one have been followed up for 5-10 years, always to their greatest recovery. There were three consecutive stages: pain, stiffness, and recovery. The stiffness stage was usually related to the duration of the recovery stage. The total duration was longer than is generally supposed (an average total of 30.1 months in contrast to about 18 months as often postulated). Generally speaking, the longer the stiffness stage is, the longer is the recovery stage. In 4 patients the second shoulder became similarly affected, 6 months to 7 years after the first, and followed a similar chronological sequence to the first. After greatest recovery, slight restriction of movement was found in more than half the cases, but in only 3, all of long duration, was the restriction a handicap. Arthrography, carried out on both shoulders in all patients during the recovery stage, showed in the affected shoulder fewer rotator cuff defects than expected at this age and fewer (four) than in the contralateral one (twenty-three); seemingly, the condition leads to the obliteration of some defects.
A prospective study of randomized analysis treatment of 50 cases of frozen shoulder was carried out in 3 Swiss medical centres. Three separate aetiological groups were studied: post-traumatic (40%), neurological (14%) and idiopathic (46%). An increased radioisotope bone scan (99 mTc diphosphonate) was found in 96% of cases, regardless of aetiology. The so-called idiopathic frozen shoulder showed a scapulo-humeral increase in radioisotope uptake in several areas (in 82% of cases) without involvement of the ipsilateral carpus. Clinically, the neurological type was associated with a shoulder-hand syndrome with positive bone scan of the shoulder and the wrist in all cases. The post-traumatic type showed a diffuse (in 50% of the cases) or at several circumscribed areas (also in 50%) increase in radioisotope uptake in the shoulder. In 45% of the post-traumatic type, there was also a shoulder-hand syndrome with uptake in the wrist also. A physical treatment and early mobilization, associated with the administration of subcutaneous salmon calcitonin for 21 days (100 U Calcitonin Sandoz) had a statistically significant increased effect on pain compared to treatment with physiotherapy alone by patients with post-traumatic frozen shoulders (p < 0.02). There was no significant difference, however, in the speed of recovery of function between the two treatment groups. These observations strengthen the hypothesis that adhesive capsulitis behave like an algoneurodystrophic process.
A new approach for the management of frozen shoulder associated with reflex sympathetic dystrophy is presented. A suprascapular nerve block was performed by needle insertion behind the lateral end of the clavicle at its junction with the insertion of the trapezius muscle; the needle was directed downwards and backwards. The suprascapular nerve was identified by its response to nerve stimulation. Three ml of 0.25% bupivacaine with 1:200,000 adrenaline was injected. The block was repeated twice weekly for a total of 2-4 treatments. Evaluation of the efficacy of the block was achieved by comparing subjective pain scores and passive range of movement before the first block and after the final one. Highly significant improvements were obtained. The choice of blockade of the suprascapular nerve is a new concept for the management of the frozen shoulder of reflex sympathetic dystrophy. This is based on the fact that the nerve contains a high proportion of sympathetic fibres supplying the shoulder joint. The new approach proved to be simple, highly successful, and reproducible.
Sixty-two patients (sixty-eight shoulders) who had been treated non-operatively for idiopathic frozen shoulder were evaluated subjectively and objectively at two years and two months to eleven years and nine months of follow-up (average, seven years). Thirty-one (50 per cent) of these patients still had either mild pain or stiffness of the shoulder, or both. The range of motion averaged 161 degrees of forward flexion, 157 degrees of forward elevation, 149 degrees of abduction, 65 degrees of external rotation, and internal rotation to the level of the fifth thoracic spinous process. Thirty-seven (60 per cent) of the sixty-two patients still demonstrated some restriction of motion as compared with study-generated control values (calculated as the average motion, in each plane, for the thirty-seven unaffected shoulders of the patients who had unilateral disease). Ten patients had restriction of forward flexion; eight, of forward elevation; seventeen, of abduction; twenty-nine, of external rotation; and ten, of internal rotation. However, when the motion of each affected shoulder of thirty-seven patients who had unilateral involvement was compared with that of the unaffected contralateral shoulder, eleven (30 per cent) demonstrated some restriction. None of these patients had restriction of forward flexion; two had restriction of forward elevation; two, of abduction; seven, of external rotation; and seven, of internal rotation. The patients who had substantial restriction in three planes or more were thirteen times more likely to be men (p greater than 0.05). Marked restriction, when it was present, was most commonly in external rotation. Only seven patients (11 per cent) reported mild functional limitation.(ABSTRACT TRUNCATED AT 250 WORDS)
We report a prospective study comparing the results of treatment for frozen shoulder by manipulation and physiotherapy, arthroscopic distension and physiotherapy, and physiotherapy alone in 75 patients. The first two gave better results than physiotherapy alone and we recommend arthroscopic distension as a good alternative to manipulation. It is more controllable and gives valuable information about the pathological lesions in the joint.
Patients (n = 150) were referred to a shoulder clinic with a diagnosis of "frozen shoulder" and the suggestion that they be submitted to manipulation. All patients were further investigated using local anesthetic blocks, routine radiography, and, often, computed tomographic scanning and arthrograms. Subsequently, it appeared that only 37 patients qualified for the diagnosis of "primary" frozen shoulder. The others had a "secondary" frozen shoulder from some other painful cause, such as a rotator cuff tear or impingement. The 37 patients were arthroscoped and then manipulated while under general anesthesia. Patients were told that both irrigation and local injection of the joint would have an additional beneficial therapeutic effect in the recovery phase, and they gave prior consent to the procedures. There were no complications. Pain relief was striking. The arthroscopic appearance was uniform: a patchy vascular reaction around the biceps, and the opening into the subscapularis bursa. The capacity of the joint was reduced. In no patient was the infraglenoid recess obliterated, and no adhesions were seen. Such findings at routine shoulder arthroscopy should alert the surgeon to a diagnosis of frozen shoulder if the clinical presentation has been subtle. The findings raise questions about the previous pathological interpretation of this condition.
Arthroscopy of the shoulder is well established as a diagnostic procedure. It carries a greater degree of accuracy than conventional imaging techniques and in addition allows the assessment of instability and the degree of mechanical derangement inside the joint.
Arthoscopic surgical procedures in the shoulder are in the developing stage. Arthroscopic acromioplasty for impingement syndrome has been shown to be a safe, effective procedure and probably better than conventional surgery. In the older patient, arthroscopic debridement of the rotator cuff is very effective at relieving pain. Arthroscopic surgery for removal of loose bodies and of a torn glenoid labrum would be the current recommended procedure rather than open surgery.
Other rapidly developing areas of potential benefit are in the arthroscopic stabilisation of the dislocating shoulder and synovectomy of the shoulder in rheumatoid arthritis and other synovial conditions. The role of arthroscopy in the frozen shoulder is not clearly established although certainly it is the diagnostic tool of first choice in this condition.
A 5-year trial of acupuncture therapy in the Finnish NHS is surveyed. In total 348 patients attending Halikko Health Centre in SW Finland were treated with needle-stimulation for a wide variety of chronic pain syndromes. The mean number of acupuncture sessions was 5 in the primary series and 41% of patients received more than one series. An analysis of results showed significant relief of pain (more than 40% reduction on the visual analogue scale) in myofascial syndromes affecting the head, neck, shoulder and arm. Osteoarthrosis of major joints, and backache, responded less favourably. In total 65% of those patients who had taken analgesics before acupuncture therapy, either stopped totally or reduced their dose considerably. Those with headache could significantly more often reduce their drug intake than those with arthritis or osteoarthrosis. More results and discussion will be published in part II later in this Journal.
A 5-year trial of acupuncture therapy in the Finnish NHS is surveyed. The material of 348 pain patients has been described in Part I. Acupuncture was less effective in the elderly, in patients with a psychiatric history, on high doses of analgesics, and in those with longstanding pain. Twenty six per cent of the patients were relieved of pain for more than two years. The response to treatment was not influenced by the patients social status or his expectations of benefit.
Arthroscopic surgery of the shoulder was performed on 439 patients over a 10-year period: these patients are reviewed after a minimum follow-up of one year. Diagnostic arthroscopy is known to be valuable and we have found that arthroscopic surgery also is safe and effective. It was useful in treating frozen shoulder, early osteoarthritis, isolated tears of the glenoid labrum and lesions of the biceps tendon. It was less useful in treating partial tears of the rotator cuff, tendonitis and severe osteoarthritis, and of little value in treating complete tears of the rotator cuff or in treating patients in whom previous operations on the rotator cuff had failed. It may prove to be a useful method of performing synovectomy in rheumatoid arthritis and of treating instability.
Fifty-six shoulders in 50 patients with adhesive capsulitis were divided into 2 groups, using different treatment programs. Group A comprised 28 shoulders in 26 patients. These were treated by therapeutic heating modalities followed by therapeutic exercises and gentle rhythmic stabilization manipulation. Group B totaled 28 shoulders in 24 patients. These were treated by prolonged pulley traction accompanied by transcutaneous nerve stimulation. Group B demonstrated much greater improvement than Group A.
Acupuncture was offered to patients with lesions affecting the locomotor system. These patients had received conventional physiotherapy treatment with limited success. The lesions treated by acupuncture were hemiplegia, low back pain, frozen shoulder, dropped foot, Sciatica, and arthritis of the knee and hip. Response to acupuncture was excellent in the more acute conditions of low back pain and frozen shoulder, where six treatment sessions were required for complete recovery. The more chronic conditions required many more treatment sessions and the improvement recorded was significant, though not complete. It was concluded that acupuncture has a valuable role to play in a physiotherapy department.
As the natural history of frozen shoulder is poorly documented, a prospective study of 40 patients followed up for 40-48 months (mean 44 months) is described. The range of movement was significantly less than age- and sex-matched controls. Objective restriction was severe in five patients and mild in a further 11. Patients were often unaware that shoulder range was impaired. Dominant arm involvement, manual labour, and mobilisation physiotherapy were associated with a less satisfactory outcome. We conclude that, while objective restriction persists, there is little functional impairment in the late stage of frozen shoulder.
Forty-two patients with frozen shoulder were followed up closely for eight months. They were all taught pendular exercises and randomly allocated to one of four treatment groups: (a) intraarticular steroids, (b) mobilisations , (c) ice therapy, (d) no treatment. This study has shown that there is little long-term advantage in any of the treatment regimens but that steroid injections may benefit pain and range of movement in the early stages of the condition.
The pathogenesis and management of frozen shoulder remain controversial. A review of the literature suggests that constrictive capsulitis is a pathological feature common to chronic cases, and this provides the rationale for manipulative treatment.
Thirty patients with frozen shoulders were randomly allocated to two treatment groups. One group received manipulation and local steroid injection and their outcome was compared to the other group treated by local steroid injection alone. Review at one month showed little difference between the two treatment groups. At three months the group treated by manipulation and steroid injection showed good improvement in range of movement (40%) compared to those who received injection alone (13%). The manipulated group also showed substantial improvement in day pain scores (80%) compared to those who received injection alone (47%) and their disability resolved in 47% compared to the injection alone group where only 13% had no disability.
The numbers of patients in this trial are too small for the results to be significant statistically but the trends shown are consistent with other similar series and it is suggested that this form of management is both logical and effective.
Even today the aetiology of the frozen shoulder is still under discussion. At the Orthopaedic Department of the Medizinische Hochschule Hannover, 118 persons with a frozen shoulder were treated as in- or outpatients between 1980 and 1988. We investigated the results of two different specific therapy concepts. Most of the patients received a mixture of drug therapy and physical rehabilitation under the guidance of a physiotherapist. In a smaller group of patients, the frozen shoulder was mobilized under anaesthesia (mobilisation force). After an average follow-up time of 3.8 years from the start of treatment, 93% of the patients was examined by means of an individual subjective rating (score). In addition, a clinical examination was performed in 69% of the cases. According to the subjective personal rating (score) as well as the improvement in range of motion, moderate mobilisation led to better results than the mobilisation under anaesthesia.
Many studies of acupuncture treatment are seriously flawed by methodological problems. Poor design, inadequate measures and statistical analysis, lack of follow-up data and sub-standard treatment are all too common. However, the major problem, which many investigators consider to be still unresolved, is the definition of an appropriate placebo control. The use of inappropriate placebo controls has bedeviled acupuncture research and led to serious misinterpretation of the results of clinical trials. While a number of different solutions have been proposed there is, as yet, no agreed way of assessing the adequacy of control conditions or of deciding which placebo to use in a particular trial. We propose that assessing the credibility of treatments and control conditions may provide a way forward to a more rigorous, consensus approach.
Adhesive capsulitis is a clinical syndrome of pain and severely decreased joint motion ("frozen shoulder") caused by thickening and contraction of the joint capsule and synovium. Although arthrographic criteria for the diagnosis have been described, to our knowledge, the MR characteristics have not been reported. Accordingly, we studied the MR findings in 10 patients with this syndrome.
MR images of 25 subjects were included in the study. Nine had adhesive capsulitis documented by arthrography, and one had adhesive capsulitis proved at surgery. The MR findings in these patients were compared with those of 15 asymptomatic volunteers. Images were assessed for thickness of the joint capsule and synovium, for thickness of the coracohumeral ligament, and for volume of articular fluid. Capsule and synovium thickness was measured adjacent to the axillary recess. The volume of intraarticular fluid was calculated from direct measurements of the axillary recess and biceps tendon sheath. The rotator cuff interval was qualitatively evaluated for the presence of abnormal tissue.
Thickening of capsule and synovium on MR images was characteristic of adhesive capsulitis, with a significant difference between mean thickness in patients with adhesive capsulitis (5.2 mm) and in asymptomatic volunteers (2.9 mm) (p < .01). Capsule and synovium thickness greater than 4 mm was a specific (95%) and sensitive (70%) criterion for the diagnosis of adhesive capsulitis. There was no significant difference in volume of articular fluid or thickness of the coracohumeral ligament between patients with adhesive capsulitis and asymptomatic volunteers (p > .5). The rotator cuff interval was not useful for assessing changes of adhesive capsulitis.
Joint capsule and synovium thickness greater than 4 mm is a useful MR criterion for the diagnosis of adhesive capsulitis. The volume of articular fluid seen on MR images is not significantly diminished in patients with adhesive capsulitis.
To describe treatment of frozen shoulder syndrome (adhesive capsulitis) via conservative chiropractic treatment to the shoulder joint, utilizing specific contact, low force, instrumental adjusting procedures. A case report, providing an illustrative example of the same, is presented along with a review of the relevant literature.
A 53-yr-old woman suffered severe shoulder pain of over 6 months' duration. The patient had been diagnosed as having adhesive capsulitis and had undergone a variety of different treatment regimens without obtaining relief, including various NSAIDs, analgesics and physical therapy. At the time of her presentation, her condition had progressed to the point of near total immobility of the shoulder joint, accompanied by severe pain with resulting marked restriction in her normal activities of daily living.
The patient's shoulder was conservatively managed with chiropractic adjustments to the affected shoulder joint, as well as to the cervicothoracic spine. Treatment consisted of mechanical force, manually assisted short lever chiropractic adjustments, delivered via an Activator Adjusting Instrument. Successful resolution of the presenting symptomatology was achieved.
Chiropractic care may be able to provide an effective mode of therapeutic treatment for certain types of these difficult cases. Low force instrumental adjustments, in particular, may present certain benefits in these cases that the more forceful manipulations and/or mobilizations cannot. As such, further formal investigation of this type of therapeutic intervention for treatment of frozen shoulder may be warranted on a larger scale.
Thirty-two patients, who had frozen shoulders which had not improved with physiotherapy, were treated by manipulation under general anaesthesia or by steroid injection and hydraulic distension under local anaesthesia. Distension is recommended as it is easy to carry out and gave better results than manipulation.
A series of 51 patients, seen in Leicester, with "frozen shoulder", and referred for arthrographic examination, were assessed both before and after distension arthrography, using air and a low-osmolar contrast media combined with a steroid and local anaesthetic injection. 38 attended for further assessment at up to 6 months later. 16 patients were found to have a rotator cuff tear. There was no significant change in the mean range of active movement in the patients with rotator cuff tears, but symptomatic improvement ensued in 44% of cases. In those found to have no rotator cuff tear, and external rotation of less than 35 degrees, a significant improvement in range of movement was seen. While those with less limitation of external rotation showed no change in their range of movement, they did experience symptomatic improvement in 73% of cases. We conclude that shoulder distension arthrography, with steroid and local anaesthetic injection, may be of symptomatic benefit in patients with frozen shoulder and without a rotator cuff tear, while only those with external rotation of less than 35 degrees are likely to improve their range of motion.
Although corticosteroid injections have been reported to be effective in capsulitis of the shoulder, the optimal dose has not been established. The purpose of this study was to compare relief of symptoms following a lower dose with that following a higher dose of triamcinolone acetonide given intra-articularly.
Thirty-two patients were given low dose suspension; 25 patients were given high dose suspension.
Randomized, double-blind clinical trial. Each patient was given a course of three injections. Pain, sleep disturbance, functional impairment and passive range of motion (ROM) were assessed at intake and at one, three and six weeks after the initial injection. Data were analysed by independent sample t-tests and nonparametric Mann-Whitney U-tests.
The group which received the 40 mg dose showed significantly greater improvement than the group receiving the 10 mg dose.
The study shows that in the treatment of frozen shoulder greater symptom relief is obtained with a dose of 40 mg triamcinolone acetonide intra-articularly than with a dose of 10 mg. The effect on pain and sleep disturbance was more marked than on ROM. Intra-articular injections with triamcinolone acetonide appear to be an effective method to obtain symptom relief for patients with painful capsulitis of the shoulder.
A problem acupuncture research has to face is the concept of a control group. If, in control groups, non-acupoint needling is done, physiological acupuncture effects are implied. Therefore the effects shown in this group are often close to those shown in the acupuncture group. In other trials, control groups have received obviously different treatments, such as transcutaneous electrical nervous stimulation or TENS-laser treatment; it is not clear if the effects of acupuncture are due only to the psychological effects of the treatment.
We developed a placebo acupuncture needle, with which it should be possible to simulate an acupuncture procedure without penetrating the skin. In a cross-over experiment with 60 volunteers we tested whether needling with the placebo needle feels any different from real acupuncture.
Of 60 volunteers, 54 felt a penetration with acupuncture (mean visual analogue scale [VAS] 13.4; SD 10.58) and 47 felt it with placebo (VAS 8.86; SD 10.55), 34 felt a dull pain sensation (DEQI) with acupuncture and 13 with placebo. None of the volunteers suspected that the needle may not have penetrated the skin.
The placebo needle is sufficiently credible to be used in investigations of the effects of acupuncture.
The National Institutes of Health recently recommended acupuncture as an effective tool for the treatment of various health problems. Acupuncture is an old technique but has been popular in the United States only since 1972. Its history, theories, and indications are not well known to the medical community.
We reviewed the literature to gather information on the history, techniques, physiology, indications, adverse effects, and opposing views to acupuncture.
The mechanism by which acupuncture works involves neurotransmitters and adrenocorticotropic hormones. It appears to be effective in the treatment of pain, nausea, and drug detoxification and in stroke victims. Studies suggest acupuncture is no more effective than placebo. Acupuncture side effects have rarely been reported.
Acupuncture appears to be a safe and effective alternative medical therapy for certain health problems. More controlled research is necessary to better understand the range of its clinical application.
Frozen shoulder is a common problem in general practice, but its treatment is difficult since none of the currently used therapies are proven to be effective.
To assess the effectiveness of suprascapular nerve block to relieve pain and improve range of movement, and its suitability for use in primary care. This small study by a single practitioner aims to justify a larger multicentred trial.
A randomized trial of 30 patients to compare a single suprascapular nerve block with a course of intra-articular injections. Patients' pain levels and ranges of movement were assessed over a 12-week period.
Suprascapular nerve block produced a faster and more complete resolution of pain and restoration of range of movement than a series of intra-articular injections. These differences were confirmed by statistical analysis using the Mann-Whitney U-test (P < 0.01 for pain levels and P < 0.05 for range of abduction and external rotation.)
This study suggests that suprascapular nerve block is a safe and effective treatment for frozen shoulder in primary care, and justifies a larger multicentred trial using independent blinded assessment. Such a study should include a third group treated by suprascapular nerve block without steroid; a more comprehensive assessment of patient debility.