100cm by 100cm Poster Template

1
A Case Study on the Effectiveness of Western
Acupuncture in Treating Shoulder
Impingement Yvonne Parnell B.Sc., Dip., Ph. Th.
(M.I.A.P.T) Institute of Physical Therapy and
Applied Health Science
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Introduction
Treatment Methodology
Conclusions
Although western acupuncture has not been fully
validated as an effective treatment protocol for
shoulder impingement, in this instance it had
benefits beyond what physical therapy alone could
achieve for my patient. Physical therapy
treatment provided my patient with a significant
increase in his shoulder movement which enabled
him to complete the day-to-day tasks that he
enjoys engaging. Introducing western acupuncture
helped to garner further gains in ARO to the
extent that he no longer noticed a difference
between his right and left shoulder movement. His
feeling of tightness on GH FX and GH ABD also
reduced significantly. In addition to the
patient benefits, western acupuncture also had
consultation benefits in that it reduced the
duration of the consultation and the intensity of
hands-on treatment. The main drawback of
providing western acupuncture treatment is the
increase in practice overheads. While
promising results were obtained during this case
study, wider trials need to be established to
validate the benefits of western acupuncture over
traditional physical therapy methods. In addition
to this, the protocol for point selection needs
to be more clearly defined in order to support
the therapist in their clinical reasoning and
development of evidence-based treatment plans.
Treatment took place twice weekly over a three
week period. Treatment sessions were 30 minutes
in duration, with 15 minutes dedicated to western
acupuncture treatment. The patients response
to western acupuncture was measured at the outset
of each consultation using the Measure Your Own
Medical Outcome Profile 2 (MYMOP2) 11. Point
selection was based on research 5,9 and
customised to the patients presentation.
Disposable, single use, Type J
Seirin acupuncture needles were used during
treatment with a diameter of 0.16mm and a length
of 30mm. Needles were stimulated for 10 seconds
every 2 minutes until De Qi was reported.
Flicking was used initially, followed by
rotational clockwise and counter clockwise
movements and then pistioning until De Qi was
felt. De Qi was described as a sensation of
heaviness, numbness and radiating paraesthesia
5,10.
Western acupuncture is growing in its use within
general practice as the evidence in relation to
its effectiveness increases 1, 2, 3. A study
into the contribution of acupuncture to
healthcare in the UK revealed that an estimated 4
million acupuncture sessions were provided
annually 1. Shoulder disorders account for an
estimated 1 of all general practice encounters
in the UK 4. Approximately, 70 of shoulder
disorders relate to rotator cuff injuries with
shoulder impingement being the most common
diagnosis 5,6. While the prevalence of
shoulder injuries is high, many of the common
treatments such as ultrasound, non-steroidal
anti-inflammatories, surgery and manipulation
under anaesthesia have been shown to have little
or no effect over placebo and many have
significant side effects 2,7. Acupuncture is a
treatment that has shown positive effects on many
conditions 8 however, the evidence in respect
of shoulder pain is inconclusive 2. This is
reportedly due to methodological shortcomings
because of non-specific or placebo effects,
effects of transdermal puncture and difficulties
in blinding 8,9. The scientific effect of
acupuncture is not fully understood and several
hypotheses have been proposed such as the
release of b-endorphins in the lumbar spine,
increased 5-hydroxy tryptophan level in the
cerebrum overriding pain stimuli and the more
traditional explanation of the freeing of a
blockage Qi or a stagnation of blood by
acupuncture 8. This poster presents the
findings of western acupuncture treatment on a
patient with chronic shoulder impingement and its
suitability as a treatment modality in a physical
therapy setting. Western medical acupuncture is
a therapeutic modality involving the insertion of
fine needles it is an adaptation of Chinese
acupuncture using current knowledge of anatomy,
physiology and pathology, and the principles of
evidence based medicine.
References

1. Freedman, J. (2013) An Audit of 500 Acupuncture
   Patients in General Practice. Acupuncture in
   Medicine, 20 (1) 30-34
2. Buchbinder, G.S. and Hetrick, S.E. (2008)
   Acupuncture for Shoulder Pain, The Cochrane
   Collaboration, 4 1-27
3. Pirotta, M. (2007) Acupuncture in
   musculoskeletal disorders Is there a point?
   Australian Family Physician, 36 (6)447-448
4. Mitchell, C., Adebajo, A. And Hay, E. (2005)
   Shoulder pain diagnoses and management in
   primary care. British Medical Journal, 121124-8
5. Johansson, K., Adolfsson, L.E. and Foldevi,
   M.O.M. (2005) Effects of acupuncture versus
   ultrasound in patients with impingement
   syndrome randomized clinical trial. Physical
   Therapy, 85490-501
6. Johansson, K., Bergston, A., Schroder, K. And
   Foldevi, M. (2011) Subacromial cortosteriod
   injection or acupuncture with home exercises when
   treating patients with aubacromial impingement in
   primary care a randomized clinical trial.
   Family Practice, 28355-365
7. Vas, J., Ortega, J.V., Olmo, V.,
   Perez-Fernandez, F., Hernandez, L., Medina, I.,
   Seminario, J.M., Herrera, A., Luna, F.,
   Perea-Milla, E., Mendez, C., Madrazo, F.,
   Jimenez, C. And Aguilar, I. (2008) Single-point
   acupuncture and physiotherapy of the treatment of
   painful shoulder a multicentre randomized
   controlled trial. Rheumatology, 47 887-893
8. Kelly, R. (2009) Acupuncture for Pain. American
   Family Physician, 80 (5)482-484
9. Guerra, J., Bassa, E., Andres, M., Verdugo, F.
   And Gonzales, M. (2003) Acupuncture for Soft
   Tissue Shoulder Disorders A Series of 201
   Cases. Acupuncture in Medicine, 21 (1-2) 18-22
10. Hopton, A.K., Curnoe, M.K. and MacPherson, H.
    (2012) Acupuncture in practice mapping the
    providers, the patients and the settings in a
    national cross-sectional survey. BMJ Open
    Access, 2 1-9
11. Paterson, C. (1996) Measuring outcome in a
    primary care setting a patient-generated
    measure, MYMOP, compared to the SF-36 health
    survey. British Medical Journal 3121016-1020

Results
The patients progress was monitored at the
beginning of each consultation (Rx) by
reassessing the positive assessment results from
the initial examination. Results were tracked
using MYMOP2. MYMOP2 is used to rate two
symptoms that the patient most notices most about
their condition and one activity that it mostly
affects. These are then rated on a scale of 0-6,
where 6 is the worst their symptoms can be and 0
is the best. In addition to this, they also rate
their wellbeing, note medications they are taking
for the problem and their attitudes towards
reducing the medication. In respect of this
client, he noted his symptom 1 as tightness in
raising his arm to the side (abduction). Symptom
2 was noted as tightness lifting arm overhead
(flexion). The activity mostly affected was
reported as reaching overhead. The
patient reported his wellbeing was a 0/6 at each
consultation. He did not take any medications
for his complaint and there were no negative
treatment side effects reported. Over 6
consultations, the patients GH ARO increased
from 160 FX to 175 degrees with reduced
tightness. Active GH ABD increased from 120 to
170 degrees with no pinching and only a mild
tightness felt at the end of range. His movement
was fluid throughout all ranges.
Presentation
A 67 year old male presented complaining of
reduced shoulder mobility as a result of open
shoulder surgery for a ruptured supraspinatus
tendon. The patient received post operative
physiotherapy for six weeks but never regained
full function of his previously healthy shoulder.
He attended Silchester Physical Therapy for
treatment 2 years post injury. The patient
reported difficulty in reaching overhead with his
right arm. He noted no pain in the movement of
his arm, only tightness. Physical therapy
treatment was initially applied for 8
consultations. The patients active range of
movement (ARO) of the glenohumeral joint (GH)
increased from 40 degrees abduction (ABD) to 120
and from 110 degrees of flexion (FX) to 160 by
the 6th consultation with no further gains
achieved in ARO by the 8th consultation. A
month after the patients final physical therapy
consultation, he re-attended for treatment using
western acupuncture.
Examination
At the outset of the western acupuncture
treatment the patient was re-examined. The
results of the examination indicated that the
patient was experiencing a subacromial
impingement, weakness in the deltoid muscle and
rotator cuff group with associated muscular
hypertonicity. ARO of the GH revealed a
restriction of 160 FX with significant tightness
on the anterior GH and posterior shoulder girdle.
GH ABD was restricted to 120 degrees with poor
movement quality from 40-120 degrees and a mild
pinching sensation at 90 degrees.
Acknowledgements
Thank you to My client who kindly supported my
study in this field and provided helpful feedback
and monitoring of results. My colleague, Lucy
Mooney, for her support in helping to solidify
the direction of my case study and for her
support throughout our studies in Western
Acupuncture. IPTAS for providing me with an
opportunity to present my research.