Department of Rehabilitation Medicine, The Fushun People's Hospital, 47 Xiangyun Street West section, Zigong, China.
Department of Radiology, The Fushun People's Hospital, 490 Jixiang Road, Fushi Street Zigong, Fushun, China.
BMC Musculoskelet Disord. 2022 Apr 20;23(1):367. doi: 10.1186/s12891-022-05327-4.
Frozen shoulder is a common painful disease of the shoulder joint characterized by structural changes in the shoulder joint, restricting both active and passive shoulder joint activities. Proprioceptive neuromuscular facilitation (PNF) effectively improved and maintained the range of motion; however, it is not clear whether it can improve the shoulder joint structure in patients with frozen shoulder. This pilot study used magnetic resonance imaging (MRI) observation to assess the improvement of the local structure of the shoulder joint upon PNF treatment to elucidate a target based on structure for the treatment of frozen shoulder.
Forty-eight patients with frozen shoulder were randomly divided into the traditional manual therapy group and the PNF technique group. Changes in the thicknesses of the coracohumeral ligament (CHL) and capsule in axillary recess (CAR) of the shoulder joint were observed via MRI upon admission and at 4 weeks after treatment. A visual analog scale (VAS) and passive shoulder range of motion (ROM) at abduction, anteflexion and external rotation position were used to evaluate the improvement of shoulder joint pain and function in the initial, mid-term, and discharge of the two groups of patients.
The primary outcome results shown that the PNF joint mobilization significantly reduced the thickness of the CHL (p = 0.0217) and CAR (p = 0.0133). Compared with simple joint mobilization, The mid-term and discharge rehabilitation assessment results showed that PNF has a better effect on shoulder pain. At the mid-term evaluation, the ROM of the PNF group was significantly better than that of the Control group in the three directions (p < 0.05).
As an adjunctive therapy, PNF can improve the shoulder joint structure of patients with frozen shoulder and is an effective treatment strategy for frozen shoulder.
冻结肩是一种常见的肩关节疼痛性疾病，其特征为肩关节结构改变，限制主动和被动肩关节活动。本体感觉神经肌肉促进（PNF）可有效改善和维持关节活动度，但尚不清楚其是否能改善冻结肩患者的肩关节结构。本研究采用磁共振成像（MRI）观察，评估 PNF 治疗后肩关节局部结构的改善情况，为冻结肩的治疗提供基于结构的靶点。
将 48 例冻结肩患者随机分为传统手法治疗组和 PNF 技术组。入院时和治疗 4 周后，通过 MRI 观察肩关节喙肱韧带（CHL）和腋窝（CAR）的厚度变化。采用视觉模拟评分（VAS）和肩关节外展、前屈和外旋位被动活动度（ROM）评估两组患者肩关节疼痛和功能改善情况。
主要结局结果显示，PNF 关节松动术可显著降低 CHL（p=0.0217）和 CAR（p=0.0133）的厚度。与单纯关节松动术相比，中期和出院康复评估结果显示 PNF 对肩部疼痛的效果更好。在中期评估时，PNF 组在三个方向的 ROM 均明显优于对照组（p<0.05）。
作为辅助治疗，PNF 可改善冻结肩患者的肩关节结构，是冻结肩的有效治疗策略。
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