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.

Frozen shoulder:A systematic review of therapeutic options

Frozen shoulder is a common disease which causes significant morbidity. Despite over a hundred years of treating this condition the definition, diagnosis, pathology and most efficacious treatments are still largely unclear. This systematic review of current treatments for frozen shoulder reviews the evidence base behind physiotherapy, both oral and intra articular steroid, hydrodilatation, manipulation under anaesthesia and arthroscopic capsular release. Key areas in which future research could be directed are identified, in particular with regard to the increasing role of arthroscopic capsular release as a treatment.

Frozen shoulder-A prospective randomized clinical trial

AIM To compare the results of arthroscopic capsular release with intra-articular steroid injections in patients of frozen shoulder.METHODS Fifty-six patients with frozen shoulder were randomised to one of two treatment groups: Group 1, complete 360 degree arthroscopic capsular release and group 2, intra-articular corticosteroid injection(40 mg methyl prednisolone acetate). Both groups were put on active and passive range of motion exercises following the intervention. The outcome parameters were visual analogue scale(VAS) score for pain, range of motion and Constant score which were measured at baseline, 4, 8, 12, 16 and 20 wk after intervention.RESULTS All the parameters improved in both the groups. The mean VAS score improved significantly more in the group 1 as compared to group 2 at 8 wk. This greater improvement was maintained at 20 wk with P value of 0.007 at 8 wk, 0.006 at 12 wk, 0.006 at 16 wk and 0.019 at 20 wk. The Constant score showed a more significant improvement in group 1 compared to group 2 at 4 wk, which was again maintained at 20 wk with P value of 0.01 at 4, 8, 12 and 16 wk. The gain in abduction movement was statistically significantly more in arthroscopy group with P value of 0.001 at 4, 8, 12, 16 wk and 0.005 at 20 wk. The gain in external rotation was statistically significantly more in arthroscopy group with P value of 0.007 at 4 wk, 0.001 at 8, 12, and 16 wk and 0.003 at 20 wk. There was no statistically significant difference in extension and internal rotation between the two groups at any time. CONCLUSION Arthroscopic capsular release provides subjective and objective improvement earlier than intra-articular steroid injection.

Arthroscopic Capsular Release for Frozen Shoulder—Time to Thaw the Delay?

Introduction: Frozen shoulder is a common condition that affects the working population. Current management regimes are variable nationwide and the evidence base on which to base these decisions is poor. The longevity and severity of symptoms often result in great economic burden, both to health services and in terms of absence from work. Early surgical intervention with arthroscopic capsular release may result in improved symptoms and earlier return to both work and leisure activities. Aims: The aim of our prospective cohort study was to investigate whether early intervention with arthroscopic capsular release resulted in improvement of symptoms and whether this would in turn provide overall economic benefit to society. Methods: Patients diagnosed with frozen shoulder at an elective orthopaedic specialist shoulder clinic were recruited prospectively. Data were gathered by way of questionnaire to ascertain the demographic information of the patient as well as their previous treatment in the primary care setting and absence from work. Initial Oxford Shoulder Score (OSS) was also calculated: Arthroscopic capsular release was then performed and further data gathered at four-week post-operative follow-up. Economic impact of delay to treatment and cost of intervention were calculated using government data from the national tariff which cost different forms of treatment. Statistical analysis was then performed on the results. Results: Twenty five patients were recruited. Mean results were: Age of patients: 53.5 years, duration of symptoms prior to intervention: 35.2 weeks, days absent from work: 31.5, number of previous physiotherapy sessions: 7.2, number of steroid injections: 1.3. Mean pre-operative OSS was 37.4 (range 27 - 58, SD 7.4). Mean post-operative OSS was 15.9 (range 12 - 22, SD 2.3), P 0.01. Mean improvement in OSS was 21.5 (range 12 - 38, SD 7.1). The cost of non-operative treatment per patient including absence from work to the point of surgical intervention was ￡3954. The overall cost of arthroscopic capsular release per patient was ￡1861, a difference of ￡2093. There were no surgical complications. Conclusion: Arthroscopic capsular release improved shoulder function on OSS within four weeks. This is significantly shorter than the natural history of frozen shoulder. The overall cost of arthroscopic capsular release is significantly less than the cost of treating the patients non-operatively up to the point of surgical intervention. Early surgical intervention may improve symptoms quickly and reduce economic burden of the disease. A randomised controlled trial comparing early with late intervention would further elucidate potential benefits.

Corticosteroid injection alone vs additional physiotherapy treatment in early stage frozen shoulders

AIM To investigate the additional value of physiotherapy after a corticosteroid injection in stage one or two idiopathic frozen shoulders(FSs).METHODS A two center, randomized controlled trial was done. Patients with a painful early stage idiopathic FS were eligible for inclusion. After written consent, patients were randomly allocated into two groups. All patients received an ultrasound-guided intra-articular corticosteroid injection. One group underwent additional physiotherapy treatment(PT) and the other group did not(non-PT). The primary outcome measure was the Shoulder Painand Disability Index(SPADI). Secondary outcomes were pain(numeric pain rating scale), range of motion(ROM), quality of life(RAND-36 score), and patient satisfaction. Follow-up was scheduled after 6, 12 and 26 wk.RESULTS Twenty-one patients were included, 11 patients in the non-PT and ten in the PT group, with a mean age of 52 years. Both treatment groups showed a significant improvement at 26 wk for SPADI score(non-PT: P = 0.05, PT: P = 0.03). At the 6 wk follow-up, median SPADI score was significant decreased in the PT group(14 IQR: 6-38) vs the non-PT group(63 IQR: 45-76)(P = 0.01). Pain decreased significantly in both groups but no differences were observed between both treatment groups at any time point, except for night pain at 6 wk in favor of the PT group(P = 0.02). Significant differences in all three ROM directions were observed after 6 wk in favor of the PT group(P ≤ 0.02 for all directions). A significantly greater improvement in abduction(P = 0.03) and external rotation(P = 0.04) was also present in favor of the PT group after 12 wk. RAND-36 scores showed no significant differences in health-related quality of life at all follow-up moments. At 26 wk, both groups did not differ significantly with respect to any of the outcome parameters. No complications were reported in both groups.CONCLUSION Additional physiotherapy after corticosteroid injection improves ROM and functional limitations in early-stage FSs up to the first three months.

Arthroscopic capsular release and manipulation under anaesthesia for frozen shoulders:A hot topic

A frozen shoulder is a common cause of shoulder pain and stiffness.The etiology and pathology of frozen shoulders is not fully understood yet.Frozen shoulderis characterized by a decrease in intra-articular volume and capsular compliance.This can lead to significant limitations in daily life.The majority of the patients can be treated conservatively,with functional recovery to be expected in two to three years.However,if conservative treatment fails,manipulation under anaesthesia and arthroscopic capsular release can both be considered as appropriate treatments.Manipulation is a traditionally well-established technique but in recent years it seems that arthroscopic capsular release has gained popularity.Manipulation is a relative time efficient and technically low-demanding procedure in which the glenohumeral joint is forced into different directions under general anaesthesia to release the capsular contracture,thereby increasing the range of motion of the joint.In arthroscopic capsular release the glenohumeral capsule can be released in a more controlled manner under direct vision.There are no prospective comparative trials available to display superiority of one procedure over the other.In addition,the optimal timing of both these interventions still has to be determined.An overview of the literature concerning this topic and a description of both procedures with its own advantages and disadvantages is provided.

Atypical progress of frozen shoulder after COVID-19 vaccination:A case report

BACKGROUND After vaccination was mandated worldwide,various adverse effects associated with the coronavirus disease 2019(COVID-19)vaccination,including shoulder pain,have been reported.Here,we report a case of new-onset shoulder pain after BNT162b2(Comirnaty,Pfizer-BioNTech)mRNA vaccination.CASE SUMMARY A 50-year-old man visited our rehabilitation center with left shoulder range of motion(ROM)limitation that had persisted for more than 5 mo.The history included no specific noteworthy events,except vaccination.The pain in the patient’s left deltoid muscle appeared 1 day after the second BNT162b2 vaccination and intensified to severe pain.The patient self-administered aspirin,with which the pain subsided immediately,whereas ROM limitation persisted.At the first visit,the patient complained of dull pain and ROM restriction of the left shoulder(flexion 130°,abduction 110°,and external rotation 40°).Among the diagnostic studies conducted for the evaluation of the shoulder,magnetic resonance imaging showed a thickened coracohumeral ligament.Nerve conduction studies and needle electromyography showed no electrodiagnostic abnormalities.The patient received comprehensive rehabilitation for 7 mo and had an overall improvement in pain and ROM of the left shoulder.CONCLUSION In this case of severe shoulder pain after COVID-19 vaccination that subsided immediately with aspirin treatment,the exact cause and mechanism of pain are unclear.However,the clinical symptoms and diagnostic workups in our report suggest the possibility that the COVID-19 vaccination triggered an immunochemical response that resulted in shoulder pathology.

Influence of enhancing dynamic scapular recognition on shoulder disability,and pain in diabetics with frozen shoulder:A case report

BACKGROUND Frozen shoulder(FS)is a familiar disorder.Diabetics with FS have more severe symptoms and a worse prognosis.Thus,this study investigated the influence of enhancing dynamic scapular recognition on shoulder disability and pain in diabetics with FS.CASE SUMMARY A Forty-five years-old male person with diabetes mellitus and a unilateral FS(stage II)for at least 3 mo with shoulder pain and limitation in both passive and active ranges of motion(ROMs)of the glenohumeral joint of≥25%in 2 directions participated in this study.This person received dynamic scapular recognition exercise was applied to a diabetic person with a unilateral FS(stage II).The main outcome measures were upward rotation of the scapula,shoulder pain and disability index,and shoulder range of motion of flexion,abduction,and external rotation.The dynamic scapular exercise was performed for 15 min/session and 3 sessions/wk lasted for 4 wk.After 4 wk of intervention,there were improvements between pre-treatment and post-treatment in shoulder pain,shoulder pain and disability index,shoulder ROM,and upward rotation of the scapula.CONCLUSION This case report suggested that enhancing dynamic scapular recognition may improve shoulder pain and disability;upward rotation of the scapula;and shoulder ROM of shoulder abduction,flexion,and external rotation after 4 wk.

Effects of Tongluozhitong gel on frozen shoulder and expression in IL-1β, TNF-α, MMP-3 in rabbits

Objective:To investigate the efficacy of TongLuoZhiTong Gel in the treatment of frozen shoulder model and the effects of frozen shoulder-related factors IL-1β,TNF-αandMMP-3 in rabbit.Methods:Twenty-four male healthy adult rabbits were randomly divided into the following three groups:blank group(group A),model control group(group B),and TongLuoZhiTong Gel treatment group(group C).Except for the blank group,the rabbits were subjected to a frozen shoulder model by continuous mechanical strain and ice application.After the model was completed,both groups A and B were not treated;group C was treated with external application of TongLuoZhiTong Gel,5 times a week for 2 weeks.Two weeks later,the synovial tissue was abstracted in the frozen shoulder joint,and then observed under the light microscope after HE staining.The Krenn grading of chronic synovitis was used to evaluated the degree of inflammation of the synovium.At the same time,the expression levels of IL-1β,TNF-αand MMP-3 in serum and periarticular tissues of each group were detected by enzyme-linked immunosorbent assay(ELISA).Results:Compared with the blank group,the Krenn score of the shoulder group was significantly increased after model establishment(P<0.05),and the local skin was red and swollen,suggesting successful modeling.Compared with the model group,after two weeks treatment of TongLuoZhiTong Gel,the inflammatory infiltration of the synovial tissue sections was significantly relieved,and the Krenn score was significantly decreased(P<0.05).In terms of fibrogenic chemical factors and inflammatory chemical factors,TongLuoZhiTong Gel treatment group can significantly reduce the expression of IL-1β,TNF-αand MMP-3 in rabbit serum and periarticular tissue homogenate(P<0.05).Conclusion:TongLuoZhiTong Gel can effectively alleviate the synovial inflammation of the frozen shoulder model of rabbits,and can significantly reduce the levels of IL-1β,TNF-αand MMP-3 in the serum and surrounding tissues of rabbits.

Prevalence of Diabetes and Its Effect on the Course and Treatment of Frozen Shoulder

Background: Frozen shoulder is a painful condition that can lead to long-term disability. The frequency of frozen shoulder among diabetic patients is about 10% to 39%. Diabetics have a higher prevalence of frozen shoulder than the general population, and these individuals are less responsive to therapy and have a larger range of motion limitation. Aim: The aim of this thesis is to determine the prevalence of diabetes among patients with frozen shoulder and to compare them in terms of demographics, clinical and treatment features. Method: This study was performed on patients who had been diagnosed with frozen shoulder at an orthopedic center in Mashhad, Iran, from 2012 to October 2021. The frequencies and cross tabulations were used to analyze the data by SPSS to determine the significance of relationships. The chi-square and t-tests have been used with a p-value less than 0.05 as the alpha level of significance. Results: Among the patients, the average age was 56 years old. Among 310 patients with Frozen shoulder, 36% were diabetic. There was no statistically significant difference in gender and level of activity between patients with and without diabetes. In contrast, the side of the affected shoulder, duration of frozen shoulder, stage of frozen shoulder and treatment of frozen shoulder were statistically significantly different between the two groups (p p Conclusion: Based on this study, around one-third of frozen shoulder patients have diabetes. Although there was a statistically significant difference in the treatment of frozen shoulder between patients with and without diabetes groups, diabetic individuals have a more severe course of illness, and their treatment is less effective.

46 Frozen Shoulder Patients Treated by Acu-point Massage Therapy

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内服活络效灵丹联合肩关节镜下松解术治疗冻结肩临床观察

目的探究内服活络效灵丹联合肩关节镜下松解术治疗冻结肩的临床效果。方法选取2017年7月—2022年11月江西省泰和县中医院骨科收治的46例冻结肩患者,随机分为研究组和对照组,各23例。研究组采取内服活络效灵丹联合肩关节镜下松解术治疗,对照组采取单纯的肩关节镜下松解术治疗,并进行为期6个月的随访。比较两组治疗前后视觉模拟量表(VAS)、加州大学肩关节评分系统(UCLA)评分、美国肩肘外科医师协会(ASES)评分、Constant-Murley评分与肩关节活动度差异,评价两组患者肩关节活动功能;观察治疗后6个月内患者冻结肩康复情况。结果研究组VAS评分显著低于对照组(P<0.05);研究组UCLA评分、ASES评分、Constant-Murley评分显著高于对照组(P<0.05);研究组肩关节活动程度显著高于对照组(P<0.05)。结论内服活络效灵丹联合肩关节镜下松解术在冻结肩治疗中能取得优良的效果,手术以微创为主,以其创伤小、住院周期短、恢复快的特点使得患者容易接受,再结合中药活络效灵丹内服可起到治病求本的作用,中西医结合,标本兼治,在临床中是值得大范围推崇的一种行之有效的方案,能够解决冻结肩患者肩关节疼痛伴活动受限带来的苦恼。

Treatment of a rotator cuff tear combined with iatrogenic glenoid fracture and shoulder instability:A rare case report

BACKGROUND The brisement manipulation is an effective treatment for refractory shoulder stiffness.Rotator cuff tears can sometimes exist in combination with adhesive capsulitis.Arthroscopic capsular release combined with rotator cuff repair has achieved good outcomes in published reports.CASE SUMMARY We report the case of a patient with right shoulder pain for more than 1 year that was suspected to have adhesive capsulitis and a rotator cuff tear that was treated with brisement manipulation and arthroscopic management.An iatrogenic glenoid fracture with shoulder instability occurred during the manipulation.Arthroscopic treatment for fracture fixation,capsular release,and rotator cuff repair was performed,and the functional results are reported.CONCLUSION Arthroscopic fixation for iatrogenic glenoid fracture and repairing coexisting rotator cuff tear can provide the stability needed for early rehabilitation.

Arthroscopic findings after manipulation under anesthesia in idiopathic capsulitis of the shoulder:A prospective study

BACKGROUND Manipulation under anesthesia(MUA)of the shoulder joint is a commonly used method for the treatment of adhesive capsulitis.Though it has been known to be associated with a variety of complications,there is a paucity of studies describing the arthroscopic findings after MUA.AIM To describe the arthroscopic findings in patients with idiopathic adhesive capsulitis of the shoulder after MUA.METHODS We recruited 28 patients with idiopathic adhesive capsulitis who underwent arthroscopic capsular release.Manipulation of the shoulder was performed under anesthesia in all of these patients before capsular release.Intra-articular findings were recorded during arthroscopic capsular release in these patients.RESULTS All patients showed the presence of synovitis.Twenty-seven patients showed tears in the capsule on the anterior aspect.One patient had an avulsion of the anterior rim of the glenoid and labrum following the manipulation.Four patients had partial rotator cuff tears,and one patient showed a superior labrum anterior posterior lesion,which was not diagnosed preoperatively on magnetic resonance imaging.CONCLUSION MUA leads to rupture of the capsule,which is the desired outcome.However,the site of rupture of the capsule is dependent on the maneuvers of MUA.In addition,partial tears of the rotator cuff and osteochondral fractures of the glenoid can also occur.

封闭治疗肩周炎的应用解剖学研究

目的 为封闭治疗肩周炎提供解剖学基础。方法 查找封闭注射治疗肩周炎的操作方法。利用30例肩部三维重建模型,探讨骨性定位标志与病变部位的几何关系,并获得改良的封闭注射方法。用改良方法对34例防腐标本进行封闭注射,经解剖验证注射的准确性。结果 几何关系分析发现肩峰前角进针,7号针头呈扇形注射,几乎可注入整个肩峰下间隙;在喙突尖与肩峰前角连线的中点,向肱骨头可刺入关节腔。解剖发现肱二头肌腱与大结节前缘存在一定的间隙,可为进针点。改良的注射方法准确率为100%。结论 熟悉肩部的几何关系和解剖特点,改良的封闭注射方法有助于提高封闭注射的准确性。

Effectiveness of Kaltenborn Joint Mobilization Technique Versus Muscle Energy Technique on Pain and Disability in Patients with Shoulder Adhesive Capsulitis

The objective of this study was to compare the effectiveness of Kaltenborn joint mobilization techniques with muscle energy techniques in adhesive capsulitis.Study was conducted in population of Sargodha who is seeking physiotherapy treatment for adhesive capsulitis in physiotherapy rehabilitation departments and centers.The study design was randomized,controlled,and multicenter.Around 75 patients were selected by inclusion and exclusion criteria,and were divided into three groups by lottery method of randomization.Group 1 obtained Kaltenborn method of treatment,Group 2 obtained muscle energy technique,and Group 3 is control group that obtained conventional treatment in the form of heat and range of motion exercises.Duration of study was 6 months,and the interventions were performed for two weeks,with a total of 10 sessions.A baseline measurement was taken on shoulder pain and disability index(SPADI).A post intervention measurement was taken on same outcome measurement tools and was compared using ANOVA statistical analysis.The pre-intervention measurements on SPADI were 61.11±8.79,60.91±9.90,and 61.18±9.00 in control,Kaltenborn,and METs groups,respectively.The post intervention measurements were 49.33±9.95,39.09±9.45,and 27.69±11.97 in control,Kaltenborn,and METs groups,respectively.This study concluded that both techniques are effective in the treatment of adhesive capsulitis to decrease the pain and disability in experimental groups in comparison to control groups.METs is superior to Kaltenborn in pain and disability management when compared to each other.

经穴疏导加痛点揉拨手法对急性期冻结肩患者肩关节活动度及炎症因子的影响

目的:探究经穴疏导加痛点揉拨手法对急性期冻结肩患者的治疗效果,以及肩关节活动度和血清炎症因子的影响。方法:采用随机数字表法将2021年7月—2023年7月于武汉市中医医院接受治疗的120例急性期冻结肩患者分为常规组和联合组,每组60例。常规组给予常规推拿治疗;联合组在常规组的基础上给予经穴疏导加痛点揉拨手法治疗。比较两组治疗前后疼痛评分(VAS评分)、ADL评分、肩关节活动度以及血清白细胞介素-10(IL-10),转化生长因子-β(TGF-β),肿瘤坏死因子-α(TNF-α)水平。结果:联合组的临床有效率为90.00%(54/60),高于常规组的71.67%(43/60),(P<0.05);与本组治疗前比较,两组患者的VAS评分、血清TGF-β、TNF-α水平显著下降(P<0.05),ADL评分、肩关节活动度、血清IL-10显著升高(P<0.05);治疗后联合组VAS评分、血清TGF-β、TNF-α低于常规组(P<0.05),ADL评分、肩关节活动度、血清IL-10高于常规组(P<0.05)。结论:经穴疏导加痛点揉拨手法对急性期冻结肩患者的治疗效果显著,且改善了患者的肩关节活动度,抑制了炎症反应。

术中冰冻病理诊断对眼睑肿物切除的价值探讨及病理类型分析

目的 探讨送检术中冰冻病理诊断(frozen sections, FS)的眼睑肿物病理类型及其对眼睑肿物和切缘的诊断准确率,分析FS与石蜡病理诊断不一致的常见原因。方法 选取2016年12月至2021年12月首都医科大学附属北京同仁医院送检FS眼睑肿物标本561份,分析眼睑肿物的病理类型,并以石蜡病理诊断为金标准,分析FS对眼睑肿物和切缘的诊断准确率。结果 561份标本中,左眼280份,右眼281份;上睑225份,下睑311份,内眦18份,外眦7份;肿物最大直径1~35 mm,平均(15.1±9.4)mm。其中良性病变165份(29.4%),位居前三位的分别为炎性病变、色素痣和脂溢性角化病;恶性病变396份(70.6%),位居前三位的分别为基底细胞癌、皮脂腺癌和鳞状细胞癌。FS对肿瘤和切缘的诊断准确率分别为97.1%、99.3%,肿瘤延迟诊断率为6.2%。肿瘤诊断不一致类型为误分类(60.0%,9/15)、假阴性(26.7%,4/15)及假阳性(13.3%,2/15)。诊断不一致的原因为解读失误(73.3%,11/15)、制片失误(26.7%,4/15)。结论 送检FS的眼睑肿物以恶性病变为主,并以基底细胞癌和皮脂腺癌多见;FS对眼睑肿物及切缘均具有较高的诊断准确率,能很好地指导手术开展,皮脂腺癌和恶性肿瘤的特殊亚型是与石蜡病理诊断不一致的主要因素,切片深度不够是导致漏诊和诊断不充分的主要原因,日常工作中对于可疑复发及较小的肿瘤应给予充分评估。

麻醉下手法松解联合关节镜技术治疗冻结肩合并肩袖损伤的临床疗效

目的探讨麻醉下手法松解联合关节镜技术治疗冻结肩合并肩袖损伤的临床疗效。方法回顾性分析2017年1月—2021年12月本院收治的25例冻结肩合并肩袖损伤的患者资料,接受麻醉下手法松解后行关节镜下关节囊松解术联合肩袖修补术治疗。术后3个月、6个月、12个月及末次随访时评估患者的肩关节疼痛、功能评分以及活动度。主要观察指标:疼痛视觉模拟评分(visual analogue scale,VAS)、Constant-Murley评分、美国肩肘协会评分(American Shoulder and Elbow Surgeon,ASES)和肩关节的活动度。结果所有患者均接受至少1年的随访,末次随访时,患者肩关节疼痛、功能评分和活动度均较术前明显改善,差异有统计学意义(P<0.01)。结论麻醉下手法松解联合关节镜技术治疗冻结肩合并肩袖损伤能使患者获得快速康复以及持久良好的活动度。

手法治疗肩周炎有效性和安全性的Meta分析

背景近年出现较多特色手法治疗肩周炎的随机对照试验(RCT),但缺乏新的关于手法治疗肩周炎有效性和安全性的系统评价。目的通过Meta分析方法评价手法治疗肩周炎的有效性和安全性,通过亚组分析了解包含“摇法”的手法是否较未包含“摇法”的手法效果更优。方法计算机检索PubMed、Cochrane Library、Embase、Medline、中国知网(包括中国硕博士学位论文全文数据库、中国优秀硕士学位论文全文数据库)、中国生物医学文献数据库、万方数据知识服务平台中有关手法治疗肩周炎有效性和安全性的RCT,试验组干预措施为手法,对照组干预措施为非药物疗法,检索时间为建库至2023-03-01。由2名研究人员提取资料,并进行质量评价。采用Revman 5.3软件进行Meta分析。结果最终共纳入12篇文献,893例肩周炎患者,其中试验组451例,对照组442例。Meta分析结果显示,视觉模拟疼痛量表(VAS):手法治疗改善VAS程度优于物理治疗、针灸治疗、常规治疗(SMD=1.09,95%CI=0.81~1.37,P<0.00001;SMD=1.05,95%CI=0.31~1.79,P=0.006;SMD=0.96,95%CI=0.67~1.26,P<0.00001);手法对照物理治疗的亚组分析结果显示,含“摇法”手法与未含“摇法”手法的效果差异显著(Z=4.39,P=0.04)。Constant-Murley(C-M)评分:手法治疗改善C-M评分程度优于物理治疗组(MD=2.79,95%CI=2.27~3.32,P<0.00001)。关节活动度:手法治疗改善被动前屈、被动外展、被动外旋程度优于物理治疗(SMD=1.40,95%CI=0.10~2.70,P=0.03;SMD=1.45,95%CI=0.18~2.71,P=0.02;SMD=1.77,95%CI=0.18~3.36,P=0.03)。亚组分析结果显示,在改善被动前屈和被动外展方面,含“摇法”手法与未含“摇法”手法的效果存在显著差异(Z=7.34,P=0.007;Z=2.25,P=0.03)。总体有效率:手法治疗总体有效率高于物理治疗(RR=1.16,95%CI=1.02~1.32,P=0.03);手法治疗和针灸治疗总体有效率比较,差异无统计学意义(RR=1.24,95%CI=1.00~1.54,P=0.05)。治愈率:手法治疗治愈率优于物理治疗和针灸治疗(RR=3.71,95%CI=1.29~10.67,P=0.01;RR=1.79,95%CI=1.09~2.94,P=0.02)。Egger's检验和Begger's检验提示无显著的发表偏倚(P=0.66、0.66)。手法操作导致的骨折、其他创伤等案例在纳入研究中均未见报道。结论现有文献证据表明手法治疗能有效降低肩周炎患者疼痛、肩关节功能障碍,提高患者肩关节活动度、总体有效率、治愈率,含有“摇法”的手法在VAS改善、被动前屈、被动外展方面能进一步提高疗效,总体手法安全性较高,但仍需更多大样本,高质量的RCT进一步证实。