vha frozen shoulder (1)

7/31/2019 Vha Frozen Shoulder (1)

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Frozen Shoulder&

Acupuncture

Presented by

Will Sheppy


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Topics

Pathology of Frozen Shoulder Statistics of Frozen Shoulder

Tradition East Asian Medical view of Frozen Shoulder Western Medical Tx of Frozen Shoulder

Corticosteroid injection Physical Therapy

TCM Tx of Frozen Shoulder Acupuncture Electro-Acupuncture


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Pathology of Frozen Shoulder

The cause of frozen shoulder is unknown, so

its diagnosis is based on symptom criteria.

Arthroscopic biopsy of patients with frozenshoulder revealed cellular evidence of both

chronic inflammation and proliferative fibrosis(Hand, 2007)


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Statistics of 223 Frozen Shoulder

Frozen shoulder lasted about 4 years.

It affects females more often.

There is no arm preference.

It is not strongly association with other illness.

Frozen shoulder has a positive natural history and will

most often resolve on its own. If there is an acute and severe onset prognosis is not as

good as slow progression.

The most common treatment is physical therapy and

steroid injection.


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Statistics of 223 Frozen Shoulder

The mean interval from symptom onset to completion was 4.4 years, range 2 to 20 years. Of the 223 shoulders, 137 (61%) were female and 86 (39%) were male. The dominant arm was affected in 48% (129) and non-dominant in 52% (140).

Of the 223 patients, 38(17%) had high cholesterol, 31(14%) were diabetic, 15 (7%) heartdisease, 7 (3%) had Dupuytrens contracture, 6 (3%) had osteoporosis. Analyses of the severity of presenting symptoms yielded a subgroup at risk of a worse

prognosis. Those patients who reported unbearable symptoms in the first 6 months had asignificantly worse outcome compared to those who reported severe, moderate, or mildsymptoms. Twenty-one percent of patients (9/42) with unbearable symptoms at onset wenton to have persistent severe symptoms, compared to the 3.1% (7/227) without unbearablesymptoms.

Patients received a variety of treatments and often received more than one modality of

treatment, including no treatment (95), steroid injection (139), physiotherapy (55),arthroscopic hydrodistension (20), manipulation under anesthesia (5), and arthroscopicrelease (5).

Twenty percent of patients (45/223) reported bilateral symptoms. None occurredsimultaneously.

There were no recurrent cases. Symptoms were reported as slow in onset in 61% (163 shoulders) and sudden in 39% (106

shoulders).(Hand, 2008)


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Tradition East Asian Medicine view

of Frozen Shoulder

Frozen Shoulder is caused by

A Deficiency leaving an opening for coldinvasion which lingers in the tendons andbones

A decrease in Liver Energy and Blood

Decent of Yang Energy


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of Frozen Shoulder

The closest relationship traditional Chinese medicinehas to frozen shoulder is Bi Syndrome

Bi syndrome in the elderly is commonly caused byinternal factors (deficiency of Qi and Blood).

Deficiency Stagnation Bi syndrome

Weak External Invasion

(Maciocia, 1994)


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of Frozen Shoulder

Frozen shoulder often occurs around the ageof 50. In Japan it is commonly known as fifty

year old shoulder.


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of Frozen Shoulder

Chapter 1 of the Neijing Suwen

At forty-eight the yang energy of the head begins to deplete,

the face becomes sallow, the hair grays, and the teethdeteriorate. By Fifty-six years the liver energy weakens,causing the tendons to stiffen.

At forty-two all three yang-channels, taiyang, shoayang,yangming are exhausted, the entire face is wrinkled, and the

hair begins to turn grey. At forty-nine years the ren and chongchannels are completely empty, and the tien kui has dried up


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of Frozen Shoulder

By Fifty-six years the liver energy weakens,

causing the tendons to stiffen

Chapter 43 of the Neijing Suwen

Qi Bo says, When bi conditions penetrate to

the five zang organs, death will result. Whenbi lingers in the bones and tendons, itremains for a long time. When bi lingers in

the skin and muscles, it is easily resolved.


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of Frozen Shoulder

At forty-two all three yang-channels, taiyang,shoayang, yangming are exhausted

All the arm meridians cross the shoulder. However,most of the important structures of the shoulder arein the lateral and posterior aspects and are thereby

governed by the arm yang meridians. (Legge &Charles, 1999)

Yang leaving the upper body is especially damagingto the shoulder because of its strong association withyang channels.


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Western Medical Tx of Frozen

Shoulder

Corticosteroid injections

Steroid injections provides short term painrelief in frozen shoulder but benefits are notmaintained much beyond six to twelveweeks.


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Shoulder (research)

Corticosteroid Injections Three week course of 30mg of prdnisolone daily is of significant short

term benefit in adhesive capsulities but benefits are not maintained

beyond six weeks (Buchbinder, R., Hoving, J. L., Green, S., Hall, S.,Forbes, A., & Nash, P., 2004)

Intra-articular corticosteroids injections have the additive effect ofproviding rapid pain relief, mainly in the first couple of weeks of theexercise treatment period. By the 12th week there was no significantdifference between the two groups. (Bal, 2008)

intra-articular injection of corticosteroid, coupled with a simple homeexercise program, is superior to a 12 session supervisedphysiotherapy program with steroids in improving shoulder pain andfunction at 6 weeks in patients. They found that 12 months afterenrollment, all groups had achieved the same degree of improvementwith respect to shoulder pain and disability. (Carette, 2003)


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Shoulder

Physical Therapy

Studies show that physiotherapy is good atincreasing range of motion, but had differentresults on its treatment of pain.


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Shoulder (research)

Physical Therapy At 3 weeks, 35% of patients in the physical therapy

group were considered to have had successfultreatment compared with 18.6% in the ibuprofenalone group. There was no significant difference inthe success rate between the two groups at the 12thweek follow up. (Pajareya, 2004)

At total of 158 participants were assessed after jointdistension at 6, 12 and 26 weeks. They found thatphysiotherapy provided no additional benefits interms of pain, function, or quality of life, but resultedin sustained greater active range of motion.


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TCM Tx for Frozen Shoulder

Acupuncture

Acupuncture was effective at reducing painwhereas physical therapy was better atimproving range of motion.

Acupuncture also has fewer adverse

reactions than the use of opioid analgesics,anti-inflammatory medications orcorticosteroid Injections.


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(research)

Acupuncture

Compared with the exercise group, the exercise plus

acupuncture group experienced significantly greaterimprovement with treatment. It was concluded that thecombination of acupuncture with shoulder exercise may offereffective treatment for frozen shoulder. (Sun, 2001)

The physical therapy group showed significant improvement inmotion pain and range of motion. The acupuncture only group

did not show any significant improvement in active and passiverange of motion; it did see significant improvement in restingand motion pain. The combination of physical therapy andacupuncture had improvement in both pain and range ofmotion. (Ma, 2006)


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Electro-Acupuncture

Electro-Acupuncture is an easy way to providestimulation while patient does ROMmovement

Shows similar results to acupuncture.


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(research)

Electro-Acupuncture

It concluded that either electro-acupuncture or interferential

electrotherapy in combination with shoulder exercises iseffective in treating frozen shoulder patients. There was nodifference between the two interventions. The improvementachieved were well maintained in both intervention groups atleast until the 6 month follow-up session. (Lin, M.1994)

In another study which looked at 150 subjects with frozen

shoulder found that combining electro-acupuncture withregional nerve block had significant higher pain control, longerduration, and better range of movement of the shoulder jointthan that of electro-acupuncture or regional nerve blockperformed alone. This was a study performed in China.(Cheing, 2008)


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Tips For Treatment

Use Heat

Heat has been found to be helpful in treatingfrozen shoulder. It is suggested that deep heatmodality increases tissue temperature and itsextensibility, making passive range of motionmore effective (Pajareya, 2004).


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Tips For Treatment

Use ROM exercise

Acupuncture reliefs pain but does little to increaserange of motion

It was concluded that the combination ofacupuncture with shoulder exercise may offereffective treatment for frozen shoulder. (Sun,2001)


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Bibliography

Books

Beers, M.H., Kaplan, L., & Berkwits, M., (eds.). (2006) The

Merck Manual of Diagnosis and Therapy. Boston: Merck &Company, Incorporated, 2006.

Legge & Charles,(1999) Close to the Bone. New York: SydneyCollege

Maciocia, G. (1994) The Practice of Chinese Medicine : TheTreatment of Diseases with Acupuncture and Chinese Herbs.

New York: Churchill Livingstone Ni, Maoshing.(1995) The Yellow Emperor's Classic of Medicine

: A New Translation of the Neijing Suwen with Commentary.Minneapolis: Shambhala Publications, Incorporated


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Bibliography

Journals Hand, G. C. R., Athanasou, N. A., Matthews, T., & Carr, A. J. (2007). The

pathology of frozen shoulder. The Journal of Bone & Joint Surgery89, 928-932

Hand, C., Clipsham, K., Rees,J. L.,& Carr, A. J. (2008). Long-term outcome offrozen shoulder. Journal of Shoulder and Elbow Surgery17, 232-236 Matsumoto Hiromi. (1998). Acupuncture treatment for Gojyukata (frozen

shoulder). North Americal Journal of Oriental Medicine5, 5-10 Sun, K. O., Chan, K. C., Lo, S. L., & Fong, D. Y. T. (2001). Acupuncture for

frozen shoulder. Hong Kong Medical Journal7, 381-391 Ma, T., Kao, M. J., Lin, I. H., Chiu, Y. L., Chien, C., Ho, T. J., Chu, B. C., &

Chang, Y. H., (2006). A study on the clinical effects of physical therapy and

acupuncture to treat spontaneous frozen shoulder. The American Journal ofChinese Medicine34, 759-775


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BibliographyJournals

Buchbinder, R., Hoving, J. L., Green, S., Hall, S., Forbes, A., & Nash, P. (2004). Short courseprednisolone for adhesive capsulitis (frozen shoulder of stiff painful shoulder): a randomized, double blindplacebo controlled trial. Annuals of Rheumatic Diseases63, 1460-1469

Bal, A., Eksioglu, E., Gulec, B., Aydog, E., Gurcay E., & Cakci A. (2008). Effectiveness of corticosteroidinjection in adhesive capsulitis. Clinical Rehabilitation22, 502-512

Buchbinder, R., Youd, J. M., Green, S., Stein, A., Forbes, A., Harris, A., Bennell, K., Bell, S., & Wright, W.J. (2007). Efficacy and cost-effectiveness of physiotherapy following glenohumeral joint distension foradhesive capsulitis: randomized trial. Arthritis Rheumatism57, 1027-10237

Pajareya, K., Chadchavalpanichaya, N., Painmanakit, S., Kaidwan, C., Puttaruksa, P., & Wongsaranuchit,Y. (2004). Effectiveness of physical therapy for patients with adhesive capsulitis: a randomized controlledtrial. Journal of The Medical Association of Thailand87, 473-480

Carette, S., Moffet, H., Tardif, J., Bessette, L., Morin, F., Fremont, P., Bykerk, V., Thorne, C., Bell, M.,Bensen, W., & Blanchett. (2003). Intraarticular corticosteroids, supervised physiotherapy, or a combination

of the two in the treatment of adhesive capsulitis of the shoulder: a placebo-controlled trial. ArthritisRheumatism48, 829-838

Ulett, G., Han, S., & Han J. (1996). Electroacupuncture: mechanisms and clinical application. BiologicalPsychiatry44, 129-138

Cheing, G., So, E., & Chao, C. (2008) Effectiveness of electroacupuncture and interferentialelectrotherapy in the management of frozen shoulder. Journal of Rehabilitation Medicine40,166-170

Lin, M., Huang C., Lin, J., & Tsai, S. (1994) A comparison between the pain relief effect ofelectroacupuncture, regional never block and electroacupuncture plus regional never block in frozenshoulder. Department of Anesthesiology and Pain Center, Taipei Municipal Chung-Hsing Hospital.

Marcus, A., & Gracer R. (1994) A modern approach to shoulder pain using the combined methods ofacupuncture and Cyriax-based orthopaedic medicine. American Journal of Acupuncturevol22 no1 5-14

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