Efficacy and safety of Tuina and intermediate frequency electrotherapy for frozen shoulder: MRI-based observation evidence

Abstract

Background: Tuina and Intermediate Frequency (IF) electrotherapy are commonly used treatments for frozen shoulder (FS). This study aimed to compare the clinical efficacy of Tuina and IF electrotherapy in the treatment of stage II frozen shoulder and to provide evidence-based treatment for FS.

Methods: The FS patients were randomized into two groups, the observation group, which received Tuina, and the control group, which received IF electrotherapy. The total treatment duration was 20 minutes per treatment, 3 times per week; the treatment period was 6 weeks. Assessments were performed at baseline, 3 weeks, 6 weeks, and 16 weeks after follow-up. Primary assessments included visual analog scale (VAS), Constant-Murley scale (CMS), and secondary assessments included shoulder MRI, rotator cuff muscle diffusion tensor imaging (DTI).

Results: A total of 57 patients participated in this study, in the observation group (n = 29) and the control group (n = 28). At the end of the 3rd and 6th weeks of treatment, Tuina was significantly more effective than IF electrotherapy in reducing the VAS score and improving the Constant-Murley total score (P<0.05), but there was no significant difference in scores between the two groups at the 16-week follow-up (P>0.05). MRI results in both groups: compared to the control group, the observation group had better results in reducing the degree of periapical edema and reducing the thickness of the axillary humeral capsule (P<0.05); and the observation group had significantly more efficacy than the control group in improving the diffusion state of water molecules in the rotator cuff muscles (P<0.05).

Conclusion: Tuina is more effective than IF electrotherapy in improving the symptoms of FS patients as it can rapidly relieve the pain and restore the function of the affected shoulder, reduce the edema of the shoulder capsule, restore the function of the rotator cuff muscles, and shorten the natural course of FS. Name of the registry: This study was registered in the Shandong University of Traditional Chinese Medicine Affiliated Hospital; Grant No. (2021) Lun Audit No. (033) - KY; Date of registration: 2021.4.27.

Keywords: Frozen shoulder; IF electrotherapy; MRI; RCT; Tuina.

Figure 1

Oblique sagittal fat suppression T2-weighted MRI images, respectively, and ROI (35-40 mm²) were selected at the same level for all subjects, and these are circled in yellow. The FA and ADC values of the muscles corresponding to ROI were measured.

Figure 2

49-year-old woman with FS, severe pain and limited range of motion for more than 4 months. A. Oblique coronal fat-suppressed T2-weighted MR image shows diffuse joint capsule edema of the axillary humerus with thickening of contracture (arrow). B. After 6 weeks of treatment, the edema and thickness of the axillary joint capsule were reduced (arrow). C. Oblique sagittal fat-suppressed T2-weighted MR image shows obvious axillary joint capsule edema (arrow). D. After 6 weeks of treatment, the edema of the joint capsule of the axillary humerus was better than before (arrow).

Figure 3

63-year-old woman with FS, severe pain and limited range of motion for more than 7 months. A. Oblique sagittal fat-suppressed T2-weighted MR image shows edema and thickening (3.8 mm) of the coracohumeral li- gament (arrow). B. After 6 weeks of treatment, the edema of the coracohumeral ligament was reduced and the thickness decreased to 2.7 mm (arrow). C. Oblique sagittal fat-suppressed T2-weighted MR image shows marked anterior extracapsular edema (arrow). D. After 6 weeks of treatment, showing disappearance of anterior extracapsular edema (arrow).

Figure 4

A. Oblique coronal fat suppression T2-weighted MR image showing subsacral effusion of the deltoid muscle (arrow). B. After 6 weeks of treatment, the deltoid subsacral fluid disappeared (arrow). C. Axial fat-suppressed T2-weighted MR image shows fluid in long head biceps tendon sheath (arrow) at humeral neck. D. After 6 weeks of treatment, the volume of fluid in the biceps tendon decreased (arrow).

Figure 5

The upper group of pictures shows the DTI fiber bundle imaging of the shoulder muscles of 4 patients before and after treatment. Before the treatment of the shoulder muscles of patients with FS, the muscle fiber bundles were disordered, with poor integrity and compactness, or even shortened; after the treatment, the muscle fibers were full, continuous, and smooth, with good integrity and compactness.