Acupuncture alleviates pain and restores mobility to patients with scapulohumeral periarthritis (pain and range of motion disorder of the shoulder). This condition involves shoulder inflammation affecting the muscles, tendons, and bursa. In severe cases, there may be adhesive capsulitis (frozen shoulder).
Yueyang Affiliated Hospital (Hunan University of Traditional Chinese Medicine) researchers tested two approaches to acupuncture therapy. One protocol involved the application of local acupuncture points. The other acupoint prescription protocol employed the addition of three distal acupuncture points. The combined protocol of distal and local acupoints produced a 91.7% total effective rate in the clinical trial. [1]
A total of 72 patients with scapulohumeral periarthritis were admitted into Yueyang Hospital. The sample was randomly divided into a local plus distal acupuncture group and a local acupoint group. Patient age range was 40–65 years and the course of disease was within 2 years. There was no statistical difference in terms of mean age and mean course of disease prior to the beginning of acupoint application.
For the local acupoint group, a seated position was taken. Sterile filiform needles (30 mm) were inserted into LI15 (Jianyu), MUE48 (Jianqian), and SI9 (Jianzhen). Jianqian is an extra acupoint located on the anterior aspect of the shoulder, midway between the anterior axillary crease and LI15. This compliments SI9, which is on the posterior aspect of the shoulder, 1 cun superior to the posterior axillary crease.
Needles were inserted perpendicularly and a mild reinforcing-attenuating method was applied. After obtaining a deqi sensation, moxa was connected to the end of the needles and remained for 30 minutes. For the local plus distal acupuncture group, three additional acupoints were added to the aforementioned protocol: LI3 (Sanjian, Third Space), SI3 (Houxi, Back Stream), TB3 (Zhongzhu, Central Islet). The distal points also received the mild reinforcing-attenuating method of stimulation. For both groups, treatment was administered daily for 2 weeks, with a one day break at the end of the first week.
A common distal point used for pain control is LI4 (Hegu). Here, the prior point on the large intestine channel was chosen, LI3. Based on Chinese medicine jingluo (经络) theory, this point is a shu-stream and wood point that is indicated for the treatment of wind-heat, inflammation of the throat and teeth, and abdominal fullness and diarrhea. According to distal point principles, this point is also indicated for the treatment of neck stiffness along with customary local indications such as hand inflammation and difficulty with flexion and extension of the fingers. One ancient text (Ode of Xi-hong) notes that LI3 with BL23 together are applicable for the treatment of shoulder and back pain leading to qi and blood deficiency.
SI3 is a shu-stream, wood, and confluent point of the governing vessel (Du Mai). This is a common distal point used for the treatment of arm, finger, elbow, neck, shoulder, and back pain. This point is also useful for the treatment of headaches. This point clears wind-heat, calms the spirit-shen, and benefits the sensory organs. This point is also used for patients with malaria. SI3 is located on the ulnar border of the hand, in the depression proximal to the head of the 5th metacarpal bone.
TB3 is a shu-stream and wood point on the sanjiao meridian. Located on the dorsum of the hand, TB3 is in the depression proximal to the 4th and 5th metacarpo-phalangeal joints. Note that all 3 distal points used in the investigation are shu-stream points, which are indicated for heaviness sensations and painfulness of the joints. SJ3 clears heat, benefits the ears, clears the eyes, benefits the head, and stops pain. Indications for use include finger, elbow, upper arm, and shoulder dysfunction, inflammation, and pain. Additional indications include tinnitus, headaches, dizziness, febrile diseases, itching, redness of the eyes, and painful throat obstruction.
Results
Observation parameters were based on the Constant Murley Score (CMS), which is used to assess the shoulder. This is a 100 point scale based on: pain (15 points), activities of daily living (20 points), overall strength (25 points), shoulder range of motion (40 points). Greater numerical designations indicate greater function. Prior to treatment, the scores for the distal plus local acupuncture group and the local only acupuncture group were 54.56 ±6.20 and 55.50 ±5.16 respectively. Following treatment, the figures changed to 89.39 ±9.10 and 81.94 ±9.36. Efficacy criteria were classified into 4 categories:
- Fully recovered: shoulder pain eliminated, mobility restored
- Significantly effective: pain markedly relieved, mobility improved
- Effective: pain relieved, mobility slightly improved
- Ineffective: pain persisted, symptoms unchanged or aggravated.
Among the 36 cases in the local plus distal acupuncture group, 13 cases were fully recovered, 15 were significantly effective, 5 were effective, and 3 were ineffective. Among the 36 cases in the distal acupuncture group, 7 cases were fully recovered, 13 were significantly effective, 11 were effective, and 5 were ineffective. The efficacy rates for the two groups were 91.7% and 86.1% respectively. Both groups benefitted from acupuncture therapy, but the group receiving both local and distal acupoints had greater outcomes.
Reference:
[1] Li Jiali, Wang Yaan, Jiang Xueyu, Clinical Observation on Treating Scapulohumeral Periarthritis With Acupuncture on Sanyang, Asian-Pacific Traditional Chinese Medicine, Vol. 17, No. 5.
