Electroacupuncture combined with rehabilitation techniques for patients with rotator cuff injury

Abstract

Recently, we read a retrospective study by Chen et al, which demonstrated that electroacupuncture is highly effective in relieving pain due to rotator cuff injuries and accelerating the recovery of shoulder function, promoting repair of rotator cuff injuries. This study provides a new way to the conservative treatment of early rotator cuff injuries. In the present letter, we review the current treatment of rotator cuff injury with electroacupuncture combined with rehabilitation techniques and propose our views.

Key Words: Electroacupuncture therapy; Rehabilitation technique; Rotator cuff injury; Shoulder joint function

Core Tip: The study by Chen et al included 97 patients with rotator cuff injuries. Forty-eight patients in the control group were treated with rehabilitation techniques, whereas forty-nine patients in the study group were treated with electroacupuncture combined with rehabilitation techniques. The results showed that electroacupuncture combined with rehabilitation techniques had a good treatment effect in patients with rotator cuff injuries, demonstrating high safety.

TO THE EDITOR

Recently, we read an article titled “Effect of electroacupuncture combined with rehabilitation techniques on shoulder function in patients with rotator cuff injuries”[1]. This article[1] provides clinical evidence for the effectiveness of traditional Chinese medicine treatment of rotator cuff injuries, which is a novel and effective treatment method. Previous conservative treatments for rotator cuff injuries are limited, including non-steroid anti-inflammatory drugs, phonophoresis, extracorporeal shock wave therapy (ESWT), ozone therapy, and local injection therapy[2-5]. However, some of these treatments are expensive and their effectiveness is uncertain, so there is an urgent need to find low-cost, low-side-effect treatments that are easily accepted by patients.

Emerging studies have shown that electroacupuncture can inhibit the induction and transmission of pain signals and, consequently, mediate anti-nociceptive and anti-inflammatory effects by rebalancing the neural-immune-endocrine interactions[6]. The anti-inflammatory and anti-nociceptive signaling pathways are regulated by electroacupuncture at the peripheral, spinal, and supraspinal levels in inflammatory pain models, and the mechanisms of electroacupuncture-induced analgesia are associated with the inhibition of peripheral and central sensitization[7]. Peripherally, electroacupuncture inhibits the release of pain-related inflammatory mediators during inflammatory responses caused by tissue injury, the expression of pro-nociceptive receptors in peripheral neurons, and the phosphorylation of molecules of cellular signaling pathways, all of which desensitize peripheral pain perception. Furthermore, electroacupuncture also promotes the release of peripheral opioid peptides, cannabinoids, and adenosine to inhibit peripheral inflammatory pain. Centrally, electroacupuncture inhibits the activation of spinal cord excitatory neurons, including N-methyl-d-aspartate receptor and alpha-amino-3-hydroxy-5-methyl-4-isoxazolepropionic acid receptors-mediated postsynaptic excitation, the activation of MAPK phosphorylation-induced cellular signaling pathways, the activation of glial cells, and the release of inflammatory mediators, such as inflammatory cytokines, chemokines, and ATP, thereby inhibiting central sensitization[7,8]. And simultaneously, electroacupuncture treatment of rotator cuff injury has been shown to effectively increase the collagen content, thus promoting the proliferation of collagen fibre bundles to repair the injured tissue and increase the maximum load of the rotator cuff[8,9]. Wang et al[10] selected 40 patients with rotator cuff injury, and after 6 weeks of electroacupuncture treatment, the visual analog scale score and shoulder joint movement were greatly improved. Tendon-bone healing is a key point in the management of rotator cuff injuries, and it may be affected by the stiffness of tendons and muscles. Rehabilitation techniques are effective in preventing tendon-muscle stiffness and improving joint function[11]. However, the effect of electroacupuncture combined with rehabilitation technology in the treatment of tendon diseases is still unknown. In the study of Chen et al[1], they used electroacupuncture combined with rehabilitation techniques for the treatment of rotator cuff injuries, demonstrating superior pain reduction and shoulder function recovery compared to traditional treatment. The authors adopted the combination of the two methods, which is the embodiment of integrated treatment of Chinese and Western medicine. Better results have been obtained with lower cost treatment. And the whole research process is very rigorous and complete. The results of this study are of high value, and the treatment used is relatively accessible and inexpensive, and has encouraging efficacy.

However, we still have concerns about some aspects of this article: (1) The study is single-centered, with a small sample size. These factors could all potentially lead to biased results. The study employed a single-blind method; how to avoid the subjective bias of the researchers is worth considering. Will there be a need for multicenter, large-sample randomized controlled trials in the future to draw more reliable conclusions? (2) In the inclusion criteria, patients with small and partial rotator cuff tears were included. Should the presence of frozen shoulder and fatty infiltration be considered, as these conditions have a significant impact on shoulder joint function and recovery? (3) The study's results indicate that electroacupuncture combined with rehabilitation therapy is significantly effective in treating small rotator cuff tears. Are the patient's shoulder joint pain and functional impairment related to small rotator cuff tears? Can electroacupuncture combined with rehabilitation promote the healing of the rotator cuff? If so, what is the specific mechanism? And additional imaging studies, such as MRI, should be provided. If not, what about the long-term efficacy? Will non-healing of small rotator cuff tears lead to recurrent shoulder joint pain and functional impairment? Therefore, further follow-up is needed; (4) Zhang et al[7] suggested that electroacupuncture is more effective in suppressing inflammatory and neuropathic pain at 2-10 Hz than at 100 Hz. The frequency of electroacupuncture used in this paper was 100 Hz. Would the pain relief effect have been better if 10 Hz had been used? (5) The inclusion criteria for patients in this study were only patients with rotator cuff injuries. In clinical practice, rotator cuff injuries are often combined with subacromial impingement syndrome. Is the treatment of electroacupuncture combined with rehabilitation techniques applicable to such patients? and (6) The effective rate of the study group reported in this paper was 94.90%, and those patients who did not have any effect after treatment should be reported and analyzed.

CONCLUSION

In conclusion, the value of the results of this study is high, and the treatment methods adopted are relatively easy to obtain and inexpensive. For patients with rotator cuff injury in the early stage, this is an alternative and effective treatment method.