Pain management of hemiplegic shoulder pain post stroke in patients from Nanjing,China

We selected 106 hemiplegic patients with shoulder pain hospitalized after stroke from three hospi- tals in Nanjing, China between February 2007 and January 2012. All patients had complete clinical data sets and accounted for 45.5% of the inpatients because of stroke. Results showed that the number of patients with hemiplegic shoulder pain post stroke increased yearly, attacking mainly males 50-69 years of age. Of 106 patients, there were 60 cases （56.6%） of adhesive capsulitis, 19 （17.9%） of shoulder subluxation, 14 （13.2%） of complex regional pain syndrome, and 13 （12.6%） of central pain. The main symptoms were shoulder pain （100%）, limit of shoulder mobility （98.1%）, and adhesion of the scapula （56.6%）. MRI of the shoulder showed tendon and ligament lesions （57.1%） and rotator cuff tear （38.1%）. 53.8% of central pain was related to the thalamus, in addition to the basal ganglia, brain stem, and cerebellopontine angle. Shoulder pain, upper limb motor function, and function independence were significantly improved after comprehensive rehabilitation. In par- ticular, electroacupuncture based on basic physical therapy exhibited efficacy on shoulder subluxa- tion and complex regional pain syndrome. Multiple linear regression results showed a negative re- lationship of efficacy of pain management with the attack period of shoulder pain, involvement of the posterior limb of the internal capsule, and duration between onset and rehabilitation treatment, but a positive correlation with pain-related education, pain regression period, and pain diagnosis.

Type A aortic dissection developed after type B dissection with the presentation of shoulder pain: A case report

BACKGROUND Aortic dissection(AD)is a life-threatening condition with a high mortality rate without immediate medical attention.Early diagnosis and appropriate treatment are critical in treating patients with AD.In the emergency department,patients with AD commonly present with classic symptoms of unanticipated severe chest or back pain.However,it is worth noting that atypical symptoms of AD are easily misdiagnosed.CASE SUMMARY A 51-year-old woman was first diagnosed with scapulohumeral periarthritis due to left shoulder pain.After careful examination of her previous medical history and contrast-enhanced computed tomography angiography,the patient was diagnosed with a new type A AD after chronic type B dissection in the ascending aorta.The patient was successfully treated with surgical replacement of the dissected aortic arch and remains in good health.CONCLUSION New retrograde type A AD after chronic type B dissection is relatively rare.It is worth noting that a physician who has a patient with suspected AD should be vigilant.Both patient medical history and imaging tests are crucial for a more precise diagnosis.

DEVELOPMENT OF CLINICAL STUDIES ON ACUPUNCTURE TREATMENT OF SHOULDER PAIN IN PATIENTS WITH WIND STROKE

In the present paper, the authors review some new results of acupuncture treatment of shoulder pain in stroke patients from ① application of filiform needle with different needling manipulations, ② selection and combination of acupoints, and ③ some special needling methods including point-injection. Generally, if acupuncture therapy is used in combination with other rehabilitation methods, the therapeutic effect of shoulder-pain-relief will be much better. Regarding the acupoint selection, both local acupoints and those of the yang meridians are primarily used in clinical practice. Further studies on treating shoulder pain of hemiplegia based upon the basic theory of TCM are necessary.

Risk Factors for Shoulder Pain in Japanese Badminton Players： A Quantitative-Research Survey

This study aimed to elucidate the key risk factors for shoulder pain in Japanese middle school-, high school-, and university-level badminton players and use a regression formula to predict the probability of shoulder pain onset based on risk factor combinations. Based on a self-report questionnaire survey, we included 461 individuals （102 middle school students, 134 high school students, and 225 university students） with a history of shoulder pain in the previous year and 541 individuals with no shoulder pain in the previous year. Then, we performed logistic regression analysis of individual characteristics and history of shoulder pain to analyze the factors associated with shoulder pain onset. Analysis of patients excluding those currently experiencing shoulder pain indicated that a history of shoulder pain （〉 1 year previously） predicted shoulder pain onset. Analysis of patients excluding those with a history of shoulder pain indicated that undergoing care, being of university age, having a long history of competing, and short cool-down times were associated with recurrent pain. However, results were different for each age group. The fact that half the Japanese middle school, high school, and university badminton players had a history of shoulder pain suggests that they will experience recurrent shoulder pain. The results also suggest that different factors are important in each age group. Thus, it is critical to establish evidence-based countermeasures to prevent shoulder pain that interferes with play.

Spa therapy relieves knee and shoulder pain:a randomized controlled trial

Objective:To study the effect of spa therapy on relieving knee and shoulder pain.Methods:Participants were randomized to an intervention group(n=26)or a control group(n=23).The intervention group received the hot spring intervention program(1-2 times a day for two weeks),while the control group didn’t receive any intervention.Primary outcomes were assessed by the Western Ontario and McMaster University Osteoarthritis Index(WOMAC)and Shoulder Pain and Disability Index(SPADI).Secondary outcomes were assessed by general physical symptoms and Short Form-36(SF-36)health survey.Results:All parameters before intervention were homogenous between the groups.At baseline,there was no significant difference in WOMAC and SPADI index between the two groups,but there was a statistically significant difference in blurred vision,which was worse in the intervention group than in the control group(P<0.05).After intervention,general physical symptoms were relieved significantly in the intervention group compared with the control group(P<0.05).WOMAC index,SPADI index,social functioning,and general physical symptoms were relieved significantly after intervention in the intervention group(P<0.05).There is a significant difference in the blurred vision before and after the comparison of the control group(P<0.05).Conclusion:Spa therapy may relieve knee and shoulder pain and improve general physical symptoms and quality of life.

Therapeutic efficacy of acupuncture combined with neuromuscular joint facilitation in treatment of hemiplegic shoulder pain

BACKGROUND Stroke is a type of cerebrovascular disease with high prevalence,mortality,and onset of disability.As a neurodevelopmental therapy,neuromuscular joint facilitation(NJF)is widely used in the treatment of orthopedic and neurological disorders in the clinical practice.It is mainly used for central nervous system diseases or orthopedic diseases,movement disorders,and pain rehabilitation.According to related studies,NJF can also be used as a rehabilitation treatment in patients with hemiplegic shoulder pain(HSP).AIM To investigate the clinical efficacy of acupuncture combined with NJF in patients with HSP.METHODS Forty patients with HSP were randomly divided into a treatment group and a control group.The treatment group was treated with acupuncture combined with NJF and the control group was treated with acupuncture alone.All patients were assessed by using the visual analogue scale(VAS),Fugl-Meyer assessment(FMA),Barthel index(BI),and passive range of motion(PROM)before and after the training.All the clinical data were analyzed using SPSS 20.0 statistical software.RESULTS There was no statistical difference in the general characteristics between the two groups.In the terms of duration of treatment,age,and pre-treatment indicators,the two groups were comparable(P>0.05).After the treatment,VAS,PROM,BI,and FMA scores were significantly improved in the two groups of patients(P<0.05).The VAS,PROM and FMA scores were significantly higher in the treatment group than in the control group(P<0.05).However,there was no significant difference in BI scores between the two groups(P>0.05).CONCLUSION Both acupuncture alone and acupuncture combined with NJF in the treatment of HSP are effective,and can improve the clinical symptoms of patients.Acupuncture combined with NJF can improve the upper limb motor function,relieve pain,and increase joint mobility in patients with HSP.The combination therapy is better than acupuncture alone.However,there is no significant difference in improving the score of patients’self-care ability.

The Relationship between Neck and Shoulder Pain and the Sagittal Alignment of the Spine in Standing in Younger Generation

Background: The relationship between chronic neck and shoulder pain and posture remains controversial. The purpose of this study was to investigate the relationship between chronic neck and shoulder pain and spinal sagittal alignment in standing posture in younger generation. Methods: Subjects included 57 females and 32 males (average age, 29.9 ± 5.7 years). All subjects were 20s or 30s. Spinal curvature was assessed using SpinalMouse. The subjects were also divided into a normal group (VAS zero group) and a pain group by VAS results. Statistical analysis was performed by Student’s t-test. Significance was defined as p < 0.05. Results: The normal group and pain group included 29 and 60 subjects, respectively. In terms of location of pain, thirty-one subjects felt neck pain, 50 felt pain above the scapula, and 17 felt pain between the thoracic spine and scapula. Thoracic kyphosis and lumbar lordosis in the pain group were significantly higher than those in the normal group (p = 0.013 and p = 0.020, respectively). Thoracic kyphosis in subjects with neck pain or pain above scapula was significantly higher than that in subjects without pain (p = 0.0075 and p = 0.025, respectively). Lumbar lordosis in subjects with pain above the scapula or interscapula was significantly higher than that in subjects without pain (p = 0.016).

Neural Modulation of Hemiparetic Shoulder Pain by Repetitive Ultrasound-Guided Suprascapularis Nerve Block

Background: Neural blockade is widely used in clinical practice to alleviate acute or chronic pain, including pain during rehabilitation. To date there is little controlled evidence to confirm the efficacy of nerve blocks in hemiparetic shoulder pain after stroke. Design: This study is a prospective, open label, cohort trial reporting result from a cohort of stroke patients affected by shoulder pain. Aim: As a cohort study report, in which it is often firstly reported the possibility of an association between an observed effect and a specific environmental based on detailed clinical evaluations and histories, we aim to firstly provide clues in identifying Suprascapularis Nerve blockade as further valuable approach for shoulder pain after stroke. Population: We studied a cohort of patients affected by hemiparetic shoulder pain after Stroke. Methods: Our protocol foresees nerve blocks to be performed each 3 out of 4 days (treatment lasting 30 days) in conjunction with a rehabilitation program with the first aim to provide the window of opportunity to proceed with effective rehabilitation. 47 potential study subjects fulfilled the study criteria and were enrolled. Twenty-four subjects were randomised to the study Group to receive SSNB for the pain of their hemiparetic shoulder while 23 subjects randomized to the control Group whose member did not receive SSNB. They received serial blocks each 3 out of 4 days during rehabilitation.Results: Both treatment reported a reduction in the intensity of their shoulder pain, according to data collected from day 1 through day 42 (6 weeks). Study Group patients, receiving SSNBs, reported significant improvement from entry through the whole follow-up period. The efficiency data were higher for SSNB Group after 2 weeks and again for SSNb group at the end of treatment. Conclusion: Excellent pain relief was achieved in SSNB without clinically relevant complications, these patients having a better improvement on pain during rehabilitation, than the control subjects. Great efficacy has been achieved by combining a nerve block and rehabilitation. About Clinical Rehabilitation Impact, we believe that Suprascapularis nerve blocks can help the stroke survivors maintain an ambulatory or outpatient treatment status, maintain participation in a physical therapy or rehabilitation program, decrease the need for analgesics and in some cases lead to a complete pain relief.

Effect of ear acupuncture plus injection at Zusanli(ST 36) on shoulder pain and cytokines after gynecologic laparoscopic surgery

Objective： To explore the clinical efficacy of ear acupuncture plus injection at Zusanli（ST 36） in treating shoulder pain after laparoscopic gynecological surgery, and to observe its effect on cytokines.Methods： Two hundred patients with shoulder pain after laparoscopic gynecological surgery were randomized into two groups based on their visiting sequence, 100 cases each. The observation group was intervened by ear acupuncture plus injection at Zusanli（ST 36）, and the control group was intervened by oral administration of Ibuprofen, 10 d as a treatment course. The clinical efficacies of the two groups were compared after 2 treatment courses; the visual analogue scale（VAS）,present pain intensity（PPI） and 36-item short-form health survey（SF-36） were measured before and after the treatment;the changes of interleukin（IL）-6 and IL-10 after the treatment were also observed.Results： The VAS and PPI scores were significantly changed after the treatment in both groups（both P〈0.01）. After the treatment, the VAS score in the observation group was significantly different from that in the control group（P〈0.05）. The component scores of SF-36 were significantly changed after the treatment in both groups（P〈0.01）; after the treatment, the scores of physical functioning（PF）, bodily pain（BP）, social functioning（SF）, and mental health（MH） in the observation group were significantly different from those in the control group（all P〈0.05）. The contents of IL-6 and IL-10 dropped significantly after the intervention in both groups（both P〈0.01）, and the between-group differences were also statistically significant（both P〈0.01）. The total effective rate of the observation group was higher than that of the control group（P〈0.05）.Conclusion： Ear acupuncture plus injection at Zusanli（ST 36） can significantly improve the shoulder pain after laparoscopic gynecological surgery, down-regulate the expressions of IL-6 and IL-10, and boost the recovery.

Clinical Observation on the Post-stroke Shoulder Pain and Blood Viscosity Treated by Acupuncture-moxibustion Therapy

Objective： To reveal the therapeutic effect of acupuncmre-moxibustion therapy for the treatment of post-stroke shoulder pain. Methods： Ninety patients with post-stroke shoulder pain were randomized into three groups at ratio of 1：1：1, to receive acupuncture-moxibustion therapy （AM）, acupuncture-moxibustion plus Chinese herbal decoction （AMCH）, and Chinese herbal decoction （CH） respectively. Results： In the comparison of the therapeutic effects and blood viscosity, there was significant difference between the AM and CH group, as well as between the AMCH and CH group （P〈0.01）; the difference was not significant between the AM and AMCH group. Conclusion： Acupuncture-moxibustion is an effective therapy in the treatment of the post-stroke shoulder pain, and it can also reduce the blood viscosity in short-term.

Shoulder pain after abdominal laparoscopic operation： a multicenter study

Sboulder pain is the most common complication of laparoscopic operations.1 The incidence and severityof shoulder pain has been well documented.2 This complication was commonly regarded as the result of CO2 pneumoperitoneum, which induced extension and stimulation to the diaphragmatic muscle. The incidence and severity of shoulder pain was correlated to the pressure and duration of CO2 pneumoperitoneum.3,4 However, we noticed that in non-pneumoperitoneum laparoscopic operations, patients experienced a higher incidence and more severe post-operative shoulder pain. This was a challenge to the theory that pneumoperitoneum induces shoulder pain. Therefore a more detailed study was required to provide more objective data to explain this phenomenon.

Effectiveness of bee venom acupuncture in alleviating post-stroke shoulder pain: a systematic review and meta-analysis

BACKGROUND：Shoulder pain is a common complication of stroke.Bee venom acupuncture（BVA）is increasingly used in the treatment of post-stroke shoulder pain.OBJECTIVE：To summarize and evaluate evidence on the effectiveness of BVA in relieving shoulder pain after stroke.SEARCH STRATEGY：Nine databases,namely MEDLINE,EMBASE,the Cochrane Library,the China National Knowledge Infrastructure（CNKI）,the Japan Science and Technology Information Aggregator,Electronic（J-STAGE）,and four Korean medical databases,namely,the National Assembly Library,the Research Information Service System,the National Discovery for Science Leaders,and OASIS,were searched from their inception through August 2014 without language restrictions.INCLUSION CRITERIA：Randomized controlled trials（RCTs）were included if BVA was used at acupoints as the sole treatment,or as an adjunct to other treatments,for shoulder pain after stroke.DATA EXTRACTION AND ANALYSIS：Two review authors independently selected trials for inclusion,assessed methodological quality and extracted data.RESULTS：A total of 138 potentially relevant articles were identifi ed,4 of which were RCTs that met our inclusion criteria.The quality of studies included was generally low,and a preponderance of positive results was demonstrated.All four trials reported favorable effects of BVA on shoulder pain after stroke.Two RCTs assessing the effects of BVA on post-stroke shoulder pain,as opposed to saline injections,were included in the meta-analysis.Pain was signifi cantly lower for BVA than for saline injections（standardized mean difference on 10-cm visual analog scale：1.46 cm,95%CI=0.30–2.62,P=0.02,n=86）CONCLUSION：This review provided evidence suggesting that BVA is effective in relieving shoulder pain after stroke.However,further studies are needed to confi rm the role of BVA in alleviating post-stroke shoulder pain.Future studies should be conducted with large samples and rigorous study designs.

Can Ashi Points Stimulation Have Specific Effects on Shoulder Pain? A Systematic Review of Randomized Controlled Trials

Objective： To provide an evidence-based overview regarding the efficacy of Ashi points stimulation for the treatment of shoulder pain. Methods： A comprehensive search [PubMed, Chinese Biomedical Literature Database, China National Knowledge Infrastructure （CNKI）, Chongqing Weipu Database for Chinese Technical Periodicals （VIP） and Wanfang Database] was conducted to identify randomized or quasi-randomized controlled trials that evaluated the effectiveness of Ashi points stimulation for shoulder pain compared with conventional treatment. The methodological quality of the included studies was assessed using the Cochrane risk of bias tool. RevMan 5.0 was used for data synthesis. Results： Nine trials were included. Seven studies assessed the effectiveness of Ashi points stimulation on response rate compared with conventional acupuncture. Their results suggested significant effect in favour of Ashi points stimulation [odds ratio （OR）： 5.89, 95% confidence interval （CI）： 2.97 to 11.67, P〈0.01, heterogeneity： x 2=3.81, P=0.70, 12=0% ]. One trial compared Ashi points stimulation with drug therapy. The result showed there was a significantly greater recovery rate in group of Ashi points stimulation （OR： 9.58, 95% CI： 2.69 to 34.12）. One trial compared comprehensive treatment on the myofascial trigger points （MTrPs） with no treatment and the result was in favor of MTrPs. Conclusions： Ashi points stimulation might be superior to conventional acupuncture, drug therapy and no treatment for shoulder pain. However, due to the low methodological quality of included studies, a firm conclusion could not be reached until further studies of high quality are available.

The Effects of Interferential Stimulation on Pain and Motion after Shoulder Surgery: A Prospective Randomized Study

Purpose: The purpose of this study is to determine the effects of interferential stimulation on pain and motion after shoulder surgery. Study Design: Randomized Controlled Trial. Methods: 102 patients undergoing arthroscopic rotator cuff repair or labral repair were prospectively randomized to receive either an interferential stimulation unit immediately after surgery (STIM) or not to receive the unit (NO-STIM). Each patient was measured for the range of motion (ROM) in forward flexion (FF), abduction (ABD), internal rotation (IR) and external rotation (ER). These measurements were taken prior to surgery and at the 6 weeks post-operative time point. Visual Analogue Scale (VAS) scores (0 - 10) and the amount of narcotic taken (standardized to 10 mg equivalents of hydrocodone) were measured and compared between the two groups at 2 days and 4 weeks post-operatively. 51 patients were excluded due to failure to document VAS scores and medication usage, lack of follow-up at the 6 weeks post-operative time point or hospitalization after surgery. This left 27 patients in the STIM group and 24 patients in the NO-STIM group. Results: No difference was found in the amount of narcotic taken after 2 days (STIM 14.37 ± 1.02, NO-STIM 15.88 ± 1.22, p = 0.34) or after 4 weeks (STIM 45.32 ± 4.36, NO-STIM 48.96 ± 5.50, p = 0.60). No difference in mean VAS scores were found at 2 days (STIM 5.56 ± 0.53, NO-STIM 4.63 ± 0.57, p = 0.24) or 4 weeks (STIM 1.68 ± 0.39, NO-STIM 1.38 ± 0.34, p = 0.57). At 6 weeks post-operatively, a difference was found in ER (STIM 62.5 ± 4.09, NO-STIM 50.4 ± 4.09, p = 0.04), and no differences found in FF (STIM 134.2 ± 5.29, NO-STIM 133.3 ± 4.85, p = 0.60), ABD (STIM 124.8 ± 6.22, NO-STIM 119.6 ± 5.42, p = 0.53) or IR (STIM 60.0 ± 3.69, NO-STIM 55.9 ± 3.03, p = 0.39). A post-hoc power analysis performed using an á = 0.05 revealed the study to be 90% powered to identify a difference of one narcotic equivalent between groups and 90% powered to identify a 0.3 difference in VAS scores. Conclusions: The use of an interferential stimulator in the immediate post-operative period had no effect on pain or narcotic usage following arthroscopic rotator cuff repair or labral repair. External rotation was significantly greater in the interferential stimulator group while no differences were found in other motion parameters.

A Comparison of Subacromial Bursae Block, Suprascapular Nerve Block and Interscalene Brachial Plexus Block after Arthroscopic Shoulder Surgery

Background: The aim of this study was to compare the analgesic efficacy of subacromial bursae block (LA), suprascapular nerve block (SSB), and interscalene brachial plexus block (ISB) after arthroscopic shoulder surgery. Methods: 91 patients scheduled to undergo an arthroscopic shoulder acromioplasty under GA in an outpatient setting were included. The patients were prospectively randomized into 4 groups: 1) interscalene brachial plexus block, 2) suprascapular nerve block, 3) subacromial bursae block, 4) control group for comparison. Pain scores (VAS), supplemental analgesia, and side effects were recorded in the recoveryroom, 4 hours and 24 hours after surgery. Results: Group ISB had significantly lower pain scores at rest in the postanesthesia care unit than the SSB group (p = 0.037) and the control group (p = 0.0313). The same results were seen 4 hours follow-up. The LA group had significantly lower pain scores at rest in the postanesthesia care unit than the control group (p = 0.046) and after 4 hours follow-up significantly lower pain scores than both the SSB group (p = 0.021) and the control group (p = 0.037). After 24 hours, there were no differences between the two groups. Conclusion: In this prospective, randomized, blinded study we demonstrated that a single-dose interscalene brachial plexus block (ISB) and a subacromial bursae block (LA) are equal and the most efficient analgesic techniques after arthroscopic shoulder acromioplasty. LA is less expensive, faster and with fewer complications than ISB and therefore we suggest subacromial bursae block is an effective, safe and easy way of postoperative pain reduction after arthroscopic acromioplasty. Level of evidence: Level I. Treatment study.

肩部控制训练联合神经松动术对脑卒中偏瘫患者肩痛及上肢功能的效果

目的观察肩部控制训练基础上联合神经松动术治疗脑卒中偏瘫患者肩痛的效果。方法2020年1月至2021年11月,南通市第二人民医院脑卒中偏瘫患者43例,随机分为对照组(n=21)和治疗组(n=22)。对照组采用肩部控制训练,治疗组加用神经松动术。治疗前、治疗4周后,采用疼痛数字表法(NRS)和Fugl-Meyer评定量表上肢部分(FMA-UE)进行评定。结果对照组脱落1例,治疗组脱落2例。两组治疗后NRS和FMA-UE评分显著改善(|t|>7.898,P<0.001),且治疗组优于对照组(|t|>2.337,P<0.05)。结论肩部控制训练联合神经松动术能显著缓解脑卒中偏瘫患者的肩痛,改善其上肢运动功能。

The Use of Ultrasound Images in Manual Therapy and Additionally in Assessment of Shoulder Impingement Syndrome

The use of the ultrasound imaging (USI) in physiotherapy is becoming increasingly common but is highly operator dependent and there are safe and professional issues regarding its practical use. Currently there are no specific training guidelines relating to physiotherapists using USI. The use of ultrasound technology for medical applications began in the 1950s and has proven to be an effective, safe, non-invasive, and relatively inexpensive tool for assessing morphologic characteristics and structural integrity of visceral organs and soft tissues. The use of ultrasound to assess muscle morphology and guide rehabilitation decision-making in physical therapy practice can be traced back to the late 1960s and has been found to be reliable and valid for specific muscles during particular movements. Over the last decade there has been rapid development of this technique with increased use both by clinicians and researchers. This method is defined in literature with the denomination of Rehabilitative Ultrasound Imaging (RUSI). In this work we will see how RUSI could be of help in the evaluation of shoulder impingement syndrome (SIS).

Effect of opioid dependence or abuse on opioid utilization after shoulder arthroplasty

AIM To examine whether opioid dependence or abuse has an effect on opioid utilization after anatomic or reverse total shoulder arthroplasty(TSA).METHODS All anatomic TSA(ICD-9 81.80) and reverse shoulder arthroplasty(RSA)(ICD-9 81.88) procedures from 2007 to 2015 were queried from within the Humana claims database utilizing the Pearl Diver supercomputer(Colorado Springs, CO). Study groups were formed based on the presence or absence of a previous history of opioid dependence(ICD-9 304.00 and 304.03) or abuse(ICD-9 305.50 and 305.53). Opioid utilization among the groups was tracked monthly up to 1 year post-operatively utilizing National Drug Codes. A secondary analysis was performed to determine risk factors for pre-operative opioid dependence or abuse.RESULTS Two percent of TSA(157 out of 7838) and 3% of RSA(206 out of 6920) patients had a history of opioid dependence or abuse. For both TSA and RSA, opioid utilization was significantly higher in opioid dependent patients at all post-operative intervals(P < 0.01) although the incidence of opioid use among groups was similar within the first post-operative month. After TSA, opioid dependent patients were over twice as likely to fill opioid prescriptions during the post-operative months 1-12. Following RSA, opioid dependent patients were over 3 times as likely to utilize opioids from months 3-12. Age less than 65 years, history of mood disorder, and history of chronic pain were significant risk factors for pre-operative opioid dependence/abuse in patients who underwent TSA or RSA.CONCLUSION Following shoulder arthroplasty, opioid use between opioid-dependent and non-dependent patients is similar within the first post-operative month but is greater among opioid-dependent patients from months 2-12.

铜砭刮痧疗法联合独活寄生汤治疗风寒湿痹型神经根型颈椎病颈肩痛

目的:探讨铜砭刮痧疗法联合独活寄生汤对神经根型颈椎病颈肩痛患者的疼痛症状及睡眠质量的影响。方法:选择符合纳入标准的神经根型颈椎病颈肩痛患者130例,依据随机数字表随机分为对照组和研究组,每组各65例。对照组患者给予独活寄生汤和颈部保健运动康复干预,研究组在对照组治疗基础上给予铜砭刮痧干预,均干预4周。比较干预3、7、14 d患者颈痛量表(NPQ)评分、疼痛视觉模拟(VAS)评分、颈椎功能障碍指数(NDI)评分变化情况,并在干预30 d后比较两组患者匹兹堡睡眠质量指数(PSQI)的变化情况。结果:与对照组比较,干预3、7、14 d,研究组NPQ评分、VAS评分、NDI评分低于对照组(P<0.05,P<0.001)。NPQ评分、VAS评分、NDI评分主体内效应(F_(时点)、F_(交互))、主体间效应(F_(组间))比较,差异具有统计学意义(P<0.001)。与治疗后比较,两组PSQI入睡速度、睡眠时间、主观睡眠质量、睡眠障碍、助眠药物、日间活动和总分均降低(P<0.05),研究组睡眠效率降低(P<0.05);与对照组比较,研究组干预30 d后PSQI睡眠时间、主观睡眠质量、睡眠效率、睡眠障碍、助眠药物、日间活动、总分更低(P<0.05)。结论:铜砭刮痧疗法联合独活寄生汤可显著改善神经根型颈椎病颈肩痛患者的疼痛症状及睡眠质量,促进功能恢复。

张振宇精点力学四步手法结合运动康复治疗颈源性肩周痛经验

颈源性肩周痛是临床常见疾病,因其症状与肩关节周围炎相似,临床易被误诊误治。张振宇教授认为颈5神经背根神经节受刺激后引起肩周不适,从该病理机制入手,利用精点力学四步手法结合康复训练方案治疗本病,能够从根本上解决颈椎及周围结构退变导致的颈源性肩周疼痛症状及活动功能受限,临床疗效满意。