특발성 및 속발성 동결견에 대한 한방복합치료 성과의 후향적 분석

이주현,석경환,류수형,이수연,김홍국,유덕우,구본혁,김민정,박연철,서병관,백용현 대한침구의학회 2015 대한침구의학회지 Vol.32 No.4

Objectives : This study was performed to analyze treatment outcomes of idiopathic and sec- ondary frozen shoulder patients with clinical characteristics, as well as percentage of pain reduction, and to find out relevant factors for pain reduction in the frozen shoulders of each patient group. Methods : Data were collected from outpatients who visited the Acupuncture and Moxibustion department and treated with traditional Korean Medical treatments at a Korean Medicine Hos- pital from June 12, 2006 to June 30, 2015. Patients were divided into two groups; idiopathic and secondary frozen shoulder, based on imaging and medical records. Clinical characteristics (demographic characteristics, disease characteristics, treatment characteristics) and percent- age pain reduction were collected. Percentage pain reduction was compared between two groups and relevant factors for pain reduction were analyzed. Results: 78 outpatients’medical records were reviewed. There was no significant difference of clinical characteristics between idiopathic and secondary frozen shoulder patients. In per- centage pain reduction, there was no significant difference between the two groups. In the id- iopathic frozen shoulder group, patients who had a short duration from the onset had a tendency for less pain (p<0.05). In the secondary frozen shoulder group, patients taking herbal medicine experienced significantly less pain (p<0.05). Conclusions: We could find no significant difference in percentage pain reduction with traditional Korean medicine between idiopathic and secondary frozen shoulder. Duration from the onset could be relevant in percentage pain reduction in idiopathic frozen shoulder, and taking herbal medicine could be relevant in the percentage pain reduction in secondary frozen shoulder.

Strategies for conservative management of the frozen shoulder

Nam Su Cho,Hee Seok Shim,Se Jung Hong 대한정형외과 스포츠의학회 2016 Arthroscopy and Orthopedic Sports Medicine Vol.3 No.1

Frozen shoulder is characterized by severe restriction of both active and passive shoulder motions in the absence of an identifiable intrinsic shoulder disorder. A gradual and painful loss in glenohumeral motion results from progressive fibrosis and from contracture of the glenohumeral joint capsule. Effective treatment for frozen shoulder should address the underlying pathology. The first line of treatment of frozen shoulder is usually that of conservative measures and only when frozen shoulder persists more invasive procedures are opted for. Conservative interventions address both the pharmacological and the physical aspects of treatment. For example, synovitis and inflammatory mediators are pharmacologically managed and capsular contracture is treated through physical therapy. Common conservative interventions for the treatment of frozen shoulder are nonsteroidal anti-inflammatory drugs, corticosteroid injections, physiotherapy, manipulation under anesthesia, and hydrodilation. Major gaps in the literature and knowledge exist such as the paucity of randomized controlled trials, a lack of studies that differentiated patients by their stage of adhesive capsulitis, and an incomplete understanding of the disease’s natural course. Recognizing that progression of clinical stages reflects progression in the underlying pathological changes should guide development of treatments. The purpose of the present review is to evaluate the existing evidence regarding the effectiveness of conservative management for the treatment of primary frozen shoulder.

A Comparative Study of the Behaviors of Normal and Frozen Shoulder: A Finite Element Study

이해아,김성연,채수원 한국정밀공학회 2017 International Journal of Precision Engineering and Vol.18 No.4

Frozen shoulder is a common condition characterized by a stiff shoulder. Thickening of an axillary pouch and a coracohumeral ligament, which are the passive stabilizers of the shoulder joint, is widely known as a manifestation of frozen shoulder. In this study, the effect of frozen shoulder on the shoulder behavior was investigated by using five finite element shoulder models. Finite element analysis was performed for the shoulder motions. The rotational angle, strain distribution, and the stress distribution were assessed relatively. The mean rotational angle was 54.9 ± 4.5° in external rotation, 35.9 ± 2.8° in internal rotation, 21.2 ± 6.0° in adduction, and 28.2 ± 2.1° in abduction. The resultant angle was decreased 4.1° in external rotation, 4.6° in internal rotation, 1.5° in adduction, and 2.3° in abduction from the normal shoulder to frozen shoulder respectively. The thickening of the AP had more effect on the rotational motions and abduction, on the other hand, the thickening of the CHL had more effect on adduction. The overall strain distribution was similar between the normal and frozen shoulder, however, the high-strain area and the strain value were reduced in frozen shoulder.

Effect of Chuna(Shoulder Traction) Treatment on Frozen Shoulder During Korean Medical Treatment

조나영,여인호,정세호,Hee Jin Sung,이참결,이은용,노정두 대한침구의학회 2014 대한침구의학회지 Vol.31 No.2

Objectives : Through an analysis of the previous studies, It is estimated that Chuna(shoulder traction) is effective in reducing the pain and increasing motion range of shoulder joint of the patient. So this study is to investigate the effects of Chuna(shoulder traction) on frozen shoulder. Methods : After treated with acupuncture and electro stimulating therapy, the subjects were measured list of measurement. And then treated with Chuna(shoulder traction) therapy, the subjects were measured list of measurement again. All treatment was performed by the same doctor who is a highly qualified about Chuna(shoulder traction). Chuna(shoulder traction) treatment takes 15 minutes. Three kind of Chuna(shoulder traction) therapy were performed for 5 minutes each. Depending on the degree of the subject's pain, treatment strength was adjusted. Results :- Chuna simultaneous treatment group, shoulder joint range of flexion, extension, abduction, adduction, external rotation and internal rotation movement improved statistically significant. - Chuna simultaneous and acupuncture treatment group, visual analogue scale(VAS) scores of two groups decreased statistically significant. Conclusions : The result suggests that Chuna(shoulder traction) can be effective to recover range of motion and reduce pain on patients with frozen shoulder.

Effect of Chuna (Shoulder Traction) Treatment on Frozen Shoulder During Korean Medical Treatment

Jo, Na Young,Yeo, In Ho,Jung, Se Ho,Sung, Hee Jin,Lee, Cham Geol,Lee, Eun Yong,Roh, Jeong Du Korean AcupunctureMoxibustion Medicine Society 2014 대한침구의학회지 Vol.21 No.1

Objectives : Through an analysis of the previous studies, It is estimated that Chuna(shoulder traction) is effective in reducing the pain and increasing motion range of shoulder joint of the patient. So this study is to investigate the effects of Chuna(shoulder traction) on frozen shoulder. Methods : After treated with acupuncture and electro stimulating therapy, the subjects were measured list of measurement. And then treated with Chuna(shoulder traction) therapy, the subjects were measured list of measurement again. All treatment was performed by the same doctor who is a highly qualified about Chuna(shoulder traction). Chuna(shoulder traction) treatment takes 15 minutes. Three kind of Chuna(shoulder traction) therapy were performed for 5 minutes each. Depending on the degree of the subject's pain, treatment strength was adjusted. Results : - Chuna simultaneous treatment group, shoulder joint range of flexion, extension, abduction, adduction, external rotation and internal rotation movement improved statistically significant. - Chuna simultaneous and acupuncture treatment group, visual analogue scale(VAS) scores of two groups decreased statistically significant. Conclusions : The result suggests that Chuna(shoulder traction) can be effective to recover range of motion and reduce pain on patients with frozen shoulder.

오십견 환자의 관절 가동 범위 회복과 통증 완화에 미치는 정적 신장 기법과 유지-이완 기법의 효과

함석찬,김인복,Hahm, Suk-Chan,Kim, In Bok 대한물리치료과학회 2012 대한물리치료과학회지 Vol.19 No.3

Background : Patients with frozen shoulder have pain and limited range of motion (ROM) at the affected shoulder. Shoulder pain of these patients usually decreases with recovery of range of motion. The aim of this study is to identify effects of static stretching and hold-relax on recovering ROM and reducing pain of patients with frozen shoulder. Methods : In this study, 15 patients with frozen shoulder who were only treated with physical therapy were recruited. Patients who received any surgical procedure or hydrotherapy were excluded. The subjects were divided randomly into 3 groups; control(n=5), static stretching(n=5) and hold-relax(n=5) groups. Patients were treated with stretching and the total number of treatments was 12 times. The ROM was measured at baseline, after fourth, eighth and final treatments. Shoulder pain and disability index(SPADI) scores were assessed before and after doing all treatments. Repeated measures ANOVA was used to analyze ROM change within each group. Changes of ROM between groups was analyzed by one way ANOVA followed by post hot analysis(Tukey's HSD). SPADI score within each group analyzed using Wilcoxon signed ranks test. A p-value<0.05 was considered statistically significant. Study Design : Repeated measures design. Result : There were significant differences of ROM in both treatment groups except internal rotation of static stretching group. ROM was significantly increased in treatment groups compared with control group, but the difference of ROM change between two treatment groups did not differ significantly. SPADI scores for treatment groups significantly decreased compared with pre-SPADI score. Conclusion : The result suggests that hold-relax can be more effective than static stretching to recover range of motion and alleviate shoulder pain on patients with frozen shoulder.

Frozen Shoulder에 있어서 마사지의 치료적 접근

홍성찬,김영빈,박병근,정동혁,이정윤,이동헌 圓光大學校 附設 體力科學硏究所 2003 體力科學硏究 Vol.26 No.1

Painful stiffness of the shoulder is an ill-defined clinical entity that is difficult to assess and delicate to treat. The nomenclature used is broad and includes terms such as frozen shoulder, adhesive capsulitis, focal algodystrophy, stiff shoulder, contracted shoulder, and others. Apart from its idiopathic form, the disease can be initiated by trauma, infection, tumour, radiation, systemic and local metabolic disturbances. Pathoanatomically, the common denominator is an inflammatory vascular proliferation followed by thickening, scarring, and retraction of the joint capsule. The inflammatory process often starts at the rotator interval and may extend to the subacromial space. Clinical diagnosis is based on history and physical examination. Generally the onset of pain precedes the perception of a reduced range of motion by weeks or months. In early stages of the disease, the inflammatory type of pain dominates, i.e., the patient's main complaint ist pain at night. In the later stage, range of motion gradually decreases. Patients do not often complain about reduced motion, probably because of its slow onset. The purpose of this study is to find out the effectiveness of the massage applied to the patients with Frozen Shoulder by measuring, assessing and analyzing the changes in intensity and unpleasantness of pain and range of motion(ROM) before and after massage. Surveyed from Jan. 2001 to December 2002 were 104 patients suffering from Frozen Shoulder. In the therapeutic massage program, such methods as Effleurage, Petrissage and Deep transverse friction were selected as they are among traditional massage treatments frequently used for joints with pain and restricted ROM. Effleurage and Petrissage were applied for 20 minutes in total before and after Deep Transverse Friction. After massage program, the intensity and unpleasantness of pain were measured and analyzed by means of VAS(visual analogue scale)-I and VAS-U, while ROM was measured and analyzed by using Goniometer. The major findings from this study are as follows; 1. The surveyed patients range from 28 to 75 in age, with highest numbers of 44(42.31%) registered in the fifties and next ones of 24(23.08%) in the forties. Divided by sex, 59 are women and 45 are men totalling 104 with average age of 51.4. 2. There was significant decrease in the intensity of pain and unpleasantness of pain after massage(p<.05). 3. There appeared, however, significant increase in ROM after massage(p<.05). 4. From the analysis into chronological changes in ROM before and after massage with ANOVA, it became evident that the longer the period of treatment was, the higher the ROM increases drastically, while significant difference was shown in Abduction and in External and Internal Rotation(p<.05). Summed up, it can be generally concluded that massage is an effective treatment to rid the patients with Frozen Shoulder of pains safely and promptly. This study was conducted to determine more accurate impact of massage. From the above outcomes, it was revealed that massage has proven to reduce the pains, exercising huge influence to increase ROM. It is, therefore, suggested to continue and expand the study on the cure of Frozen Shoulder and to motivate patients, orthopedists, physiatrists, physiotherapists, and sports massagists etc. to consider massage as safest and most efficient pain remedy.

PNF를 이용한 아래등세모근 강화 운동이 동결견 환자의 통증, 관절가동범위 및 장애에 미치는 영향

강태우,송귀빈,김범룡,Kang, Tae-Woo,Song, Gui-Bin,Kim, Beom-Ryong 대한고유수용성신경근촉진법학회 2021 PNF and Movement Vol.19 No.3

Purpose: The study aimed to determine the effect of the proprioceptive neuromuscular facilitation (PNF) lower trapezius muscle strengthening exercise on pain, shoulder range of motion, and shoulder pain and disability index (SPADI) in patients with frozen shoulder. Methods: Following baseline measurements, 30 subjects (n=30) with frozen shoulder were randomized into two groups: the PNF group (n=15), which received PNF strength training of the lower trapezius muscles, and the control group (n=15), which received gentle palpation of the skin. Each group participated in the intervention for 30 minutes, three times per week, for six weeks. The visual analogue scales for pain, range of motion, and SPADI of both groups were recorded at both pre- and post-intervention. Paired t-tests were used to determine significant changes in the post-intervention period compared with pre-intervention, and independent t-tests were used to analyze differences in the dependent variables between the two groups. Results: After the six-week intervention, both groups experienced significantly decreased pain and SPADI (p < 0.05) and significantly increased shoulder flexion, abduction, internal rotation, and external rotation range of motion (p < 0.05). The PNF group that received the PNF strength exercise of the lower trapezius muscles showed greater improvements in pain and range of motion than those of the control group (p < 0.05). Conclusion: These results suggest that the PNF lower trapezius strengthening exercise reduces shoulder pain and disability levels and enhances shoulder range of motion in patients with frozen shoulder.

開結舒經湯(개결서경탕) 투여를 포함한 동결견 환자 한방복합치료 치험례 1례

최기원,이유진,권민진,박한빈,장원석,김호,배인수,윤준흠,Choi, Ki-won,Lee, Yu-jin,Kwon, Min-jin,Park, Han-bin,Jang, Won-suk,Kim, Ho,Bae, In-su,Youn, Jun-heum 대한한방내과학회 2021 大韓韓方內科學會誌 Vol.42 No.5

Background: This case study suggests the potential usefulness of Korean medicine treatment with herbal medicines for shoulder pain and improving the quality of life of patients with frozen shoulder. Case Summary: A patient had shoulder pain and decreased daily living function due to frozen shoulder. Korean medicine treatments, including herbal medicine; acupuncture at points TE14, HT1, BL11, SI10, and LI15; and pharma-acupuncture containing Sinbaro, were applied for 31 days. The Numeric Rating Scale scores for shoulder pain decreased from 7 to 4, and the Shoulder Pain and Disability Index scores decreased from 71.54 to 66.15, with an increase in range of motion from 30° flexion, 60° abduction, and 10° external rotation to around the normal range of motion. Conclusion: Korean medicine treatment can be considered an effective conservative management option for pain and decreased daily living function in patients with frozen shoulder.

동결견에 대한 뜸치료 효과의 체계적 문헌고찰

한시훈,이기언,변다영,김영익,김민균,민부기,임한빛,정연재,오민석 한방재활의학과학회 2019 한방재활의학과학회지 Vol.29 No.3

Objectives The purpose of this research is to evaluate the effectiveness of moxibustion theraphy for frozen shoulder through systematic review and meta-analysis. Methods The effect of moxibustion for frozen shoulder was constructed as a key question to search randomized controlled trials (RCTs) in 16 databases without type of publication restriction. Results A total of 790 studies were searched and 22 RCTs were finally selected through primary and secondary selection/exclusion process. In most of the evaluation indexes used in each study, moxibustion treatment for shoulder pain was statistically significant compared with other treatments. A meta-analysis of effective rate in 10 studies comparing moxibustion with acupuncture and acupuncture showed a statistically significant effect of moxibustion treatment. And there was a significant effect on the improvement of the shoulder mobility, but the effect size of shoulder pain was no significant effect for shoulder pain reduction. In addition in the result of meta-analysis of 4 studies' effective rate comparing moxibustion with electronic acupuncture, the effect of moxibustion was significantly higher than that of electronic acupuncture in frozen shoulder. Conclusions Moxibustion therapy was effective in symptoms in patients with frozen shoulder. However because of the high risk of bias in the quality of the included studies, the applicability of this study seems to be limited. It is thought that future randomized controlled trials will need to be designed and performed by reviewing ways to minimize bias. (J Korean Med Rehabil 2019;29(3):35-49)