Objective.
To investigate the therapeutic effect of acupuncture combined with neuroenergetic electrical stimulation on patients with shoulder subluxation and shoulder pain after stroke. METHODS: One hundred and twenty patients with early stroke shoulder subluxation were randomly divided into two groups: the control group (n=70) and the treatment group (n=50). Both groups received exercise therapy for rehabilitation; the treatment group was also treated with acupuncture and functional electrical stimulation once a day for 30 minutes for 2 months. The treatment effects of both groups were evaluated before and after 2 months of treatment, respectively. RESULTS: The rate of reset of shoulder subluxation and the improvement rate of shoulder pain symptoms in the treatment group were significantly higher than those in the control group.
CONCLUSIONS.
The effect of acupuncture combined with functional electrical stimulation in treating shoulder subluxation and shoulder pain after stroke was better than that of conventional rehabilitation training.
Shoulder subluxation and shoulder pain are the most common complications in stroke patients, with an incidence of 60%-70%. They are most common in the late post-stroke period and early post-spasticity period, causing pain and functional limitation of the affected shoulder and upper limb. The majority of shoulder dislocations cannot be reset by themselves. I used acupuncture, functional electrical nerve stimulation and rehabilitation training to explore the efficacy of the treatment.
Data and Methods
1. General data: 120 patients with early stroke were admitted from January 2008 to June 2009, 66 males and 54 females, aged 48 to 65 years, average 56.3 years. The time of onset was 2 weeks to 1 month; the time of appearance of shoulder subluxation was 7 to 20 days. There were 75 cases of cerebral infarction and 45 cases of cerebral hemorrhage, all of which were confirmed by CT or MRI examination. The patients were randomly divided into two groups according to the order of consultation, in which 70 cases in the treatment group used rehabilitation training + acupuncture and functional electrical stimulation; 50 cases in the control group used conventional rehabilitation training. There was no significant difference (P>0.05) between the two groups when comparing the composition factors such as age of onset, time of onset and degree of disease.
2. Treatment methods.
①Treatment group.
(1) Acupuncture treatment: take the shoulder k, arm, shoulder s, will, shoulder front, shoulder well, tianzong, shoulderzhen peri-shoulder acupuncture points, all acupuncture points are used to tonic method, all points to soreness, numbness, rise, heavy as the gaining qi, every 5 to 10 minutes to perform acupuncture once, each retention of acupuncture 30 minutes is appropriate.
(2) Apply a functional low-frequency instrument to stimulate the muscles around the shoulder joint. The electrodes are divided into two groups, each group of two square electrodes with an area of 3cmx3cm, one group is placed on the middle of the deltoid muscle (middle) and the middle of the supraspinatus muscle of the affected shoulder, and one group is placed on the middle of the infraspinatus muscle and the posterior part of the deltoid muscle. The best frequency of functional electrical stimulation was 30Hz, the waveform was bidirectional rectangular waveform, the on/off ratio was 1:2, the intensity of stimulation was acceptable to the patient without causing muscle fatigue, the treatment time was 30 minutes/time, 1 time/day, 30 days was a course of treatment.
②Control group.
(1) Correct the posture of the scapula, passively move the shoulder joint and maintain the full range of passive movement of the shoulder without pain. When moving the scapula to full supination, the therapist needs to move the patient’s shoulders forward at the same time, otherwise the healthy side shoulder is backward and the affected side shoulder is forward only an appearance.
(2) Stimulate the activity and tension of the stabilizing muscles around the shoulder joint, which can be done through the activity of weight-bearing of the affected arm, stimulating proprioception and reflexively stimulating the muscle activity through the extrusion of the joint. If the upper extremity of the affected side is adjusted in a spasticity-inhibiting mode position (elbow extended, wrist dorsally extended, fingers extended, flat on the treatment table), the patient’s weight is used to compress and weight-bear the joints of the affected extremity. The therapist uses the hand to help ensure the correct position of the scapula during elongation of the affected side, and does rapid, repeated squeezing through the palm of the affected hand toward the shoulder to keep the patient’s hand extended forward and prevent the shoulder from retracting.
Assessment criteria
Efficacy assessment criteria: no shoulder dislocation with shoulder pain is achieved as the therapeutic effect. Diagnostic criteria: descending scapular band, low position of the inferior angle of the scapula, pterygoid shoulder, depression between the acromion and the humerus > 1 transverse finger. Displacement criteria: normal external features of the shoulder joint, depression between the acromion and the humerus <1/2 transverse fingers.
Results
1. The results of the two groups after 2 courses of treatment: among 70 cases in the treatment group, 59 cases were repositioned and 11 cases were not repositioned, with a repositioning rate of 84.29%; among 50 cases in the control group, 22 cases were repositioned and 28 cases were not repositioned, with a repositioning rate of 44%. The difference in the reset rate between the two groups was significant (P<0.05), and the treatment group was significantly better than the control group.
DISCUSSION
The mechanism of shoulder dislocation and shoulder pain after stroke: The stability of the shoulder joint depends on the joint maintenance of the muscles, tendons and ligaments around the joint. The shoulder joint is mainly composed of the superior supraspinatus, the rostro-humeral ligament, the posterior infraspinatus, the posterior deltoid, and the anterior subscapularis and glenohumeral ligaments to strengthen the joint capsule. Under normal conditions, the scapular glenoid faces upward, forward and outward, with the humeral head moving laterally in downward motion, so the glenoid is tilted upward and plays an important role in preventing downward dislocation. When the upper arm is tucked in, the upper part of the joint capsule and the rostro-humeral ligament are tensed, passively preventing the lateral movement of the humeral head and thus preventing downward dislocation, i.e., the locking mechanism of the shoulder joint. The most important muscles to prevent glenohumeral dislocation are those with horizontally oriented muscle fibers, especially the supraspinatus, posterior deltoid, and infraspinatus muscles. In stroke patients, the locking mechanism of the shoulder joint is destroyed during the soft palsy period, mainly because: first, the deltoid and supraspinatus muscles are hypotonic, which makes it difficult to maintain the normal position of the humeral glenoid joint; second, the upper limb prolapses downward when sitting or standing under the influence of the gravity of the affected upper limb, which makes the shoulder capsule and ligaments relax and be pulled, and the humeral head slides down from the glenoid, resulting in shoulder joint subluxation; third, the scapula retracts, resulting in internal rotation of the humerus. This affects the coordinated movement of the shoulder joint, causing pressure and pain in the soft tissues of the shoulder during supination and abduction movements. Therefore, the treatment of shoulder dislocation and shoulder pain after stroke with acupuncture and functional electrical stimulation should be carried out as early as possible.
Treatment significance of acupuncture and functional electrical stimulation: The key to the treatment of shoulder subluxation and shoulder pain after stroke is to restore the locking mechanism of the shoulder joint and strengthen the stability of the joint, so the treatment focuses on restoring the muscle tone of the deltoid, supraspinatus and infraspinatus muscles. Studies have shown that increasing the constant input of sensory information through continuous reinforcement of upper limb proprioception awakens the used neural pathways and synapses and induces neuromuscular activity. The muscle contraction triggered by low-frequency electrical stimulation is a kind of semi-active movement, which can promote the recovery of muscle tone and produce deep sensation such as proprioception and position sense by conducting muscle contraction joint movement; stimulating the skin and producing superficial sensation reduces the patient’s neglect of the hemiplegic limb; low-frequency current stimulation therapy is based on this principle to restore the locking mechanism of the shoulder joint, thus achieving the prevention and treatment of shoulder joint subluxation and shoulder pain after stroke. It can also reduce the economic burden of patients and improve the quality of life, which is easy for patients to accept.