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J Acupunct Res > Volume 31(2); 2014 > Article
Jo, Yeo, Jung, Sung, Lee, Lee, and Roh: Effect of Chuna(Shoulder Traction) Treatment on Frozen Shoulder During Korean Medical Treatment
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Abstract

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.

Introduction

In the joints of the human body, the shoulder joint has the widest range of motion1). It is supplemented by strong muscles and many ligaments because the scapula and many articular capsule has available in this space2). Commonly known that the shoulder pain shows high frequency next to low back pain, and causes many problems in human daily life3).
Osipgyeon, frozen shoulder and adhesive capsulitis are synonymous. It means certain diseases that accompanied by limitation of motion of the shoulder joints. It is difficult to describes the cause of this disease4). Among the musculoskeletal degenerative diseases, frozen shoulder can appear before and after 50 years old by unknown cause, and the pain is progressed in the shoulder joint and is accompanied by severe limitation of motion5). The pain and movement disorders in the shoulder can cause a lot of trouble in daily life. Commonly, the pain and joint movement limitation progressed after 3∼4 month from the onset, the later 3∼4 month pain can be reduced, the last 3∼4 month joint movement can slowly recovered. Patients are generally recovered naturally, but not all the patients, and some of the patients pain and joint movement limitation can remained rest of the life6).
The general treatments of frozen shoulder are hot pack, transcutaneous electrical nerve stimulation (TENS), interferential current therapy(ICT), ultra sound therapy, active joint movement, passive expansion exercise and a lot of kinds of exercise. The most important part of the treatments is restoration of the range of motion by the stretching.
Chuna manual medicine is one of the oriental medical treatments. It is changed unbalanced state of musculoskeletal conditions for balanced7). Among them, the shoulder traction treatments apply to shoulder. By the pulling force of the muscle, adhesion and spasms soft tissue are relieved. This action is effective for pain relief, muscle function recovery, blood circulation improvement. And it is available for joint displacement, muscle injury, stiffness and numbness. In clinical, the shoulder traction treatments used in musculoskeletal disorders such as impingement syndrome, frozen shoulder and periarthritis of shoulder8).
In previous studies for muscle function, the effect of the various treatments such as acupuncture static stretching, muscle energy techniques(MET) and massage therapy was demonstrated9,10).
Chuna is also applied to a variety of shoulder disorders1114). 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. Study on the effect of Chuna therapy for frozen shoulder is not enough. Thus, we are performed Chuna(shoulder traction) for frozen shoulder patients, results were statistically significant. So we report it.

Subject and methode

A. Subject

The research involved 21 patients who visited the acupuncture & moxibustion department at Semyeong University Hospital of Oriental Medicine for frozen shoulder treatment from November 1, 2013, to April 30, 2014. They were diagnosed with frozen shoulder and had no abnormalities with the X-ray examination. Purpose of the study, procedures and adverse reactions were explained enough to participants and all participants agreed to voluntarily participated.

B. Selection criteria

Contributors should satisfy the following conditions.
  1. Pain lasting more than 1 month

  2. Restrictions on the movement of the shoulder

  3. No other disease showed up on the X-ray, except for osteoporosis

  4. No history of Surgical Treatment or surgery

C. Exclusion criteria

  1. Calcification or arthritis disease showed up on the X-ray

  2. Mental disorders, immune disorders or related drug takers

  3. Suspected cervical nerve disease by physical examination

  4. The pregnant

  5. Patients with skin infections

  6. Other patient that doctor determines not suitable for this study

D. Method

After treated with acupuncture and electro stimulating therapy(Hanil Korea, 10 Hz 15 minutes), the subjects were measured list of measurement. Physical therapy and medicine treatment were not simultaneous.
The selected acupuncture points are Gyeonu(LI15Gyeollyo(TE14Cheonjong(SI11) and sore spot in supraspinatus, inpraspinatus and rhomboid muscle (Dondbang Korea 0.3 × 40 mm). It was chosen with reference to the Acupuncture and Moxibustion textbook.
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. The follows were performed for 5 minutes each. Depending on the degree of the subject’s pain, treatment strength was adjusted.

1. Supine scapulohumeral joint traction

Participants lies supine position. Doctor stands on the affected side of the patient’s. Main hand is positioned affected side distal upper arm of the patient. Auxiliary hand placed in front of the shoulder. After a fixed shoulder, traction from the inner to outer side of the upper arm(Fig. 1).

2. Supine sternoclavicular joint traction

Participants lies supine position. Doctor stands on the affected side of the patient’s. Main hand is positioned affected side sternoclavicular joint of the patient. Auxiliary hand placed in elbow. Main hand traction sternoclavicular joint from the inner to outer side. Auxiliary hand assist to the movement(Fig. 2).

3. Lateral recumbent scapulothoracic joint rolling

Participants lies lateral recumbent position. The affected side arms behind his back. Doctor stands on the affected side of the patient’s. Main hand is positioned affected side scapular of the patient. The fingers fumble for the inside of the shoulder blade. Using both hands, rotate the blade to the outside (Fig. 3).

E. Evaluation items

Participants taken acupuncture treatment and Chuna subsequently. Evaluation were performed three times for all items, just before treatment, afteracupuncture treatment and after Chuna treatment. Evaluation items are as follows.

1. Passive motion range of the shoulder joint

Participants lies supine position. Doctor moves the shoulder joint to abduction, adduction, external rotation and internal rotation for measuring movement angle of shoulder joint. And then participants lies lateral recumbent position. Doctor moves the shoulder joint to flexion extension and measure for movement angle of shoulder joint again. When participants are beginning to feel the pain, the angle was measured. Measurements were repeated three times, and the average value was decided.

2. Measurement of shoulder pain

Pain levels were measured using by visual analogue scale(VAS). Measure graduated from 0 to 10 was used. It signify that phase 0 is no pain and 10 is most severe stage. Participants were directly point the degree of their pain.

F. Statistics

The data were analyzed by SPSS/ 12.0 for Windows program. Paired t-t test used for comparison before and after treatment. T-test has been used for comparison acupuncture treatment with Chuna and acupuncture combined treatment. For posteriori statistical verification, Duncan’s multiple range test has been used.

Result

A. Distributions of gender and age

Distributions are 21 people that is composed of 6(28.6 %) man and 15(71.4 %) woman. By age, 30’s is 1 people(4.8 %), 40s and 50’s are 8 people(38.0 %) both, 60’s is 4 people(19.0 %). 40’s and 50’s are the most percentage(Table 1).

B. Comparison of flexion angle

In analysis of flexion angle change, acupuncture group had changed 104.5±9.8 to 107.4±9.1. It is not statistical significance change. Chuna simultaneous treatment group had changed 104.5±9.8 to 131.2±8.6 (p=0.04). It is statistical significance change(Table 2).

C. Comparison of extension angle

In analysis of extension angle change, acupuncture group had changed 39.2±3.0 to 38.4±4.1. It is not statistical significance change. Chuna simultaneous treatment group had changed 39.2±3.0 to 47.7±2.4 (p=0.02). It is statistical significance change(Table 3).

D. Comparison of adduction angle

In analysis of adduction angle change, acupuncture group had changed 25.1±1.7 to 26.2±4.7. It is not statistical significance change. Chuna simultaneous treatment group had changed 25.1±1.7 to 30.3±0.4 (p=0.02). It is statistical significance change(Table 4).

E. Comparison of abduction angle

In analysis of abduction angle change, acupuncture group had changed 80.4±0.7 to 80.9±2.2. It is not statistical significance change. Chuna simultaneous treatment group had changed 80.4±0.7 to 87.3±3.4 (p=0.01). It is statistical significance change(Table 5).

F. Comparison of pronation angle

In analysis of pronation angle change, acupuncture group had changed 27.8±4.9 to 28.3±2.6. It is not statistical significance change. Chuna simultaneous treatment group had changed 27.8±4.9 to 45.2±1.4 (p=0.01). It is statistical significance change(Table 6).

G. Comparison of supination angle

In analysis of supination angle change, acupuncture group had changed 80.4±0.7 to 80.9±2.2. It is not statistical significance change. Chuna simultaneous treatment group had changed 80.4±0.7 to 87.3±3.4(p=0.03). It is statistical significance change (Table 7).

H. Comparison of VAS

In analysis of supination VAS change, acupuncture group had changed 4.47±0.8 to 3.35±0.9(p=0.04). It is statistical significance change. Chuna simultaneous treatment group had changed 4.47±0.8 to 2.13±1=0.7(p=0.02). It is statistical significance change(Table 8).

Discussion

The clinical characteristics of frozen shoulder is pain and Limited range of motion15). The duration of treatment is from weeks up to several months. Sometimes symptoms disappear spontaneously. In some cases, shoulder joint movement is restricted permanently. Thus, the initial treatment is important16). Its primarily purpose is recovery of range of motion. To it, treatments such as acupuncture, pharmacopuncture, cupping drug therapy and Chuna are performed.
Frozen shoulder was mentioned in Huang Di Nei Jing. Peculiar pathologicla product(Dam-eum) and negative energy like wind(Pung) cold(Han) and wet (Seup) are cause of frozen shoulder in Korean medicine17).
In western medicine, several authorities has various views on the definition and cause of frozen shoulder.
Codman described frozen shoulder that common diseases which can cause shoulder pain and disability, and first used the term frozen shoulder officially18). After he used that term, the shoulder joint diseases are generally diagnosed as frozen shoulder, but some say that it is not the disease which can diagnose medically but the symptoms which use as informally19).
Conventry said that frozen shoulder is diagnosed only severely limited motion range of shoulder joint. Nevaiser classified the progress of frozen shoulder into 4 grades, the adhesive capsulitis is can clearly checked the contraction of joint membrane by arthrography, painful stiff shoulder is cannot checked it20).
Among many muscles, ligaments, and joints, coracoacromial ligaments and coracoid process build the coraco acromial arch, which locates just upper parts of rotator cuff, and it has bursa which can buffer the friction. If supinate your shoulder joint, rotator cuff is wedged between great tubercle and coracoacromial arch so it can cuase damage and consistent damages can cause degeneration of ligamnets. Hammon reported that this can cause frozen shoulder21), paker also reported the degeneration of rotator cuff, bursa, biceps tendon, other tissues is the cause of frozen shoulder, and it creates swelling, fibrosis, round cell infiltration, which limits the motion ranges22).
For relief of symptoms, treatments such as analgesics, muscle relaxants, various physical therapy and exercise therapy are performed2325).
When in normally position, each part of the human body can be performed unique features. External power used in Chuna is return the position of part of the body26). It have been assumed that these principles help reduce the pain and recover range of motion of patients with frozen shoulder.
In previous studies show that traction therapy is effective to increase the movable range of the shoulder joint. Chuna also increase the range of motion in the shoulder joint. Chuna therapy for patients with frozen shoulder has a significance in two respects. One is expanding coverage of Chuna therapy and the other is relief of symptoms. But this study has limitations. First of all, number of participants was small and a long-term treatment was not done. Many people are involved and long-term studies should be made in future. And various measuring tools for effect of treatments are lacking. If utilizing digital infrared thermal imaging (DITI) and so on, this study would have been get further objective result.

Conclusion

Evaluated shoulder range of motion, and the degree of pain after acupuncture and Chuna simultaneous therapy, we have the following conclusions.
  1. Acupuncture and Chuna treatment are effective in restore range of motion of shoulder joint and reducing pain.

  2. After acupuncture treatment, range of flexion, abduction, adduction, external rotation and internal rotation increased. range of extension decreased within the error range.

  3. Chuna simultaneous treatment group, shoulder joint range of flexion, extension, abduction, adduction, external rotation and internal rotation movement improved statistically significant.

  4. Chuna simultaneous and acupuncture treatment group, Both groups VAS scores decreased statistically significant.

Chuna(shoulder traction) can be effective to recover range of motion and reduce pain on patients with frozen shoulder.

Fig. 1.
Supine scapulohumeral joint traction
acupunct-31-2-111-11f1.gif
Fig. 2.
Supine sternoclavicular joint traction
acupunct-31-2-111-11f2.gif
Fig. 3.
Supine sternoclavicular joint traction
acupunct-31-2-111-11f3.gif
Table 1.
Distributions of Gender and Age
Age Male Female Total
21∼30 0 0 0
31∼40 0 1 1
41∼50 1 7 8
51∼60 3 5 8
60 ∼ 2 2 4

Total 6 15 21
Table 2.
Flexion Angle Change
Acupuncture Chuna simultaneous treatment
Before 104.5±9.8 104.5±9.8

After 107.4±9.1 131.2±8.6
Table 3.
Extension Angle Change
Acupuncture Chuna simultaneous treatment
Before 39.2±3.0 39.2±3.0
After 38.4±4.1 47.7±2.4
Table 4.
Adduction Angle Change
Acupuncture Chuna simultaneous treatment
Before 25.1±1.7 25.1±1.7
After 26.2±4.7 30.3±0.4
Table 5.
Abduction Angle Change
Acupuncture Chuna simultaneous treatment
Before 80.4±0.7 80.4±0.7
After 80.9±2.2 87.3±3.4
Table 6.
Pronation Angle Change
Acupuncture Chuna simultaneous treatment
Before 27.8±4.9 27.8±4.9
After 28.3±2.6 45.2±1.4
Table 7.
Supination Angle Change
Acupuncture Chuna simultaneous treatment
Before 25.3±3.5 25.3±3.5
After 26.1±2.9 39.1±1.2
Table 8.
VAS Change
Acupuncture Chuna simultaneous treatment
Before 4.47±0.8 4.47±0.8
After 3.35±0.9 2.13±0.7

VI. References

1. Beag EE. The shoulder-a structure of subtlety. Journal of South Orthopedic Assoc. 1995;4(3):167–8.

2. Snider Robert K. Essentials of musculoskeletal. Carep. 2003;97.

3. Van Den Dolder PA, Roberts DL. A trial into the effectiveness of soft tissue massage in the treatment of shoulder pain. Austria Journal of Physio therapy. 2003;49(3):183–8.
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4. MI Jayson. Frozen shoulder adhesive capsulitis. BMJ. 1981;283.

5. Mao CY, Jaw WC, Cheng HC. Frozen shoulder: correlation between the response to physical therapy and follow-up shoulder arthrography. Arch Physycal Medicine Rehabilitation. 1997;17(2):78857–9.
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6. Reeves B. The natural history of the stiff and painful should. Orthopedic Clinical North America. 2005;4:193–6.

7. Korean Society Chuna Manual Medicine for Spine and Nerves. Chuna manual medicine. Korean Society Chuna Manual Medicine for Spine and Nerves. 2013;3–5.

8. Jin XZ, Oh JG. Effect of Tuina therapy and functional exercise to cervicogenic shoulder pain and range of motion. Journal of Korean Society Sports Medicine. 2013;11(4):451–9.

9. Hahm SC, KiM IB. Effects of static stretching and hold-relax on recovering range of motion and reducing pain of patients with frozen shoulder. Journal of Korean Academy of Physical Therapy Science. 2012;19(3):39–47.

10. Kim JG. Effects of ROM(range of motion) and VAS (visual analogue scale) on MET exercise and massage therapy in frozen shoulder patients. Journal of Basic science. 2010;27(1):45–55.

11. Kim MB, Chung SH, Kim SS. The influences of Chuna(shoulder traction) therapy for shoulder pain and range of movement in hemiplegic patients after stoke. Journal of Oriental Rehabilitation Medicine. 2007;17(2):185–98.

12. Lee KM, Lim SH, Yoon DY, Kim SJ, Jeong SH. Two clinical cases on patients with pain and limited range of motion about shoulder subsequent to scapular fracture by oriental medical treatments and Chuna treatment. Journal of Korean Society Chuna Manual Medicine for Spine and Nerves. 2009;4(2):99–107.

13. Moon TW, Eom TW, Chung YH. The clinical report on 3 cases of patients with shoulder impingement syndrome improved by Chuna treatment and burning acupuncture therapy. Journal of Korean Society Chuna Manual Medicine for Spine and Nerves. 2009;4(1):7–18.

14. Lee KH, Ji JO, Lee MJ, Lee KN. Clinical studies on the manipulation therapy of shoulder disorders. The Journal Of Korean Qigong Medical Society. 2000;4(2):28–44.

15. Cailliet R. Shoulder pain. 3rd ed. Philadelphia: FA Davis Company. 1992:78–83.

16. Culhan E, Peat M. Functional anatomy of the shoulder complex. Journal of Orthopedic Sports Physical Therapy. 1993;18(1):342–53.
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17. Korean Acupuncture and Moxibustion Society Textbook Compilation Committee. The Acupuncture and Moxibustion. 2:Jipmoondang. 2008;24–40.

18. Sallter RB. Textbook of disorders and injuries of the musculoskeletal system. 2nd ed. Baltimore: Williams & Wilkins. 1983:179–82.

19. Tanigawa MC. Comparison of the hold-relax procedure and passive mobilization on increasing and on increasing muscle light. Journal of Physical Therapy. 1972;52(7):725–35.
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20. Noel E, Thomas T, Schaeverbeke T, Thomas P, Bonjean M, Revel M. Frozen shoulder joint. Journal of Bone Spine. 2000;67(5):393–400.

21. Loyd JA, Lord HM. Adlhesive capsulitis of the shoulder artho-graphic diagnosis and treatment. South Medicine Journal. 1983;76(1):876–83.
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22. Williams P. Gray’s anatomy. 38th ed. Edinburgh: Churchill Livingstone. 1995:505–10.

23. Peasall AW, Speer KP. Frozen shoulder syndrome, diagnostic and treatment strategies in the primary care setting. Journal of Medicine and Science in Sports and Exercise. 1998;30(4):33–9.

24. Patricia GM, Keith L, Krissann MK, Carol AO. In science of common postural abnormalities in the cervical, shoulder, and thoracic regions and their with pain. Morgan Kaufmann. 1992;176–9.

25. Paker RD, Froimson AL, Winsberg DD, Arsham NZ. Frozen shoulder: chronology, pathogernesis, clinical picture, and treatment. Journal Of Orthopedics. 1989;12(6):869–73.
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26. Yoon BH, Choi JW. Introduction of Chuna. Gunja. 2008;16–23.



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