Acupuncture is effective for the treatment of frozen shoulders (adhesive capsulitis), a disorder characterized by pain and stiffness of the rotator cuff region. Henan University of Traditional Chinese Medicine researchers compared two acupuncture treatment protocols and determined that, while both approaches to patient care were effective, a combined protocol of acupuncture plus moxibustion produces superior patient outcomes to patients receiving only acupuncture. Patients receiving only acupuncture had a 75.86% total effective rate. Patient receiving both acupuncture and moxibustion had a 93.10% total effective rate. [1]

A total of 60 patients with frozen shoulders were recruited for the study and were randomly assigned to treatment group 1 (acupuncture monotherapy) or treatment group 2 (combined acupuncture and moxibustion). One patient was excluded from each group due to incomplete data, leaving 29 patients in each treatment group. Group 1 was comprised of 13 male and 16 female patients, ages 46–72 years (mean age 55.3 years), with a disease duration of 5 days to 6 months (mean duration 3.0 months). Group 2 was comprised of 14 male and 15 female patients, ages 44–75 years (mean age 56.8 years), with a disease duration of 7 days to 6 months (mean duration 3.1 months). There were no statistically significant differences in baseline characteristics between the two groups at the start of the investigation.

 

Design
Biomedical diagnostic criteria included the following:

  • onset at approximately 50 years of age
  • a history of exposure to cold, external trauma, or repetitive actions
  • shoulder soreness and pain
  • aversion to wind and cold in the limbs
  • joint pain
  • limited range of motion
  • multiple tender spots on the affected shoulder
  • muscle atrophy
  • physiological changes in fat distribution or calcification, confirmed by x-ray

Chinese medicine diagnostic criteria included the following:

  • onset at approximately 50 years of age
  • increased prevalence in manual laborers
  • chronic shoulder pain that is worse at night and aggravated by weather changes or fatigue
  • joint dysfunction
  • muscle atrophy
  • multiple tender spots on the affected shoulder

For inclusion in the study, patients were required to meet the above diagnostic criteria and also be between 40–75 years of age, with symptoms occurring within the previous 6 months. Patients were also required to give informed consent to participate in the study. Exclusion criteria included the following:

  • concurrent hemopoietic or psychiatric disorders
  • heart, liver, or kidney dysfunction
  • primary disease of a life-threatening nature
  • pregnancy or lactation
  • allergies to moxa
  • cervical spondylosis
  • coronary heart disease, diabetes, or cholecystitis
  • internal shoulder nodules or tumors

 

Acupuncture Treatment
Both groups received acupuncture treatments administered at the following acupoints:

  • Jianyu (LI15)
  • Jianzhen (SI9)
  • Jianliao (TB14)
  • Yanglingquan (GB34)
  • Tiaokou (ST38) penetrating to Chengshan (BL57) 
  • Ashi points

Treatment was conducted with patients in a seated position. Tender spots were identified through a combination of flexion, extension, raising the arms, and palpation. Following standard disinfection, 0.30mm × 40mm or 0.30mm × 50mm needles were selected and inserted perpendicularly into Jianyu, Jianzhen, and Jianliao to a depth of 25–35mm, perpendicularly into Yanglingquan to a depth of 35mm, and into Tiaokou penetrating to Chengshan to a depth of 40–50mm. Needle depths were adjusted appropriately according to patients’ body size. Once a sore or distending sensation was achieved in the local area, needles were retained for 40 minutes.

Patients in group 2 also received intensive moxibustion applied to the affected shoulder immediately after acupuncture treatment. The researchers selected three-year aged moxa rolls, approximately 200mm in length and 18mm in diameter, weighing 23.5g each. They were cut into six sections and distributed evenly inside a moxa box (30cm × 22cm × 17cm, net height 7cm, hole height 1cm). The box was placed on the affected shoulder and the moxa was ignited before closing the lid and covering it with a cloth. Patients with anterior shoulder pain were treated in a supine position and patients with posterior shoulder pain were treated in a prone position. Moxibustion was administered for 40–50 minutes to induce local skin redness and sweating.

Treatment was administered daily with each course lasting five days. A total of two courses were administered, separated by a two-day break. Throughout the treatment period, all patients were instructed to perform exercises to improve range of motion and shoulder function. These included extension, abduction, raising, hand clapping, and wall climbing motions, and were performed morning and evening for 30 minutes each time.

 

Results
Outcome measures included a VAS (visual analog scale) for pain, Constant-Murley Shoulder Score, and total clinical effective rates for each group. Patients self-rated their shoulder pain on a VAS of 0–10, with higher scores indicative of more severe pain. Both groups saw significant reductions in VAS scores following treatment (p<0.05); however, reductions were significantly greater in group 2 (p<0.05).

The Constant-Murley Shoulder Score was used to assess pain, activities of daily living, mobility, and strength. The scale has a maximum score of 100, with lower scores indicative of more severe dysfunction. Both groups saw significant improvements in Constant-Murley scores following treatment (p<0.05). Improvements were significantly greater in group 2 (p<0.05).

The total clinical effective rates were calculated for the two groups. Patients were classified as recovered, improved, or unaffected depending on their level of improvement following treatment. In group 1, there were 10 recovered, 12 improved, and 7 unaffected patients, giving a total effective rate of 22 (75.86%). In group 2, there were 19 recovered, 8 improved, and 2 unaffected patients, giving a total effective rate of 27 (93.10%). The total effective rate was significantly greater in group 2 (p<0.05).

The results of this study indicate that acupuncture is an effective treatment for frozen shoulders with the potential to reduce pain and improve shoulder function. The data indicates that the efficacy of acupuncture is enhanced by the addition of intensive moxibustion.

 

1. Gao Ling, Li Xiao, Wang Dong-bin, Du Mei-lu, Xie Jin, Gao Xi-yan (2019) “Clinical trial of treatment of frozen shoulder by intensive moxibustion plus acupuncture” Acupuncture Research Vol.44 (4) pp.297-301.

 

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