Effectiveness Of Radial Extracorporeal Shockwave For Scapulohumeral Periarthritis Treatment Guided By The Theory Of Soft Tissue Surgery

Scapulohumeral periarthritis is a chronic and aseptic inflammatory disease of soft tissue around shoulder joint,such as tendon sheath,bursa and joint capsule.Shoulder pain and dysfunction of affected limbs are the main symptoms,which seriously affect the quality of life and physical and mental health of patients.Up to now,the disease is mainly based on conservative therapy,aiming to shorten the natural course of disease,alleviate pain symptoms,improve limb function and enhance the quality of life.In recent years,extracorporeal shock wave has been proved to loose adhesions around shoulder joint and improving clinical symptoms,thereby it has been widely used in the treatment of scapulohumeral periarthritis.However,in most of reports related to therapy of extracorporeal shock wave the peri-shoulder pain points were commonly select(mainly deltoid,supraspinatus and infraspinatus)for treatment,and the therapeutic efficacy needs to be improved.In this study,guided by the theory of soft tissue surgery,based on the attached muscles around shoulder joint and the muscles involved in shoulder joint activities,we aim to further improve the clinical efficacy and quality of life of patients with scapulohumeral periarthritis by increasing the region of extracorporeal shock wave therapy.Objective To investigate the clinical effectiveness of increasing the treatment site under guidance of the theory of soft tissue surgery for treating patients with scapulohumeral periarthritis by extracorporeal shock wave.Methods Sixty patients with chronic scapulohumeral periarthritis admitted to our hospital from June 2018 to March 2019 were enrolled and randomly divided into control group and observation group(each,n=30).Both groups received radial extracorporeal shock wave therapy with energy flow density of 0.15-0.25 mJ/mm,frequency of 10-12 Hz and for 2000 shocks at each treatment site.The control group selected two conventional treatment sites(anterolateral shoulder and dorsal shoulder)for a total of 4000 shocks.On the basis of two treatment sites of anterolateral shoulder and dorsal shoulder,the observation group was added other two treatment sites,thoracolumbar and lumbosacral.Thus,the total shocks were 8000 in the observation group.Both groups were treated twice a week for two weeks.Before treatment,at the end of treatment(0 weeks after treatment),4 weeks and 12 weeks after treatment,the patients’ shoulder pain symptoms were assessed by visual analogy scale(VAS),and the shoulder joint function assessment scale(SJFAS).The 36-item short-form health survey(SF-36)were used to assess patients’ quality of life,the Pittsburgh Sleep Quality Index(PSQI)questionnaire was used to assess patients’ sleep quality,and the Hospital Anxiety and Depression Scale(HADS)was used to assess patients’ psychological status.The treatment-related adverse events were recorded in two groups.Results Before treatment,there was no significant difference in general data between the observation group and the control group(P > 0.05).After treatment on 0,4 and 12 weeks,the VAS scores of the observation group were all significantly lower than those in control group(P<0.05).At 0,4 and 12 weeks after treatment,the SJFAS scores in observation group was significantly higher than those in control group(P<0.05).At 0,4 and 12 weeks after treatment,the scores of four dimensions of role-physical,bodily pain,role-emotional and mental health in SF-36 of the observation group were all significantly higher than those in control group(P<0.05).At 0,4 and 12 weeks after treatment,the PSQI scores in observation group were significantly better than those in control group(P<0.05).At 0,4 and 12 weeks after treatment,HADS-A and HADS-D scores in the observation group were significantly lower than those in the control group(P<0.05).No treatment-related adverse events were observed in both groups.Conclusion Under the guidance of the theory of soft tissue surgery,increasing the treating region for scapulohumeral periarthritis for extracorporeal shock wave therapy is safe and effective,which can further alleviate pain symptoms,restore shoulder joint function,improve quality of life,enhance sleep quality and improve psychological status.