REVIEW OF ACUPUNCTURE FOR FROZEN SHOULDER

Objective To assess the efficacy and possible adverse effects of acupuncture on frozen shoulder. Methods Based on the key words, i.e. acupuncture, electroacupuncture, acupuncture-moxibustion, frozen shoulder, adhesive capsulitis, shoulder disorders etc., the Chinese databases were retrieved, including Oochrane Musculoskeleta Group, Oochrane Controlled Trials Register, Oochrane Complementary Medicine Field, and the central database of the Oochrane Library as well as MEDLINE, EMBASE and Chinese Biomedical CD （OBM-disc）. 20 Chinese medical journals and relevant academic conference proceedings have been searched manually. The reference lists of identified documents were checked as the supplementary retrieval. Results 6 randomized controlled trials on frozen shoulder with acupuncture and electroacupuncture were included, indicating quite advanced study quality. There were 34 to 257 participants in the trials, 668 in total. The total OR of CMS/OSA was OR 3.49 （95 % CI - 2.64 to 9.63）, the total OR of VAS was OR - 1.24 （95% CI -3.50 to 1.01）, the total OR of ROM was OR 35.70 （95% CI 22.91 to 48.49）; the total OR of MELLE was OR 4.30 （95% OI 2.32 to 7.98）. Conclusion It is shown in the present limited inclusive trials on frozen shoulder that acupuncture is the safe therapy and effective on improving the global function, relieving pain, and improving the range of motion of shoulder. All the therapeutic effects of acupuncture are superior to those in control group. However, much more high quality trials are required to provide much stronger evidence. Additionally, much more evidences on validity of frozen shoulder with other assessing indexes involved are required in the treatment with acupuncture.

Acupuncture and the Elevation Manipulation of Massage for Treatment of Frozen Shoulder

The authors have treated 50 cases of frozen shoulder in recent years with electro-acupuncture and the elevation manipulation. The results were satisfactory and reported as follows.

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.

Clinical study of warm acupuncture combined with massage in treatment of periathritis of shoulder

Objective: To analyze the clinical efficacy of warm acupuncture and moxibustion combined with manipulation in the treatment of periarthritis of shoulder. Methods: In this study, 120 patients with periarthritis of shoulder who were admitted to the department of orthopedics of the second affiliated hospital of Heilongjiang university of traditional Chinese medicine from June 2018 to June 2019 were selected, and the patients were divided into warm acupuncture group, massage group, combined treatment group and control group with a random number table, with 30 patients in each group. Warm acupuncture and moxibustion group received 4 weeks of warm acupuncture and moxibustion treatment, massage group received 4 weeks of massage treatment, patients in the combined treatment group received 4 weeks of warm acupuncture and moxibustion treatment, patients in the control group received 4 weeks of ultrashort wave combined plaster treatment. The use of ibuprofen, VAS score, Melle score, TCM syndrome score and serum inflammatory factors before and after treatment were analyzed and compared in each group of patients to evaluate the clinical efficacy. Results:shoulder joint pain and activity limitation were significantly improved in each group, VAS score, Melle score, TCM syndrome score and serum inflammatory factor levels were significantly decreased compared with before treatment (P < 0.05), and the improvement in the combined treatment group was significantly better than that in other groups (P < 0.05). Conclusion: Warm acupuncture combined with manipulation can significantly improve the clinical symptoms of periarthritis of shoulder, improve the mobility of shoulder joint, and inhibit the internal inflammatory response, which is significantly better than using warm acupuncture or manipulation alone and conventional physical therapy.

46 Frozen Shoulder Patients Treated by Acu-point Massage Therapy

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Efficacy assessment for different acupuncture therapies in the treatment of frozen shoulder

Objective To explore better therapies for the treatment of frozen shoulder. Methods One hundred and seventy-four cases were divided into a filiform needle group （56 cases）, an electroacupuncture group （57 cases） and a warming needle group （61 cases） according to the randomized, controlled and single-blind study principles. Jiānqián （肩前 Extra）, Jiānyú （肩髃 LI 15）, Jiānliáo （肩髎 TE 14）, Nàoshū （臑俞 SI 10）, Wàiguān （外关 TE 5）, Hégǔ （合谷 LI 4） were used in all three groups but treated with filiform needle, electroacupuncture and warming needle technique respectively. The needles were retained for 30 min. It was given once every other day and 5 times constituted as one course. Pain indices and activity degree of shoulders were measured and recorded before and after treatment every time. Results The total effective rate was 93.0% （53/57） in the electroacupuncture group and 95.1% （58/61） in the warming needle group, both superior to that of 78.6% （44/56） in the filiform needle group （both P〈0.01）, but there was no significant difference between electroacupuncture group and warming needle group （P〉0.05）. After one course of treatment, the decline indices of shoulder pain of electroacupuncture group （4.28±0.22） and warming needle group （3.74±0.17） were both significantly greater than that of filiform needle group （2.78±0.18）（both P〈0.01）. And the decline indices of electroacupuncture group was also greater than that of warming needle group （P〈0.05）. The improvements of shoulder activity degree of warming needle group （76.92±5.53） and electroacupuncture group （60.37±3.80） were both greater than that of filiform needle group （42.50±3.67） （both P〈0.01）. And shoulder activity degree of warming needle group was also greater than that of electroacupuncture group （P〈0.01）. After one course of treatment, improvement of shoulder activity degree and decline indices of shoulder pain in these three groups were better than that after the first time treatment （all P〈0.01）. Conclusion All these three acupuncture therapies can achieve good therapeutic effects for frozen shoulder. The therapeutic effects of electroacupuncture and warming needle groups are superior to that of filiform needle group. All these three therapies could significantly reduce patients’ pain and improve their shoulder activity degree. The analgesic effect of electroacupuncture is the best, and the shoulder activity degree improved by warming needle is the best. The improvement of clinical therapeutic effect mainly depends on the therapy and the treatment times when the same acupoints are selected and the condition of illness are similar.

针刺“肩三针”治疗肩周炎研究进展

肩周炎是一种临床多发疾病,针刺“肩三针”在减轻肩周疼痛、改善肩关节功能方面疗效显著,但临床研究较少,且缺乏对相关手法术式以及临床研究的归纳总结。因此,试通过检索知网、维普、PubMed、Web of Science数据库,就针刺“肩三针”为主治疗肩周炎的操作方法以及临床研究做一综述,为今后针刺“肩三针”为主治疗肩周炎的试验研究和临床运用提供一定的参考。

内热针联合神经肌肉关节促进技术对冻结肩的临床疗效

观察内热针联合神经肌肉关节促进技术(NJF)对冻结肩的临床效果。方法:选取江苏省人民医院浦口分院康复医学科收治的60例冻结肩患者为研究对象,随机分为观察组和对照组各30例。观察组采用内热针联合NJF治疗,对照组采用口服塞来昔布胶囊联合关节松动术治疗;分别于治疗前、治疗3周后对两组患者肩关节活动度(ROM)、疼痛视觉模拟评分(VAS)及Constant-Murley肩关节功能评分作为疗效评价。结果:治疗3周后,两组患者Constant肩关节评分、VAS评分及ROM均较治疗前明显改善,差异有统计学意义(P<0.05),且观察组Constant评分、ROM及VAS疼痛评分均明显优于对照组,差异有统计学意义(P<0.05),但两组治疗后肩关节后伸比较,差异无统计学意义(P>0.05);观察组总有效率高于对照组,差异有统计学意义(P<0.05)。结论:内热针联合神经肌肉关节促进技术治疗冻结肩,可缓解肩部疼痛,并更大程度地改善肩部功能,提高患者生活质量。

基于经筋理论刍议筋针结合运动疗法治疗肩周炎

筋针疗法是南京中医药大学刘农虞教授整理从业30余年针灸临床、教学、科研经验后总结出来的一种独特的针刺疗法。肩周炎作为临床的一种常见病和多发病,中医学归属于“经筋病”范畴,且部分十二经筋走行分布于肩关节,筋针疗法具有一定特色及优势。根据肩周炎病情的发展,阐述筋针结合运动疗法在筋肉型、筋骨型、筋脉型三个阶段的治疗思路。

针刺运动疗法对改善痰瘀阻络型脑卒中后肩痛的临床效果

目的 分析针刺运动疗法对改善痰瘀阻络型脑卒中后肩痛的临床效果。方法 选取2020年3月至2022年9月江苏省常州市武进中医医院康复科收治的84例脑卒中后肩痛患者为对象,采用随机数字表法将其分为常规组和试验组,每组42例。常规组采用低周波治疗,试验组在常规组基础上给予针刺运动疗法治疗。于治疗前,治疗3、7、10 d时比较两组肩痛程度,于治疗前、治疗2周后比较两组改良Barthel指数(MBI),Fugl-Meyer评估表上肢部分(FMA-U)评分,匹兹堡睡眠质量量表(PSQI)评分。结果 常规组脱落1例,最终完成41例,试验组脱落3例,最张立完成39例。两组治疗3、7、10 d时肩痛程度评分均低于治疗前(P<0.05);试验组治疗3、7、10 d时肩痛程度评分低于常规组(P<0.05)。治疗后,两组MBI评分、FMA-U评分高于治疗前,PSQI评分低于治疗前,试验组MBI评分、FMA-U评分高于常规组,PSQI评分低于常规组(P<0.05)。治疗后,两组肩关节前屈、后伸、外展、内旋、外旋活动度较治疗前升高,且试验组高于常规组(P<0.05)。结论 针刺运动疗法可改善痰瘀阻络型脑卒中后肩痛程度和肩关节活动度,促进上肢运动功能的恢复,有利于提高睡眠质量。

温针灸联合激痛点推拿疗法治疗肩周炎的效果及对肩功能、炎性因子水平的影响

目的探讨温针灸联合激痛点推拿疗法治疗肩周炎的效果及对肩功能、炎性因子水平的影响。方法择取2020年3月至2021年3月收治的80例肩周炎患者为研究对象,根据随机数字表法将其分为对照组与观察组,每组40例。两组均给予常规西药治疗,同时对照组采用激痛点推拿疗法,观察组在对照组基础上加温针灸治疗。比较两组的治疗效果。结果观察组的治疗总有效率高于对照组,差异具有统计学意义(P<0.05)。治疗后,观察组的Constant-Murley肩关节评分量表各维度评分高于对照组,差异具有统计学意义(P<0.05)。治疗后,观察组的肿瘤坏死因子-α(TNF-α)、白细胞介素-6(IL-6)、单核细胞趋化蛋白-1(MCP-1)、基质金属蛋白酶-3(MMP-3)水平低于对照组,差异具有统计学意义(P<0.05)。结论温针灸联合激痛点推拿疗法不仅能够提高肩周炎患者的临床治疗效果,改善肩功能,还能抑制炎性因子水平,值得推广。

牵张推拿手法联合放散式体外冲击波治疗早期原发性冻结肩的多中心随机对照临床研究

目的:观察牵张推拿手法联合放散式体外冲击波治疗早期原发性冻结肩的临床疗效。方法:将240例符合诊断标准的早期原发性冻结肩患者,分为3组,观察组和对照组各90例,空白对照组60例,观察组予牵张推拿手法联合放散式体外冲击波治疗,对照组予放散式体外冲击波治疗,空白对照组予塞来昔布口服,比较3组的CMS评分、VAS评分和疗效。结果:VAS评分比较,3组均较治疗前评分降低,观察组评分最低,对照组次之,空白对照组评分最高,P<0.05,差异具有统计学意义。3组CMS评分比较,空白对照组评分最低,对照组次之,观察组评分最高,P<0.05,差异具有统计学意义。3组疗效比较,P<0.05,差异具有统计学意义。结论:牵张推拿手法联合放散式体外冲击波治疗早期原发性冻结肩有着良好的疗效,值得临床推广。

基于数据挖掘探析针刺治疗风寒湿型冻结肩的辨经选穴规律

目的:基于数据挖掘探索针刺治疗风寒湿型冻结肩的有效经络及配穴规律。方法:通过Note-Express检索整合CNKI、Wanfang、VIP、Pub-Med、Science Direct、JAMA-Network、Web of Science等中英文数据库中近十年有关针刺治疗风寒湿型冻结肩的RCT试验,对符合纳入标准的文献经络及配穴建立数据库,构建复杂网络,进行聚类分析及关联分析。结果:共纳入38篇文献,提取出57条针刺治疗风寒湿型冻结肩处方,涉及有效正经10条、腧穴33个。复杂网络得出肩髃、肩贞、肩髎各自所归的手阳明大肠经、手太阳小肠经和手少阳三焦经的度值位居前三;聚类分析得到3个高频腧穴聚类群及3个经络聚类群;关联分析得到肩髃、肩髎、肩贞、风池、阳陵泉为治疗风寒湿型冻结肩的核心组方。结论:针刺治疗风寒湿型冻结肩选穴以肩关节周围为主,远端配穴为辅,首选手三阳经经穴有法可循、有据可依。

镜像疗法对冻结肩的临床疗效研究

目的:探讨镜像疗法治疗冻结肩的临床疗效。方法:纳入2021年3月—2023年3月就诊于上海市静安区彭浦新村街道社区卫生服务中心门诊的冻结肩患者90例,按随机号码表法分为对照组和治疗组各45例。两组均口服双氯芬酸钠双释放肠溶胶囊每天1次,每次1粒,连续10d,并参加为期4周的常规康复治疗,每次40min,1次/d,5d/周。对照组增加肩关节松动术,每次20min,5d/周,10次为1个疗程,连续2个疗程。治疗组增加肩关节镜像疗法,每天训练1次,5 d/周,10次为1个疗程,连续治疗2个疗程。于治疗前、治疗1个和2个疗程后评估患者肩关节疼痛及活动范围。结果:与治疗前相比,治疗1个和2个疗程后,两组肩关节疼痛均有所减轻,关节活动度均有所提高(每天训练1次,5d/周,10次为1个疗程,连续治疗2个疗程。P<0.01);治疗组2个疗程后的效果更为明显(P<0.01)。结论:采用镜像疗法治疗冻结肩患者,能够增加患者肩关节的活动范围,提高肩关节的运动功能,降低患者的疼痛感,是一种简单、安全、低成本的治疗方法,值得在社区康复中推广。

关节腔液压扩张术结合烧山火针刺疗法治疗肩周炎106例临床疗效观察

目的 观察关节腔液压扩张术结合烧山火针刺疗法治疗肩周炎的临床疗效。方法 选取2021年1月至2023年12月骨科门诊收治的肩周炎患者212例,采用随机数字表法分为两组,各106例。观察组采用关节腔液压扩张术结合烧山火针刺疗法治疗,对照组仅采用烧山火针刺疗法治疗。结果 观察组临床治疗总有效率98.11%高于对照组66.04%(P <0.05)。观察组治疗后各临床症状功能评分高于对照组(P<0.05)。结论 关节腔液压扩张术结合烧山火针刺疗法治疗肩周炎疗效显著,可明显改善患者临床症状,具有较高的临床价值。

益肾解痉汤联合针刺治疗卒中后肩手综合征的临床研究

目的观察益肾解痉汤联合针刺在卒中后肩手综合征的临床疗效。方法选取2019年12月至2021年12月收治的120例卒中后肩手综合征患者为研究对象,按照随机数字表法分为3组,在均予西医常规康复治疗的基础上中药组40例加用益肾解痉汤治疗,针刺组40例加用针刺治疗,联合组40例加用益肾解痉汤联合针刺治疗。3组均治疗4周后统计疗效,比较3组治疗前及治疗2、4周肩关节上举活动度、肩关节外展活动度、肩手综合征评估量表(SHSS)评分及疼痛视觉模拟量表(VAS)评分变化情况,比较3组治疗前及治疗2、4周血清P物质(SP)及缓激肽(BK)水平变化情况,比较3组治疗前及治疗2、4周T淋巴细胞亚群CD3^(+)、CD4^(+)及CD8^(+)水平变化情况,比较3组治疗前及治疗2、4周尺神经与正中神经复合肌肉动作电位(CMAP)波幅及传导速度变化情况。结果联合组总有效率97.50%(39/40),中药组82.50%(33/40),针刺组80.00%(32/40),联合组总有效率高于中药组及针刺组(P<0.05)。与本组治疗前比较,3组治疗2、4周肩关节上举活动度、肩关节外展活动度均增大(P<0.05),SHSS评分及疼痛VAS评分均降低(P<0.05),且联合组治疗2、4周肩关节上举活动度及肩关节外展活动度均大于中药组及针刺组治疗同期(P<0.05),SHSS评分及疼痛VAS评分均低于中药组及针刺组治疗同期(P<0.05)。与本组治疗前比较,3组治疗2、4周血清SP及BK水平均降低(P<0.05),且联合组治疗2、4周血清SP及BK水平均低于中药组及针刺组治疗同期(P<0.05)。与本组治疗前比较,3组治疗2、4周T淋巴细胞亚群CD3^(+)、CD4^(+)及CD8^(+)水平均无明显变化,比较差异均无统计学意义(P>0.05)。结论益肾解痉汤联合针刺治疗卒中后肩手综合征临床疗效确切,可有效改善患者临床症状,促进神经修复,促进肢体功能恢复,其作用机制可能与降低血清SP、BK水平有关。

腹针疗法配合运动治疗肩周炎的效果

目的:评估腹针疗法配合运动治疗肩周炎的效果。方法:选取2021年1月—2023年9月南京市中医院收治的100例肩周炎患者作为研究对象,将其随机分为研究组和对照组,各50例。对照组接受常规治疗,而研究组则采用腹针疗法配合运动进行治疗。比较两组临床疗效、疼痛程度、肩关节功能评分、肩关节活动度及生活质量。结果:研究组总有效率为98.00%,显著高于对照组的82.00%,差异有统计学意义(P<0.05)。治疗后,研究组视觉模拟评分法(VAS)评分低于对照组,Constant-Murley肩关节功能(CMS)评分、日常生活能力量表(ADL)评分显著高于对照组,差异有统计学意义(P<0.05)。治疗后,研究组肩关节前屈、外旋、外展和后伸均显著高于对照组,差异有统计学意义(P<0.05)。结论:腹针疗法配合运动治疗肩周炎的效果显著,可以减轻肩关节疼痛,改善关节活动度。

运动调神针刺联合穴位贴敷对风寒湿阻型肩周炎患者的影响

目的:探究运动调神针刺联合穴位贴敷对风寒湿阻型肩周炎患者的影响。方法:选取2022年1月—2023年1月厦门航空有限公司门诊部收治的90例风寒湿阻型肩周炎患者为研究对象,利用随机数表法将患者分为对照组(n=45)、研究组(n=45)。对照组患者给予穴位贴敷,研究组在对照组基础给予运动调神针刺。比较两组临床疗效、疼痛情况、肩关节功能、肩关节活动度、疼痛介质[P物质(SP)、血清前列腺素E_(2)(PGE_(2))]和症候积分。结果:研究组总有效率高于对照组,差异有统计学意义(P<0.05)。治疗后,两组SP、PGE_(2)均降低,且研究组低于对照组,差异有统计学意义(P<0.05)。治疗后,两组外展、外旋、内旋、前屈、后伸活动度均增大,且研究组大于对照组,差异有统计学意义(P<0.05)。治疗后,两组中医症候积分、视觉模拟评分法(VAS)评分均降低,且研究组低于对照组,两组Neer评分升高,且研究组高于对照组,差异有统计学意义(P<0.05)。结论:运动调神针刺联合穴位贴敷可减轻风寒湿阻型肩周炎患者的疼痛介质水平,进而减轻疼痛程度,促进临床症状改善,提高肩关节功能和临床疗效。

中医综合疗法联合关节腔灌注治疗冻结肩疗效观察

目的:观察中医综合疗法联合关节腔灌注治疗冻结肩的临床疗效。方法:将120例冻结肩患者随机分为常规治疗组、中医综合治疗组及联合治疗组,各40例。常规治疗组给予口服艾瑞昔布片配合常规功能锻炼;中医综合治疗组给予中医推拿、当归四逆汤口服及常规功能锻炼;联合治疗组予中医综合治疗配合肩关节灌注治疗。各组疗程均为4周。在治疗前及治疗6周后分别行CRP、PGE2水平检测,中文版Constant-Murley肩关节功能评分(CMS评分)以及临床治疗效果评定。结果:3组患者治疗后较治疗前CRP、PGE2水平均有下降(P<0.01),CMS评分均上升(P<0.01);在CRP、PGE2水平及CMS评分方面,中医综合治疗组优于常规治疗组(P<0.01),联合治疗组治疗后较中医综合治疗组改善更明显(P<0.01);常规治疗组和中医综合治疗组总有效率比较无统计学意义(P>0.05),但联合治疗组总有效率明显优于常规治疗组(P<0.01)和中医综合治疗组(P<0.01)。各组治疗过程中无不良反应出现。结论:中医综合疗法联合关节腔灌注治疗冻结者可减轻炎症反应,缓解疼痛并改善肩关节功能,优于常规治疗及中医综合疗法。

朱琏针灸抑制Ⅱ型手法联合抻筋指推法治疗肩关节周围炎的临床效果

目的探讨朱琏针灸抑制Ⅱ型手法联合抻筋指推法治疗肩关节周围炎的临床效果。方法选取2022年1月至2023年12月佛山市南海经济开发区人民医院收治的98例肩关节周围炎患者作为研究对象,按照随机数字表法分为对照组(49例)和观察组(49例)。对照组患者采用常规针灸联合推拿治疗,观察组患者采用朱琏针灸抑制Ⅱ型手法联合抻筋指推法治疗,两组患者均连续治疗4周。比较两组患者的临床疗效、疼痛程度[简化McGill疼痛问卷(SF-MPQ)]及Melle评分。结果观察组的治疗总有效率高于对照组,差异有统计学意义(P<0.05)。两组患者治疗前的SF-MPQ、Melle各项评分比较,差异无统计学意义(P>0.05);治疗后,两组患者的SF-MPQ、Melle各项评分均低于本组治疗前,且观察组的SF-MPQ、Melle各项评分均低于对照组,差异有统计学意义(P<0.05)。结论朱琏针灸抑制Ⅱ型手法联合抻筋指推法治疗肩关节周围炎效果良好,可以减轻疼痛,改善肩关节功能,值得推广。