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Medicina

Clinical Efficacy of Small Needle Knife Therapy on Stage I-II Frozen Shoulder

Published: November 17, 2023
doi:
10.3791/65904
, , ,
1Longhua Hospital,Shanghai University of Traditional Chinese Medicine, 2Key Laboratory of theory and therapy of muscles and bones,Ministry of Education

Summary

The protocol presented here describes the detailed operation method and proves the effectiveness of a small needle knife in the treatment of frozen shoulders.

Abstract

Frozen shoulder is a kind of aseptic inflammatory disease of the shoulder caused by strain, trauma, and other reasons, resulting in shoulder joint pain and limited function. The protocol presented here demonstrates the operation of a small needle knife in treating frozen shoulders, including patient management, material preparation, positioning, operation, and postoperative care. The purpose of this protocol is to relieve the pain and functional limitations and improve the living ability of patients with frozen shoulders. In our study, 76 stage I-II frozen shoulder patients who met the inclusion criteria were randomly divided into a control group and a treatment group (n=38). Patients in the control group received functional exercise, while the treatment group received small needle knife therapy with functional exercise. The visual analogue scores (VAS), the Constant and Murley scores (CMS), and the thickness of the coracohumeral ligament (CHL) under ultrasound were evaluated. After small needle knife therapy, the VAS score was significantly lower in the treatment group (5.11 ± 0.89) than in the control group (5.49 ± 0.65; t=-2.065, p<0.05); the CMS score was significantly higher in the treatment group (64.72 ± 4.78) than in the control group (60.97 ± 6.00; t=2.947, p<0.05); the CHL thickness was significantly decreased in the treatment group (2.38 ± 0.36) than in the control group (2.57 ± 0.42; t=-2.117, p<0.05). These results indicate that the small needle knife significantly relieved the pain symptoms, improved the shoulder function, reduced the CHL thickness, and improved the quality of life and, therefore, had significant therapeutic efficacy in stage I-II frozen shoulder patients.

Introduction

Frozen shoulder is a disease characterized by pain and limitation of active and passive shoulder movement, which causes great inconvenience to the work and life of patients1. The global incidence of frozen shoulder is 2%-5%2,3 and higher in females than in males, showing a certain genetic tendency4. The majority of frozen shoulder patients are 40-60 years old5. Moreover, the frozen shoulder brings about a heavy social burden due to the longer recovery cycle and the absence of established treatment consensus in the clinic practice.

The main treatment methods for frozen shoulders include oral or external use of herbal medicine, acupuncture, massage, functional exercise, and so on6; however, the compliance of the patients is poor due to the multiple treatment frequency and longer time-consuming, and cannot meet the urgent necessities of patients to improve pain and functional limitations. Therefore, it is urgently needed to identify more effective therapeutics in the clinical management of frozen shoulder patients.

Small needle knife therapy is a special and effective external treatment of traditional Chinese medicine, which has arisen rapidly in the field of traditional Chinese medicine in recent decades7. It has the advantages of quick effect, definite curative effect, and high repeatability. Moreover, the operation instrument is cheap and easy to obtain, the operation process is simple, and the method is not limited by the environment and condition. The normal work and life of patients are not affected after the small needle knife therapy since the micro-incision will be recovered quickly without damage to the body, causing infection, or other side effects8,9,10,11. Systematic reviews showed that the efficacy of small needle knife on frozen shoulder was significantly superior to acupuncture, massage, and oral Chinese medicine12,13. Modern studies show that the mechanism of small needle knife treatment of frozen shoulder is to dredge the meridians and collaterals, promote the circulation of qi and blood, cut and strip the lesion tissue, remove adhesion, promote tissue repair, and restore the dynamic balance of the human body14,15.

The protocol presented here demonstrates the operation of small needle knife in treating frozen shoulders including patient management, material preparation, positioning, operation, and postoperative care. The purpose of this protocol is to relieve the pain and functional limitations and improve the living ability of patients with frozen shoulders.

With the development of small needle knife therapy, its application has been extended from the treatment of neck, shoulder, waist, leg pain, and other muscle and bone diseases to internal medicine, surgery, gynecology, pediatrics, and other diseases, playing an increasingly important role in the field of rehabilitation medicine16. In recent years, the small needle knife shows a more accurate, scientific, and safe therapeutic efficacy due to the application of ultrasound-guided small needle knife visualization therapy, whose development has entered a new stage17,18.

Protocol

The protocol of this study has been approved by the Human Research Ethics Committee of Longhua Hospital Affiliated with Shanghai University of Traditional Chinese Medicine (Approval Number: 2023-LHXS-030). Before the trial, written informed consent was provided by each patient included in the study. A total of 76 patients with stage I-II frozen shoulder in the rehabilitation department of Longhua Hospital affiliated to Shanghai University of Traditional Chinese Medicine from December 2022 to May 2023, who met the inclusi…

Representative Results

In the control group, 1 patient received other treatment (intra-articular steroid injection) due to aggravation of pain, so the trial was terminated, and the remaining 37 patients in the control group were included in the final statistical analysis. For 2 patients in the treatment group CHL could not be detected under ultrasound, so the test was eliminated, and the remaining 36 patients in the treatment group entered the final statistical analysis. Baseline characteristics<br …

Discussion

In this study, we found that the small needle knife therapy significantly relieved the pain symptoms, improved the shoulder joint function, reduced the thickness of CHL, and improved the quality of life in stage I-II frozen shoulder patients. The small needle knife therapy had exact effect on frozen shoulder. However, the operation site is controversial. Due to the different knowledge backgrounds, many operation sites can be selected to treat frozen shoulders with small needle knife. The main operation sites are tender p…

Divulgazioni

The authors have nothing to disclose.

Acknowledgements

We appreciate the financial support from (1) National Nature Science Foundation (81973877), (2)the Three year Action Plan of Shanghai to Further Accelerate the Inheritance, Innovation and Development of Traditional Chinese Medicine (ZY (2021-2023)-0201-01) , (3) Pudong New Area Health System Pudong Famous Physician Training Plan (PWRzm2020-15), and (4) Chinese Medicine Rehabilitation Service Enhancement Project (Medical 032).

Materials

Disposable sterile injection needle Shanghai Mishava Medical Industry Co., Ltd 601900973 Type specification:0.5 x 38 RWLB
Disposable sterile small needle-knife Wujiang Yunlong Medical equipment Co., Ltd PR-4040 Type specification:40 mm x 40 mm 
Disposable sterile syringe Shandong Weigo Group Medical polymer Products Co., Ltd 601909174 Type specification:10 mL
Lidocaine hydrochloride Shanghai Hefeng Pharmaceutical Co., Ltd 6904996104121 Type specification:5 mL
Marker pen Zebra Trading (Shenzhen) Co., Ltd 4901681518111 Type specification:1.0 mm/0.5 mm
Sterile absorbent cotton ball Shanghai Honglong Medical Supplies Equipment Co., Ltd 601905637 Type specification:0.3  25 g
Sterile disposable medical plastic cup Shanghai Honglong Medical Supplies Equipment Co., Ltd 709008633 Type specification:Waist-shaped disc
Sterile dressing block Ningbo Haishu Shenyuan Medical Materials Co.,  Ltd 601909470 Type specification:7.5 cm x 7.5 cm x 8 floors
Sterile medical tweezers Shanghai Honglong Medical Supplies Equipment Co.,Ltd 603917444 Type specification:Small size
Sterile rubber surgical gloves Guilin Hengbao health protection Co.,  Ltd 6971787071320 Type specification:6.5
Sterile self-adhesive dressing Shanghai ISO Medical Products Co., Ltd 601909414 Type specification:10 cm x 15 cm
Sterile water for injection Shanghai Xinyi Jinzhu Pharmaceutical Co., Ltd 6938493300953 Type specification:5 mL
Type II skin disinfectant Shanghai Likang Disinfection high-tech Co., Ltd 6909157000359 Type specification:500 mL/ bottle
Ultrasound Suzhou Daer Medical Equipment Co., Ltd 100018857 uSmart3300 portable color ultrasound system
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Tags

Keyword Extraction:Small Needle KnifeFrozen ShoulderClinical EfficacyStage I-IIPain FunctionLife AbilityTherapeutic EffectsRepeatabilityAvailabilityPatient ManagementVisual Analogue ScoresConstant And Murley ScoresCoracohumeral Ligament Thickness
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Citazione di questo articolo
Guo, S., Liu, D., Yang, Y., Hu, Z. Clinical Efficacy of Small Needle Knife Therapy on Stage I-II Frozen Shoulder. J. Vis. Exp. (201), e65904, doi:10.3791/65904 (2023).
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