RU2619493C1 - Method for shoulder periarthrosis treatment - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: trigger points are determined, and a mixture of drugs containing 1.0 ml of diprospan suspension, 2.0 ml of 2 % lidocaine solution, and 1.0 ml of 0.05% cyanocobalamin solution is introduced therein. During the first session, the total amount of mixture is divided by the number of the determined trigger points, and the mixture is introduced in equal amounts into each point. After mixture introduction, the acupuncture needle is put into GI10 point (shousanli) for 20 minutes. During subsequent sessions, trigger points are determined as well. The amount of the preparations mixture introduced into the trigger point is equal to the amount introduced during the first session.

EFFECT: effective treatment due to the rapid relief of pain and increase in joint movement amplitude, drugs therapeutic effect potentiation by acupuncture procedures with decreasing of the administered drug doses and their side effects.

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Description

The invention relates to medicine, namely to rheumatology, neurology, reflexology, and can be used to treat both acute and protracted forms of the shoulder-scapular periarthrosis.

Shoulder-shoulder-blade periarthrosis (PLP) (synonyms adhesive shoulder capsulitis, “frozen shoulder”) is a collective generalizing concept that combines various pathological conditions characterized by pain and limitation of range of motion in the shoulder joint. Patients with shoulder-scapular periarthrosis account for 80-85% of all patients with diseases of the shoulder joint.

One of the leading factors contributing to the development of pathological changes in the shoulder joint is a chronic pain syndrome. Shoulder pain occurs in more than 20% of patients visiting an arthrologist or rheumatologist. Basically, these are working people aged 35-65 years. A variety of forms of the painful shoulder is associated with the features of the development of the periarticular apparatus of the shoulder joint, which carries out the most various movements in it: flexion, extension, abduction, adduction, rotation and circular motion. The pain not only leads to a limitation of the range of motion in the joint with the development of secondary changes in the capsule of the tendon-ligamentous apparatus, but also causes pathological reactions that close like a “vicious circle”.

Treatment of shoulder-scapular periarthrosis can include a different combination of the following methods: taking non-steroidal anti-inflammatory drugs, prescribing intra-articular injections of hormonal anti-inflammatory drugs, manual therapy, acupuncture, massage, physiotherapy, and therapeutic exercises.

If the results of non-hormonal drugs are not enough, the doctor will prescribe a short course of hormonal injections - “Diprospan” or “Flosteron”. Of the methods of physiotherapeutic treatment, laser and magnetotherapy have proven themselves well. Manual therapy and massage have a good effect. A special place is occupied by physiotherapy. Together with the rest of the therapy, it helps to restore mobility to the shoulder joint ( http://mirsustava.ru/periartroz/ , viewing date 05/10/2016).

However, many researchers note the insufficient, and sometimes even low effectiveness of the traditionally applied treatment regimens, which leads to long periods of disability (in 20% of cases), and the frequent development of recurrent and chronic forms (in 35-50% of patients). The consequence of this may be the occurrence of persistent functional disorders that significantly limit physical activity and, consequently, disability, and also have a negative impact on the quality of life of patients.

Known methods of treatment are usually long-lasting. Duration of treatment with drug therapy is about 10-15 days, while the use of non-steroidal anti-inflammatory drugs can give various side effects. When treating with exercise therapy and physiotherapy, the terms are even longer depending on the patient's condition. In this regard, the development of new and improvement of existing methods of treatment of shoulder-scapular periarthrosis remains an urgent task.

A known method of treating shoulder-scapular periarthrosis, including the inactivation of trigger points (TT) in the muscles of the belt of the upper limb. They were inactivated comprehensively and simultaneously in all the muscles involved. In parallel, manual, medical, physiotherapeutic and kinesiotherapeutic effects were performed. Manual therapy included, as a rule, 5 sessions. Moreover, before each session, the trigger zone was preheated by applying ointment application containing iodine-bromine, vasodilating and warming components for 5-7 minutes on the skin surface in its projection. In cases where the TT had an elastic-elastic consistency, clear contours, along with the inactivation of the TT, were used for drug injection. Directly in TT were introduced: - diprospan 0.5+ novocaine 0.5% - 2-3 ml (1, and if necessary 2 injections with an interval of 14 days); - novocaine 0.5% 3-5 ml (2-3 injections after 2 days on the 3rd). In addition, physiotherapy was performed with ultrasound with hydrocortisone on the skin projection of the active trigger points (7-10 sessions). In addition to manual, medicamentous and physiotherapeutic effects, kinesitherapy complexes were used in the treatment of patients with PLP (Ocheretina I.G. CONSERVATIVE TREATMENT OF SHOULDER-SCAPULAR PERIARTHROSIS TAKING INTO ACCOUNT MYOFASCIAL DYSFUNCTIONAL SYNDROME. and orthopedics. Kurgan - 2004 - 28 p.).

However, this method of treatment requires a large number of procedures, equipment, narrow specialists (kinesiologist), i.e. the method is complex and not always feasible. In addition, the method is long.

A known method of treating brachio-scapular periarthrosis, including the introduction of diprospan into palpation-defined painful areas (trigger points) in the shoulder area. 1 ml of diprospan is injected to a depth of 1-2 cm. In the case of the frozen shoulder syndrome, the course of treatment included 3 injections with an interval of 7-10 days ( http://www.painstudv.ru/matls/treat/diprospan.htm V.A. Shirokov, “The experience of introducing diprospan into trigger points with various forms of shoulder-shoulder-blade periarthrosis”, viewing date 10.05.2016).

However, this method is not effective enough - restoration of the full range of motion or the disappearance of pain was noted in 46.7%, a decrease in pain and an increase in range of motion were detected in 41.9%. In addition, the method is long.

The aim of the invention is to increase efficiency and reduce treatment time.

This goal is achieved in that the trigger points in the shoulder-scapular region are determined and a mixture of drugs is introduced into them. The mixture contains a suspension of diprospan 1 ml, a 2% solution of lidocaine 2 ml, and a 0.05% solution of cyanocobalamin 1 ml. At the same time, in the first session, the total amount of the mixture (4 ml) is divided by the number of detected trigger points and the mixture is injected in equal amounts to each point. After introducing the mixture, an acupuncture needle is placed at GI10 for 20 minutes. The trigger points are determined at each treatment session, and the amount of the mixture injected into each trigger point remains equal to the amount entered at the point in the first session. Treatment sessions are carried out daily. The course of treatment includes 1-3 sessions.

Comparative analysis with the prototype showed that the proposed method differs from the known one in that a mixture of preparations containing a suspension of diprospan 1.0 ml, a 2% solution of lidocaine 2.0 ml and a 0.05% solution of cyanocobalamin 1.0 is introduced into the trigger points ml, and the total amount of the mixture (4 ml) is divided by the number of defined trigger points and the mixture is injected in equal amounts to each point, and after the mixture is introduced into the GI10 point (show san-li), an acupuncture needle is placed for 20 minutes, while each session determines the trigger points, and the amount entered with esi drugs trigger point is equal to the number entered in the trigger point on the first session. The course of treatment includes 1-3 sessions, sessions are carried out daily.

Thus, this technical solution meets the criteria of the invention of "novelty."

The analysis of patent and medical literature showed that the proposed method of treatment differs not only from the prototype, but also from other technical solutions in this and related fields. So, the authors have not found methods of treatment that would include the proposed modes of the method. Namely, the combination of introducing the proposed mixture of drugs in the proposed amount into the trigger points and acupuncture allows us to achieve the goal - to increase efficiency and reduce treatment time to 1-3 days, reduce pain, restore the range of motion in the joint. The advantages of the method are that when vitamin B12 (cyanocobalamin) and lidocaine are added to the mixture, the side effects of diprospan, in particular its sclerosing effect, are reduced, in addition, given that the mixture is placed at certain points, a lower dose of drugs is required. Those. the effectiveness is significantly increased, and the treatment time is reduced, and the doses of drugs are reduced. Acupuncture in this case also allows you to potentiate the therapeutic effect, while reducing the dose of the drugs used and thereby their side effect is minimized.

When using the proposed method, there are no complications and adverse reactions, which allows it to be used on an outpatient basis, in the conditions of sanatoriums, etc.

Thus, the proposed technical solution meets the criteria of the invention "inventive step" and "industrial applicability".

The method is as follows. The patient determines painful on palpation points - trigger points (TT) in the shoulder-scapular region. In the vast majority, 3-5 points of maximum pain are detected. Identified TTs are labeled with 5% alcohol iodine using a cotton swab. A mixture of preparations is prepared: diprospan suspension 1.0 ml + lidocaine solution 2% 2.0 ml + cyanocobalamin solution 0.05% (0.5 mg / ml) 1.0 ml, a total of 4 ml of the mixture is obtained. 4 ml is the maximum total amount of a mixture of drugs that is administered in one treatment session. Divide the mixture by the number of defined trigger points in equal amounts. The mixture is injected with an insulin syringe into the TT to a depth equal to the length of the needle. After the mixture is introduced, an acupuncture needle is placed at point GI10 (show-san-li) until the intended sensations (irradiation along the channel) are received for 20 minutes.

If the pain has not disappeared after the first injection, the trigger points in the shoulder and shoulder area are also determined the next day. The dots are marked with iodine and a mixture of preparations containing a suspension of diprospan 1.0 ml, 2% lidocaine solution 2.0 ml and 0.05% cyanocobalamin solution 1.0 ml is introduced, and the amount of the mixture introduced into the TT is equal to the amount of the mixture that was injected into the point in the first session. The mixture is injected with an insulin syringe into the TT to a depth equal to the length of the needle. After the mixture is introduced, an acupuncture needle is placed at point GI10 (show-san-li) until the intended sensations (irradiation along the channel) are received for 20 minutes. If necessary (pain preservation), the procedure is repeated the next day - TT is determined in the shoulder and shoulder blades, a mixture of preparations is prepared: diprospan suspension 1.0 ml + 2% lidocaine solution 2.0 ml + 0.05% cyanocobalamin solution 1.0 ml . At the same time, in each TT detected during the session, a mixture of drugs is introduced in an amount equal to the amount of the mixture introduced into the TT in the first session. After the mixture is introduced, an acupuncture needle is placed at point GI10 (show-san-li) until the intended sensations (irradiation along the channel) are received for 20 minutes. The acupuncture needle is placed at the point GI10 (show-san-whether), regardless of whether it is a pain (trigger) point or not. A mixture of drugs at point GI10 (show-san-li) is administered if it is a trigger point. The course of treatment is 1-3 procedures. Procedures are carried out daily.

Example 1. Patient T., 46 years old, complains of pain in the region of the right shoulder joint, the pain radiates to the neck during movement and to the area of the scapula. Due to pain, limitation of the mobility of the shoulder joint. The pain has been disturbing for several years, it has been repeatedly treated on this subject with traditional methods without an obvious effect.

On examination, a visible restriction of movements with the right hand was revealed. The patient clearly spares the hand. When moving the arm to the side and forward, pain in the right shoulder joint is determined. YOUR 8 points, lead 30.8 °, flexion 47 °, extension 17.5 °. Ds: Shoulder-shoulder-blade periarthrosis on the right.

The patient was treated according to the proposed method, as described above, painful points in the shoulder and shoulder blades were first determined - palpation revealed a very painful point on the front surface of the shoulder joint at the site of attachment of the biceps tendon. In addition, the point on the trapezius muscle on the sore side was painful. Also painful were two points in the interscapular region, in the middle of the distance between the spine and the inner edge of the scapula, at the level of 2-3 thoracic vertebrae. Having determined TT (4), using a cotton swab moistened with 5% alcohol solution of iodine, mark them. Then we prepare a mixture of drugs, consisting of a suspension of diprospan 1 ml, 2% solution of lidocaine 2.0 ml, 0.05% solution of cyanocobalamin 1.0 ml. Divide 4 ml of the mixture into 4 points and introduce a mixture of drugs at each point of 1.0 ml. The mixture is injected at a point to a depth equal to the length of the insulin needle. After introducing the mixture at point GI 10, we put an acupuncture needle until the sensations in the form of irradiation along the forearm are received for 20 minutes. In this patient, the GI 10 point is not a trigger point and a mixture of drugs was not injected into it.

When the patient is examined the next day, her health is much better, the pains do not bother. YOUR 1 point, lead 169 °, flexion 135 °, extension 35 °. The patient is almost healthy. Subsequently, for 12 months (observation period), the shoulder and arm were not disturbed.

Example 2

Patient S., 39 years old. He complained of pain in the shoulder joint on the left with irradiation in the forearm, restriction of movement up and to the side. Considers himself ill for 3 months. On ultrasound of the same group of joints: Signs of chronic damage to the tendon of the infraspinatus muscle, tendosynovitis of the long head of the biceps of the shoulder, tendonitis of supraspinatus and subscapularis on the left.

YOUR 9 points, lead 29.3 °, flexion 45 °, extension 15 °. Ds: Shoulder-shoulder-blade periarthrosis on the left.

The treatment was carried out according to the proposed method, as described above. First, we determine the trigger points in the shoulder and shoulder blades - upon palpation, the following painful points are revealed: a point on the front surface of the shoulder joint at the place of attachment of the bicep tendon, a point on the trapezius muscle, two points medial to the inner edge of the shoulder blade and GI point 10 show san. Having determined TT (points 5), using a cotton swab moistened with 5% alcohol solution of iodine, mark them. Then we prepare a mixture of drugs, consisting of a suspension of diprospan 1 ml, 2% solution of lidocaine 2.0 ml, 0.05% solution of cyanocobalamin 1.0 ml. Divide 4 ml of the mixture into 5 points and introduce a mixture of drugs at each point of 0.8 ml. The mixture is injected at a point to a depth equal to the length of the insulin needle. After introducing the mixture of drugs at the point GI 10, we put an acupuncture needle to obtain the intended sensations in the form of irradiation on the forearm for 20 minutes.

Over the next 24 hours after the procedure, a positive effect is observed with a decrease in pain intensity by 50 percent. At the second session, 3 trigger points were determined - a point on the front surface of the shoulder joint at the place of attachment of the biceps tendon, a point on the trapezius muscle and a point medial to the inner edge of the scapula. TTs were labeled with iodine and a mixture of drugs was introduced in them, consisting of a suspension of diprospan 1.0 ml, 2% lidocaine solution 2.0 ml, 0.05% cyanocobalamin solution 1.0 ml, and the amount of the drug was introduced at each point which was entered at a point in the first session, i.e. introduced 0.8 ml of a mixture of drugs at each point. The mixture was injected at a point to a depth equal to the length of the insulin needle. After the mixture of drugs was introduced, an acupuncture needle was placed at the GI 10 point to obtain the intended sensations in the form of irradiation in the forearm for 20 minutes.

At the 3rd session, one trigger point was determined (on the front surface of the shoulder joint). It was labeled with iodine and a mixture of drugs was introduced into it, consisting of a suspension of diprospan 1.0 ml, 2% lidocaine solution 2.0 ml, 0.05% cyanocobalamin solution 1.0 ml. 0.8 ml of a mixture of drugs was added to the point. The mixture was injected at a point to a depth equal to the length of the insulin needle. After the mixture of drugs was introduced, an acupuncture needle was placed at the GI 10 point to obtain the intended sensations in the form of irradiation in the forearm for 20 minutes.

After the 3rd session: the range of motion in the joint in full volume (lead 164.8 °, flexion 131 °, extension 32 °), the pain syndrome was stopped (YOUR 1 point). Observation for 9 months: there were no exacerbations, the shoulder and arm are not disturbed.

The proposed method was treated 30 patients aged 35-51 years with a diagnosis of shoulder-scapular periarthrosis. Of these, 16 were men and 14 were women. In all patients, before and after treatment, pain intensity and range of motion in the shoulder joint were evaluated. The intensity of the pain syndrome on a visual analogue scale (VAS) before treatment was 7–9 points. Also, in all patients, a limitation of the range of motion in the shoulder joint was noted: abduction 31.6 ° ± 2.4 °, flexion 45.8 ° ± 2.9 °, extension 15.2 ° ± 2.4 °.

In all patients, after treatment, a good clinical effect was obtained - the pain syndrome was stopped, the range of motion in the joint was restored. After treatment by the proposed method: YOUR 0-2 points, the range of motion in the joint increased and amounted to: lead 171.6 ° ± 6.4 °; bending 135.7 ° ± 4.9 °, extension 32.3 ° ± 2.8 °.

Moreover, in 13 patients, pain and limitation of mobility were stopped from one session, 10 patients needed two treatment sessions, and 7 patients needed three sessions.

A relapse of the disease occurred four months after treatment in 2 patients, in 4 patients the effect of the treatment lasted up to 8 months, in 23 patients from 8 months to 1 year (observation period). Preservation of the treatment effect depended on the social and labor conditions and the patient’s lifestyle.

Thus, the proposed method allows you to quickly stop the pain, increase the amplitude of movements in the joint.

Claims (4)

1. A method of treating brachio-scapular periarthrosis, including determining trigger points and introducing diprospan into them, characterized in that a mixture of preparations containing a suspension of diprospan 1.0 ml, 2% lidocaine solution 2.0 ml and 0.05 is injected into the trigger points % solution of cyanocobalamin 1.0 ml, and in the first session, the total amount of the mixture is divided by the number of defined trigger points and the mixture is injected in equal amounts to each point, and after the mixture is introduced at point GI10 (show san), an acupuncture needle is placed at 20 minutes, while in subsequent sessions that as determined trigger points, and the amount of mixture introduced drugs trigger point is equal to the number inputted into a point on the first session. 2. The method according to p. 1, characterized in that the total amount of the mixture of drugs that are administered in one treatment session does not exceed 4 ml. 3. The method according to p. 1, characterized in that the sessions are carried out daily. 4. The method according to p. 1, characterized in that the course of treatment includes 1-3 sessions.