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JoVE Journal Medicine

Medicine

Clinical Efficacy of Small Needle Knife Therapy on Stage I-II Frozen Shoulder

Published: November 17, 2023 doi: 10.3791/65904
Automatic Translation
1, 1, 1,2, 1
1Longhua Hospital, Shanghai University of Traditional Chinese Medicine, 2Key Laboratory of theory and therapy of muscles and bones, Ministry of Education

Summary

The protocol presented here describes the detailed operation method and proves the effectiveness of a small needle knife in the treatment of frozen shoulders.

Abstract

Frozen shoulder is a kind of aseptic inflammatory disease of the shoulder caused by strain, trauma, and other reasons, resulting in shoulder joint pain and limited function. The protocol presented here demonstrates the operation of a small needle knife in treating frozen shoulders, including patient management, material preparation, positioning, operation, and postoperative care. The purpose of this protocol is to relieve the pain and functional limitations and improve the living ability of patients with frozen shoulders. In our study, 76 stage I-II frozen shoulder patients who met the inclusion criteria were randomly divided into a control group and a treatment group (n=38). Patients in the control group received functional exercise, while the treatment group received small needle knife therapy with functional exercise. The visual analogue scores (VAS), the Constant and Murley scores (CMS), and the thickness of the coracohumeral ligament (CHL) under ultrasound were evaluated. After small needle knife therapy, the VAS score was significantly lower in the treatment group (5.11 ± 0.89) than in the control group (5.49 ± 0.65; t=-2.065, p<0.05); the CMS score was significantly higher in the treatment group (64.72 ± 4.78) than in the control group (60.97 ± 6.00; t=2.947, p<0.05); the CHL thickness was significantly decreased in the treatment group (2.38 ± 0.36) than in the control group (2.57 ± 0.42; t=-2.117, p<0.05). These results indicate that the small needle knife significantly relieved the pain symptoms, improved the shoulder function, reduced the CHL thickness, and improved the quality of life and, therefore, had significant therapeutic efficacy in stage I-II frozen shoulder patients.

Introduction

Frozen shoulder is a disease characterized by pain and limitation of active and passive shoulder movement, which causes great inconvenience to the work and life of patients1. The global incidence of frozen shoulder is 2%-5%2,3 and higher in females than in males, showing a certain genetic tendency4. The majority of frozen shoulder patients are 40-60 years old5. Moreover, the frozen shoulder brings about a heavy social burden due to the longer recovery cycle and the absence of established treatment consensus in the clinic practice.

The main treatment methods for frozen shoulders include oral or external use of herbal medicine, acupuncture, massage, functional exercise, and so on6; however, the compliance of the patients is poor due to the multiple treatment frequency and longer time-consuming, and cannot meet the urgent necessities of patients to improve pain and functional limitations. Therefore, it is urgently needed to identify more effective therapeutics in the clinical management of frozen shoulder patients.

Small needle knife therapy is a special and effective external treatment of traditional Chinese medicine, which has arisen rapidly in the field of traditional Chinese medicine in recent decades7. It has the advantages of quick effect, definite curative effect, and high repeatability. Moreover, the operation instrument is cheap and easy to obtain, the operation process is simple, and the method is not limited by the environment and condition. The normal work and life of patients are not affected after the small needle knife therapy since the micro-incision will be recovered quickly without damage to the body, causing infection, or other side effects8,9,10,11. Systematic reviews showed that the efficacy of small needle knife on frozen shoulder was significantly superior to acupuncture, massage, and oral Chinese medicine12,13. Modern studies show that the mechanism of small needle knife treatment of frozen shoulder is to dredge the meridians and collaterals, promote the circulation of qi and blood, cut and strip the lesion tissue, remove adhesion, promote tissue repair, and restore the dynamic balance of the human body14,15.

The protocol presented here demonstrates the operation of small needle knife in treating frozen shoulders including patient management, material preparation, positioning, operation, and postoperative care. The purpose of this protocol is to relieve the pain and functional limitations and improve the living ability of patients with frozen shoulders.

With the development of small needle knife therapy, its application has been extended from the treatment of neck, shoulder, waist, leg pain, and other muscle and bone diseases to internal medicine, surgery, gynecology, pediatrics, and other diseases, playing an increasingly important role in the field of rehabilitation medicine16. In recent years, the small needle knife shows a more accurate, scientific, and safe therapeutic efficacy due to the application of ultrasound-guided small needle knife visualization therapy, whose development has entered a new stage17,18.

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Protocol

The protocol of this study has been approved by the Human Research Ethics Committee of Longhua Hospital Affiliated with Shanghai University of Traditional Chinese Medicine (Approval Number: 2023-LHXS-030). Before the trial, written informed consent was provided by each patient included in the study. A total of 76 patients with stage I-II frozen shoulder in the rehabilitation department of Longhua Hospital affiliated to Shanghai University of Traditional Chinese Medicine from December 2022 to May 2023, who met the inclusion criteria, were randomly divided into a control group and a treatment group, with 38 cases in each group. The operator must be familiar with the anatomy of the shoulder joint and the specific surgical method.

1. Recruitment of patients

  1. Use the following inclusion criteria to enroll patients in this study: Conform to the diagnostic criteria of frozen shoulder; stage I or II frozen shoulder; regardless of gender, 40-65 years old; VAS score ≤ 7; without other treatment at the same time.
  2. Use the following exclusion criteria to not include patients in this study: Patients with blood coagulation dysfunction; diabetic patients with unstable blood sugar control; pregnant pand lactating women; patients with damaged treatment sites or serious infection; Patients with allergies to anesthesia.

2. Exercises regime for control group

  1. Subject patients in the control group to a treatment course of functional exercises as described below19.
    1. Hand wall climbing: Ask the patient to stand facing the wall with both feet open and raising both hands to climb up along the wall. Ask the patient to take the hands to the highest scales with the maximum tolerance and record this for each patient.
    2. Assisted hand: In a standing position, ask the patient to keep the affected upper limb in the state of backward extension and perform internal rotation to the opposite side by pulling the wrist of the affected upper limb with the healthy upper limb, and then maintain the upward pulling state to the maximum tolerance for the patient.
    3. Pendulum swings: In standing and bending down position, ask the patient to support the healthy arm of each patient and drop to the affected side and perform the back and forth, left and right, as well as circle movements. Increase the range of motion when the symptoms are improved and draw circles by holding an object which is 1-2 kg (such as water bottles, dumbbells) to increase the intensity of stretching exercises.
  2. Course of functional exercise: Ensure the patients in the control group perform functional exercises every day including wall climbing, assisted hand and the pendulum swings, 30 times/day for 4 weeks.
    NOTE: The functional exercise must be carried out within the tolerance range; otherwise, it may cause soft tissue strain in the shoulder and lead to deterioration of the condition.
  3. Follow the principle of - from light to heavy, from small to large, step by step and continuously - during the functional exercise. Ask the patient to avoid long-term shoulder work, heavy lifting, or strenuous activities, though the patient can perform all day-to-day activities during treatment.

3. Exercise regime for treatment group

  1. Subject patients in the treatment group to small needle knife therapy with functional exercises.
  2. Preoperative preparation
    1. Material preparation (Figure 1): Sterilize disposable medical plastic cup, medical tweezers, absorbent cotton ball, dressing block, a 40 mm x 40 mm disposable sterile small needle knife, marker pen, type II skin disinfectant, 2% lidocaine hydrochloride, sterile water for injection, 10 mL disposable sterile syringe, disposable sterile injection needle, rubber surgical gloves, self-adhesive dressing.
    2. Patient information check: Check the basic information of each patient (name, age, affected shoulder). Explain the process and advantages of the small needle knife therapy. Make sure that the patients fully understand and relax during the operational procedure.
    3. Patient preparation: Fully expose the affected shoulder in a sitting position.
    4. Positioning (Figure 2): Mark the obvious tenderness points of the affected shoulder, such as the coracoid process point (attachment point of the short head of the biceps), lesser tuberosity of greater (attachment point of the subscapular muscle), intertubercular sulcus (attachment point of the long head of the biceps muscle), subacromial bursae (attachment point of the supraspinatus muscle), 2 cm behind the greater tuberosity of humerus (attachment point of the teres minor muscle)20.
    5. Disinfection: Prepare cotton balls in type II skin disinfectant. Routinely disinfect the skin 3x with gradually reduced diameter starting from 15 cm around the marking point.
  3. Operational procedure (Figure 2)
    1. Load 5 mL 2% lidocaine plus 5 mL of sterile water into a 10 mL syringe to prepare a 10 mL 1% lidocaine working solution. 
    2. Replace the 22G needle with a 25G needle (use thinner needles to ease the pain). Wear the sterile gloves on the left hand and hold the syringe in the right hand.
    3. Insert the needle into the mark and make sure no blood returns upon aspiration. Perpendicularly inject 1-2 mL of 1% lidocaine working solution at each marked point.
    4. Small needle knife insertion (Figure 2): Wear sterile gloves in the right hand to hold the small needle knife. Rapidly insert the small needle knife into the lidocaine injection site perpendicularly with a depth of about 1-3 cm. Make sure that the blade of the small needle knife is parallel to the muscle fibers to avoid damage to important blood vessels and nerves.
    5. Perform the 3-step manipulation of longitudinal incision, stripping and releasing the adhesion7,15. The patient will feel local soreness and pain, and the operator will feel resistance under the knife.
    6. Withdraw the needle when the operator feels a sense of looseness under the knife.
  4. Postoperative care (Figure 2)
    1. Press the injection site for 1 min with a dry sterile cotton ball. Cover the operating area with a sterile self-adhesive dressing.
    2. Assist the patients to dress well.
      NOTE: Put the medical waste into the medical waste trash can.
    3. Ask the patient to sit still for about 15 min before leaving the operating room to avoid postoperative discomfort. Advice the patient to keep the self-adhesive dressing dry until it is removed 48 h later to avoid bleeding and infection.
  5. Course of small needle knife therapy21: Subject the patients in the treatment group to small needle knife therapy, once a week with a total of 4 sessions. Carry out the same functional exercises for patients in the treatment group as done for the control group.

4. Post-intervention outcome assessments

  1. Evaluation index22,23,24
    1. Use the visual analogue scores (VAS), the Constant and Murley scores (CMS), and the thickness of CHL under ultrasound to assess the outcome.
      NOTE: The baseline measurements were performed before and one week after the treatment.
  2. Assessment instruments
    1. Use the GJJDC01 high-precision joint motion electronic measuring instrument for shoulder joint motion measurement and a portable color ultrasound system (Figure 3).
  3. Assessment instruments operation method (Figure 3)
    1. Measurement of shoulder range of motion.
      1. Press ON to turn on the power. Ask the subject to uplift the shoulder to the maximum angle possible. Rotate the measuring ruler and obtain the measured value.
      2. Set the measuring instrument scale back to 0 and repeat the measurement 2x. Press and hold OFF to turn the power off.
    2. Measurement of the thickness of CHL using an ultrasound.
      1. Turn ON the ultrasound machine by pressing the Power button. Press the Patient button, click New Patient, and enter the name of the subject.
      2. Ask the patient to fully expose the affected shoulder in a seated position. Move the shoulder joint of the patient passively to locate the CHL. Align the ultrasound probe with the CHL.
      3. Press the Freeze button to save the ultrasound image. Press the Caliper button to test CHL thickness. Record the measurement and turn it OFF.

5. Statistical analysis

  1. Present the continuous variables as mean ± standard deviation (SD). Use the independent sample t-test to compare the differences between the two groups. All statistical tests were two-sided, and P<0.05 was considered statistically significant. All analyses were performed using statistical software.

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Representative Results

In the control group, 1 patient received other treatment (intra-articular steroid injection) due to aggravation of pain, so the trial was terminated, and the remaining 37 patients in the control group were included in the final statistical analysis. For 2 patients in the treatment group CHL could not be detected under ultrasound, so the test was eliminated, and the remaining 36 patients in the treatment group entered the final statistical analysis.

Baseline characteristics
The differences in gender, age, affected side, course of disease, and stage of patients between the two groups were comparable (p > 0.05). There were 13 males and 24 females in the control group, 19 males and 17 females in the treatment group. Patients in the two groups ranged in age from 40 to 65 years, with 51.92 ± 7.17 years in the control group and 52.56 ± 7.10 years in the treatment group. There were 13 cases affected on the left side, 21 cases affected on the right side, and 3 cases affected on both sides in the control group, while 17 cases were affected on the left side, 17 cases on the right side, and 2 cases on both shoulders in the treatment group. The disease course of the two groups ranged from 1 to 9 months, the median was 3 months in the control group (interquartile range, 2 to 4.5) and 3 months in the treatment group (interquartile range, 2.0 to 5.0). There were 22 stages I and 15 stage II cases in the control group, while 19 stage I and 17 stage II patients were in the treatment group (Table 1).

VAS score and CMS score were improved with small needle knife therapy
After small needle knife therapy, the VAS score was significantly lower in the treatment group (5.11 ± 0.89) than in the control group (5.49 ± 0.65; t=-2.065, p<0.05). The CMS score was significantly higher in the treatment group (64.72 ± 4.78) than in the control group (60.97 ± 6.00; t=2.947, p<0.05; Table 2).

CHL thickness was improved with small needle knife therapy
The CHL thickness was significantly decreased in the treatment group (2.38 ± 0.36) than in the control group (2.57 ± 0.42; t=-2.117, p<0.05; Table 2). Ultrasound images of CHL thickness from the representative patients are provided here (Figure 4 and Figure 5). The two representative female patients, with right shoulder pain and limited mobility for 3 months meeting the diagnostic criteria for frozen shoulder, voluntarily participated in the test. After excluding the contraindications, the patients were informed of the advantage and the disadvantage of small needle knife treatment and functional exercise. Through the random number table method, the No.1 patient, who was 53 years old, entered the control group to receive functional exercise treatment, and the No.2 patient, who was 57 years old, entered the treatment group to receive functional exercises with small needle knife therapy. The baseline VAS scores of both patients were 6 points, the CMS scores were 43 points, and the CHL thickness was 2.8 mm (Table 3 and Figure 4). After the treatment course, the VAS score was 3 points, CMS score was 67 points, and CHL thickness was 1.4 mm for the patient in the treatment group, while the VAS score was 5 points, CMS score was 55 points, and CHL thickness was 2.4 mm for the patient in the control group (Table 3 and Figure 5), indicating an improvement in pain, shoulder function and CHL thickness of the patient in the treatment group.

Adverse reaction
Two patients in the treatment group experienced swelling and pain around the pinhole after small needle knife treatment, which improved after 1 week of hot compress with saline and did not affect normal treatment and follow-up. No obvious adverse reactions were observed in the control group.

Figure 1
Figure 1: Materials for small needle knife treatment. The figure shows all the equipment, reagents and instruments used in this study. Please click here to view a larger version of this figure.

Figure 2
Figure 2: Operation diagram of small needle knife therapy. (A) Label and disinfection. Equation 1 coracoid process point - attachment point of the short head of the biceps; Equation 2 intertubercular sulcus - attachment point of the long head of the biceps muscle; Equation 3 subacromial bursae - attachment point of the supraspinatus muscle; Equation 4 lesser tuberosity of humerus - attachment point of the subscapular muscle; (B) Local anesthesia. (C) Small needle knife therapy operation. (D) Postoperative care. Please click here to view a larger version of this figure.

Figure 3
Figure 3: Assessment instruments used in this study. (A-B) A GJJDC01 high-precision joint motion electronic measuring instrument for shoulder joint motion measurement. (C-D) Ultrasound system. Please click here to view a larger version of this figure.

Figure 4
Figure 4: Ultrasound images of baseline CHL thickness. (A) Patient No. 1 in the control group. (B) Patient No. 2 in the treatment group. Abbreviations: CP = coracoid process; HOH = humeral head. Please click here to view a larger version of this figure.

Figure 5
Figure 5: Ultrasound images of post-intervention CHL thickness. (A) Patient No. 1 in the control group after a treatment course of functional exercises. (B) Patient No. 2 in the treatment group after a treatment course of functional exercises with small needle knife therapy. Please click here to view a larger version of this figure.

Baseline Control group (n=37) Treatment group (n=36) Total P
Gender (n/%) 0.129
Male 13 (35.1) 19 (52.8) 32 (43.8)
Female 24 (64.9) 17 (47.2) 41 (56.2)
Age-year (mean± SD) 51.92±7.17 52.56±7.10 52.23±7.09 0.704
Affected side (n/%) 0.613
Left 13 (35.1) 17 (47.2) 30 (41.1)
Right 21 (56.8) 17 (47.2) 38 (52.1)
Bilateral 3 (8.1) 2 (5.6) 5 (6.8)
Course of disease-month 0.436
Median 3.0 3.0 3.0
Interquartile range 2.0-4.5 2.0-5.0 2.0-5.0
Stage (n/%) 0.565
I 22 (59.5) 19 (52.8) 41 (56.2)
II 15 (40.5) 17 (47.2) 32 (43.8)

Table 1: Basic information of all included patients.

Observation index Group n Baseline After treatment
VAS score (mean ± SD, mm) Treatment group 36 6.22±0.64 5.11±0.89*
Control group 37 6.19±0.62 5.49±0.65
CMS score (mean ± SD, mm) Treatment group 36 44.36±5.92 64.72±4.78*
Control group 37 44.14±6.34 60.97±6.00
CHL thickness (mean ± SD, mm) Treatment group 36 2.66±0.40 2.38±0.36*
Control group 37 2.62±0.39 2.57±0.42
* Compared with control group, P < 0.05.

Table 2: Scores collected between the treatment and control group. VAS score, CMS score, CHL thickness were compared between the two groups. For significance calculation, t-test was used, and the data were expressed as the mean ± SEM. Compared with the control group, * p < 0.05).

Name Group Gender Age (year) Affected side Course of disease Stage Baseline After treatment
(month) VAS CMS CHL (mm) VAS CMS CHL (mm)
No.1 patient Control group Female 53 Right 3 1 6 43 2.8 5 55 2.4
No.2 patient Treatment group Female 57 Right 3 1 6 43 2.8 3 67 1.4

Table 3: Information case study and the tests done. Basic information, VAS score, CMS score, and CHL thickness of the two representative cases.

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Discussion

In this study, we found that the small needle knife therapy significantly relieved the pain symptoms, improved the shoulder joint function, reduced the thickness of CHL, and improved the quality of life in stage I-II frozen shoulder patients. The small needle knife therapy had exact effect on frozen shoulder. However, the operation site is controversial. Due to the different knowledge backgrounds, many operation sites can be selected to treat frozen shoulders with small needle knife. The main operation sites are tender points, acupuncture points, and specific anatomical parts. Because the principle of treatment is similar, no matter what operation sites are selected, a certain therapeutic effect can be achieved, but the therapeutic effect is slightly different due to the operation sites of different parts. Under the guidance of blocking leads to pain, most physicians choose tenderness points combined with anatomical knowledge as the operation sites. By observing the pathological changes of frozen shoulder under ultrasound, it was found that the main pain points of frozen shoulder were the coracoid process point (attachment point of the short head of the biceps), lesser tuberosity of humerus (attachment point of the subscapular muscle), intertubercular sulcus (attachment point of the long head of the biceps muscle), subacromial bursae (attachment point of the supraspinatus muscle), and the 2 cm behind the greater tuberosity of humerus (attachment point of the teres minor muscle)20. Therefore, these five tenderness points were applied as the fixed operation sites, and additional obvious tenderness points according to the specific conditions of patients were added.

The mechanism of small needle knife has been studied in great depth with its gradual popularization. It is currently believed that the frozen shoulder pain is mainly caused by inflammation, angiogenesis, and new innervation25,26,27,28. Studies have shown that inflammatory factors such as interleukin-1α, interleukin-6 and tumor necrosis factor, the vascular endothelial growth factor, and the general nerve marker PGP9.5 and nerve growth marker GAP43 are all increased in patients with frozen shoulder29,30. Studies have shown that the small needle knife therapy reduces serum inflammatory factor levels, and local tension, promotes active substance production in nerves and blood vessels and thus reduces the production of inflammatory transmitters and pain transmitters in nerve endings31,32,33, which allows the microcirculation being built up again to reduce inflammation and relieve pain. The main cause of limited mobility in frozen shoulder patients is fibrosis, where fibroblasts from type I and type III collagen transform into myofibroblasts, resulting in fibrotic contracture and stiffness of the shoulder joint, which restricts movement34,35. Studies have shown that small needle knife therapy alleviates the fibrosis process and improves shoulder joint function. The fibrosis-related factors mainly include transforming growth factor-β (TGF-β) and matrix metalloproteinases family (MMPs)27,36,37. Through the incision and release of adhesion, the small needle knife therapy inhibits the TGF-β release, reduces the MMP-1 level, and prevents the fibrosis process, thereby improving contracture stiffness, promoting local blood circulation, and restoring the overall dynamic balance of the human body37,38. A study on the mechanism of small needle knife not only provides more theoretical support but also further proves the effectiveness and safety of small needle knife therapy.

As for the test methods on treatment effects, evaluation of the treatment effect of frozen shoulder in the literature mainly includes five aspects: pain degree, joint range of motion, living ability, ligament thickness in ultrasound or MRI, and adverse reaction39,40,41. In this study, VAS score was used to evaluate pain degree, CMS score was used to evaluate joint range of motion and living ability, and ultrasound was used to measure CHL thickness and ask patients about adverse reactions.

We have monitored the adverse reactions that may be caused by the application of small needle knife during the treatment and follow-up period and swelling and pain around the pinhole have been identified. However, these adverse reactions did not affect the planned treatment and follow-up. Since the entire treatment and follow-up period was only 4 weeks, sequelae and complications were not investigated in this current study. However, literature has reported that the sequelae of small needle knife treatment include adhesion, vascular and nerve injury. The adhesion may be caused by repeated (more than 6 times) small needle knife treatment21, and the vascular and nerve injury is due to the unfamiliarity with shoulder anatomy of the doctors who perform the small needle knife treatment42. In this study, only 4 small needle knife treatments were performed, which achieved therapeutic efficacy while avoiding adhesion. The experienced doctor who performed small needle knife treatments has been engaged in the medical industry for more than 30 years and is familiar with shoulder anatomy, which could ensure the safety of small needle knife treatment. The possible sequelae or complications have been asked by telephone follow-up.

There are some limitations of this study. Although more and more studies have proposed using CHL thickness as diagnostic and evaluation criteria for frozen shoulders, there is still no consensus and guidelines. The investigation time and sample size of this study were limited, therefore, a large sample size and multi-center trial with long-term follow-up focusing on the specific stage of frozen shoulder is needed.

In conclusion, this study demonstrated that the small needle knife therapy had a significant effect on the stage I-II frozen shoulder, which significantly relieved the pain symptoms, improved the shoulder function, reduced the thickness of CHL, and improved the quality of life in stage I-II frozen shoulder patients, with the advantages of safety, a short course of treatment and fewer side effects, which is worthy of promotion and application.

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Disclosures

The authors report no conflicts of interest.

Acknowledgments

We appreciate the financial support from (1) National Nature Science Foundation (81973877), (2)the Three year Action Plan of Shanghai to Further Accelerate the Inheritance, Innovation and Development of Traditional Chinese Medicine (ZY (2021-2023)-0201-01) , (3) Pudong New Area Health System Pudong Famous Physician Training Plan (PWRzm2020-15), and (4) Chinese Medicine Rehabilitation Service Enhancement Project (Medical 032).

Materials

Name Company Catalog Number Comments
Disposable sterile injection needle Shanghai Mishava Medical Industry Co., Ltd 601900973 Type specification:0.5 x 38 RWLB
Disposable sterile small needle-knife Wujiang Yunlong Medical equipment Co., Ltd PR-4040 Type specification:40 mm x 40 mm 
Disposable sterile syringe Shandong Weigo Group Medical polymer Products Co., Ltd 601909174 Type specification:10 mL
Lidocaine hydrochloride Shanghai Hefeng Pharmaceutical Co., Ltd 6904996104121 Type specification:5 mL
Marker pen Zebra Trading (Shenzhen) Co., Ltd 4901681518111 Type specification:1.0 mm/0.5 mm
Sterile absorbent cotton ball Shanghai Honglong Medical Supplies Equipment Co., Ltd 601905637 Type specification:0.3  25 g
Sterile disposable medical plastic cup Shanghai Honglong Medical Supplies Equipment Co., Ltd 709008633 Type specification:Waist-shaped disc
Sterile dressing block Ningbo Haishu Shenyuan Medical Materials Co.,  Ltd 601909470 Type specification:7.5 cm x 7.5 cm x 8 floors
Sterile medical tweezers Shanghai Honglong Medical Supplies Equipment Co.,Ltd 603917444 Type specification:Small size
Sterile rubber surgical gloves Guilin Hengbao health protection Co.,  Ltd 6971787071320 Type specification:6.5
Sterile self-adhesive dressing Shanghai ISO Medical Products Co., Ltd 601909414 Type specification:10 cm x 15 cm
Sterile water for injection Shanghai Xinyi Jinzhu Pharmaceutical Co., Ltd 6938493300953 Type specification:5 mL
Type II skin disinfectant Shanghai Likang Disinfection high-tech Co., Ltd 6909157000359 Type specification:500 mL/ bottle
Ultrasound Suzhou Daer Medical Equipment Co., Ltd 100018857 uSmart3300 portable color ultrasound system

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References

  1. Abrassart, S., et al. 'Frozen shoulder' is ill-defined. How can it be described better. EFORT Open Rev. 5 (5), 273-279 (2020).
  2. Ramirez, J. Adhesive capsulitis: Diagnosis and management. Am Fam Physician. 99 (5), 297-300 (2019).
  3. Hsu, J. E., Anakwenze, O. A., Warrender, W. J., Abboud, J. A. Current review of adhesive capsulitis. J Shoulder Elbow Surg. 20 (3), 502-514 (2011).
  4. Hand, C., Clipsham, K., Rees, J. L., Carr, A. J. Long-term outcome of frozen shoulder. J Shoulder Elbow Surg. 17 (2), 231-236 (2008).
  5. White, D., Choi, H., Peloquin, C., Zhu, Y., Zhang, Y. Secular trend of adhesive capsulitis. Arthritis Care Res. 63 (11), 1571-1575 (2011).
  6. Qin, X., et al. Traditional Chinese Medicine for Frozen shoulder: An evidence-based guideline. J Evid Based Med. 16, 246-258 (2023).
  7. Zhu, J., et al. The effects of small needle knife therapy on pain and mobility from knee osteoarthritis: a pilot randomized-controlled study. Clin Rehabil. 34 (12), 1497-1505 (2020).
  8. Deng, D. W., et al. Clinical effect of small needle knife on frozen shoulder. Massage Rehabil Med. 13 (13), 15-20 (2022).
  9. Liu, L., et al. Advances in the treatment of frozen shoulder with small needle knife. Rheumatol Arthritis. 11 (12), 67-70 (2022).
  10. Ruan, J. Clinical efficacy and safety analysis of small needle knife combined with functional exercise in the treatment of frozen shoulder. Chinese J Med Sci. 10 (9), 39-41 (2019).
  11. Kwon, C. Y., Yoon, S. H., Lee, B. Clinical effectiveness and safety of acupotomy: An overview of systematic reviews. Complement Ther Clin Pract. 36, 142-152 (2019).
  12. Liu, F. S., Jin, X. F., Guo, C. Q. Systematic review of acupuncture versus small needle knife for frozen shoulder. Chinese J Traditional Chinese Med. 27 (3), 582-585 (2021).
  13. Yang, W. Y. Systematic review on curative effect of small-needle-knife therapy combined with manipulation for frozen shoulder. Chinese J Info Traditional Chinese Med. (12), 94-98 (2018).
  14. He, J. On the role and relationship between "needle" and "knife" in small needle knife therapy. Clin J Acupuncture Moxibustion. (9), 28-29 (2000).
  15. Hu, Z. J. Clinical Practice of practical small needle knife. , Shanghai Science and Technology Press. Shanghai. (2018).
  16. Wen, H. W., Zeng, W. Q. Bibliometrics and knowledge graph analysis of small needle knife. Chinese J Lib Info Traditional Chinese Med. 45 (6), 13-17 (2021).
  17. Qin, X., et al. Outcomes of visualized puncture needle and small needle knife therapy in primary frozen shoulder based on multimodal ultrasound imaging. J Healthc Eng. 2022, 1076112 (2022).
  18. Zeng, X., Ding, Z. H., Fu, L. Q., Liu, S. Y. Research progress of ultrasound small needle knife visualization. J Acupuncture Res. 46 (6), 546-548 (2019).
  19. Mertens, M. G., Meert, L., Struyf, F., Schwank, A., Meeus, M. Exercise therapy is effective for improvement in range of motion, function, and pain in patients with frozen shoulder: A systematic review and meta-analysis. Arch Phys Med Rehabil. 103 (5), 998-1012 (2022).
  20. Xu, W. S., Liu, T. Clinical observation of "C" shape release by small needle knife in treatment of frozen shoulder. J Liaoning Uni Traditional Chinese Med. 21 (9), 185-188 (2019).
  21. Liang, C. X. Basic research on a recommended program of clinical practice guidelines for small needle knife treatment of frozen shoulder. Beijing University of Chinese Medicine. , (2012).
  22. Tian, Z. R., Yao, M., Wang, Y. J., Cui, X. J. Development and application of Constant-Murley shoulder joint Rating scale in Chinese. Chinese Med Bone Sett. 31 (5), 20-25 (2019).
  23. Yin, L., et al. Application of visual diagnosis and treatment technique (ultrasound) in diagnosis and treatment of frozen shoulder and evaluation of curative effect. Chinese J Med Ultrasound. 16 (11), 810-814 (2019).
  24. Fan, Z. D. The role of measurement of coracohumeral ligament thickness in diagnosis and evaluation of the curative effect of frozen shoulder. Soochow University. , (2018).
  25. Reeves, B. The natural history of the frozen shoulder syndrome. Scand J Rheumatol. 4 (4), 193-196 (1975).
  26. Xu, Y., Bonar, F., Murrell, G. A. Enhanced expression of neuronal proteins in idiopathic frozen shoulder. J Shoulder Elbow Surg. 21 (10), 1391-1397 (2012).
  27. Rodeo, S. A., Hannafin, J. A., Tom, J., Warren, R. F., Wickiewicz, T. L. Immunolocalization of cytokines and their receptors in adhesive capsulitis of the shoulder. J Orthop Res. 15 (3), 427-436 (1997).
  28. Green, H. D., et al. A genome-wide association study identifies 5 loci associated with frozen shoulder and implicates diabetes as a causal risk factor. PLoS Genet. 17 (6), e1009577 (2021).
  29. Hand, G. C., Athanasou, N. A., Matthews, T., Carr, A. J. The pathology of frozen shoulder. J Bone Joint Surg Br. 89 (7), 928-932 (2007).
  30. Lho, Y. M., et al. Inflammatory cytokines are overexpressed in the subacromial bursa of frozen shoulder. J Shoulder Elbow Surg. 22 (5), 666-672 (2013).
  31. Han, Y. L., Sun, W. Q., Huo, S. F., Xu, Z. H. Recent therapeutic effect and mechanism of small needle knife in the treatment of patients with cold-dampness-blocking frozen shoulder. World of Chinese Medicine. 13 (5), 1254-1257 (2018).
  32. Zhou, D., et al. Effect of small needle knife therapy on expression of IL-1β, TNF-α, and ASIC1 in local tissue of rabbits with frozen shoulder. Shanghai J Acupuncture Moxibustion. 40 (6), 762-768 (2021).
  33. Zhang, Z. F. Effect of small needle knife and local closure on pain mediators and inflammatory factors in patients with frozen shoulder. Clin Res Chinese Med. 10 (8), 82-84 (2018).
  34. Bunker, T. D., Reilly, J., Baird, K. S., Hamblen, D. L. Expression of growth factors, cytokines and matrix metalloproteinases in frozen shoulder. J Bone Joint Surg Br. 82 (5), 768-773 (2000).
  35. Millar, N. L., et al. Frozen shoulder. Nat Rev Dis Primers. 8 (1), 59 (2022).
  36. Li, H. Y., Chen, S. Y., Zhai, W. T., Chen, J. W. Expression of TGF-β and MMPs in capsula tissue of frozen shoulder patients. J Shanghai Jiaotong Uni. 29 (11), 1363-1366 (2009).
  37. Cher, J. Z. B., et al. Alarmins in Frozen Shoulder: A Molecular Association Between Inflammation and Pain. Am J Sports Med. 46 (3), 671-678 (2018).
  38. Wang, J. Experimental study on the treatment of frozen shoulder in rats with "C" shaped small needle knife. Hubei Uni Chinese Med. , (2020).
  39. Bai, Y., Chen, B., Qin, Y. N., Du, Y. H. Thoughts on constructing the core outcome index set of clinical research on frozen shoulder. Chinese Med J. 36 (1), 69-73 (2019).
  40. Buchbinder, R., et al. A Preliminary Core Domain Set for Clinical Trials of Shoulder Disorders: A Report from the OMERACT 2016 Shoulder Core Outcome Set Special Interest Group. J Rheumatol. 44 (12), 1880-1883 (2017).
  41. Fan, Z. D. The role of measurement of coracohumeral ligament thickness in diagnosis and evaluation of curative effect of frozen shoulder. Soochow University. , (2018).
  42. Xiu, Z. B., et al. Clinical guidelines of small needle knife for knee osteoarthritis. J Rehabil. 33 (3), 193-201 (2019).

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Medicine Small needle knife Frozen shoulder
Clinical Efficacy of Small Needle Knife Therapy on Stage I-II Frozen Shoulder
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Guo, S., Liu, D., Yang, Y., Hu, Z.… More

Guo, S., Liu, D., Yang, Y., Hu, Z. Clinical Efficacy of Small Needle Knife Therapy on Stage I-II Frozen Shoulder. J. Vis. Exp. (201), e65904, doi:10.3791/65904 (2023).

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