Fan Xiao-peng, Cheng Bo, Huang Yin, Gu Kan, Zong Lei

Yueyang Hospital of Integrated Traditional Chinese and Western Medicine Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai 200437, China

Immediate Effects of Hegu Needling on Adhesive Scapulohumeral Periarthritis

Fan Xiao-peng, Cheng Bo, Huang Yin, Gu Kan, Zong Lei

Yueyang Hospital of Integrated Traditional Chinese and Western Medicine Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai 200437, China

Objective: To observe the immediate effects of Hegu needling at Ashi points in patients with adhesive scapulohumeral periarthritis (SP).

Methods: A total of 60 SP cases were randomized into a treatment group and a control group, 30 in each group. Cases in the treatment group were treated with Hegu needling at Ashi points and normal needling at other local points. Cases in the control group were treated with normal needling at local points alone. The therapeutic efficacy was then evaluated and analyzed using short-form of McGill pain questionnaire (SF-MPQ) and Japanese Orthopaedic Association (JOA) shoulder scoring system.

Results: Hegu needling at Ashi points can substantially alleviate pain in patients with adhesive SP, showing a statistically significant difference when compared with the control group (P＜0.01 orP＜0.05). In addition, cases in the treatment group obtained better effects in abductor muscle strength, endurance, arm raising, internal rotation, external rotation, activities of daily living (ADL) and joint stability than those in the control group (P＜0.01 orP＜0.05).

Conclusion: Hegu needling at Ashi points is effective for adhesive SP.

Acupuncture Therapy; Periarthritis; Shoulder Pain; Points, Ashi

Scapulohumeral periarthritis (SP) is a chronic aseptic inflammation of the shoulder joint due to degeneration of the surrounding soft tissues. Since it is commonly seen in middle-aged or elderly population, SP is also known as‘fifties shoulder’, ‘shoulder wind leakage’ or ‘frozen shoulder’. Over time, patients may develop adhesion of the shoulder capsule, coupled with limited activity of the shoulder joint and compromised quality of life. Acupuncture is now used as one of the major therapies for SP. There have been numerous reports regarding acupuncture for SP in China[1-4]over the recent years. We treated 30 SP cases with Hegu needling at Ashi points and normal acupuncture on three shoulder points [Jianyu (LI 15), Jianliao (TE 14) and Jianqian (Extra)] and compared with 30 cases treated with needling the same three shoulder points alone. The results are summarized as follows.

1 Clinical Materials

1.1 Diagnostic criteria

This is based on the diagnostic criteria stipulated in the 2nd National Academic Conference on Scapulohumeral Periarthritis in 1991. Shoulder pain aggravated at night or in rainy, cloudy or cold days but relieved by warmth; limitation in arm raising, abduction and shoulder joint rotation;tenderness on or inferior to the acromion, coracoid, greater/lesser tubercles and intertubercular groove, atrophy of deltoid, supraspinatus and infraspinatus muscles; and exclusion of dislocation, fracture, osteomyelitis, tuberculosis, tumor or severe osteoporosis by X-ray.

1.2 Inclusion criteria

Those who met the above diagnostic criteria; during adhesion phase of SP; discontinued other therapies or drugs that may affect the therapeutic efficacy evaluation; willing to participate in the trial and sign the informed consent.

1.3 Exclusion criteria

Those with dysfunctions of the shoulder joint due to tumor or neurological conditions; having liver disease, HIV-AIDS or unhealed trauma; having severe conditions involving heart, liver, kidney, blood or respiratory system; having severe mental disorders; and having other major diseases or those who are not suitable for acupuncture treatment.

1.4 General data

The 60 cases who met the inclusion criteria were outpatients between September 2010 and February 2011. They were randomized into a treatment group and a control group by the random number in computer, 30 in each group. There were no statistically significant differences in gender, age, duration of disease and affected area between the two groups (P＜0.05), indicating that they were comparable (table 1).

Table 1. Between-group comparison of general data

2 Treatment Methods

2.1 Treatment group

Acupoints: Ashi points, Jianqian (Extra), Jianyu (LI 15) and Jianliao (TE 14).

Method: The locations of points are based on theLocation of Points(National Standard of the People’s Republic of China, GB12346-90). After a routine disinfection, conduct Hegu needling at two Ashi points using filiform needles of 0.38 mm in diameter and 60 mm in length. Puncture the two points perpendicularly, withdraw the needles subcutaneously upon arrival of qi, insert the needles obliquely to both sides and then remove the needles. Better effects can be achieved if the needles can reach the adhesions in interosseous space, ligament and muscle-skeleton attachments. After this, puncture the three shoulder points perpendicularly and retain the needles for 20 min upon arrival of qi.

2.2 Control group

Acupoints: They were same as those that were used in the treatment group.

Method: Puncture two Ashi points around the shoulder joint perpendicularly and then puncture the three shoulder points perpendicularly. Retain the needles for 20 min upon arrival of qi.

3 Treatment Effect

3.1 Observation indexes

3.1.1 Short-form of McGill pain questionnaire (SF-MPQ)

The SF-MPQ was used before and after treatment to score the intensity of pain.

0: No pain.

1: Mild pain.

2: Moderate (tolerable) pain.

3: Severe (intolerable) pain.

3.1.2 Japanese Orthopaedic Association (JOA) shoulder scoring system

The JOA scores were evaluated before and after treatment to compare the changes in sum of scores and observe the effect of treatment protocol on the sum of scores.

All rating scales were evaluated by professionals who were not involved in treatment and scoring.

3.2 Statistical methods

The SPSS 16.0 version software package was used for statistical analysis, () for experimental data expression, the Chi-square test for numeration data and ranked data, thet-test for normal distributed data and the nonparametric test for abnormal distributed data.

3.3 Treatment results

3.3.1 Comparison of SF-MPQ scores

Before treatment, there were no statistical differences in SF-MPQ scores between the two groups (P＞0.05), indicating that the two groups were comparable. As for the treatment group, there were statistical differences in SF-MPQ scores after treatment (P＜0.01 orP＜0.05). As for the control group, there was statistical difference in severe pain only after treatment. After treatment, there was between-group statistically significance difference in severe pain score (P＜0.01), along with statistical differences in cramping and dull pain (P＜0.05), indicating a better pain alleviation in the treatment group than the control group (table 2).

3.3.2 Comparison of JOA shoulder scores

Before treatment, there were no statistical difference in JOA shoulder score between the two groups (P＞0.05), indicating that the two groups were comparable. After treatment, the JOA scores were improved in both groups and there was between-group statistical difference in JOA score (P＜0.01 orP＜0.05), indicating a better effect in the treatment group than the control group (table 3).

Table 2. Comparison of SF-MPQ scores before and after treatment (, point)

Table 2. Comparison of SF-MPQ scores before and after treatment (, point)

Note: Compared with the intra-group results before treatment, 1)P＜0.01, 2)P＜0.05; compared with the control group, 3)P＜0.01, 4)P＜0.05

GroupsnTime Severe pain Cramp pain Dull pain Treatment 30 Before treatment After treatment Control 30 Before treatment After treatment 2.67±0.48 0.40±0.261)3)2.67±0.48 2.13±0.63 2.73±0.45 1.33±0.481)4)2.57±0.50 1.70±0.472)2.87±0.35 1.30±0.471)4)2.80±0.41 2.20±0.71

Table 3. Between-group comparison of JOA shoulder scores (, point)

Table 3. Between-group comparison of JOA shoulder scores (, point)

Note: BT=Before treatment; AT=After treatment; compared with the intra-group results before treatment, 1)P＜0.01, 2)P＜0.05; compared with the control group after treatment, 3)P＜0.01, 4)P＜0.05

GroupsnTime pain Muscle strength EnduranceAbility of daily livingArm raisingExternal rotation Internal rotation Joint stability Treatment 30 BT AT 28.50±2.331)3)1.60±0.72 4.80±0.401)4)3.83±1.870.30±0.27 4.67±0.761)4)2.10±1.24 9.23±1.011)4)4.00±2.27 13.3±2.321)3)2.30±1.70 7.90±1.671)4)2.93±1.72 5.27±0.981)4)11.67±3.79 13.17±2.451)4)Control 30 BT AT 22.33±4.691)1.63±0.72 2.27±1.14 4.17±3.960.27±0.15 1.40±0.402)2.07±1.31 4.57±2.082)3.70±2.45 6.00±2.612)2.57±1.92 6.30±2.282)2.40±1.77 4.47±1.252)11.83±3.82 12.50±3.41

4 Discussion

In Chinese medicine, SP falls under the category of Bi-Impediment syndrome. Its contributing factors include constitutional deficiency coupled with prolonged injury/strain or external contraction of wind, cold and dampness. If left untreated or improperly treated, phlegm-stasis may obstruct the meridians around the shoulder, causing impaired mobility of the shoulder joint. This condition can be diagnosed as deficiency in root cause but excess in symptoms. Deficiency of the liver and kidney in SP patients (around or above 50 years old) may cause unsmooth flow of qi and blood and subsequent malnourishment of muscles/tendons and loosened striae. This may in turn make them susceptible to contract wind, cold and dampness. Retention of wind-cold-dampness in the joint may cause pain, cramp and impaired motion. Over time, impaired motion of the shoulder joint may cause adhesion of soft tissues and pain. Pain alleviation is the key to managing soft tissue injury[5]. Patients in adhesion phase of SP often experience impaired active and passive movement of the shoulder joint, coupled with multiple tenderness spots around the muscular origins and terminations, shoulder capsule and ligaments. Because these areas are most susceptible to wear and tear, patients often present with more severe aseptic inflammation and adhesion[6].

Thanks to its stronger needling sensation but fewer points, the multi-direction Hegu needling can relieve spasm and pain[7].

Hegu needling is mainly indicated for muscle Bi-Impediment syndrome. Direct Hegu needling at Ashi points can activate local meridian qi, regulate local meridians, circulate local qi and blood, resolve stasis and thus alleviate pain, especially the severe pain in adhesion phase of SP. This method can also help alleviate the cramping pain and dull pain in SP.

The three shoulder points include Jianyu (LI 15), Jianliao (TE 14) and Jianqian (Extra). They are commonly used for SP[8-9], along with Ashi points.

This study has suggested that patients in the treatment group obtained better effects in severe pain, cramping pain, dull pain and JOA scores than those in the control group. This indicates that compared with normal needling, Hegu needling can more effectively release the cramping adhesive tissue, reduce the tension of the levator scapulae muscle, accelerate the absorption of stagnant blood and exudation and improve localized blood circulation.

The multi-direction needling in deep muscular layers in Hegu needling can improve the localized metabolism and blood circulation, release muscle/ligamentadhesion, relieve cramp, circulate qi and blood and thus alleviate pain[10]. Clinical observation has shown that, as a method of stronger needling sensation, fewer points and better effect for chronic soft tissue pain, Hegu needling is effective for adhesive SP.

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Translator: Han Chou-ping

R246.2

A

Date: April 20, 2013

Author: Fan Xiao-peng, M.M.

Zong Lei, supervisor of master degree candidates, chief physician.

E-mail: lzong65@163.com