Analysis of risk factors for advanced age in patients with frozen shoulder

OBJECTIVE

To explore the risk factors of elderly patients with frozen shoulder.

METHODS

262 cases of scapulohumeral periarthritis treated in our hospital from January 2020 to December 2020 were analyzed retrospectively. According to the age of patients, patients younger than 60 years old were divided into middle-aged group (101 cases), patients between 60 and 75 years old were divided into old-aged group (91 cases), and patients ≥ 75 years old were divided into old-aged group (70 cases). The general demographic data and clinical data of the three groups were compared. Visual analogue scale (VAS) was used to evaluate the degree of pain. Finally, the dependent variable is set as whether the onset age of scapulohumeral periarthritis patients is advanced. Univariate and multivariate Logistic regression was used to analyze the risk factors of frozen shoulder patients at an advanced age.

RESULTS

There were no significant differences in general demographic data, fixed position, hypertension history, smoking history, drinking history, supraspinatus muscular atrophy and physical exercise among the three groups (all P > 0.05). The course of disease, diabetes, surgical treatment, pain degree, operation time, cholecystitis, coronary heart disease, pain degree three months after operation and cervical spondylosis in the elderly group were all higher than those in the middle-aged group and the elderly group, and the differences were statistically significant (all P < 0.05). The course of scapulohumeral periarthritis, the degree of pain and the degree of pain 3 months after operation in the elderly group were higher than those in the middle-aged group, with significant differences (all P < 0.05). Univariate Logistic regression analysis showed that the risk factors of scapulohumeral periarthritis in the elderly included diabetes mellitus (OR = 3.067, 95% CI 1.881-4.587, P < 0.001), operative treatment (OR = 3.076, 95% CI 1.365-6.765, P = 0.006), VAS score (OR = 2.267, 95% CI 1.117-3.887, P = 0.013), operation time (OR = 1.537, 95% CI 1.305-2.579, P < 0.001), cholecystitis (OR = 2.143, 95% CI 1.019-4.876, P = 0.023), coronary heart disease(OR = 3.128, 95% CI 1.428-7.019, P = 0.005), VAS at 3 months after operation (OR = 1.537, 95% CI 0.786-2.635, P = 0.002), and cervical spondylosis(OR = 1.162, 95% CI 1.029-1.321, P = 0.012). Multivariate logistic regression analysis showed that the risk factors for the onset of the disease at advanced age included fatty infiltration (OR = 4.021, 95% CI 2.981-9.682, P < 0.001), surgical treatment (OR = 4.109, 95% CI 1.419-7.832, P = 0.008), VAS score (OR = 3.081, 95% CI 1.042-7.931, P = 0.046) and operation time (OR = 1.537, 95% CI 1.305-2.579, P < 0.001).

CONCLUSION

Risk factors of frozen shoulder at advanced age include fat infiltration, surgical treatment, VAS score and surgical time. In clinical practice, we should refer to the above indicators to help patients with early medical intervention and prevent their onset.

[Treatment of scapulohumeral periarthritis by "metal hook fishing"-like needling technique combined with Tuina manipulation]

OBJECTIVE

To observe the clinical effect of "metal hook fishing" (MHF)-like needling technique combined with Tuina manipulation in the treatment of scapulohumeral periarthritis.

METHODS

A total of 72 patients with scapulohumeral periarthritis were randomly divided into MHF-like needling (MHF) and conventional needling groups (n=36 in each group). For patients of the GHF group, the doctor pressed the acupoint with the left index finger, held the disposable acupuncture needles to insert into the Jianqian, Jianyu (LI15), Jianliao (SJ5), Jianzheng (SJ9) and Ashi-point respectively with the right hand, waited for qi-arriving, twirled the needles forward about 3 to 6 times. When a tightened feeling was achieved beneath the needle tip, the doctor held the needle body to slightly shake it 3 to 6 times which mimicked a fish to swallow a hook, kept the situation for a while till relaxation, followed by retaining the needle for 30 min and then withdrew it slowly. Afterwards, the doctor performed Tuina manipulation at the upper limbs for 20 to 30 min. For patients of the conventional needling group, the same acupoints were needled and stimulated with the uniform reducing and reinforcing method for 1 min, followed by retaining the needles for 30 min. Then, massage was performed for 20 to 30 min in the same way as those in the MHF group. The treatment was conducted once daily, 6 times a week for 2 weeks. After the treatment, the visual analogue scale (VAS) was used to assess the pain degree, the range of motion (ROM) scale of the shoulder joint adopted to assess the function, and the activity of daily living (ADL) scale used to assess the patients' daily living ability. The therapeutic effects of the two groups were evaluated after the treatment.

RESULTS

After the treatment, the VAS scores of the two groups were notably decreased (P<0.05), being significantly lower in the GHF group than in the conventional needling group (P<0.05). The ROM score and ADL score of the two groups were obviously increased (P<0.05), being significantly higher in the MHF group than in the conventional needling group (P<0.05). Of the 36 cases in the conventional needling and MHF groups, 7 and 17 were cured, 11 and 12 experienced remarkable improvement, 13 and 4 were improved, and 5 and 3 were ineffective, with the total effective rate being 86.1% （31/36） and 91.7% (33/36), respectively. The total effective rate of MHF group was evidently higher than that of the conventional needling group (P<0.05).

CONCLUSION

Both MHF and conventional needling is effective in relieving scapulohumeral periarthritis, and the effect of MHF is ob-viously superior to that of conventional needling in relieving pain state and improving function of the affected shoulder joint.

[Treatment of scapulohumeral periarthritis by Fuyang-pot warming combined with electroacupuncture stimulation]

OBJECTIVE

To observe the clinical therapeutic effect of Fuyang-pot warming combined with electroacupuncture (EA) in the treatment of scapulohumeral periarthritis (SPA).

METHODS

A total of 90 cases of SPA patients were randomized into EA, Fuyang-pot warming and EA plus Fuyang-pot warming (combination) groups (n=30 per group). Fuyang-pot warming including pressing, mild moxibustion, scraping-pushing, cupping, tapping, etc. was applied to Fengchi (GB20), Dazhui (GV14), Jianjing (GB21), Jianyu (LI15), Zhongfu (LU1), Ashi-point, etc., and EA (2 Hz /100 Hz,1-1.5 mA) was appled to GB20, GV14, GB21, LI15, Binao (LI14), Tiaokou (ST38), Chengshan (BL57), Ashi-point, etc. The treatment was performed for 30 min every time, once every other day for 2 weeks. The visual analogue scale (VAS, 0-10 points) was used to assess the pain severity. The Constant-Murley shoulder assessment scale (100 points in total, including 15 points in pain severity and 20 points in daily living activities, 40 points in joint motion range, and 25 points in myodynamia) was used to assess the functional state of the shoulder. The rating scale of the American Shoulder and Elbow Surgeons (ASES, 4 grades) was used to evaluate the ability of daily living activities.

RESULTS

Following the treatment, intra-group comparison showed that the VAS score was significantly reduced in the three groups in comparison with their own pre-treatment (P<0.01). The total scores of Constant-Murley scale, and scores of activities of daily living and active motion range, myodynamia, and ASES shoulder-joint function were all considerably increased in the three groups in comparison with their own pre-treatment (all P<0.01). The therapeutic effect of EA plus Fuyang-pot warming was significantly superior to that of simple EA and simple Fuyang-pot warming in reducing VAS score and increasing total score of Constant-Murley scale and scores of activities of daily living, active motion range, myodynamia as well as ASES shoulder joint function (P<0.01). Of the 30, 29 and 30 cases in the combination, EA and Fuyang-pot warming groups, 9, 2 and 4 were basically cured, 14, 8 and 12 experienced marked improvement, 4, 12 and 9 were improved, and 3, 7 and 5 failed in the treatment, with the cured plus effective rates being 76.67%, 34.48% and 53.33%, respectively. The cure plus effective rate was apparently higher in the combined treatment group than in the simple EA and simple Fuyang-pot warming groups (P<0.01), but had no significant difference between the simple EA and simple Fuyang-pot warming groups (P>0.05).

CONCLUSION

Fuyang-pot warming combined with EA is effective in relieving pain, and enhancing the daily life quality in scapulohumeral periarthritis patients.