Acupuncture Treatment after Shoulder Arthroscopy after Recurrent Dislocations

Abstract

BACKGROUND:

The shoulder has the greatest range of motion of the entire joint in the body. Therefore it accounts for almost 50% of all joint dislocations. Most commonly, the dislocation is anterior and may occur because of trauma. Symptoms are intense pain, inability to move, numbness of the arm, weakness, swelling and visibly out of place shoulder. This condition requires emergency medical assistance to relocate the shoulder and do X = ray and MRI scans.

CASE REPORT:

The treated patient is a 20-year-old girl who has undergone shoulder arthroscopy after recurrent dislocations. 2 years after the surgery, another trauma happened, and the shoulder was dislocated again along with a broken piece of the bone. The patient decided instead of open surgery to do acupuncture treatment. 10 treatments were done, 3 with fire needle and 7 with normal needle acupuncture in 5 months. The patient was also taking Glucosamine and Calcitriol and was advised to rest the arm, not to bore it, not to lift weight and not to make sudden movements. Less than a year, the results are amazing, there’s no pain in the shoulder, the movement is unlimited and eased. The MRI image is with normal findings with a little piece of 3 mm still to heal on the broken part.

CONCLUSION:

For such a serious condition as shoulder dislocation, acupuncture gave amazing and very satisfying results, with no need of open surgery.

Introduction

The shoulder has the greatest range of motion of all the joint in the body, and it accounts for almost 50% of all joint dislocations. Most commonly, the dislocation is anterior and may occur because of trauma. Symptoms are intense pain, inability to move, numbness of the arm, weakness, swelling and visibly out of place shoulder. This condition requires emergency medical assistance to relocate the shoulder and do an X-ray and MRI scans [1] [2]. In cases where is needed cartilage and ligament repair for tears, it is done via arthroscopy. In this case, the surgeon manipulates with instruments through the thin tube inserted through a few small (1 cm) incisions into the patient’s skin (shoulder). There’s a minimum of pain after surgery, and the patient can get back to work quickly. Recovery is usually rapid, throughout 4 weeks and if the person is an athlete, will need a few more months before starting with the sports activities [3].

When the ligaments in the shoulder are looser, shoulder dislocation can happen relatively easy, and it is harder for the shoulder’s rotator cuff muscles to maintain the stability of the shoulder [4]. When the shoulder has been dislocated, a bone structure can be broken as well in the process, and many soft tissue structures may be damaged. After the acute care administration, acupuncture plays an important role in the promotion of soft tissue healing. Acupuncture treatment can restore the normal function of the muscle and muscle tone and alleviate the pain in the shoulder to a greater degree, effectively treats the pathologies of the soft tissues of the shoulder and improves the quality of the person`s life [5] [6] [7].

Case report

The treated patient is a 20-year-old girl who has undergone shoulder arthroscopy after recurrent dislocations. The recurrent dislocations were happening because of lifting weights. After a sudden movement, the shoulder could not back in the joint position, and urgent intervention was needed with non-bloody reposition to the right humeroscapular joint. After three months of immobilisation, the doctors concluded that it is necessary to make shoulder arthroscopy. The MRI scan before the surgery showed smooth transplantation of bone structures without signs of fresh bleeding. In the projection of the medial side of the rotator cuff supraspinatus was visible a rupture of the same. Signs of complete rupture and contraction were not seen. In the projection of soft tissue structures, there were no signs of the existence of free fluid. Figure 1 is shown the MRI scan of the right shoulder before the surgery.

Figure 1.

MRI scan of the right shoulder before the surgery

Two years after the surgery, another trauma happened after falling off a scooter in water, and the shoulder was dislocated again along with a broken piece of the bone. The damage was greater, and the doctors suggested to do an open stem cell transplant operation or by installing a specially designed titanium plate in the shoulder. The doctors said the surgery is inevitable and there is no other way to treat the shoulder. The patient decided instead of open surgery to do acupuncture treatment. On Figure 2 is shown an MRI scan right after the second trauma and before starting the acupuncture treatment.

Figure 2.

MRI scan done right after the second trauma and before starting the acupuncture treatment

The treatment was done in a clinic for Traditional Chinese Medicine and acupuncture in Skopje, Macedonia by a doctor specialist in acupuncture. Treatments were done indoors, at room temperature, once weekly. The fire needle treatments were with duration of 5-10 minutes and the treatments with a normal needle were with duration of 30-45 minutes.

Ten treatments were done, 3 with fire needle and 7 with normal needle acupuncture in 5 months. The patient has also prescribed two doses of Glucosamine 500 mg two times a day and Calcitriol 0.25 mg once a day. The patient was advised to rest the arm, not to bore it, not to lift weight and not to make sudden movements for at least 3 months. Treatments were done with aim to help the bone and surrounding tissues to recover faster, to ease the constant pain in the shoulder and upper arm, to heal the damaged tendons and ligaments, to bring back the normal function of the shoulder and arm and prevent from further dislocations. Calcitriol was taken to mineralise the bone and Glucosamine as a supplement to help relieve the pain and stiffness in the joint, cartilage, ligaments and tendons.

Less than a year, the results came up amazing, there is no pain in the shoulder and arm, and the movement is unlimited and eased in all directions. On figure 3 and figure 4 are shown the MRI scans done after the treatment. The MRI image is with normal findings with a little piece of 3 mm still to heal on the broken part of the shoulder.

Figure 3.

MRI scan done after the treatment

Figure 4.

MRI scan done after the treatment

The results after the acupuncture treatment are showing normal tendon of m. Supraspinatus, m. Subscapularis, mm. Infraspinatus, m. Teres minor. Normal Biceps Labral complex. The normal tendon of m. Biceps intrascapular long and labrum. Normal capsuloglagigmental complex, normal rotator cuff part and normal acromioclavicular joint. Type II morphology of the acromion is present. No present fluid is detected in the subacromial-subdeltoid bursa. Normal visualization of coracohumeral and coracoacromial ligaments. Normal quadrilateral space and normal axillary space. Normal m. Deltoideus and m. Trapezius. Present 3 mm cavity (may be seen as a cyst on the scan) in the healing process in the head of the humerus by the insertion of the supraspinal tendon.

On figure 5 is shown the treated place and the treated points. Treatment was done on Ashi, i.e. trigger points located on the most painful places in the affected area.

Figure 5.

Treated points with fire needle acupuncture

The shoulder joint has a complex structure which allows an incredible range of motion, but on the other side the blood supply is relatively poor, and when there is injury, it heals slowly. Acupuncture treatments help with the healing process by stimulating the circulation of Qi and Blood, reducing the inflammation in the affected area, removing the pain, removing the blockages from the meridians, clearing the accompanying symptoms, strengthening the immune system and allowing free movement in the joints in everyday life without pain [8].

In conclusion, for such a serious condition as shoulder dislocation, acupuncture gave amazing and very satisfying results in this case, without the need for open surgery. The patient continues to use the arm in all daily activities, adding gradually a moderate physical activity. In the coming months, the patient’s condition will be monitored and will be scheduled for routine examinations.