RU2429812C1 - Method of treating patients with scapulohumeral periarthrosis - Google Patents

Abstract

FIELD: medicine. ^ SUBSTANCE: scapulohumeral periarthrosis is treated by nonsteroid anti-inflammatory drugs, anaesthetics and vitamins, by local cryotherapy with using Kryotur 600 apparatus immediately followed by neuropulse cuppent therapy. An acute period of the disease requires cryotherapy at temperature (-6) - (-12)C for 8-10 minutes. In a subacute period not accompanied by secondary synovitis phenomena, cryotherapy is carried out at (0) - (-6)C for 5-10 minutes. 4 procedure fields are exposed to neuropulse current. The IV channel electrodes are crosswise fixed within a shoulder joint; the I channel electrodes are arranged longitudinally in a paravertebral area on an affected side at a level of the I-III thoracic vertebras; the II channel electrodes are found paravertebrally on an opposite side; the III channel electrodes are fixed within a deltoid muscle. The operating mode of all the channels is group-mixed with pulse current frequency of the IV channel is fixed and equal to 100 Hz, the channel current migration period is 8 seconds. The neuropulse current exposure time is 10-15 minutes. The therapeutic course is 8-10 daily procedures. ^ EFFECT: higher clinical effectiveness ensured by pain syndrome relief, increased range of shoulder joint movement and lower number of carried out physiotherapeutic procedures. ^ 4 ex

Description

The invention relates to medicine, in particular to traumatology and orthopedics, as well as physiotherapy, and can be used in the treatment of patients with shoulder-shoulder periarthrosis.

Known methods for the treatment of patients with shoulder-shoulder periarthrosis, consisting in cryotherapy (General and local air cryotherapy. Collection of articles edited by V.V. Portnov. - Moscow, 2005. - 36 p. - S.20-21).

As a prototype according to the closest technical essence, the method of treatment of patients with a shoulder-shoulder periarthrosis is selected, which consists in the effect of local cryotherapy on the shoulder joint, as well as in drug exposure, including non-steroidal anti-inflammatory, analgesics, and vitamins. They use the mobile installation Cryojet S 200. The technique is combined. First, a large oval-slit nozzle (BOSCH) conducts an impact for 3-4 minutes on the corresponding paravertebral zones at the level of the upper thoracic and lower cervical spine with the capture of the deltoid region. Then, the exposure is carried out alternately from the lateral surfaces (lateral and medial) of the upper shoulder in the direction of the deltoid region for 3-4 minutes. After a labile technique, pain points are determined by palpation. If available, the effect is carried out for 0.5-1 minutes for each pain point. The total exposure time should not exceed 3-4 minutes. A course of 10-12 procedures used daily with a break on weekends (General and local air cryotherapy. Collection of articles edited by V.V. Portnov. - Moscow, 2005. - 36 p. - S.20-21).

The prototype method is not effective enough. So, according to the authors of the prototype method, the reduction of pain occurs only to the 8th - 10th procedure, which, in our opinion, is associated with the use of cryotherapy only and the absence of other physiotherapeutic factors of influence. In addition, in this method, air cooled to -30 ° C is supplied using a large oval-slotted and small round-slotted nozzles with a hole diameter of 1 dm and 1-2 cm, respectively, at different distances (2-7 cm) from nozzles to the surface of the patient’s body, with different flow rates of chilled air, which does not provide the possibility of cryotherapy at various temperature conditions. Obviously, this also affects the insufficiently high efficiency of treatment. So, for example, the authors of the prototype method observe a significant increase in the amplitude of motion in the joint in only 52.0% of cases, and the course of treatment is 10-12 procedures.

The technical result of the invention is to increase the effectiveness of the treatment by reducing pain, increasing the amplitude of movements in the shoulder joint and reducing the number of physiotherapeutic procedures.

The technical result is achieved by the fact that medical treatment is carried out, cryotherapy and neuro-impulse current therapy are carried out on the shoulder joint area. Moreover, therapy with neuro-impulse currents is carried out immediately after cryotherapy. Medication includes non-steroidal anti-inflammatory, analgesic, and vitamins. Local cryotherapy is carried out using the Kryotur 600 apparatus, and in the acute phase of the shoulder-shoulder periarthrosis, cryotherapy is carried out at an exposure temperature of - (-6) - (- 12) ° C, the duration of the procedure is 8-10 minutes. In the subacute phase of the disease without secondary synovitis, cryotherapy is carried out at a temperature of (0) - (- 6) ° C, the duration of the procedure is 5-10 minutes. Neuropulse currents act on 4 procedural fields, while the electrodes of the IV channel are fixed transversely in the region of the shoulder joint; channel I electrodes - longitudinally in the paravertebral region on the affected side at the level of I-III thoracic vertebrae; channel II electrodes - paravertebral on the opposite side; Channel III electrodes are fixed in the deltoid region. The operation mode of all channels is group mixed, while the frequency of the pulse current of channel IV is fixed and equal to 100 Hz, the period of current migration through the channels is 8 seconds. The duration of exposure to neuro-impulse currents is 10-15 minutes, the course of treatment is 8-10 procedures conducted daily.

The method is as follows.

The patient is placed on the couch. Cryotherapy is performed using a cryohead from the Kryotur 600 apparatus (Uniphy Elektromedizin, Germany), which is taken across the skin around the shoulder joint. The dosage of the procedure depends on the severity of the process. With exacerbation of the shoulder-shoulder periarthrosis, cryotherapy is carried out at an exposure temperature of (-6) - (-12) ° C, the duration of the procedure is 8-10 minutes. In the subacute phase of the disease without secondary synovitis, cryotherapy is used at a temperature of (0) - (- 6) ° C, the duration of the procedure is 5-10 minutes. Immediately after cryotherapy, neuroimpulse currents are applied. To do this, use the 4-channel apparatus “Miorhythm-040”, which provides the possibility of simultaneous combined exposure to several procedural fields without moving the electrodes, which can significantly increase the effectiveness of treatment. Exercise effects on 4 procedural fields. Channel IV electrodes are fixed transversely in the shoulder joint; channel I electrodes - longitudinally in the paravertebral region on the affected side at the level of I-III thoracic vertebrae; channel II electrodes - paravertebral on the opposite side; Channel III electrodes are fixed in the deltoid region. The operation mode of all channels is group mixed, while the frequency of the pulse current of channel IV is fixed and equal to 100 Hz, the period of migration of current through the channels is 8 seconds. The duration of exposure to neuro-impulse currents is 10-15 minutes, the course of treatment is 8-10 procedures conducted daily.

Distinctive features of the invention are:

1. Local cryotherapy is carried out using the apparatus "Kryotur 600".

2. In case of exacerbation of the shoulder-shoulder periarthrosis, cryotherapy is carried out at an exposure temperature of (-6) - (- 12) ° С, the duration of the procedure is 8-10 minutes, in the subacute phase of the disease without secondary synovitis, cryotherapy is carried out at a temperature of (0) - (- 6 ) ° C the duration of the procedure is 5-10 minutes.

3. Immediately after cryotherapy, neuroimpulse currents additionally affect the area of the shoulder joint.

4. Neuropulse currents act on 4 procedural fields, while the electrodes of channel IV are fixed transversely in the region of the shoulder joint; channel I electrodes - longitudinally in the paravertebral region on the affected side at the level of I-III thoracic vertebrae; channel II electrodes - paravertebral on the opposite side; Channel III electrodes are fixed in the deltoid region.

5. The operation mode of all channels is group mixed, while the frequency of the pulse current of channel IV is fixed and equal to 100 Hz.

6. The period of current migration through the channels is 8 sec.

7. The duration of exposure to neuro-pulse currents is 10-15 minutes.

8. The course of treatment - 8-10 procedures conducted daily.

A causal relationship between the distinctive essential features and the achieved result:

1. The use of the apparatus "Kryotur 600" (Uniphy Elektromedizin, Germany) is preferable in comparison with the mobile installation Kriojet, since It allows you to set the exposure temperature and duration of the procedure.

2. The developed parameters of cryotherapy for both acute and subacute stages of the disease allow for highly effective treatment of shoulder-shoulder periarthrosis.

3. An additional effect of neuro-impulse currents on the affected shoulder joint is necessary to enhance the analgesic effect and stimulate the reparative-regenerative processes in the shoulder joint and surrounding tissues.

4. The effect of neuro-impulse currents on 4 procedural fields is explained by the fact that the pathological process captures not only the shoulder joint, but also the surrounding tissues.

5. The operation mode of the group channels allows you to simultaneously affect 4 procedural fields, and the mixed mode is necessary for the operation of I-III channels with a periodically changing pulse current frequency, and for the IV channel to work with a fixed frequency of 100 Hz, which mainly has an analgesic effect.

6. The authors chose a period of current migration through the channels of 8 seconds, as well as a duration of exposure to neuro-pulse currents of 10-15 minutes, since these parameters provide the maximum treatment efficiency.

7. The number of procedures, that is, 8-10 conducted daily, is sufficient to obtain the maximum therapeutic effect, in contrast to the prototype method, including 10-12 procedures.

Case Studies

Example 1

And / b 18248. Patient E., 71 years old, pensioner.

Diagnosis at admission: Shoulder-shoulder periarthrosis on the right, stage II, acute phase.

The patient was admitted to the hospital with complaints of intense pain in the right shoulder joint, aggravated by the abduction of the arm and when the arm was laid behind the back.

Objectively: pain on palpation of the right shoulder joint and surrounding tissues, limitation of the amplitude of movement - 3 points. On the radiograph: cystic changes in the structures of the head of the right shoulder and the acromial process, narrowing of the joint gap of the acromioclavicular joint, destructive and bone-traumatic changes were not detected.

The treatment according to the claimed method amounted to 8 procedures of local cryotherapy and therapy with neuroimpulse currents. Traditional medication was prescribed: Ketonal suppositories 2 times a day rectally, Ketonal forte tablets 100 mg 2 times a day, oral solutions of 50% analginum - 4.0 ml, diphenhydramine 1% - 2.0 ml, novocaine 0.5% - 10.0 ml, sodium chlorine 0.9% - 200.0 ml intravenously drip No. 5, vitamins of group B intramuscularly No. 10. Cryotherapy was performed using a Kryotur 600 apparatus (Uniphy Elektromedizin, Germany), a cryohead was guided over the skin around the right shoulder joint at an exposure temperature of -6 ° C, the duration of the procedure was 8 minutes. Immediately after cryotherapy, they were exposed to neuropulse currents. Used a 4-channel apparatus "Miorhythm-040". Channel IV electrodes were fixed transversely in the region of the right shoulder joint; electrodes of channel I were located longitudinally in the paravertebral region on the right at the level of I-III thoracic vertebrae; electrodes of the II channel - paravertebral left at the level of I-III thoracic vertebrae; Channel III electrodes were fixed in the region of the right deltoid muscle. The operation mode of all channels is group mixed, while the frequency of the pulse current of channel IV is fixed and equal to 100 Hz, the period of migration of current through the channels is 8 seconds. The current strength in the IV channel was increased until the patient had a sensation of pronounced vibration under the electrodes, in the I-III channels - until the appearance of muscle contractions. Duration of exposure - 10 minutes. The course of treatment amounted to 8 procedures conducted daily.

After the treatment, the general condition improved, the pain syndrome decreased after the 2nd procedure, and the pain stopped on the 6th day. The limitation of the amplitude of motion in the right shoulder joint after treatment is 0-1 points. By the time of discharge on the 14th day from the start of treatment, he had no complaints, there were no pains in the right shoulder joint.

Example 2

And / b 16247. Patient F., 41, driver.

Diagnosis at admission: Shoulder-shoulder periarthrosis on the left, stage II, acute phase.

The patient was admitted to the clinic with complaints of intense pain in the left shoulder joint, aggravated by the abduction of the arm and when the hand is laid behind the back, limiting the amplitude of movement in the left shoulder joint.

Objectively: pain on palpation of the left shoulder joint and surrounding tissues, limitation of the amplitude of movement - 3 points. On the radiograph: narrowing of the joint gap of the acromioclavicular joint, destructive and bone-traumatic changes were not detected.

The course of treatment according to the claimed method amounted to 9 procedures of local cryotherapy and therapy with neuroimpulse currents. Traditional medication was prescribed: Ketonal suppositories 2 times a day rectally, Ketonal forte tablets 100 mg 2 times a day, oral solutions of 50% analginum - 4.0 ml, diphenhydramine 1% - 2.0 ml, novocaine 0.5% - 10.0 ml, sodium chlorine 0.9% - 200.0 ml intravenously drip No. 5, vitamins of group B intramuscularly No. 10. Cryotherapy was performed using a Kryotur 600 apparatus (Uniphy Elektromedizin, Germany), a cryohead was guided over the skin around the left shoulder joint at an exposure temperature of -12 ° C, the duration of the procedure was 10 minutes. Immediately after cryotherapy, they were exposed to neuropulse currents. Used a 4-channel apparatus "Miorhythm-040". Channel IV electrodes were fixed transversely in the region of the left shoulder joint; channel I electrodes were placed longitudinally in the paravertebral region on the left at the level of I-III thoracic vertebrae; electrodes of the II channel - paravertebral right at the level of I-III thoracic vertebrae; Channel III electrodes were fixed in the region of the left deltoid muscle. The operation mode of all channels is group mixed, while the frequency of the pulse current of channel IV is fixed and equal to 100 Hz, the period of migration of current through the channels is 8 seconds. The current strength in the IV channel was increased until the patient had a sensation of pronounced vibration under the electrodes, in the I-III channels - until the appearance of muscle contractions. Duration of exposure is 10 minutes. The course of treatment amounted to 9 procedures conducted daily.

After the treatment, the general condition improved, the pain syndrome decreased after the 1st procedure, the pain was stopped on the 5th day. The limitation of the amplitude of motion in the left shoulder joint after treatment is 0-1 points. By the time of discharge on the 14th day from the start of treatment, he had no complaints; there were no pains in the left shoulder joint.

Example 3

And / b No. 19575. Patient S., 50 years old, docker.

Diagnosis at admission: Shoulder-shoulder periarthrosis on the right, stage II, subacute course.

From the anamnesis, it is known that a 5-year-old patient was treated with various methods (drug therapy, laser therapy, electrophoresis of novocaine and other drugs) in a clinic, sanatoriums. Upon admission, the patient complained of pain in the right shoulder joint during arm movement, radiating to the neck and arm, limiting the amplitude of movements.

Objectively: pain on palpation of the right shoulder joint and surrounding tissues, limitation of the amplitude of motion - 4 points. On the roentgenogram: cystic changes in the structures of the head of the right shoulder and the acromial process, narrowing of the joint gap of the acromioclavicular joint, osteophytes, subchondral osteosclerosis, destructive and bone-traumatic changes were not detected.

The course of treatment according to the claimed method was 10 local cryotherapy and neuroimpulse current therapy against the background of traditional drug therapy: Ketonal suppositories 2 times a day rectally, Ketonal Forte tablets 100 mg 2 times a day orally, 50% analgin solutions - 4.0 ml, diphenhydramine 1% - 2.0 ml, novocaine 0.5% - 10.0 ml, sodium chlorine 0.9% - 200.0 ml intravenous drip No. 5, group B vitamins intramuscularly No. 10. Cryotherapy was performed using a Kryotur 600 apparatus (Uniphy Elektromedizin, Germany), a cryo-head was taken over the skin around the right shoulder joint, the duration of the procedure was 10 minutes. Immediately after cryotherapy, they were exposed to neuropulse currents. Used a 4-channel apparatus "Miorhythm-040". Channel IV electrodes were fixed transversely in the region of the right shoulder joint; electrodes of channel I were located longitudinally in the paravertebral region on the right at the level of I-III thoracic vertebrae; electrodes of the II channel - paravertebral left at the level of I-III thoracic vertebrae; Channel III electrodes were fixed in the region of the right deltoid muscle. The operation mode of all channels is group mixed, while the frequency of the pulse current of channel IV is fixed and equal to 100 Hz, the period of migration of current through the channels is 8 seconds. The current strength in the IV channel was increased until the patient had a sensation of pronounced vibration under the electrodes, in the I-III channels - until the appearance of muscle contractions. Duration of exposure is 15 minutes. The course of treatment amounted to 10 procedures conducted daily.

After treatment: Limit the amplitude of movement in the right shoulder joint - 0-1 points. The decrease in pain occurred after the 1st procedure, the relief of pain on the 6th day. When discharged after 14 days, he did not show any complaints; there were no pains in the right shoulder joint.

Example 4

And / b No. 18642. Patient T., 65 years old, retired.

Diagnosis at admission: Shoulder-shoulder periarthrosis on the right, stage II, subacute course.

At admission, the patient complained of pain and weakness in the right shoulder joint, limiting the amplitude of movements in the right shoulder joint.

Objectively: pain on palpation of the right shoulder joint and surrounding tissues, limitation of the amplitude of movement - 2 points. On the radiograph: narrowing of the joint gap of the acromioclavicular joint, destructive and bone-traumatic changes were not detected.

The course of treatment according to the claimed method was 10 local cryotherapy and neuroimpulse current therapy against the background of traditional drug therapy: Ketonal suppositories 2 times a day rectally, Ketonal Forte tablets 100 mg 2 times a day orally, 50% analgin solutions - 4.0 ml, diphenhydramine 1% - 2.0 ml, novocaine 0.5% - 10.0 ml, sodium chlorine 0.9% - 200.0 ml intravenous drip No. 5, group B vitamins intramuscularly No. 10. Cryotherapy was performed using a Kryotur 600 apparatus (Uniphy Elektromedizin, Germany), a cryohead was guided over the skin around the right shoulder joint at an exposure temperature of -6 ° C, the duration of the procedure was 5 minutes. Immediately after cryotherapy, they were exposed to neuropulse currents. Used a 4-channel apparatus "Miorhythm-040". Channel IV electrodes were fixed transversely in the region of the right shoulder joint; electrodes of channel I were located longitudinally in the paravertebral region on the right at the level of I-III thoracic vertebrae; electrodes of the II channel - paravertebral left at the level of I-III thoracic vertebrae; Channel III electrodes were fixed in the region of the right deltoid muscle. The operation mode of all channels is group mixed, while the frequency of the pulse current of channel IV is fixed and equal to 100 Hz, the period of migration of current through the channels is 8 seconds. The current strength in the IV channel was increased until the patient had a sensation of pronounced vibration under the electrodes, in the I-III channels - until the appearance of muscle contractions. Duration of exposure is 15 minutes. The course of treatment amounted to 10 procedures conducted daily.

After the treatment, the limitation of the amplitude of motion in the right shoulder joint is 0-1 points. The decrease in pain occurred after the 2nd procedure, the relief of pain on the 7th day.

When discharged after 14 days, she did not show any complaints; there were no pains in the right shoulder joint.

The inventive method was tested in 33 patients (20 patients with the acute stage of the shoulder-shoulder periarthrosis, 13 with the subacute stage), aged 40 to 72 years, 21 men and 12 women with a disease duration from 1 year to 5 years. The clinical picture was typical and was characterized by the presence of pain in the affected shoulder joint, aggravated by abduction of the arm and when the hand is laid behind the back, limiting the amplitude of movements in the shoulder joint.

The data obtained were compared with the data described and obtained using the prototype method.

The patient group consisted of 8 people (5 patients with acute stage of humeroscapular periarthrosis, 3 with subacute stage) aged 50 to 72 years, 5 men, 3 women. Patients received cryotherapy from the standard Cryojet C200 installation against the background of standard drug therapy (General and local air cryotherapy. Collection of articles edited by V.V. Portnov. - Moscow, 2005. - 36 p. - S.20-21).

In patients receiving treatment by the present method, the positive dynamics was clearly expressed. The decrease in pain occurred on average by the 6th - 7th procedure, while when using the prototype method - by the 8th - 10th procedure.

In 28 of the 33 patients who received treatment according to the claimed method, a significant increase in the amplitude of movements was observed, that is, in 84.8% of cases, while in patients who received treatment according to the prototype method, only in 52.0% of cases. Thus, when using the proposed method, a significant increase in the amplitude of movements in the shoulder joint was noted in 32.8% of cases more often.

The number of physiotherapeutic procedures carried out by the present method is 8-10, and by the prototype method - 10-12.

Thus, the inventive method of treating patients with a shoulder-shoulder periarthrosis allows, in comparison with the prototype method, to reduce pain in a shorter time, increase the range of motion in the shoulder joint and reduce the number of physiotherapeutic procedures, which increases the effectiveness of the treatment.

Claims (1)

A method of treating patients with a shoulder-shoulder periarthrosis, which consists in the effect of local cryotherapy on the shoulder joint area, as well as a drug effect, including non-steroidal anti-inflammatory, painkillers, and vitamins, characterized in that they also act on the shoulder joint immediately after cryotherapy with neuro-pulse currents, and local cryotherapy is carried out using the Kryotur 600 apparatus, and in the acute phase of the shoulder-shoulder periarthrosis, cryotherapy is carried out at an exposure temperature of (-6) - (-12) ° C, the duration of the procedure is 8-10 minutes, in the subacute phase of the disease without secondary synovitis, cryotherapy is carried out at a temperature of (0) - (-6) ° C, the duration of the procedure is 5- 10 min., Neuroimpulse currents act on 4 procedural fields, while the electrodes of channel IV are fixed transversely in the region of the shoulder joint; channel I electrodes - longitudinally in the paravertebral region on the affected side at the level of I-III thoracic vertebrae; channel II electrodes - paravertebral on the opposite side; channel III electrodes are fixed in the deltoid muscle region, the operation mode of all channels is group mixed, while the frequency of the pulse current of channel IV is fixed at 100 Hz, the period of current migration through the channels is 8 s, the duration of exposure to neuro-pulse currents is 10-15 minutes, the treatment course is 8 -10 treatments daily.