Acupoint Embedding Combined with Radial Extracorporeal Shock Wave Therapy Versus Conventional Pharmacotherapy for Poststroke Shoulder–Hand Syndrome: A Retrospective Cohort Study on Pain,Motor Recovery,and Inflammatory Biomarkers

Abstract

Background

Shoulder–hand syndrome (SHS) is a common and difficult-to-treat complication after stroke, with conventional drug therapy often providing only short-term relief.

Objective

This study aimed to compare the efficacy of acupoint embedding therapy combined with radial extracorporeal shock-wave therapy (rESWT) versus standard drugs for poststroke SHS.

Methods

A total of 104 patients with stage I poststroke SHS were divided into a combination group (n = 55, receiving acupoint embedding and rESWT for 4 weeks) and a control group (n = 49, receiving conventional drug therapy). Outcomes measured included pain (VAS), upper limb motor function [Fugl–Meyer Assessment-Upper Extremity (FMA-UE)], daily living ability (modified Barthel index), hand swelling, surface electromyography (sEMG) parameters, shoulder passive range of motion (PROM), and serum inflammatory factors (TNF-α, IL-6).

Results

After 4 weeks, the combination group was associated with significantly greater improvement than the control group in all measured outcomes (all P < .05), including pain relief, functional recovery, reduced swelling, better shoulder PROM, improved muscle activation, and lower inflammatory markers. The combination group also had a higher total clinical effective rate (89.09% vs. 79.59%, P = .036) and a lower incidence of adverse events (14.55% vs. 34.69%, P = .016).

Conclusion

For poststroke SHS, the combination of acupoint embedding and rESWT was associated with greater improvements than conventional drug therapy, providing superior pain relief, functional recovery, and anti-inflammatory effects, with a better safety profile.

Keywords

shoulder–hand syndrome stroke acupoint embedding therapy radial extracorporeal shock-wave therapy

Get full access to this article

View all access options for this article.

References

Babazadeh-Zavieh

S. S.

Ansari

N. N.

Ghotbi

Naghdi

Mansouri

Khanmohammadi

Haeri

S. M. J.

(2022). Effects of dry needling plus exercise therapy on post-stroke spasticity and motor function: A case report. Complementary Therapies in Clinical Practice, 46, 101520. https://doi.org/10.1016/j.ctcp.2021.101520

Brunelli

Gentileschi

Spanò

Pratesi

Calvani

Mucci

Foti

(2022). Effect of early radial shock wave treatment on spasticity in subacute stroke patients: A pilot study. BioMed Research International, 2022, 8064548. https://doi.org/10.1155/2022/8064548

Castro

B. K. C.

Corrêa

F. G.

Maia

L. B.

Oliveira

V. C.

(2021). Effectiveness of conservative therapy in tendinopathy-related shoulder pain: A systematic review of randomized controlled trials. Physical Therapy in Sport, 49, 15–20. https://doi.org/10.1016/j.ptsp.2021.01.010

Feigin, V. L., Brainin, M., Norrving, B., Martins, S. O., Pandian, J., Lindsay, P., F Grupper, M., & Rautalin, I. (2025). World stroke organization: Global stroke fact sheet 2025. International Journal of Stroke, 20(2), 132–144. https://doi.org/10.1177/17474930241308142

Ferraro

M. C.

O'Connell

N. E.

Sommer

Goebel

Bultitude

J. H.

Cashin

A. G.

Moseley

G. L.

McAuley

J. H.

(2024). Complex regional pain syndrome: Advances in epidemiology, pathophysiology, diagnosis, and treatment. Lancet Neurology, 23(5), 522–533. https://doi.org/10.1016/S1474-4422(24)00076-0

Gao

Chen

Shen

(2025). Effectiveness of acupuncture and moxibustion combined with rehabilitation training for post-stroke shoulder-hand syndrome: A systematic review and meta-analysis. Frontiers in Neurology, 16, 1576595. https://doi.org/10.3389/fneur.2025.1576595

Gao

Nie

Zhu

Kuang

Wang

Chen

Zhang

Zheng

Xia

Yin

Pan

Xie

(2020). Non-pharmaceutical therapy for post-stroke shoulder-hand syndrome: Protocol for a systematic and network meta-analysis. Medicine (Baltimore), 99(23), e20527. https://doi.org/10.1097/MD.0000000000020527

Harden

R. N.

McCabe

C. S.

Goebel

Massey

Suvar

Grieve

Bruehl

(2022). Complex regional pain syndrome: Practical diagnostic and treatment guidelines, 5th edition. Pain Medicine, 23(Suppl 1), S1–s53. https://doi.org/10.1093/pm/pnac046

Heide

Røe

Mørk

Myhre

Brunborg

Brox

J. I.

Hoksrud

A. F.

(2024). Is radial extracorporeal shock wave therapy (rESWT), sham-rESWT or a standardised exercise programme in combination with advice plus customised foot orthoses more effective than advice plus customised foot orthoses alone in the treatment of plantar fasciopathy? A double-blind, randomised, sham-controlled trial. British Journal of Sports Medicine, 58(16), 910–918. https://doi.org/10.1136/bjsports-2024-108139

10.

Helboe

K. S.

Eddelien

H. S.

Kruuse

(2023). Visual symptoms in acute stroke – A systematic review of observational studies. Clinical Neurology and Neurosurgery, 229, 107749. https://doi.org/10.1016/j.clineuro.2023.107749

11.

Huang

Yao

Huang

Wang

Zhou

Huang

Tan

Jie

Wang

Yang

Liang

Yue

Mao

Lai

Zheng

(2023). Effectiveness of acupuncture for pain relief in shoulder-hand syndrome after stroke: A systematic evaluation and Bayesian network meta-analysis. Frontiers in Neurology, 14, 1268626. https://doi.org/10.3389/fneur.2023.1268626

12.

Kanika Goyal

Goyal

(2023). Effectiveness of the physiotherapy interventions on complex regional pain syndrome in patients with stroke: A systematic review and meta-analysis. Journal of Bodywork and Movement Therapies, 35, 175–181. https://doi.org/10.1016/j.jbmt.2023.04.040

13.

Kazemi

A. H.

Adel-Mehraban

M. S.

Jamali Dastjerdi

Alipour

(2024). A comprehensive practical review of acupoint embedding as a semi-permanent acupuncture: A mini review. Medicine (Baltimore), 103(23), e38314. https://doi.org/10.1097/MD.0000000000038314

14.

Khalifa

H. A.

Darwish

M. H.

El-Tamawy

M. S.

Elazizy

H. M.

Abu Ella

I. A.

Abo-Zaid

N. A.

Abdelkhalek

M. M.

Moustafa

E. B. S.

(2023). The influence of radial extracorporeal shock wave therapy on shoulder pain and structural abnormalities in stroke patients. Archives of Medical Science, 19(6), 1731–1738. https://doi.org/10.5114/aoms/151477

15.

Kim

H. J.

Choi

Jung

Park

Joo

Lee

(2022). Efficacy of radial extracorporeal shockwave therapy in rehabilitation following arthroscopic rotator cuff repair: A STROBE compliant study. Medicine (Baltimore), 101(35), e30053. https://doi.org/10.1097/MD.0000000000030053

16.

Lei

Dai

Xue

Zhang

Wang

Zhang

Cong

Wang

(2022). Acupuncture for shoulder-hand syndrome after stroke: An overview of systematic reviews. Medicine (Baltimore), 101(46), e31847. https://doi.org/10.1097/MD.0000000000031847

17.

Lima Pessôa

Netto

J. G. M.

Adolphsson

Longo

Hauwanga

W. N.

McBenedict

(2024). Complex regional pain syndrome: Diagnosis, pathophysiology, and treatment approaches. Cureus, 16(12), e76324. https://doi.org/10.7759/cureus.76324

18.

Liu

Zhou

Duan

Huo

Nie

Liu

Sun

Wei

Zhang

Yuan

Zheng

Liu

Wang

Miao

Wang

(2023). Chinese Stroke Association guidelines for clinical management of ischaemic cerebrovascular diseases: Executive summary and 2023 update. Stroke and Vascular Neurology, 8(6), e3. https://doi.org/10.1136/svn-2023-002998

19.

Money

(2019). Pathophysiology of complex regional pain syndrome and treatment: Recent advancements. Current Emergency and Hospital Medicine Reports, 7(4), 203–207. https://doi.org/10.1007/s40138-019-00198-x

20.

Monsour

Rodriguez

R. A.

Sheikh

Campbell

T. M.

(2021). Patient tolerability of suprascapular and median nerve blocks for the management of pain in post-stroke shoulder-hand syndrome. Neurological Sciences, 42(3), 1123–1126. https://doi.org/10.1007/s10072-020-04816-5

21.

Page

S. J.

Fulk

G. D.

Boyne

(2012). Clinically important differences for the upper-extremity Fugl-Meyer scale in people with minimal to moderate impairment due to chronic stroke. Physical Therapy, 92(6), 791–798. https://doi.org/10.2522/ptj.20110009

22.

Pan

Ling

Yang

Huang

Zhan

Zhong

Chen

(2021). Clinical study of Qingpeng ointment treating shoulder-hand syndrome after cerebral hemorrhage during the rehabilitation period. Combinatorial Chemistry & High Throughput Screening, 24(7), 968–975. https://doi.org/10.2174/1386207323666201211093227

23.

Saldiran

Yazgan

Akgöl

A. C.

Mutluay

F. K.

(2022). Radial shock-wave therapy for frozen shoulder patients with type 2 diabetes mellitus: A pilot trial comparing two different energy levels. European Journal of Physical and Rehabilitation Medicine, 58(3), 412–422. https://doi.org/10.23736/S1973-9087.22.07087-3

24.

Senarath

I. D.

Thalwathte

R. D.

Pathirage

Kularatne

S.A.M.

(2023). The effectiveness of radial extracorporeal shock wave therapy vs transcutaneous electrical nerve stimulation in the management of upper limb spasticity in chronic-post stroke hemiplegia–A randomized controlled trial. PLoS One, 18(5), e0283321. https://doi.org/10.1371/journal.pone.0283321

25.

Shafiee

MacDermid

Packham

Walton

Grewal

Farzad

(2023). The effectiveness of rehabilitation interventions on pain and disability for complex regional pain syndrome: A systematic review and meta-analysis. Clinical Journal of Pain, 39(2), 91–105. https://doi.org/10.1097/AJP.0000000000001089

26.

Shi

Chen

Liu

Bian

Sun

Rong

Liu

(2025). Acupuncture versus rehabilitation for post-stroke shoulder-hand syndrome: A systematic review and meta-analysis of randomized controlled trials. Frontiers in Neurology, 16, 1488767. https://doi.org/10.3389/fneur.2025.1488767

27.

Shi

Wang

Liu

Wang

(2023). Effectiveness of Huangqi Guizhi Wuwu decoction combined with rehabilitation training for shoulder hand syndrome after stroke: A systematic review and meta-analysis. Medicine (Baltimore), 102(47), e36282. https://doi.org/10.1097/MD.0000000000036282

28.

Siamwala

J. H.

Moossazadeh

D. G.

Macaulay

T. R.

Becker

R. L.

Hargens

R. H.

Hargens

A. R.

(2018). Aging decreases hand volume expansion with water immersion. Frontiers in Physiology, 9, 72. https://doi.org/10.3389/fphys.2018.00072

29.

Spekker

Tanaka

Szabó

Á.

Vécsei

(2021). Neurogenic inflammation: The participant in migraine and recent advancements in translational research. Biomedicines, 10(1), 76. https://doi.org/10.3390/biomedicines10010076

30.

Tache-Codreanu

D. L.

David

Tache-Codreanu

A. M.

Sporea

Burcea

C. C.

Blendea

D. C.

Morcov

M. V.

Cioca

I. E.

(2025). rESWT in shoulder periarthritis: Does the protocol intensity matter?—A Quasi-experimental non-randomized comparative study. Life (Basel), 15(6), 922. https://doi.org/10.3390/life15060922

31.

Wang

Xiao

Lin

Zhang

Dong

(2026). Efficacy and safety of acupuncture or moxibustion combined with rehabilitation therapy for post-stroke shoulder-hand syndrome: A systematic review and meta-analysis of randomized controlled trials. Journal of Stroke & Cerebrovascular Diseases, 35(1), 108509. https://doi.org/10.1016/j.jstrokecerebrovasdis.2025.108509

32.

Wang

Y. C.

Chang

P. F.

Chen

Y. M.

Lee

Y. C.

Huang

S. L.

Chen

M. H.

Hsieh

C. L.

(2023). Comparison of responsiveness of the Barthel Index and modified Barthel index in patients with stroke. Disability and Rehabilitation, 45(6), 1097–1102. https://doi.org/10.1080/09638288.2022.2055166

33.

Wen

Zha

Liu

Peng

Liu

Yang

Wang

(2022). Therapeutic role of additional mirror therapy on the recovery of upper extremity motor function after stroke: A single-blind, randomized controlled trial. Neural Plasticity, 2022, 8966920. https://doi.org/10.1155/2022/8966920

34.

Zhang

Fan

C.-x.

Zhu

P.-y.

Qin

Wang

(2019). Clinical efficacy evaluation of body acupuncture and scalp acupuncture combined with extracorporeal shock wave for scapulohumeral periarthritis. World Journal of Acupuncture - Moxibustion, 29(2), 108–112. https://doi.org/10.1016/j.wjam.2019.06.005

35.

Zhang

Zhao

Bai

Wang

Zhao

, & Chinese Stroke Association Stroke Council Guideline Writing Committee. (2020). Chinese Stroke Association guidelines for clinical management of cerebrovascular disorders: Executive summary and 2019 update of clinical management of stroke rehabilitation. Stroke and Vascular Neurology, 5(3), 250–259. https://doi.org/10.1136/svn-2019-000321

36.

Zhao

Zhang

Chen

Wei

(2022). Neuronal injuries in cerebral infarction and ischemic stroke: From mechanisms to treatment (review). International Journal of Molecular Medicine, 49(2), 15. https://doi.org/10.3892/ijmm.2021.5070