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Scapulohumeral periarthritis

[Introduction]

Scapulohumeral periarthritis refers to a kind of soft tissue disorder of the shoulder due to retrograde disease aggravated by long-term sprain and attack of cold or trau-matic injury that lead to chronic inflammation of the joint capsule and the soft tissues around the joint, extensive ad-hesion of the peripheral tissues and restriction of the movement of shoulder joint. It is usually seen among peo-ple over 50. Clinical manifestations are aching, heaviness and pain in the shoulder as well as dysfunction of the shoulder in movement. This disease pertains to the con-ception of obstructive syndrome in TCM. It is caused ei-ther by invasion of pathogenic wind, cold and dampness due to asthenia; or by weakness in the aged and malnutri-tion of tendons and vessels; or by stagnation of qi and blood as well as retention of dampness and phlegm that block the meridians, prevent the flow of qi and blood and lead to dysfunction of the tendons and vessels.

[Syndrome differentiation]

1. Wind-cold attacking the exterior

Short duration, pain, aching and heaviness in the shoulder, or pain involving the back and arm, aggravation in the night, restricted movement, alleviation with warmth and aggravation after the attack by wind and cold.

2. Retention of pathogenic factors due to asthe-nia of healthy qi

Lingering duration, evident restriction in lifting, ab-duction and intorsion, or atrophy of local muscles and cold sensation in the arm.

[Treatment]

1. Body acupuncture

Prescription: Jianyu (LI 15), Jianliao (TE 14), Jianqian (Ext.), Quchi (LI 11) and Ashi acupoints.

Modification. For syndrome of wind-cold attacking the exterior, Jianzhen (SI 9), Jianjing (GB 21 ), Fengchi (GB 20), Waiguan (TE 15) and Hegu (LI 4) are added; for pain involving the back, Quyuan (SI 13) and Tianzong (SI 11) are added; for pain involving the upper arm, Bi-nao (LI 14) is added; for retention of pathogenic factors

due to asthenia, Binao (LI 14), Shousanli (LI 10), Zu-sanli (ST 36), Yanglingquan (GB 34) and Tiaokou (ST 38) are added.

Performance: Several acupoints are selected each time according to the pathological conditions. Reducing needling technique is used in treating the syndrome of wind-cold attacking the exterior; retention of pathogenic factors due to asthenia is a syndrome marked by mixture of asthenia and sthenia and should be treated with mild re-inforcing and reducing techniques. Zusanli (ST 36 ) is needled with reinforcing needling technique. Tiaokou (ST 38) located on the affected side is needled with the point of the needle pointing to the direction of Chengshan (BL 57). The patient is asked to move the shoulder joint dur-ing the manipulation of the needle. Moxibustion can be used in addition and cupping may be applied for reinforce-ment of the curative effect.

2. Electro-acupuncture

Prescription: Jianyu (LI 15), Jianliao (TE 14), Jianqian (Ext.), Quchi (LI 11) and Ashi acupoints.

Performance: Each time 1 - 2 acupoints are selected. When needling sensation is felt, impulse current is atta-ched to the needles for 10 minutes. This treatment is giv-en once a day.

3. Ear acupuncture

Prescription: Shoulder (SF4,5), Clavicle (SF6) and Ear Shenmen (TF4).

Performance: Medium and strong stimulation, reten-tion of the needles for 20 - 30 minutes, once a day.





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