Arnica compositum, Hekla lava and Acidum Nitricum Together are Superior to Arnica compositum Alone in the Local Treatment of Symptomatic Calcific Periarthritis of the Shoulder: A Pilot Study.

BACKGROUND: To evaluate the usefulness of Arnica compositum (AC) + Acidum nitricum (AN) + Hekla lava (HL) ointment in Emergency Medicine Department (EMD) as alternative nonpharmacological local treatment of patients with symptomatic calcific periarthritis of the shoulder (CPS) and to compare the effectiveness of this mixture against AC ointment alone. METHODS: A series of 41 consecutive patients (20 women, 19 men, median age 49 years, range 25-80 years) with non-traumatic painful unilateral CPS were randomly assigned to receive local treatment with AC+AN+HL ointment mixture (Group A, cases, N=21) or AC ointment alone (Group B, controls, N=20). The radiological Gartner classification of the CPS, and the quantification of pre- and post-treatment pain intensity using a Visual Analogue Scale (VAS) were obtained. The orthopedic evaluation of Shoulder Motion (SM) was also performed. The use of painkillers was reported as a number of doses needed. RESULTS: Age, gender distribution, Gartner type, main calcification size, baseline VAS (VAS-0) and degree of SM did not differ (p=NS) between Groups. After 3-day therapy, the reduction of pain in Group A (4.5±2.5) was superior to that observed in Group B (2.7±2.6) (p =0.03). The same result was observed in the improvement of SM in Group A (69.4±24.9) than in Group B (51.1±21.1) (p =0.015). No local or general adverse effects were noted. The number of doses of paracetamol was similar, but Group A patients used less ibuprofen (p =0.007). CONCLUSION: Local administration of the AC+AN+HL ointment mixture, which in our pilot study was superior to AC alone, could be safely suggested as an alternative uneventful treatment of patients with CPS.

Arthroscopic treatment of symptomatic calcific periarthritis on the medial side of the knee after posterior cruciate ligament reconstruction: Case report and literature review.

Calcific periarthritis in the distal femur is a rare condition. Forty two year old Asian male visited to the outpatient clinic of orthopedic department with acute excruciating knee pain. The arthroscopic posterior cruciate ligament (PCL) reconstruction was performed 20 years ago with the bonepatellar tendon-bone (BPTB) autograft combined with Trevira (polyethylene terephthalate) artificial ligament. Severe tenderness was noted incidentally over the medial epicondyle area of the distal femur which the cancellous screw was inserted for PCL reconstruction, without any preceding trauma history or medial joint line tenderness due to degenerative change. The poorly defined calcific deposition was found in plain radiograph. The arthroscopic debridement of the calcification and screw removal from the distal femur was performed due to resist to conservative treatment with analgesics. After operation, the symptoms were resolved completely. The arthroscopic debridement of calcific periarthritis should be considered in specific cases, such as refractory cases with conservative management during 4-6 weeks. We present the arthroscopic treatment of the symptomatic calcific periarthritis on distal femur after PCL reconstruction can be effective.

[Effect on surface electromyography of deltoid in periarthritis patients under acupuncture stimulation].

OBJECTIVE: To explore the objective evaluation index of acupuncture effect through study on the differences of surface electromyography of deltoid before and after acupuncture at some specific points. METHODS: Twenty-six cases of periarthritis were treated with acupuncture at Jianyu (LI 15), Jianqian (Extra), Jianliao (TE 14) and Binao (LI 14). The treatment was given once every other day, six treatments were required. The deltoid myoelectricity indices were collected and analyzed before treatment, after treatment and after 5 s manipulations at each acupoint. RESULTS: Compared with the deltoid myoelectricity before treatment, there were statistically significant differences in the 2nd, 3rd and 5th manipulations during the acupuncture stimulation at Jianqian (Extra), the 2nd, 3rd and 6th manipulations at Binao ( LI 14) (all P < 0.05) and all the 6 manipulations at Jianyu (LI 15) (all P < 0.05). However, there was no statistically significant difference in all the 6 manipulations at Jianliao (TE 14) (all P > 0.05). And the differences of deltoid surface myoelectricity before and after the 6 acupuncture treatments were all with statistic significance (all P < 0.05). CONCLUSION: A certain therapeutic effect can be found in treatment of periarthritis with acupuncture. And the effect at Jianyu (LI 15) is proved to be the most obvious. Jianqian (Extra) and Binao (LI 14) are considered as the second obvious. While no significant effect can be found at Jianliao (TE 14).

[Efficacy observation on abdominal acupuncture for adhesion-stage shoulder periarthritis].

OBJECTIVE: To evaluate the efficacy of abdominal acupuncture for adhesion-stage shoulder periarthritis. METHODS: One hundred and fifty-seven cases of shoulder periarthritis were randomly divided into an abdominal acupuncture group (79 cases) and a body acupuncture group (78 cases). The abdominal acupuncture was applied at Zhongwan (CV 12), Shangqu (KI 17) and Huaroumen (ST 24) in the abdominal acupuncture group while conventional acupuncture was applied at Jianyu (LI 15), Jianliao (TE 14) and Jianzhen (SI 9) in the body acupuncture group. The treatment was given three times a week for both groups and ten times made an observation course. Before and after treatment, visual analogue scale (VAS) was adopted for pain assessment and functional activity score (Mallet score) was used for shoulder joint function assessment for all the patients. Also the efficacy of both groups was compared. RESULTS: The total effective rate in the abdominal acupuncture group was 92.4% (73/79), which was superior to 71.8% (56/78) in the body acupuncture group. The score of VAS after the treatment was 2.58 +/- 1.64 in the abdominal acupuncture group while 3.12 +/- 1.93 in the body acupuncture group, which had no statistical significance between each other (P > 0.05). The functional activity score after the treatment was 8.34 +/- 3.02 in the abdominal acupuncture group while 7.49 +/- 3.36 in the body acupuncture group, which had no statistical significance between each other (P > 0.05). CONCLUSION: The abdominal acupuncture is an ideal treatment for adhesion-stage shoulder periarthritis, which has better total efficacy than conventional acupuncture. It achieves the same effect in relieving pain and improving functional activity as conventional acupuncture, but also has an advantage at fast selection of acupoint and less discomfort of needling sensation.

[Extracorporeal shock wave therapy in athletes with degenerative and dystrophic disorders of locomotory system].

Degenerative and dystrophic changes of joints and ligaments are among the most prevalent disorders in professional athletes. Specification of a complex system for these diseases is an important task in sports medicine. Extracorporeal shock wave therapy is a modern and highly effective method of rehabilitation.

[Efficacy comparison of different stimulation therapies for periarthritis of shoulder].

OBJECTIVE: To compare clinical efficacy differences among electroacupuncture (EA), transcutaneous electrical nerve stimulation (TENS) therapy and acupoint massage (AM) on periarthritis of shoulder. METHODS: One hundred and twenty cases were randomly divided into an EA group, a TENS group and an AM group, 40 cases in each one. The selection of acupoints in the three groups were all the same, which were Jianqian (Extra), Xiabai (LU 4), Jianyu (LI 15), Binao (LI 14), Jianliao (TE 14), Naohui (TE 13), Xiaohai (SI 8) and Houxi (SI 3). EA was applied in the EA group with dense-disperse wave for 30 min, TENS therapy with dense-disperse wave for 30 min in the TENS group and AM combined with mobilization manipulation of Tuina on the shoulder in the AM group. All of the treatment was given once a day, six times a week and totally 4 weeks were required. The score of visual analogue scale (VAS) and improvement of shoulder joint activities in the three groups before and after the treatment were observed. RESULTS: After the treatment, the VAS score and activities of shoulder joint were all improved in the three groups (all P < 0.001) and AM group had more obvious improvement than TENS group and EA group (all P < 0.05). The effective and curative rate was 61.50 (24/39) in the AM group, which was superior to 42.9% (15/35) in the EA group and 44.4% (16/36) in the TENS group (both P < 0.05). The effective and curative rate of shoulder joint activities in the AM group was 61.5% (24/39), which was superior to 48.6% (17/35) in the EA group and 44.4% (16/36) in the TENS group (both P < 0.05). CONCLUSION: The acupoint massage has obvious clinical efficacy on periarthritis of shoulder, which could effectively relieve the pain and improve activities of shoulder joint, and it is superior to EA and TENS therapy.

[Analysis of clinical efficacy of combination therapy of small needle knife and Daqinjiu Tang in treatment of periarthritis of shoulder].

In order to explore the clinical effect of combination therapy of small needle knife and Daqinjiu Tang in treatment of periarthritis of shoulder, 118 patients with periarthritis of shoulder were divided into control group (59) and experimental group (59) evenly and randomly. Control group received treatment of small needle knife while experimental group received combination therapy of small needle knife and Daqinjiu Tang. Clinical efficacy, shoulder pain and shoulder function were assessed and analyzed between groups before and after treatments. It was showed that the total therapeutic efficacy of experimental group was significantly higher than that of control group (P < 0.05, chi2 = 6.781); Shoulder pain and function were improved after treatments for all patients (P < 0.05), but more significantly in experimental group than in treatment group (P < 0.05). It is suggested that there is confirmed therapeutic effects of combination therapy of small needle knife and Daqingjiu Tang in treatment of periarthritis of shoulder, better than utilizing small needle knife therapy alone.

[Periarthritis of shoulder treated with deep puncture by elongated needle combined with spike-hooked needle and cupping: a multicentral randomized controlled study].

OBJECTIVE: To assess the clinical efficacy and the safety for periarthritis of shoulder treated with deep puncture by elongated needle combined with spike-hooked needle and cupping. METHODS: A multicentral randomized controlled study was adopted. One hundred and twenty cases were divided into an observation group and a control group, 60 cases in each one. In observation group, elongated needle, spike-hooked needle and cupping were used to stimulate Jianyu (LI 15), Naoshu (SI 10), Naohui (TE 13) and Jianqian (Extra). In control group, a conventional needling and cupping were applied to the same points as observation group. Visual Analogue Scale (VAS) and Melle evaluation for the function activity of shoulder joint were adopted to assess and compare the efficacy on analgesia and the effect on shoulder joint range of motion before and after treatment in two groups. RESULTS: In observation group, the cured and markedly effective rate of analgesia was 91.7% (55/60), which was obviously better than 20.4% (12/59) in control group (P < 0.001). Concerning to the improvements of the range of motion in shoulder joint, the cured and markedly effective rate in observation group was 91.7% (55/60), which was better than 18. 6% (11/59) in control group (P < 0.001). VAS score and Melle score after treatment were apparently improved as compared with those before treatment in two groups (all P < 0.001). The improvements in observation group were superior to those in control group (both P < 0.001). There was no adverse event reported during the treatment in two groups. CONCLUSION: The deep puncture by elongated needle combined with spike-hooked needle and cupping achieves a significant clinical efficacy on periarthritis of shoulder and has no adverse reaction reported.

[Clinically randomized controlled trials of moxibustion with salt in bamboo circle for treatment of periarthritis of shoulder].

OBJECTIVE: To assess the clinical therapeutic effect of moxibustion with salt in bamboo circle on periarthritis of shoulder. METHODS Eighty-six cases were randomly divided into a salt-moxibustion group and an electroacupuncture group, 43 cases in each group. The salt-moxibustion group was treated by moxibustion with salt in bamboo circle on the part of obvious pain and hot compress moxibustion on its periphery. The electroacupuncture group was treated with electroacupuncture at Jianyu (LI 15), Jianliao (TE 14), Jianzhen (SI 9), etc. After treatment, the analgesic effect and improvement degrees of active function of the shoulder joint were observed and 3 months later they were followed-up. RESULTS: The two therapies had analgesic effect and could improve active function of shoulder joint, but the salt-moxibustion group in the transient analgesic effect and the improvement degree of active function of the shoulder joint was better than the electroacupuncture group (P< 0.01, P < 0.05). Follow-up survey showed good clinical therapeutic effects in the two groups. The effective rates of pain and active function of shoulder joint were 97.7% and 93.0% in the salt-moxibustion group and 93.0% and 88.4% in the electroacupuncture group, respectively, with no significant differences between the two groups. CONCLUSION: Moxibustion with salt in bamboo circle has an obvious therapeutic effect on periarthritis of shoulder, and it has transient analgesic effect and improves active function of shoulder joint, with a stable and long-term therapeutic effect.

[The new magnetic therapy TAMMEF in the treatment of simple shoulder pain]. / Il nuovo sistema di magnetoterapia TAMMEF nel trattamento della spalla dolorosa semplice.

AIMS: Numerous studies have demonstrated the utility of extremely low frequencies (ELF) electromagnetic fields in the treatment of pain. Moreover, the effects of these fields seems to depend on their respective codes (frequency, intensity, waveform). In our study we want to assess the effects of the TAMMEF (Therapeutic Application of a Musically Modulated Electromagnetic Field) system, whose field is piloted by a musical signal and its parameters (frequency, intensity, waveform) are modified in time, randomly varying within the respective ranges, so that all possible codes can occur during a single application. PATIENTS AND METHODS: Sixty subjects, affected by shoulder periarthritis were enrolled in the study and randomly divided into three groups of 20 patients each: A exposed to TAMMEF, B exposed to ELF, C exposed to a simulated field. All subjects underwent a cycle of 15 daily sessions of 30 minutes each and a clinical examination upon enrollment, after 7 days of therapy, at the end of the cycle and at a follow-up 30 days later. RESULTS: All the patients of groups A and B completed the therapy without the appearance of side effects: they presented a significant improvement of the subjective pain and the functional limitation, which remained stable at the follow-up examination. In group C, there was no improvement of the pain symptoms or articular functionality. CONCLUSIONS: This study suggests that the TAMMEF system is efficacious in the control of pain symptoms and in the reduction of functional limitation in patients with shoulder periarthritis. Moreover, the effects of the TAMMEF system cover those produced by the ELF field.

Long-term results of radiotherapy for periarthritis of the shoulder: a retrospective evaluation.

BACKGROUND: To evaluate retrospectively the results of radiotherapy for periarthritis of the shoulder METHODS: In 1983-2004, 141 patients were treated, all had attended at least one follow-up examination. 19% had had pain for several weeks, 66% for months and 14% for years. Shoulder motility was impaired in 137/140 patients. Nearly all patients had taken oral analgesics, 81% had undergone physiotherapy, five patients had been operated on, and six had been irradiated. Radiotherapy was applied using regular anterior-posterior opposing portals and Co-60 gamma rays or 4 MV photons. 89% of the patients received a total dose of 6 Gy (dose/fraction of 1 Gy twice weekly, the others had total doses ranging from 4 to 8 Gy. The patients and the referring doctors were given written questionnaires in order to obtain long-term results. The mean duration of follow-up was 6.9 years [0-20 years]. RESULTS: During the first follow-up examination at the end of radiotherapy 56% of the patients reported pain relief and improvement of motility. After in median 4.5 months the values were 69 and 89%, after 3.9 years 73% and 73%, respectively. There were virtually no side effects. In the questionnaires, 69% of the patients reported pain relief directly after radiotherapy, 31% up to 12 weeks after radiotherapy. 56% of the patients stated that pain relief had lasted for "years", in further 12% at least for "months". CONCLUSION: Low-dose radiotherapy for periarthropathy of the shoulder was highly effective and yielded long-lasting improvement of pain and motility without side effects.

[Alflutop in local therapy of shoulder periarthritis].

AIM: To study efficacy of a compound biological preparation alflutop in local therapy of shoulder periarthritis (SP), to compare its efficacy with that of periarticular diprospan. MATERIAL AND METHODS: The trial included 54 patients with SP. Clinical SP forms consisted of subacromial and subdeltoid bursitis (SSB) (42.6%), tendinitis (57.4%). Acute disease was diagnosed in 35.2% patients, chronic one--in 64.8%. Alflutop and diprospan were injected periarticularly. The patients were divided into three groups. Patients of group 1 (n = 15) received alflutop monotherapy (2 ml, 5 injections). Group 2 (n = 24) received a single injection of diprospan (7 mg). Group 3 (n = 15) patients were given combined treatment: a single injection (7 mg) of diprospan followed by alflutop infiltrations (2 mg, 5 injections). The efficacy of the treatment was judged by some score clinical parameters, dynamometrical findings, SDQ score set, thermographic and ultrasonic signs of periarticular inflammation. RESULTS: A course of periarticular alflutop infiltrations in SP demonstrated the same efficacy as a single dose diprospan. However, in acute SP with bursitis diprospan produced a significantly better results while alflutop was better in chronic SP with tendinitis. Diprospan combination with alflutop produced the highest therapeutic effect irrespective of the disease course and clinical SP course. CONCLUSION: Local administration of alflutop in SP as monotherapy alternative to glucocorticosteroids or in combination with diprospan is effective. A differentiated approach allowing for a clinical form and course of SP raises therapeutic efficacy noticeably.

Periarthritis promotes gait disturbance in zymosan-induced arthritis in rats.

OBJECTIVE AND DESIGN: We studied the contribution of periarthritis and synovitis to gait disturbance in zymosan (Zy)-induced arthritis. METHODS: Sixty Wistar rats were subjected to injection of Zy (1 mg) into their right knee joints. A first group of animals (GI) had Zy injected through the intact skin. A second group (GII) had Zy injected directly into the articular cavity after excision of the skin and subcutaneous tissue surrounding the joint. Gait disturbance was evaluated using the rat-knee joint incapacitation test. Increase in vascular permeability and cell influx were assessed in joint fluids and joint histology was performed. RESULTS: Zy injection induced a dose-dependent gait disturbance which was maximal at the third/fourth hour of arthritis, being significantly greater in GI rats, whereas cell influx (neutrophils > or = 80%) was maximal at the sixth hour. Cell influx and increase in vasopermeability did not differ between both groups. Histology revealed no significant difference between GI and GII. A third group (GIII), subjected to immune-complex arthritis, that received anti-bovine serum albumin (BSA) antibodies intra-articularly and BSA i.v., did not present gait disturbance, despite the increase in cell counts. CONCLUSIONS: Vascular permeability increase and cell influx are phenomena independent of gait disturbance. Neutrophils do not seem to contribute to development of gait disturbance in Zy arthritis. Sensitization of specific pain receptors in periarticular rather than in synovial tissue is responsible for gait disturbance in Zy-induced arthritis.

Shoulder adhesive capsulitis and shoulder range of motion in type II diabetes mellitus: association with diabetic complications.

This study was done to examine the association between shoulder adhesive capsulitis and chronic diabetic complications and diseases closely related to diabetes in Akdeniz University Hospital. Shoulder adhesive capsulitis were evaluated in 297 consecutive type II diabetic patients attending an outpatient diabetic clinic. Shoulder adhesive capsulitis was detected in 86 patients (29%). There was a significant association between shoulder adhesive capsulitis and limited joint mobility (p = 0.006), shoulder adhesive capsulitis and Dupuytren's disease (p = 0.003). Odds ratios (OR) for carpal tunnel syndrome, limited joint mobility, and Dupuytren's disease with shoulder adhesive capsulitis were respectively 1.4, 2.1, and 2.4 [95% confidence interval (CI), respectively, 0.7-2.9, 1.2-3.69, and 1.3-4.4]. Also, shoulder adhesive capsulitis was associated with the age of patients (p = 0.000) and the duration of diabetes (p = 0.03). When other associations between shoulder adhesive capsulitis and diabetic complications were compared, it was associated with retinopathy [p = 0.014, OR = 2.2 (95% CI 1.1-4.2)], but there was no association with neuropathy or macroproteinuria. On the other hand, the degrees of passive abduction, internal rotation, external rotation motions of shoulder joints in the all patients were correlated with age of patients, duration of diabetes, neuropathy, and the other hands' problems (Dupuytren's disease, limited joint mobility) (p<0.05). The presence of shoulder adhesive capsulitis may indicate presence of organ involvement.

[Frozen shoulder. Arthroscopy and manipulation in general anesthesia, followed by early passive mobilization]. / Frossen skulder. Artroskopi og manipulation i generel anoestesi, efterfulgt af tidlig passiv mobilisation.

Over a 15 month period 20 patients with 20 arthroscopically verified frozen shoulders were treated with manipulation under general anaesthesia and early passive motion. The study had a minimum of six months follow-up. The average duration of the disease before treatment was eight months. Prior to treatment all patients suffered from moderate to severe pain and the average range of motion was less than 40% of the normal shoulder. During the follow-up period 55% had obtained a normal or almost full range of motion and 75% suffered from only slight pain or had no pain at all. Fourteen patients returned to prior work within a mean of nine weeks after treatment. We found no relation between the end-result and the prior pathology. We believe that manipulation with arthroscopy is an effective way of shortening the course of an apparently self-limiting disease and should be considered when conservative treatment fails.