触发点体外冲击波联合肩周类固醇注射对原发性冻结肩患者恢复质量的影响

doi:10.3969/j.issn.1006-5725.2025.09.017

Abstract

Abstract:

Objective To investigate the efficacy of extracorporeal shock wave therapy （ESWT） combined with ultrasound-guided corticosteroid injection （CSI） for the treatment of primary frozen shoulder （PFS）. Methods Ninety-nine patients with PFS who visited the pain department of the Affiliated Hospital of Xuzhou Medical University between April 2024 and July 2024 were enrolled and randomly divided into three groups according to the randomized number table method： ESWT group （T group）， CSI group （I group）， and combined treatment group （TI group）， with 33 patients in each group. Visual analogue scale （VAS） scores， shoulder range of motion （SROM）， and Constant-Murley shoulder scores （CMS） were recorded before treatment and at 1， 4， 8， and 12 weeks post-treatment. Additionally， the patients' Ascens Insomnia Scale （AIS） scores were recorded before treatment and 1 month after treatment. The occurrence of adverse effects and the use of remedial medications during the treatment period were also documented. Results Compared with pre-treatment， VAS scores decreased， and SROM and CM scores improved at all time points after treatment in all three groups （P < 0.05）. AIS scores also decreased in all three groups at 1 month post-treatment （all P < 0.05）. Intergroup comparisons revealed that the TI group exhibited significantly lower VAS pain scores， greater SROM （forward flexion and backward extension）， and higher CM scores at 4， 8， and 12 weeks post-treatment compared to the T and I groups （Bonferroni-corrected P < 0.05）. No statistically significant differences were observed between the T and I groups for these measures （Bonferroni-corrected P > 0.05）. Additionally， there were no statistically significant differences in AIS scores or adverse effects occurrence among the three groups at 1 month post-treatment （P > 0.05）. Conclusion The combined treatment demonstrated greater efficacy compared to trigger point extracorporeal shock wave therapy alone and periapical steroid injection alone， resulting in significant improvement in the patient's clinical symptoms and quality of life.

Key words: primary frozen shoulder, trigger point, extracorporeal shock wave, corticosteroid injection

CLC Number:

R686.3

Youhua LI,Fan SUN,Yulian LIN,Chang LIU,Yujia TANG,Zhou WU,Yan YUAN. Application of extracorporeal shock wave therapy for trigger point combined with periapical steroid injection on the quality of recovery in patients with primary frozen shoulder[J]. The Journal of Practical Medicine, 2025, 41(9): 1387-1393.

Figures/Tables 6

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References 28

1	NAVARRO-LEDESMA S， HAMED-HAMED D， PRUIMBOOM L. A new perspective of frozen shoulder pathology； the interplay between the brain and the immune system ［J］.Front Physiol， 2024， 15：1248612. doi:10.3389/fphys.2024.1248612 doi: 10.3389/fphys.2024.1248612
2	DYER B P， RATHOD-MISTRY T， BURTON C， et al. Diabetes as a risk factor for the onset of frozen shoulder： a systematic review and meta-analysis ［J］. BMJ Open， 2023， 13（1）： e062377. doi:10.1136/bmjopen-2022-062377 doi: 10.1136/bmjopen-2022-062377
3	ABUDULA X， MAIMAITI P， YASHENG A， et al. Factors associated with frozen shoulder in adults： a retrospective study ［J］. BMC Musculoskelet Disord， 2024， 25（1）： 493. doi:10.1186/s12891-024-07614-8 doi: 10.1186/s12891-024-07614-8
4	DENG Z， LI X， SUN X， et al. Comparison Between Multisite Injection and Single Rotator Interval Injection of Corticosteroid in Primary Frozen Shoulder （Adhesive Capsulitis）： A Randomized Controlled Trial ［J］.Pain Physician， 2023， 26（6）： E661-e9. doi:10.36076/ppj.2023.26.e661 doi: 10.36076/ppj.2023.26.e661
5	李喜，李慎义，张轶，等. 肌骨超声在肩周炎的诊断研究进展［J］. 实用医学杂志，2022， 38（7）： 913-916.
6	ZHANG R， ZHANG H， RUI M， et al. Impact of needle warming moxibustion combined with trigger point massage on shoulder function and stress responses in elderly patients with frozen shoulder ［J］. Am J Transl Res， 2024， 16（9）： 4671-4679. doi:10.62347/dmts8090 doi: 10.62347/dmts8090
7	KALIA V， MANI S， KUMAR S P. Short-term effect of myofascial trigger point dry-needling in patients with Adhesive Capsulitis ［J］. J Bodyw Mov Ther， 2021， 25：146-150. doi:10.1016/j.jbmt.2020.10.014 doi: 10.1016/j.jbmt.2020.10.014
8	王米，李胜男，张学广，等. 超声引导下双注射联合细银质针治疗原发性冻结肩的临床研究［J］. 医学研究杂志， 2020， 49（10）： 159-162+166.
9	RAJFUR K， RAJFUR J， MATUSZ T， et al. Efficacy of Focused Extracorporeal Shock Wave Therapy in Chronic Low Back Pain： A Prospective Randomized 3-Month Follow-Up Study ［J］.Med Sci Monit， 2022， 28：e936614. doi:10.12659/msm.936614 doi: 10.12659/msm.936614
10	SHAMSELDEEN N E， HEGAZY M M A， FAYAZ N A， et al. Instrumented assisted soft tissue mobilization vs extracorporeal shock wave therapy in treatment of myofascial pain syndrome ［J］.World J Orthop， 2023， 14（7）： 572-581. doi:10.5312/wjo.v14.i7.572 doi: 10.5312/wjo.v14.i7.572
11	SAKAI S， MITSUI Y， MIYAMOTO A， et al. Factors associated with resorption of calcific deposits in the shoulder with extracorporeal shock wave therapy ［J］.J Shoulder Elbow Surg， 2024， 5：S1058-2746（24）00711-0. doi:10.1016/j.jse.2024.07.056 doi: 10.1016/j.jse.2024.07.056
12	HSIEH L F， KUO Y C， HUANG Y H， et al. Comparison of corticosteroid injection， physiotherapy and combined treatment for patients with chronic subacromial bursitis-A randomised controlled trial ［J］. Clin Rehabil， 2023， 37（9）： 1189-200. doi:10.1177/02692155231166220 doi: 10.1177/02692155231166220
13	冻结肩诊疗的多学科合作中国专家共识编写专家组，程志祥，段宝霖，等. 冻结肩诊疗的多学科合作中国专家共识（2023版）［J］. 中华疼痛学杂志，2023， 19（5）： 727-737.
14	程志祥，樊肖冲，冯智英，等. 体外冲击波疗法临床应用中国疼痛学专家共识（2023版）［J］. 中华疼痛学杂志， 2023， 19（2）： 220-235.
15	LEAFBLAD N， MIZELS J， TASHJIAN R， et al. Adhesive Capsulitis ［J］.Phys Med Rehabil Clin N Am 2023， 34（2）： 453-468. doi:10.1016/j.pmr.2022.12.009 doi: 10.1016/j.pmr.2022.12.009
16	LIANG C W， CHENG H Y， LEE Y H， et al. Corticosteroid Injection Methods for Frozen Shoulder： A Network Meta-analysis ［J］. Arch Phys Med Rehabil， 2024， 105（4）： 750-759. doi:10.1016/j.apmr.2024.01.003 doi: 10.1016/j.apmr.2024.01.003
17	KUMAR S S， KUMAR A， SANNASI R， et al. Association between shoulder girdle muscles trigger points and frozen shoulder： A cross-sectional study ［J］. J Bodyw Mov Ther， 2024， 40：1605-1609. doi:10.1016/j.jbmt.2024.08.017 doi: 10.1016/j.jbmt.2024.08.017
18	SHAH J P， THAKER N， HEIMUR J， et al. Myofascial Trigger Points Then and Now： A Historical and Scientific Perspective ［J］. PM R， 2015， 7（7）： 746-761. doi:10.1016/j.pmrj.2015.01.024 doi: 10.1016/j.pmrj.2015.01.024
19	SIMONS D G. New views of myofascial trigger points： etiology and diagnosis ［J］.Arch Phys Med Rehabil， 2008， 89（1）： 157-159. doi:10.1016/j.apmr.2007.11.016 doi: 10.1016/j.apmr.2007.11.016
20	ZHAI T， JIANG F， CHEN Y， et al. Advancing musculoskeletal diagnosis and therapy： A comprehensive review of trigger point theory and muscle pain patterns ［J］. Front Med （Lausanne）， 2024， 11：1433070. doi:10.3389/fmed.2024.1433070 doi: 10.3389/fmed.2024.1433070
21	WANG X， SUN Q， WANG M， et al. Electrical Dry Needling Plus Corticosteroid Injection for Osteoarthritis of the Knee： A Randomized Controlled Trial ［J］. Arch Phys Med Rehabil， 2022， 103（5）： 858-866. doi:10.1016/j.apmr.2021.12.026 doi: 10.1016/j.apmr.2021.12.026
22	JALILIPANAH P， OKHOVATIAN F， SERRI R A， et al. The effect of dry needling & muscle energy technique separately and in combination in patients suffering shoulder impingement syndrome and active trigger points of infraspinatus ［J］. J Bodyw Mov Ther， 2021， 26：94-100. doi:10.1016/j.jbmt.2020.12.030 doi: 10.1016/j.jbmt.2020.12.030
23	KEARNS G A， BRISMÉE J M， RILEY S P， et al. Lack of standardization in dry needling dosage and adverse event documentation limits outcome and safety reports： A scoping review of randomized clinical trials ［J］. J Man Manip Ther， 2023， 31（2）： 72-83. doi:10.1080/10669817.2022.2077516 doi: 10.1080/10669817.2022.2077516
24	SUPUTTITADA A， CHEN C P C， NGAMRUNGSIRI N， et al. Effects of Repeated Injection of 1% Lidocaine vs. Radial Extracorporeal Shock Wave Therapy for Treating Myofascial Trigger Points： A Randomized Controlled Trial ［J］. Medicina （Kaunas）， 2022， 58（4）：479. doi:10.3390/medicina58040479 doi: 10.3390/medicina58040479
25	李富林，黄宇，尹东，等. 体外冲击波治疗肱骨外上髁炎的效果评价：一项短-中期随访［J］. 实用医学杂志，2020， 36（24）： 3369-3372.
26	NAGGAR T EL， MAATY A I E， MOHAMED A E. Effectiveness of radial extracorporeal shock-wave therapy versus ultrasound-guided low-dose intra-articular steroid injection in improving shoulder pain， function， and range of motion in diabetic patients with shoulder adhesive capsulitis ［J］. J Shoulder Elbow Surg， 2020， 29（7）： 1300-1309. doi:10.1016/j.jse.2020.03.005 doi: 10.1016/j.jse.2020.03.005
27	SALDIRAN T， YAZGAN P， AKGÖL A C， et al. Radial shock-wave therapy for frozen shoulder patients with type 2 diabetes mellitus： A pilot trial comparing two different energy levels ［J］. Eur J Phys Rehabil Med， 2022， 58（3）： 412-422. doi:10.23736/s1973-9087.22.07087-3 doi: 10.23736/s1973-9087.22.07087-3
28	ACAR N， KARAARSLAN A A， KARAKASLI A. The effectiveness of extracorporeal shock wave therapy in snapping scapula ［J］.J Orthop Surg （Hong Kong）， 2017， 25（1）： 23094990166 84723. doi:10.1177/2309499016684723 doi: 10.1177/2309499016684723

项目	T组（n = 33）	I组（n = 33）	TI组（n = 33）	F/χ² /Z值	P值
年龄/（x ± s）岁	47 ± 14	51 ± 11	49 ± 13	0.216	0.806
性别/例				1.492	0.474
男	12	8	13
女	21	25	20
BMI（x ± s）/（kg/m²）	23.4 ± 3.2	24.0 ± 2.8	25.2 ± 3.7	0.824	0.442
病程［M（P₂₅，P₇₅）］/月	6（3，7）	5（3，10）	4（3，6.75）	3.752	0.153
糖尿病/［例（%）］	15（45.4）	14（42.2）	12（36.3）	3.115	0.211
患侧/例				3.299	0.521
左侧	20	14	15
右侧	11	15	13
双侧	2	4	5
分期/例				0.347	0.841
Ⅰ期	23	24	25
Ⅱ期	10	9	8
触发点数量［M（P₂₅，P₇₅）］/个	5（3，7）	4.5（3，6）	3.5（3，5）	4.946	0.084

组别	例数	治疗前	治疗后				F值	P值
组别	例数	治疗前	治疗后1周	治疗后4周	治疗后8周	治疗后12周	F值	P值
T组	33	6.9 ± 1.2	3.0 ± 0.8^?	3.2 ± 1.0^?	3.6 ± 0.7^?	3.8 ± 0.6^*	96.7	< 0.001
I组	33	6.8 ± 1.5	2.6 ± 0.9^?	3.0 ± 0.9^?	3.2 ± 0.8^?	3.3 ± 0.7^*	114.5	< 0.001
TI组	33	7.0 ± 1.3	2.4 ± 0.7^?△	2.2 ± 0.6^?△▲	2.0 ± 0.7^?△▲	1.9 ± 0.8^*△▲	148.5	< 0.001
F值		0.246	5.702	13.066	35.767	59.619
P值		0.783	0.005	< 0.001	< 0.001	< 0.001

指标	组别	例数	治疗前	治疗后				F值	P值
指标	组别	例数	治疗前	治疗后1周	治疗后4周	治疗后8周	治疗后12周	F值	P值
前屈	T组	33	112.7 ± 16.9	124.1 ± 11.8^?	128.9 ± 9.6^?	130.1 ± 9.6^?	131.2 ± 8.6^?	105.6	< 0.001
	I组	33	107.6 ± 18.7	122.4 ± 17.4^?	131.9 ± 12.7^?	132.7 ± 12.5^?	133.6 ± 11.7^?	118.8	< 0.001
	TI组	33	109.9 ± 19.2	129.3 ± 16.9^?	139.8 ± 13.9^?△▲	140.5 ± 13.1^?△▲	142.0 ± 12.1^?△▲	132.6	< 0.001
	F值		0.606	1.702	4.336	5.738	6.627
	P值		0.548	0.188	0.016	0.004	0.002
外展	T组	33	93.6 ± 15.9	103.4 ± 15.3^?	106.6 ± 15.2^?	108.3 ± 14.1^?	109.1 ± 13.8^?	104.1	< 0.001
	I组	33	94.2 ± 17.4	105.8 ± 17.1^?	110.8 ± 15.6^?	111.5 ± 14.5^?	113.3 ± 13.9^?	115.5	< 0.001
	TI组	33	90.8 ± 17.1	108.0 ± 15.5^?	120.8 ± 13.9^?△	121.6 ± 12.0^?△	122.5 ± 11.8^?△	128.6	< 0.001
	F值		0.373	1.885	4.199	4.431	4.062
	P值		0.690	0.158	0.018	0.015	0.020
后伸	T组	33	22.3 ± 5.7	31.1 ± 5.0^?	35.4 ± 3.6^?	37.0 ± 3.7^?	39.1 ± 2.8^?	106.5	< 0.001
	I组	33	21.1 ± 5.4	32.0 ± 4.0^?	36.6 ± 4.8^?	37.8 ± 4.5^?	38.8 ± 3.9^?	103.3	< 0.001
	TI组	33	24.3 ± 5.4	38.5 ± 5.6^?△▲	41.9 ± 5.9^?△▲	42.9 ± 5.7^?△▲	43.9 ± 5.3^?△▲	139.6	< 0.001
	F值		2.737	21.412	15.897	14.537	15.160
	P值		0.700	< 0.001	< 0.001	< 0.001	< 0.001

组别	例数	治疗前	治疗后				F值	P值
组别	例数	治疗前	治疗后1周	治疗后4周	治疗后8周	治疗后12周	F值	P值
T组	33	61.3 ± 9.2	66.8 ± 9.1^?	68.1 ± 9.5^?	70.4 ± 9.1^?	71.9 ± 8.7^?	100.8	< 0.001
I组	33	59.4 ± 8.6	64.8 ± 11.4^?	70.2 ± 10.1^?	72.2 ± 9.0^?	72.9 ± 8.8^?	115.3	< 0.001
TI组	33	57.4 ± 9.6	72.3 ± 9.9^?▲	77.4 ± 9.5^?△▲	79.0 ± 8.4^?△▲	80.0 ± 7.8^?△▲	132.8	< 0.001
F值		0.782	0.684	3.754	4.785	4.986
P值		0.418	0.523	0.023	0.020	0.019

组别	例数	治疗前	治疗后1个月	F值	P值
T组	33	7.1 ± 3.2	5.6 ± 2.6^?	89.6	< 0.001
I组	33	7.9 ± 3.5	6.8 ± 2.8^?	75.8	< 0.001
TI组	33	7.4 ± 3.1	6.3 ± 2.2^?	74.5	< 0.001
F值		0.238	0.375
P值		0.810	0.782

Application of extracorporeal shock wave therapy for trigger point combined with periapical steroid injection on the quality of recovery in patients with primary frozen shoulder

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组别	头晕	嗜睡	恶心	疼痛	合计/［例（%）］
T组	0	0	0	2	2（6.0）
I组	1	0	1	1	3（9.0）
TI组	0	1	0	2	3（9.0）
χ² 值					0.866
P值					0.372

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