assessing the post-intervention outcome of small needle knife therapy on frozen shoulder

Eficácia terapêutica da terapia com faca de agulha pequena no tratamento de ombro congelado

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.

Autor em destaque: Tratando o ombro congelado com terapia com faca de agulha pequena 

Eficácia clínica da terapia com faca de agulha pequena no ombro congelado estágio I-II

Our study investigated the therapeutic efficacy of small needle knife in patients with frozen shoulders, and evidence that the improvement of pain function and the life ability. Our protocol addresses the detailed operation process of small needle knife in frozen shoulder patients. Our protocol has the advantages of quicker and definite therapeutic effects, high repeatability, broader availability, also there are less physical injury in patients.

Watch this Scientific Journal Video about Assessing the Post-Intervention Outcome of Small Needle Knife Therapy on Frozen Shoulder at JoVE.com

Assessing the Post-Intervention Outcome of Small Needle Knife Therapy on Frozen Shoulder  

Avaliação do Resultado Pós-Intervenção da Terapia com Faca com Agulha Pequena no Ombro Congelado

Para começar a avaliar a amplitude de movimento do ombro dos pacientes que receberam a intervenção de terapia com agulha pequena, primeiro, peça ao paciente que levante o ombro para o máximo ângulo possível. Em seguida, pressione o botão On para ligar o instrumento de avaliação. Gire a régua de medição e obtenha o valor medido.Ajuste a escala do instrumento de medição de volta a zero antes de repetir a medição duas vezes. Mantenha pressionada a tecla Off para desligar a energia. Para medir a espessura do ligamento coracoumeral, primeiro ligue o aparelho de ultrassom pressionando o botão liga/desliga.Em seguida, abra o software de ultrassom. Pressione o botão do paciente e digite o nome do assunto. Peça ao paciente que exponha totalmente o ombro afetado na posição sentada.Mover passivamente a articulação do ombro do paciente, para localizar o ligamento coracoumeral. Depois de aplicar uma quantidade adequada de acoplador médico na sonda, alinhe a sonda de ultrassom com o ligamento coracoumeral. Pressione o botão Congelar para congelar a tela e pressione o botão Armazenar para salvar a imagem de ultrassom.Continue a gravar duas imagens diferentes, conforme demonstrado. Após pressionar o botão do paciente, procure as imagens gravadas na lista de estudo. Pressione o botão Paquímetro para entrar no modo de medição e avaliar a espessura do ligamento coracoumeral.Por fim, após registrar as medições, desligue a máquina. Após o tratamento, a espessura do ligamento coracoumeral diminuiu significativamente no grupo tratamento, comparado ao grupo controle.

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Research

JoVE Journal

Medicine

Assessing the Post-Intervention Outcome of Small Needle Knife Therapy on Frozen Shoulder

49 visualizações.  Shanghai University of Traditional Chinese Medicine. Para começar a avaliar a amplitude de movimento do ombro dos pacientes que receberam a intervenção de terapia com agulha pequena, primeiro, peça ao paciente que levante o ombro para o máximo ângulo possível. Em seguida, pressione o botão On para ligar o instrumento de avaliação. Gire a régua de medição e obtenha o valor medido.Ajuste a escala do instrumento de medição de volta a zero antes de repetir a medição duas vezes. Mantenha pressionada a tecla Off para desligar ...

Vídeo: Assessing the Post-Intervention Outcome of Small Needle Knife Therapy on Frozen Shoulder  

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

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 &plusmn; 0.89) than in the control group (5.49 &plusmn; 0.65; t=-2.065, p&lt;0.05); the CMS score was significantly higher in the treatment group (64.72 &plusmn; 4.78) than in the control group (60.97 &plusmn; 6.00; t=2.947, p&lt;0.05); the CHL thickness was significantly decreased in the treatment group (2.38 &plusmn; 0.36) than in the control group (2.57 &plusmn; 0.42; t=-2.117, p&lt;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.

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

Frozen shoulder is a kind of aseptic inflammatory disease of the shoulder caused by strain, trauma, and other reasons, resulting in shoulder joint pain ...

Medicina

Performing the Small Needle Knife Therapy on Patients with Frozen Shoulder

Begin the preoperative preparations by gathering all the necessary materials. Then proceed to check the basic information of each patient, including name, age, and the affected shoulder. Once the patient assumes a sitting position, fully expose the affected shoulder and mark the obvious tenderness points on the shoulder.Then, pour type two skin disinfectant on cotton balls, and with those, disinfect the affected area in circular motions, starting from about 15 centimeters around each marked point, and gradually reducing the diameter. Next, load five milliliters of 2%lidocaine into a 10 milliliter syringe with a 22 gauge needle. Then, load five milliliters of sterile water into the same syringe to prepare 10 milliliters of 1%lidocaine working solution.Replace the 22 gauge needle with a 25 gauge needle. While wearing sterile gloves on the left hand, hold the syringe in the right hand, insert the needle into a marked point, and ensure no blood enters the syringe after suction. Perpendicularly, inject one to two milliliters of 1%lidocaine working solution at the marked point.To perform the small needle knife insertion, hold the small needle in the right hand while wearing sterile gloves. Rapidly insert the small needle knife into the lidocaine injection site perpendicularly, maintaining a depth of about one to three centimeters. Then, perform the three step manipulation, beginning with the longitudinal incision, followed by stripping, and finally releasing the adhesion.Withdraw the needle when there is a feeling of looseness under the knife. Using a dry, sterile dressing block, press the injection site for one minute. Then cover the operating area with a sterile self-adhesive dressing.After assisting the patient in dressing properly, ask the patient to sit still for about 15 minutes before leaving the operating room to avoid postoperative discomfort. After the small needle knife therapy, the visual analog score was significantly lower in the treatment group than in the control group. The Constant and Murley score was significantly higher in the treatment group than in the control group.

Realizando a Terapia com Faca de Agulha Pequena em Pacientes com Ombro Congelado

To begin assessing the range of motion of the shoulder of the patients who received the small needle therapy intervention, first, ask the patient to lift the shoulder to the maximum angle possible. Then press the On button to switch on the assessment instrument. Rotate the measuring ruler and obtain the measured value.Set the measuring instrument scale back to zero before repeating the measurement two times. Press and hold Off, to turn the power off. To measure the thickness of the coracohumeral ligament, first turn on the ultrasound machine by pressing the power button.Then open the ultrasound software. Press the patient button and enter the name of the subject. Ask the patient to fully expose the affected shoulder in a seated position.Move the patient's shoulder joint passively, to locate the coracohumeral ligament. After applying an appropriate amount of medical coupler to the probe, align the ultrasound probe with the coracohumeral ligament. Press the Freeze button to freeze the screen, and then press the Store button to save the ultrasound image.Continue to record two different images as demonstrated. After pressing the patient button, look for the recorded images in the study list. Press the Caliper button to enter the measurement mode and assess the coracohumeral ligament thickness.Finally, after recording the measurements, turn off the machine. After the treatment, the coracohumeral ligament thickness was significantly decreased in the treatment group, compared to the control group.