Objective: To observe and analyze the clinical efficacy of intra-articular injection of sodium vitrate combined with acupuncture and acupressure in the treatment of frozen shoulder.
Methods: 100 patients with frozen shoulder were randomly divided into treatment group and control group, 50 patients in each group. The treatment group was treated with intra-articular injection of sodium glassate (20 mg/stem, 1 time/week) combined with acupuncture and tui-na for 3 weeks; the control group was treated with acupuncture combined with tui-na for 3 weeks. The degree of pain relief and functional recovery of the shoulder joint before and after treatment were compared between the two groups.
Results: After treatment, the pain level of patients in the treatment group and the control group were significantly relieved compared with that before treatment, and the difference was statistically significant (P < 0.05), and the treatment group showed more significant performance than the control group (P < 0.05); the total effective rate of the treatment group and the control group were 88.0% and 60.0%, respectively. The clinical efficacy of intra-articular sodium vitaminate combined with acupuncture and acupressure in the treatment of frozen shoulder can significantly improve pain and function.
Frozen shoulder” and “shoulder coagulation” are chronic aseptic inflammation of the joint capsule and surrounding soft tissues of the shoulder joint, which causes soft tissue adhesions around the shoulder and limits the functional activities of the shoulder joint. The prevalence of this disease is around 50 years old, with a slightly higher incidence in women than in men, and it is more common in manual laborers. In this study, 50 patients with periarthritis were treated with intra-articular injection of sodium vitreous acid combined with acupuncture and acupressure, and satisfactory results were achieved.
1. Data and methods
1.1 General information
The patients were randomly divided into treatment group and control group, with 50 cases in each group. In the treatment group, there were 19 male cases and 31 female cases; age ranged from 48 to 63 years old, with an average of 50.55 years; the duration of the disease ranged from 2 months to 8 years, with an average of 1.5 years. In the control group, there were 24 males and 26 females, aged 47-62 years old, with an average of 49.75 years; the duration of the disease ranged from 4 months to 7 years, with an average of 1.8 years. After statistical analysis, there was no statistically significant difference between the two groups in terms of gender, age and disease duration (P>0.05), which was comparable.
1.2 Diagnostic criteria According to the Diagnostic Efficacy Criteria of Chinese Medicine Evidence promulgated by the State Administration of Traditional Chinese Medicine: (1) Preferred age is around 50 years old, more women than men, more right shoulders than left shoulders, and mostly chronic onset. (2) Pain around the shoulder, especially at night, often waking up with pain, but less swelling; shoulder joint movement is obviously limited, or even shoulder and arm muscles are atrophied. Physical examination: widespread pressure pain under the shoulder peak, limited shoulder joint abduction and supination, external rotation, posterior extension, back lifting movements, inability to undress, comb hair, wash face and other movements. (3) History of chronic strain, wind and cold or trauma. (4) X-ray radiographs are mostly negative, and osteoporosis is seen in those with long duration of disease.
1.3 Exclusion criteria: non-compliance with medical prescriptions; withdrawal; inability to review on time; combined with serious heart, liver, kidney and other important organ function damage.
1.4 Determination of therapeutic effect
1.4.1 Pain score: The visual analogue scale (VAS) was used to evaluate the pain level of patients, with a score of 10 out of 10, which is proportional to the pain level, i.e. 10 indicates severe pain and 0 indicates no pain or no pain.
1.4.2 Clinical efficacy: The evaluation was conducted according to the “Clinical Disease Diagnosis Based on Cure and Improvement Criteria”, which was mainly divided into four cases: cured, effective, efficient and invalid. Cured: the clinical symptoms of the patients completely disappeared, the shoulder joint had no pain, and its function returned to normal; Effective: the clinical symptoms of the patients basically disappeared, the shoulder joint had slight pain, and its function was restored, which basically did not affect the normal life of the patients; Effective: the clinical symptoms of the patients were relieved. Effective: the patient’s clinical symptoms are relieved, the pain in the shoulder joint is significantly reduced, the number and duration of attacks are reduced, and the function is partially restored; Ineffective: the patient’s clinical symptoms do not change significantly, or even worsen.
2.Treatment methods
2.1.1 Treatment group: Intra-articular injection of sodium vitrate combined with small needle tui-na treatment. Injection operation: patient sitting, routine skin iodine alcohol disinfection, lay sterile cave towel, wear sterile gloves, keep the upper arm inward and outward rotation, choose the lower edge of the rostral prominence about 25px in the glenohumeral space into the needle, there is a slight breakthrough feeling, such as back to draw no blood, inject saline lidocaine mixture without resistance, then you can inject sodium vitrate, 1 each time, once a week, 3 times in a row.
2.1.2 Needle knife relaxation Firstly, mark the periapical pain points, disinfect with iodine and alcohol routinely, wear sterile gloves, lay sterile cavity towel, take the affected shoulder rostral point, subacromial point, inter-nodal sulcus point, small round muscle, triceps stop point in turn, use 0.5% lidocaine local anesthesia, use type I No.4 Hanzhang needle knife, the needle body is perpendicular to the skin, the knife line is parallel to the longitudinal axis of the body, enter the needle knife to reach the bone surface according to the four-step operation protocol. Cut and peel were done at each point separately, longitudinal sparing and transverse peeling. After the needle is removed, the dressing paste is applied to the incision.
2.1.3 Push and pull manipulation release Manual therapy is operated under cardiac monitoring to ensure patient safety, and treatment is terminated if arrhythmia or tachycardia occurs. After injection and acupuncture release, the patient is placed in the supine position, and the following release techniques are applied to the affected shoulder after sufficient relaxation by applying point pressure, kneading, holding and small rotation techniques. Abduction release: The patient is in the supine position, the operator holds the affected shoulder with one hand and the ulnar hawk with the other hand, slowly abduct the patient until the patient feels pain and resistance, then pause, ask the patient to relax and use the tonus to perform the abduction upward release along the horizontal plane, so that the upper arm is close to the ear, there is a “click” separation sound in this process, indicating that the adhesions are completely released. Posterior extension and internal rotation release: the patient lies on his side, the affected shoulder is on top, the operator stands behind the patient, holds the patient’s wrist with one hand, holds the elbow joint with the other hand, the back of the palm is close to the back of the waist, the operator applies force with both hands at the same time, while lifting the elbow, slowly push the wrist to the lower edge of the opposite scapula, when the fingers exceed the lower edge of the scapula, a “click” separation sound can be felt, indicating that the adhesions are completely Release. Supination release: The patient is supine, the operator holds the affected shoulder behind the shoulder peak with one hand and holds the ulnar eminence with the other hand, lift the arm from the bottom to the top until the patient feels pain and resistance, ask the patient to relax, push the affected shoulder downward with a staccato force, and strive for the upper arm to be close to the bed, there is a “click” separation sound in this process, indicating that the adhesions are completely released. Upper arm inversion and external rotation: The patient lies on his back, keeping the upper arm inward, bending the elbow at 90° The operator stands on the patient’s side, keeping the forearm inward and holding the wrist on the affected side so that the upper arm is gradually externally rotated until the forearm is pressed against the bed. After wrenching, apply gentle relaxation-type techniques to end the treatment.
2.2 Control group
The control group was treated with acupuncture and tui-na. Acupuncture points were taken: shoulder well, shoulder circumference, shoulder front, shoulder chastity, tianzong, shoulder corner and dazhi point, quchi point, wai guan point and wrist bone. The patient was placed in a seated position, and after routine sterilization, 1.5-inch milli-needles were used for acupuncture, and after acupuncture, the laxative method was used. After the needle is inserted, the patient is instructed to twist the milli-needle and perform some basic movements of the affected limb, such as lifting or abduction. The tui na method is based on the following 3 steps. Firstly, the patient is placed in a sitting position and the elbow is lifted so that the patient is in a passive external position, then the patient is rolled, held and kneaded, each for about 5 min. Lastly, the patient’s shoulder joint should be moved passively, and the shoulder joint should be used as the axis of movement, with counterclockwise or clockwise shaking and circular rotation. After the above methods, the patient’s affected area was rubbed 3-5 times repeatedly until it was relaxed, and the tui na treatment required 1 time/day, 7 days as a course of treatment.
3. Statistical methods SPSS 20.0 statistical software was used. Count data were expressed as percentages (%), χ2 test was used for comparison between groups, and measurement data were expressed as (±s).
4. Results
The difference in VAS scores between the two groups before treatment was not statistically significant (P > 0.05), but after treatment, the VAS scores of both groups decreased significantly, and the difference was statistically significant when compared with that before treatment (P < 0.05).
5. Discussion
Frozen shoulder is a common clinical disease, which refers to degenerative lesions and chronic non-specific inflammation occurring in the shoulder capsule and its surrounding ligaments, tendons and bursa. Its etiology and pathogenesis are generally considered to be related to injury (especially chronic strain) and inflammation, different degrees of inflammation in the subacromial bursa, supraspinatus tendon, biceps longus tendon and tendon sheath, acromioclavicular capsule and other parts of the shoulder and humeral joint capsule, and local microcirculatory disorders. The principle of small needle knife treatment of tendon disease is “knife to the disease”, that is, the application of needle knife to directly loosen the focal point of tendon disease, to achieve the purpose of “untie”, it takes the longest of Chinese and Western medicine, on the one hand, can play the characteristics of Chinese medicine acupuncture and moxibustion meridian doctrine, using “On the other hand, it can also play the role of the surgical knife to cut, peel and loosen local adhesions and scars, so as to relieve the pain. On the other hand, it can play the role of surgical knife to cut, peel and release local adhesions and scar lesions, which can release the pressure and implication of adhesions on sensory nerve endings, while the stimulation of cutting can also promote local blood circulation, accelerate blood and lymph circulation, thus promoting the absorption of inflammatory substances and restoring the biochemical and physical balance of lesions; together with self-rehabilitation exercises, it can restore joint functions. Sodium glutamate is a large mucopolysaccharide, an important component of synovial fluid and cartilage matrix, produced and secreted by synovial B cells and mononuclear giant eosinophils, which can be combined with glycoproteins and attached to the surface of articular cartilage to protect it, and combined with proteins and free in the joint fluid to play a lubricating role and regulate the viscoelasticity in the joint, playing an important role in maintaining joint function. In the past, although simple massage could release the adhesions and improve the function of the shoulder joint immediately, it could not eliminate the inflammation of the synovial fluid tissue, and there would be hemorrhagic exudation in the joint after the manual release, which would easily lead to re-adhesions and partial dysfunction of the shoulder joint. Sodium vitrate can well prevent the occurrence of re-adhesion, not only can reduce the pain as soon as possible, but also can improve the inflammatory response of synovial tissue, increase the joint mobility, enhance the patient’s self-confidence and reduce the patient’s worry about the expensive cost, and guarantee the early functional exercise of the shoulder joint and improve the quality of life.
After analysis and comparison, intra-articular sodium glacial injection combined with acupuncture and acupressure in the treatment group was effective in treating frozen shoulder, and the number of treatments was less.