Journal of Acupuncture Research 2025; 42:32-40
Published online January 23, 2025
https://doi.org/10.13045/jar.24.0054
© Korean Acupuncture & Moxibustion Medicine Society
Correspondence to : Byung-Kwan Seo
Department of Acupuncture and Moxibustion Medicine, Kyung Hee University Korean Medicine Hospital at Gangdong, 892 Dongnam-ro, Gangdong-gu, Seoul 05278, Korea
E-mail: seohbk@hanmail.net
This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
This report presents a case of adhesive capsulitis of the hip (ACH) diagnosed by magnetic resonance imaging in a 37-year-old female whose primary complaint was right hip pain. She underwent Korean medicine (KM) treatments, including acupuncture, pharmacoacupuncture, moxibustion, physiotherapy, and herbal medicine, from July 30, 2023, to September 25, 2023. On August 30, 2023, acupotomy and thread-embedding acupuncture were also initiated. Considerable improvements in hip pain severity were observed, with the Numerical Rating Scale for pain decreasing from six to two. Moreover, the patient also showed improvement in the scores for physical functioning and bodily pain domains of the 36-Item Short Form Survey. Our study results suggest that KM treatments, particularly acupotomy and thread-embedding acupuncture, may be effective for treating ACH. However, further clinical studies are still needed to evaluate the effectiveness of each KM treatment and to explore the long-term outcomes of KM treatments for ACH.
Keywords Acupotomy; Adhesive capsulitis; Case report; Medicine, Korean traditional; Thread-embedding acupuncture
Adhesive capsulitis of the hip (ACH) is characterized by painful, restricted motion of the hip, especially during rotations, owing to synovial inflammation in the acute stages, which progresses to capsular fibrosis in the chronic stages [1-3]. ACH is a rare condition, and both its diagnosis and treatment are challenging [4]. Only a few studies have described its diagnostic criteria [5]. The diagnosis often relies on clinical findings with generally normal radiographs, although magnetic resonance imaging (MRI) and magnetic resonance arthrography can show joint capsule thickening [3,5].
Although research on ACH and its treatment using Korean medicine (KM) is limited, studies on treatments for adhesive capsulitis of the shoulder (ACS), such as acupotomy and thread-embedding acupuncture (TEA), are more common [6-10]. Given the similar pathologies of ACH and ACS, the present paper reports a case of ACH treated with KM, including acupotomy and TEA. Our study demonstrated great improvements in the patient’s symptoms after incorporating acupotomy and TEA into her initial integrative KM treatment, which resulted in more pronounced therapeutic effects.
This study presents the case of a 37-year-old female who experienced deep pain localized in the right hip and buttock, which was exacerbated by pressure, lying down, and walking, and was particularly noticeable at night.
Before the onset of hip pain, she experienced pelvic instability beginning on July 3, 2023, without a history of trauma. Initial imaging at a local orthopedic clinic revealed no remarkable findings. A subsequent computed tomography scan performed at Kyung Hee University Hospital at Gangdong (KHUHGD) showed no abnormal lesions in the right inguinal area, but MRI revealed thickening of the right anterior joint capsule. On July 23, 2023, her condition further deteriorated and her posterior right hip pain became prominent, leading to her hospitalization in the Department of Acupuncture and Moxibustion at KHUHGD (Fig. 1).
Physical examination revealed normal neurological results, except for a limited range of motion (ROM) in right hip flexion (90°). Hip joint radiography and pelvic MRI were performed on July 18, 2023 at KHUHGD. Hip joint radiography (Fig. 2) indicated unremarkable results. Pelvic MRI (Fig. 3) showed thickening and increased T2 signal intensity in the capsule and pericapsule of the right anterior joint capsule (the iliofemoral ligament).
The patient received KM treatment from July 30, 2023, to September 25, 2023 (Fig. 4).
Before acupotomy, a KM doctor (KMD) explained the procedure and obtained the patient’s consent. Acupotomy was administered five times between August 30, 2023, and September 25, 2023, at intervals of 1 to 2 weeks. An acupotomy needle (0.5 × 50 mm, disposable sterilized needle; Dongbang Medical Co.) was used. Before insertion, the skin was sterilized using povidone-iodine. Three points at the origin of the piriformis muscle, one at the belly, and one at the insertion site were selected for the treatment.
Before the TEA treatment, the KMD explained the procedure and obtained the patient’s consent. TEA was administered five times between August 30, 2023, and September 25, 2023, at intervals of 1 to 2 weeks. Before insertion, the skin was sterilized using povidone-iodine. TEA was performed perpendicular to the muscle fiber direction at five points on the piriformis muscle using a 29-gauge × 50 mm needle with a polydioxanone suture (disposable sterilized needle; Hyundae Meditech Co., Ltd.).
Acupuncture was conducted twice daily at the GB29, GB30, BL30, and BL54 points and the tender points on the right gluteus muscle for 20 minutes. Disposable stainless steel needles (0.25 × 40 mm; Dongbang Medical Co.) were used. Electrical stimulation at 1–6 Hz (ES-160; SINWOO MEDILAND Co. Ltd.) was applied to the tender points on the gluteus medius and piriformis muscles for 20 minutes at a tolerable intensity. The details about the acupuncture treatment are described in the STandards for Reporting Interventions in Clinical Trials of Acupuncture checklist (Table 1).
Table 1 . Details of the acupuncture treatment based on the STRICTA checklist
Items | Detail | |
---|---|---|
1. Acupuncture rationale | 1a) Style of acupuncture | Manual acupuncture, Korea |
1b) Reasoning for treatment provided, based on historical context, literature sources, and/or consensus methods, with references where appropriate | Based on the textbook of acupuncture and moxibustion medicine and the consensus of board-certified professional KM doctors | |
1c) The extent to which treatment varied | None | |
2. Details of needling | 2a) Number of needle insertions per patient per session (mean and range where relevant) | Fifteen needle insertions per patient per session |
2b) Names (or location if no standard name) of points used (uni/bilateral) | Unilateral GB29, GB30, BL30, and BL54 points and tender points on the right gluteus muscle (especially the gluteus medius and piriformis muscles) | |
2c) Depth of insertion, based on a specified unit of measurement or on a particular tissue level | A depth of 20–30 mm, depending on the anatomical location of the acupuncture point | |
2d) Response sought (e.g., de qi or muscle twitch response) | “de qi” | |
2e) Needle stimulation (e.g., manual, electrical) | EA stimulation (ES-160; SINWOO MEDILAND Co. Ltd.) was conducted with 1–6-Hz frequency with a tolerable intensity | |
2f) Needle retention time | Twenty minutes of needle retention | |
2g) Needle type (diameter, length, and manufacturer or material) | Sterilized disposable 25 × 40-mm acupuncture needles (Dongbang Medical Co.) | |
3. Treatment regimen | 3a) Number of treatment sessions | 116 sessions |
3b) Frequency and duration of the treatment sessions | Twice a day for 58 days of treatment and 20 minutes per session | |
4. Other components of the treatment | 4a) Details of other interventions administered to the acupuncture group (e.g., moxibustion, cupping, herbs, exercises, lifestyle advice) | Acupotomy, TEA, phramacoacupuncture, BV, moxibustion, ICT, and herbal medicine were administered |
4b) Setting and context of treatment, including instructions to practitioners and information and explanations to the patients | All KM interventions for any reason were not prohibited during the treatment period | |
5. Practitioner background | 5) Description of the participating acupuncturists (qualification or professional affiliation, years in acupuncture practice, other relevant experiences) | Acupuncture treatment was performed by certified practitioners with at least 6 years of KM education and > 2 years of clinical experience |
6. Control or comparator interventions | 6a) Rationale for the control or comparator in the context of the research question, with sources that justify this choice | None |
6b) Precise description of the control or comparator. If sham acupuncture or any other type of acupuncture-like control is used, provide details as for Items 1 to 3 above | None |
STRICTA, STandards for Reporting Interventions in Clinical Trials of Acupuncture; KM, Korean medicine; EA, electroacupuncture; TEA, thread-embedding acupuncture; BV, bee venom; ICT, interferential current therapy.
Pharmacoacupuncture and bee venom (BV) were administered six times a week at the GB29, GB30, BL30, and BL54 points on the right buttock, using a disposable 1 mL syringe with a 26-gauge × 13 mm needle and a sterilized 30-gauge × 13 mm needle (Shinchang Medical Co. Ltd.). A total of 1 mL Hwangryunhaedok-tang pharmacoacupuncture (Korean Medical Pharmacy of KHUHGD) or Hominis Placenta pharmacopuncture (NamSangCheon Korean Medicine Clinic external herbal dispensary) was administered. Before BV, allergy skin tests were performed, and a total dose of 0.5 mL of 1:20,000 BV (Korean Medical Pharmacy of KHUHGD) was administered.
Moxibustion was performed once daily at the GB29 and GB30 points on the right buttock for 10 minutes using 1.9 × 2.1 cm moxibustion cones (Manina Moxibustion; Haitnim Co. Ltd.).
Interferential current therapy (GP-MEDIPLUS, Goodpl Co.) was administered once daily to the gluteus medius and piriformis muscles at 0–150 Hz for 15 minutes at a tolerable intensity.
Sogeonjung-tang, Bojungikki-tang Gami, and Ssanghwa-tang Gami were prescribed upon admission (Table 2). Herbal medicine was provided in three packs daily (120 cc per pack), which was to be consumed 2 hours after each meal.
Table 2 . Treatment duration and composition of the herbal medicines
Sogeonjung-tang 2023.7.30.-2023.8.13. (15 d) | Dose (g) | Bojungikki-tang Gami 2023.8.14.-2023.8.23. (10 d) | Dose (g) | Ssanghwa-tang Gami 2023.8.24.-2023.9.25. (33 d) | Dose (g) |
---|---|---|---|---|---|
Paeoniae Radix | 10 | Astragali Radix | 6 | Paeoniae Radix | 14 |
Cinnamomi Ramulus | 6 | Angelicae gigantis Radix | 6 | Jujubae Fructus | 10 |
Zingiberis Rhizoma Recens | 2 | Paeoniae Radix | 6 | Astragali Radix | 8 |
Jujubae Fructus | 2 | Cyperi Rhizoma | 6 | Ginseng Radix | 6 |
Oryzae Gluten | 20 | Ginseng Radix | 4 | Cnidii Rhizoma | 4 |
Atractylodis Macrocephalae Rhizoma | 4 | Angelicae gigantis Radix | 4 | ||
Glycyrrhizae Radix and Rhizoma | 4 | Rehmanniae Radix Preparata | 4 | ||
Citri Unshius Pericarpium | 2 | Glycyrrhizae Radix and Rhizoma | 3 | ||
Cimicifugae Rhizoma | 2 | Cinnamomi Cortex Spissus | 3 | ||
Bupleuri Radix | 2 |
A Numerical Rating Scale (NRS) was used to assess for subjective pain in the right hip. The NRS score ranged from 0 to 10, where “0” indicated no pain and “10” indicated the maximum pain. The NRS score for the pain in the right hip and buttocks before treatment was six, which improved to two at discharge (Fig. 5).
The 36-Item Short Form Survey (SF-36) questionnaire is used to evaluate an individual’s health-related quality of life. The SF-36 measures the following eight health domains: physical functioning, role limitations due to physical problems, bodily pain, general health, vitality, social functioning, role limitations owing to emotional problems, and mental health [11]. The scores for each domain range from 0 to 100, with a higher score indicating a more favorable health state. The patient’s scores for the physical functioning and bodily pain domains of the SF-36 questionnaire also improved, increasing from 25 and 20 points before treatment to 35 and 32.5 points, respectively, at discharge (Fig. 6).
ACH remains a challenging condition to diagnose, and it is often overlooked because decreased ROM is better tolerated in the hip than in the shoulder [12,13]. The pain areas reported by other patients varied from the hip joint to the thigh and groin, and radiographs often revealed no remarkable findings, making the diagnosis challenging (Table 3) [4,14-16]. This case emphasizes the importance of a thorough diagnostic workup, such as MRI, particularly in patients with unexplained hip pain and limited ROM.
Table 3 . Summary of the six cases of adhesive capsulitis of the hip
Age (y) | Sex | Symptoms | Physical examination | Radiographs | MRI or MRA | Treatment | |
---|---|---|---|---|---|---|---|
Eberlin et al. [14] | 43 | Male | Left anterolateral hip pain | - Restricted ROM with external rotation | - Minimal degenerative changes of the hips | - MRA: An anterosuperior acetabular labral tear | - Injection of anesthetic and a corticosteroid into the hip joint |
Joassin et al. [15] | 34 | Female | Right coxofemoral pain with lower back pain - Cannot walk for more than 2 km | - Normal neurological assessment - Limited ROM of the right hip joint | - Moderately intense right coxofemoral osteoarthritis | - MRI: Small degenerative lesions such as those seen in protrusive coxofemoral osteoarthritis | - Intra-articular corticosteroid injection - Physiotherapy |
Joassin et al. [15] | 76 | Male | Left hip pain with chronic back pain | - Examination of the right hip was normal - Restriction of hip ROM with extension, flexion, and internal rotation - Knee jerk was absent | - Slight bilateral coxofemoral osteoarthritis | None | - Injection of anesthetic and a corticosteroid into the hip joint - Physiotherapy |
Joassin et al. [15] | 77 | Female | - Left coxofemoral pain | - Limited hip ROM with flexion and internal/external rotation | - Moderate left coxofemoral osteoarthritis | None | - A synovectomy was performed with the removall of loose intrajoint cartilaginous fragments - As the improvement was only temporary, hip arthroplasty was performed 1 year later |
Alborno et al. [4] | 30 | Female | - Four-year history of left hip pain | - Limitation of hip ROM with flexion and external rotation | - Unremarkable | - MRI: Unremarkable - MRA: Capsular thickening in most of its parts | We recommended conservative management, including stretching exercises, physical therapy, and nonsteroidal anti-inflammatory drugs |
Lowe [16] | 55 | Female | - Five-year history of right hip pain - Pain began at the lateral hip and progressed to the anterior hip and the groin region | - Normal neurological assessment - Reduced hip ROM - Reduced strength of both hip abduction | - Normal wear-and-tear | None | - Joint mobilization and soft tissue mobilization of the spine and hips - Strengthening exercises and self-massage techniques |
MRI, magnetic resonance imaging; MRA, magnetic resonance arthrography; ROM, range of motion.
The treatment of ACH depends on the disease stage. In the acute stage, nonsteroidal anti-inflammatory drugs and intra-articular steroid injections are administered with a focus on decreasing inflammation. In the chronic stages, interventions, such as physical therapy and rehabilitation, should be aimed at decreasing the progression of fibrotic changes. Surgery is considered if there is no improvement with non-surgical treatment for 3 months [3,17].
The mechanisms by which acupotomy and TEA alleviate the symptoms of ACH are not fully understood, but several hypotheses have been proposed. Acupotomy may remove adhesions and release contractures of deep soft tissues [10], leading to an increased ROM and pain relief. TEA may provide sustained stimulation of the acupuncture points and promote blood circulation for a longer duration as compared to standard acupuncture [18]. These treatments may work synergistically to address both the acute pain and chronic fibrotic changes associated with ACH.
The multimodal treatment approach used in the present case, combining acupotomy and TEA with acupuncture, pharmacoacupuncture, moxibustion, physiotherapy, and herbal medicine, highlights the importance of addressing ACH from multiple therapeutic perspectives. Each component likely contributed to the overall positive outcome, with some modalities reducing pain and inflammation and others enhancing muscle relaxation and tissue repair. In particular, acupotomy and TEA seem to play an important role in removing tissue adhesions and sustaining treatment stimulation, leading to considerable improvements.
Although this case report suggests that KM treatments, including acupotomy and TEA, may be effective for ACH, it is limited by the single-patient nature of the study. More clinical trials with larger patient populations are necessary to evaluate the effectiveness of each KM treatment and to explore the long-term outcomes of KM treatments for ACH.
Conceptualization: SL, BKS. Data curation: SL, JS, JP, BKS. Formal analysis: SL. Investigation: SL, CJI. Methodology: SL, BKS. Project administration: SL, BKS. Resources: SL, BKS. Software: SL. Supervision: SL, BKS. Validation: SL. Visualization: SL. Writing – original draft: SL. Writing – review & editing: All authors.
The authors have no conflicts of interest to declare.
None.
This study was exempted from obtaining study approval from the Institutional Review Board of the University Korean Medicine Hospital at Gangdong (IRB No. KHNMCOH 2024-07-008). A waiver of informed consent was obtained.
Journal of Acupuncture Research 2025; 42(): 32-40
Published online January 23, 2025 https://doi.org/10.13045/jar.24.0054
Copyright © Korean Acupuncture & Moxibustion Medicine Society.
Seungeun Lee1 , Jaeho Song1
, Jinkyung Park1,2
, Chan-Ju Im1,2
, Jung-Hyun Kim3
, Bonhyuk Goo3
, Yeon-Cheol Park3
, Yong-Hyeon Baek3
, Sang-Soo Nam3
, Byung-Kwan Seo3
1Department of Acupuncture and Moxibustion Medicine, Kyung Hee University Medical Center, Seoul, Korea
2Department of Clinical Korean Medicine, Graduate School, Kyung Hee University, Seoul, Korea
3Department of Acupuncture and Moxibustion Medicine, Kyung Hee University Korean Medicine Hospital at Gangdong, Seoul, Korea
Correspondence to:Byung-Kwan Seo
Department of Acupuncture and Moxibustion Medicine, Kyung Hee University Korean Medicine Hospital at Gangdong, 892 Dongnam-ro, Gangdong-gu, Seoul 05278, Korea
E-mail: seohbk@hanmail.net
This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
This report presents a case of adhesive capsulitis of the hip (ACH) diagnosed by magnetic resonance imaging in a 37-year-old female whose primary complaint was right hip pain. She underwent Korean medicine (KM) treatments, including acupuncture, pharmacoacupuncture, moxibustion, physiotherapy, and herbal medicine, from July 30, 2023, to September 25, 2023. On August 30, 2023, acupotomy and thread-embedding acupuncture were also initiated. Considerable improvements in hip pain severity were observed, with the Numerical Rating Scale for pain decreasing from six to two. Moreover, the patient also showed improvement in the scores for physical functioning and bodily pain domains of the 36-Item Short Form Survey. Our study results suggest that KM treatments, particularly acupotomy and thread-embedding acupuncture, may be effective for treating ACH. However, further clinical studies are still needed to evaluate the effectiveness of each KM treatment and to explore the long-term outcomes of KM treatments for ACH.
Keywords: Acupotomy, Adhesive capsulitis, Case report, Medicine, Korean traditional, Thread-embedding acupuncture
Adhesive capsulitis of the hip (ACH) is characterized by painful, restricted motion of the hip, especially during rotations, owing to synovial inflammation in the acute stages, which progresses to capsular fibrosis in the chronic stages [1-3]. ACH is a rare condition, and both its diagnosis and treatment are challenging [4]. Only a few studies have described its diagnostic criteria [5]. The diagnosis often relies on clinical findings with generally normal radiographs, although magnetic resonance imaging (MRI) and magnetic resonance arthrography can show joint capsule thickening [3,5].
Although research on ACH and its treatment using Korean medicine (KM) is limited, studies on treatments for adhesive capsulitis of the shoulder (ACS), such as acupotomy and thread-embedding acupuncture (TEA), are more common [6-10]. Given the similar pathologies of ACH and ACS, the present paper reports a case of ACH treated with KM, including acupotomy and TEA. Our study demonstrated great improvements in the patient’s symptoms after incorporating acupotomy and TEA into her initial integrative KM treatment, which resulted in more pronounced therapeutic effects.
This study presents the case of a 37-year-old female who experienced deep pain localized in the right hip and buttock, which was exacerbated by pressure, lying down, and walking, and was particularly noticeable at night.
Before the onset of hip pain, she experienced pelvic instability beginning on July 3, 2023, without a history of trauma. Initial imaging at a local orthopedic clinic revealed no remarkable findings. A subsequent computed tomography scan performed at Kyung Hee University Hospital at Gangdong (KHUHGD) showed no abnormal lesions in the right inguinal area, but MRI revealed thickening of the right anterior joint capsule. On July 23, 2023, her condition further deteriorated and her posterior right hip pain became prominent, leading to her hospitalization in the Department of Acupuncture and Moxibustion at KHUHGD (Fig. 1).
Physical examination revealed normal neurological results, except for a limited range of motion (ROM) in right hip flexion (90°). Hip joint radiography and pelvic MRI were performed on July 18, 2023 at KHUHGD. Hip joint radiography (Fig. 2) indicated unremarkable results. Pelvic MRI (Fig. 3) showed thickening and increased T2 signal intensity in the capsule and pericapsule of the right anterior joint capsule (the iliofemoral ligament).
The patient received KM treatment from July 30, 2023, to September 25, 2023 (Fig. 4).
Before acupotomy, a KM doctor (KMD) explained the procedure and obtained the patient’s consent. Acupotomy was administered five times between August 30, 2023, and September 25, 2023, at intervals of 1 to 2 weeks. An acupotomy needle (0.5 × 50 mm, disposable sterilized needle; Dongbang Medical Co.) was used. Before insertion, the skin was sterilized using povidone-iodine. Three points at the origin of the piriformis muscle, one at the belly, and one at the insertion site were selected for the treatment.
Before the TEA treatment, the KMD explained the procedure and obtained the patient’s consent. TEA was administered five times between August 30, 2023, and September 25, 2023, at intervals of 1 to 2 weeks. Before insertion, the skin was sterilized using povidone-iodine. TEA was performed perpendicular to the muscle fiber direction at five points on the piriformis muscle using a 29-gauge × 50 mm needle with a polydioxanone suture (disposable sterilized needle; Hyundae Meditech Co., Ltd.).
Acupuncture was conducted twice daily at the GB29, GB30, BL30, and BL54 points and the tender points on the right gluteus muscle for 20 minutes. Disposable stainless steel needles (0.25 × 40 mm; Dongbang Medical Co.) were used. Electrical stimulation at 1–6 Hz (ES-160; SINWOO MEDILAND Co. Ltd.) was applied to the tender points on the gluteus medius and piriformis muscles for 20 minutes at a tolerable intensity. The details about the acupuncture treatment are described in the STandards for Reporting Interventions in Clinical Trials of Acupuncture checklist (Table 1).
Table 1 . Details of the acupuncture treatment based on the STRICTA checklist.
Items | Detail | |
---|---|---|
1. Acupuncture rationale | 1a) Style of acupuncture | Manual acupuncture, Korea |
1b) Reasoning for treatment provided, based on historical context, literature sources, and/or consensus methods, with references where appropriate | Based on the textbook of acupuncture and moxibustion medicine and the consensus of board-certified professional KM doctors | |
1c) The extent to which treatment varied | None | |
2. Details of needling | 2a) Number of needle insertions per patient per session (mean and range where relevant) | Fifteen needle insertions per patient per session |
2b) Names (or location if no standard name) of points used (uni/bilateral) | Unilateral GB29, GB30, BL30, and BL54 points and tender points on the right gluteus muscle (especially the gluteus medius and piriformis muscles) | |
2c) Depth of insertion, based on a specified unit of measurement or on a particular tissue level | A depth of 20–30 mm, depending on the anatomical location of the acupuncture point | |
2d) Response sought (e.g., de qi or muscle twitch response) | “de qi” | |
2e) Needle stimulation (e.g., manual, electrical) | EA stimulation (ES-160; SINWOO MEDILAND Co. Ltd.) was conducted with 1–6-Hz frequency with a tolerable intensity | |
2f) Needle retention time | Twenty minutes of needle retention | |
2g) Needle type (diameter, length, and manufacturer or material) | Sterilized disposable 25 × 40-mm acupuncture needles (Dongbang Medical Co.) | |
3. Treatment regimen | 3a) Number of treatment sessions | 116 sessions |
3b) Frequency and duration of the treatment sessions | Twice a day for 58 days of treatment and 20 minutes per session | |
4. Other components of the treatment | 4a) Details of other interventions administered to the acupuncture group (e.g., moxibustion, cupping, herbs, exercises, lifestyle advice) | Acupotomy, TEA, phramacoacupuncture, BV, moxibustion, ICT, and herbal medicine were administered |
4b) Setting and context of treatment, including instructions to practitioners and information and explanations to the patients | All KM interventions for any reason were not prohibited during the treatment period | |
5. Practitioner background | 5) Description of the participating acupuncturists (qualification or professional affiliation, years in acupuncture practice, other relevant experiences) | Acupuncture treatment was performed by certified practitioners with at least 6 years of KM education and > 2 years of clinical experience |
6. Control or comparator interventions | 6a) Rationale for the control or comparator in the context of the research question, with sources that justify this choice | None |
6b) Precise description of the control or comparator. If sham acupuncture or any other type of acupuncture-like control is used, provide details as for Items 1 to 3 above | None |
STRICTA, STandards for Reporting Interventions in Clinical Trials of Acupuncture; KM, Korean medicine; EA, electroacupuncture; TEA, thread-embedding acupuncture; BV, bee venom; ICT, interferential current therapy..
Pharmacoacupuncture and bee venom (BV) were administered six times a week at the GB29, GB30, BL30, and BL54 points on the right buttock, using a disposable 1 mL syringe with a 26-gauge × 13 mm needle and a sterilized 30-gauge × 13 mm needle (Shinchang Medical Co. Ltd.). A total of 1 mL Hwangryunhaedok-tang pharmacoacupuncture (Korean Medical Pharmacy of KHUHGD) or Hominis Placenta pharmacopuncture (NamSangCheon Korean Medicine Clinic external herbal dispensary) was administered. Before BV, allergy skin tests were performed, and a total dose of 0.5 mL of 1:20,000 BV (Korean Medical Pharmacy of KHUHGD) was administered.
Moxibustion was performed once daily at the GB29 and GB30 points on the right buttock for 10 minutes using 1.9 × 2.1 cm moxibustion cones (Manina Moxibustion; Haitnim Co. Ltd.).
Interferential current therapy (GP-MEDIPLUS, Goodpl Co.) was administered once daily to the gluteus medius and piriformis muscles at 0–150 Hz for 15 minutes at a tolerable intensity.
Sogeonjung-tang, Bojungikki-tang Gami, and Ssanghwa-tang Gami were prescribed upon admission (Table 2). Herbal medicine was provided in three packs daily (120 cc per pack), which was to be consumed 2 hours after each meal.
Table 2 . Treatment duration and composition of the herbal medicines.
Sogeonjung-tang 2023.7.30.-2023.8.13. (15 d) | Dose (g) | Bojungikki-tang Gami 2023.8.14.-2023.8.23. (10 d) | Dose (g) | Ssanghwa-tang Gami 2023.8.24.-2023.9.25. (33 d) | Dose (g) |
---|---|---|---|---|---|
Paeoniae Radix | 10 | Astragali Radix | 6 | Paeoniae Radix | 14 |
Cinnamomi Ramulus | 6 | Angelicae gigantis Radix | 6 | Jujubae Fructus | 10 |
Zingiberis Rhizoma Recens | 2 | Paeoniae Radix | 6 | Astragali Radix | 8 |
Jujubae Fructus | 2 | Cyperi Rhizoma | 6 | Ginseng Radix | 6 |
Oryzae Gluten | 20 | Ginseng Radix | 4 | Cnidii Rhizoma | 4 |
Atractylodis Macrocephalae Rhizoma | 4 | Angelicae gigantis Radix | 4 | ||
Glycyrrhizae Radix and Rhizoma | 4 | Rehmanniae Radix Preparata | 4 | ||
Citri Unshius Pericarpium | 2 | Glycyrrhizae Radix and Rhizoma | 3 | ||
Cimicifugae Rhizoma | 2 | Cinnamomi Cortex Spissus | 3 | ||
Bupleuri Radix | 2 |
A Numerical Rating Scale (NRS) was used to assess for subjective pain in the right hip. The NRS score ranged from 0 to 10, where “0” indicated no pain and “10” indicated the maximum pain. The NRS score for the pain in the right hip and buttocks before treatment was six, which improved to two at discharge (Fig. 5).
The 36-Item Short Form Survey (SF-36) questionnaire is used to evaluate an individual’s health-related quality of life. The SF-36 measures the following eight health domains: physical functioning, role limitations due to physical problems, bodily pain, general health, vitality, social functioning, role limitations owing to emotional problems, and mental health [11]. The scores for each domain range from 0 to 100, with a higher score indicating a more favorable health state. The patient’s scores for the physical functioning and bodily pain domains of the SF-36 questionnaire also improved, increasing from 25 and 20 points before treatment to 35 and 32.5 points, respectively, at discharge (Fig. 6).
ACH remains a challenging condition to diagnose, and it is often overlooked because decreased ROM is better tolerated in the hip than in the shoulder [12,13]. The pain areas reported by other patients varied from the hip joint to the thigh and groin, and radiographs often revealed no remarkable findings, making the diagnosis challenging (Table 3) [4,14-16]. This case emphasizes the importance of a thorough diagnostic workup, such as MRI, particularly in patients with unexplained hip pain and limited ROM.
Table 3 . Summary of the six cases of adhesive capsulitis of the hip.
Age (y) | Sex | Symptoms | Physical examination | Radiographs | MRI or MRA | Treatment | |
---|---|---|---|---|---|---|---|
Eberlin et al. [14] | 43 | Male | Left anterolateral hip pain | - Restricted ROM with external rotation | - Minimal degenerative changes of the hips | - MRA: An anterosuperior acetabular labral tear | - Injection of anesthetic and a corticosteroid into the hip joint |
Joassin et al. [15] | 34 | Female | Right coxofemoral pain with lower back pain - Cannot walk for more than 2 km | - Normal neurological assessment - Limited ROM of the right hip joint | - Moderately intense right coxofemoral osteoarthritis | - MRI: Small degenerative lesions such as those seen in protrusive coxofemoral osteoarthritis | - Intra-articular corticosteroid injection - Physiotherapy |
Joassin et al. [15] | 76 | Male | Left hip pain with chronic back pain | - Examination of the right hip was normal - Restriction of hip ROM with extension, flexion, and internal rotation - Knee jerk was absent | - Slight bilateral coxofemoral osteoarthritis | None | - Injection of anesthetic and a corticosteroid into the hip joint - Physiotherapy |
Joassin et al. [15] | 77 | Female | - Left coxofemoral pain | - Limited hip ROM with flexion and internal/external rotation | - Moderate left coxofemoral osteoarthritis | None | - A synovectomy was performed with the removall of loose intrajoint cartilaginous fragments - As the improvement was only temporary, hip arthroplasty was performed 1 year later |
Alborno et al. [4] | 30 | Female | - Four-year history of left hip pain | - Limitation of hip ROM with flexion and external rotation | - Unremarkable | - MRI: Unremarkable - MRA: Capsular thickening in most of its parts | We recommended conservative management, including stretching exercises, physical therapy, and nonsteroidal anti-inflammatory drugs |
Lowe [16] | 55 | Female | - Five-year history of right hip pain - Pain began at the lateral hip and progressed to the anterior hip and the groin region | - Normal neurological assessment - Reduced hip ROM - Reduced strength of both hip abduction | - Normal wear-and-tear | None | - Joint mobilization and soft tissue mobilization of the spine and hips - Strengthening exercises and self-massage techniques |
MRI, magnetic resonance imaging; MRA, magnetic resonance arthrography; ROM, range of motion..
The treatment of ACH depends on the disease stage. In the acute stage, nonsteroidal anti-inflammatory drugs and intra-articular steroid injections are administered with a focus on decreasing inflammation. In the chronic stages, interventions, such as physical therapy and rehabilitation, should be aimed at decreasing the progression of fibrotic changes. Surgery is considered if there is no improvement with non-surgical treatment for 3 months [3,17].
The mechanisms by which acupotomy and TEA alleviate the symptoms of ACH are not fully understood, but several hypotheses have been proposed. Acupotomy may remove adhesions and release contractures of deep soft tissues [10], leading to an increased ROM and pain relief. TEA may provide sustained stimulation of the acupuncture points and promote blood circulation for a longer duration as compared to standard acupuncture [18]. These treatments may work synergistically to address both the acute pain and chronic fibrotic changes associated with ACH.
The multimodal treatment approach used in the present case, combining acupotomy and TEA with acupuncture, pharmacoacupuncture, moxibustion, physiotherapy, and herbal medicine, highlights the importance of addressing ACH from multiple therapeutic perspectives. Each component likely contributed to the overall positive outcome, with some modalities reducing pain and inflammation and others enhancing muscle relaxation and tissue repair. In particular, acupotomy and TEA seem to play an important role in removing tissue adhesions and sustaining treatment stimulation, leading to considerable improvements.
Although this case report suggests that KM treatments, including acupotomy and TEA, may be effective for ACH, it is limited by the single-patient nature of the study. More clinical trials with larger patient populations are necessary to evaluate the effectiveness of each KM treatment and to explore the long-term outcomes of KM treatments for ACH.
Conceptualization: SL, BKS. Data curation: SL, JS, JP, BKS. Formal analysis: SL. Investigation: SL, CJI. Methodology: SL, BKS. Project administration: SL, BKS. Resources: SL, BKS. Software: SL. Supervision: SL, BKS. Validation: SL. Visualization: SL. Writing – original draft: SL. Writing – review & editing: All authors.
The authors have no conflicts of interest to declare.
None.
This study was exempted from obtaining study approval from the Institutional Review Board of the University Korean Medicine Hospital at Gangdong (IRB No. KHNMCOH 2024-07-008). A waiver of informed consent was obtained.
Table 1 . Details of the acupuncture treatment based on the STRICTA checklist.
Items | Detail | |
---|---|---|
1. Acupuncture rationale | 1a) Style of acupuncture | Manual acupuncture, Korea |
1b) Reasoning for treatment provided, based on historical context, literature sources, and/or consensus methods, with references where appropriate | Based on the textbook of acupuncture and moxibustion medicine and the consensus of board-certified professional KM doctors | |
1c) The extent to which treatment varied | None | |
2. Details of needling | 2a) Number of needle insertions per patient per session (mean and range where relevant) | Fifteen needle insertions per patient per session |
2b) Names (or location if no standard name) of points used (uni/bilateral) | Unilateral GB29, GB30, BL30, and BL54 points and tender points on the right gluteus muscle (especially the gluteus medius and piriformis muscles) | |
2c) Depth of insertion, based on a specified unit of measurement or on a particular tissue level | A depth of 20–30 mm, depending on the anatomical location of the acupuncture point | |
2d) Response sought (e.g., de qi or muscle twitch response) | “de qi” | |
2e) Needle stimulation (e.g., manual, electrical) | EA stimulation (ES-160; SINWOO MEDILAND Co. Ltd.) was conducted with 1–6-Hz frequency with a tolerable intensity | |
2f) Needle retention time | Twenty minutes of needle retention | |
2g) Needle type (diameter, length, and manufacturer or material) | Sterilized disposable 25 × 40-mm acupuncture needles (Dongbang Medical Co.) | |
3. Treatment regimen | 3a) Number of treatment sessions | 116 sessions |
3b) Frequency and duration of the treatment sessions | Twice a day for 58 days of treatment and 20 minutes per session | |
4. Other components of the treatment | 4a) Details of other interventions administered to the acupuncture group (e.g., moxibustion, cupping, herbs, exercises, lifestyle advice) | Acupotomy, TEA, phramacoacupuncture, BV, moxibustion, ICT, and herbal medicine were administered |
4b) Setting and context of treatment, including instructions to practitioners and information and explanations to the patients | All KM interventions for any reason were not prohibited during the treatment period | |
5. Practitioner background | 5) Description of the participating acupuncturists (qualification or professional affiliation, years in acupuncture practice, other relevant experiences) | Acupuncture treatment was performed by certified practitioners with at least 6 years of KM education and > 2 years of clinical experience |
6. Control or comparator interventions | 6a) Rationale for the control or comparator in the context of the research question, with sources that justify this choice | None |
6b) Precise description of the control or comparator. If sham acupuncture or any other type of acupuncture-like control is used, provide details as for Items 1 to 3 above | None |
STRICTA, STandards for Reporting Interventions in Clinical Trials of Acupuncture; KM, Korean medicine; EA, electroacupuncture; TEA, thread-embedding acupuncture; BV, bee venom; ICT, interferential current therapy..
Table 2 . Treatment duration and composition of the herbal medicines.
Sogeonjung-tang 2023.7.30.-2023.8.13. (15 d) | Dose (g) | Bojungikki-tang Gami 2023.8.14.-2023.8.23. (10 d) | Dose (g) | Ssanghwa-tang Gami 2023.8.24.-2023.9.25. (33 d) | Dose (g) |
---|---|---|---|---|---|
Paeoniae Radix | 10 | Astragali Radix | 6 | Paeoniae Radix | 14 |
Cinnamomi Ramulus | 6 | Angelicae gigantis Radix | 6 | Jujubae Fructus | 10 |
Zingiberis Rhizoma Recens | 2 | Paeoniae Radix | 6 | Astragali Radix | 8 |
Jujubae Fructus | 2 | Cyperi Rhizoma | 6 | Ginseng Radix | 6 |
Oryzae Gluten | 20 | Ginseng Radix | 4 | Cnidii Rhizoma | 4 |
Atractylodis Macrocephalae Rhizoma | 4 | Angelicae gigantis Radix | 4 | ||
Glycyrrhizae Radix and Rhizoma | 4 | Rehmanniae Radix Preparata | 4 | ||
Citri Unshius Pericarpium | 2 | Glycyrrhizae Radix and Rhizoma | 3 | ||
Cimicifugae Rhizoma | 2 | Cinnamomi Cortex Spissus | 3 | ||
Bupleuri Radix | 2 |
Table 3 . Summary of the six cases of adhesive capsulitis of the hip.
Age (y) | Sex | Symptoms | Physical examination | Radiographs | MRI or MRA | Treatment | |
---|---|---|---|---|---|---|---|
Eberlin et al. [14] | 43 | Male | Left anterolateral hip pain | - Restricted ROM with external rotation | - Minimal degenerative changes of the hips | - MRA: An anterosuperior acetabular labral tear | - Injection of anesthetic and a corticosteroid into the hip joint |
Joassin et al. [15] | 34 | Female | Right coxofemoral pain with lower back pain - Cannot walk for more than 2 km | - Normal neurological assessment - Limited ROM of the right hip joint | - Moderately intense right coxofemoral osteoarthritis | - MRI: Small degenerative lesions such as those seen in protrusive coxofemoral osteoarthritis | - Intra-articular corticosteroid injection - Physiotherapy |
Joassin et al. [15] | 76 | Male | Left hip pain with chronic back pain | - Examination of the right hip was normal - Restriction of hip ROM with extension, flexion, and internal rotation - Knee jerk was absent | - Slight bilateral coxofemoral osteoarthritis | None | - Injection of anesthetic and a corticosteroid into the hip joint - Physiotherapy |
Joassin et al. [15] | 77 | Female | - Left coxofemoral pain | - Limited hip ROM with flexion and internal/external rotation | - Moderate left coxofemoral osteoarthritis | None | - A synovectomy was performed with the removall of loose intrajoint cartilaginous fragments - As the improvement was only temporary, hip arthroplasty was performed 1 year later |
Alborno et al. [4] | 30 | Female | - Four-year history of left hip pain | - Limitation of hip ROM with flexion and external rotation | - Unremarkable | - MRI: Unremarkable - MRA: Capsular thickening in most of its parts | We recommended conservative management, including stretching exercises, physical therapy, and nonsteroidal anti-inflammatory drugs |
Lowe [16] | 55 | Female | - Five-year history of right hip pain - Pain began at the lateral hip and progressed to the anterior hip and the groin region | - Normal neurological assessment - Reduced hip ROM - Reduced strength of both hip abduction | - Normal wear-and-tear | None | - Joint mobilization and soft tissue mobilization of the spine and hips - Strengthening exercises and self-massage techniques |
MRI, magnetic resonance imaging; MRA, magnetic resonance arthrography; ROM, range of motion..
Heejeon Hong, Soo Kwang An, Taewook Lee, Jihun Kim, Eunseok Kim
Journal of Acupuncture Research 2025; 42(): 124-130Ji-Su Ha, Han-Song Park, Hyun-Seo Park, Ka-Hyun Kim, Hae-Won Hong, In-Ae Youn
Journal of Acupuncture Research 2023; 40(2): 143-149Kahyun Seo, Yoona Oh, Seon Hee Kim, Na Hyeon Lee, Xiaoyang Hu, Younbyoung Chae, Heeyoung Moon, Kun Hyung Kim
Journal of Acupuncture Research 2025; 42(): 111-123