Korean J Pain.  2020 Oct;33(4):344-351. 10.3344/kjp.2020.33.4.344.

The effect of postoperatively applied far-infrared radiation on pain and tendon-to-bone healing after arthroscopic rotator cuff repair: a clinical prospective randomized comparative study

• Yoon JY
• Park JH
• Lee KJ
• Kim HS
• Rhee SM
• Oh JH

• KMID: 2507140
• DOI: http://doi.org/10.3344/kjp.2020.33.4.344

Abstract

Background
The effects of far-infrared radiation (FIR) on the treatment of rotator cuff diseases remains unknown. We evaluated the safety and efficacy of FIR after arthroscopic rotator cuff repair with regard to postoperative pain and healing.
Methods
This prospective randomized comparative study included 38 patients who underwent arthroscopic rotator cuff repair due to a medium-sized tear. Patients were randomly divided into the FIR or control group (n = 19 per group). In the FIR group, FIR with an FIR radiator started 1 week postoperatively for 30 minutes per session twice daily. It lasted until abduction brace weaning at 5 weeks postoperatively. We assessed pain using a pain visual analogue scale (pVAS) and measured the range of motion (ROM) of the shoulder at 5 weeks, and 3 and 6 months, postoperatively. The anatomical outcome was evaluated using magnetic resonance imaging at 6 months postoperatively.
Results
At 5 weeks postoperatively, the average pVAS score was lower in the FIR group than in the control group (1.5 ± 0.8 vs. 2.7 ± 1.7; P = 0.019). At 3 months postoperatively, the average forward flexion was higher in the FIR group (151.6° ± 15.3° vs. 132.9° ± 27.8°;P = 0.045), but there was no significant difference at 6 months postoperatively. There was no significant difference in healing failure between the groups (P = 0.999).
Conclusions
FIR after arthroscopic rotator cuff repair could be an effective and safe procedure to reduce postoperative pain, thereby facilitating rehabilitation and better ROM in the early postoperative period.

Keyword

Far-infrared Radiation; Pain Visual Analog Scale; Postoperative Pain; Range of Motion; Rehabilitation; Rotator Cuff Repair; Rotator Cuff Tears; Shoulder Pain

Figure

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  Fig. 1 Consolidated Standards of Reporting Trials flow diagram of the study is shown. FIR, far-infrared radiation.

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  Fig. 2 Far-infrared radiation (FIR) with an FIR radiator: wave length 2-25 µm (Aladdin-H®; Taerim Medical Co. Ltd., Seongnam, Korea).

Reference

1. Yamaguchi K, Ditsios K, Middleton WD, Hildebolt CF, Galatz LM, Teefey SA. 2006; The demographic and morphological features of rotator cuff disease. A comparison of asymptomatic and symptomatic shoulders. J Bone Joint Surg Am. 88:1699–704. DOI: 10.2106/00004623-200608000-00002. PMID: 16882890.

2. Kukkonen J, Kauko T, Virolainen P, Äärimaa V. 2015; The effect of tear size on the treatment outcome of operatively treated rotator cuff tears. Knee Surg Sports Traumatol Arthrosc. 23:567–72. DOI: 10.1007/s00167-013-2647-0. PMID: 23996071.

3. Baumgarten KM, Vidal AF, Wright RW. 2009; Rotator cuff repair rehabilitation: a level I and II systematic review. Sports Health. 1:125–30. DOI: 10.1177/1941738108331200. PMID: 23015863. PMCID: PMC3445070.

4. Oh JH, Yoon JY. 2020; Various regimens for the functional recovery after arthroscopic shoulder surgery. J Korean Orthop Assoc. 55:103–16. DOI: 10.4055/jkoa.2020.55.2.103.

5. Toyokawa H, Matsui Y, Uhara J, Tsuchiya H, Teshima S, Nakanishi H, et al. 2003; Promotive effects of far-infrared ray on full-thickness skin wound healing in rats. Exp Biol Med (Maywood). 228:724–9. DOI: 10.1177/153537020322800612. PMID: 12773705.

6. Wong CH, Lin LC, Lee HH, Liu CF. 2012; The analgesic effect of thermal therapy after total knee arthroplasty. J Altern Complement Med. 18:175–9. DOI: 10.1089/acm.2010.0815. PMID: 22339105.

7. Vatansever F, Hamblin MR. 2012; Far infrared radiation (FIR): its biological effects and medical applications. Photonics Lasers Med. 4:255–66. DOI: 10.1515/plm-2012-0034. PMID: 23833705. PMCID: PMC3699878.

8. Li K, Zhang Z, Liu NF, Feng SQ, Tong Y, Zhang JF, et al. 2017; Efficacy and safety of far infrared radiation in lymphedema treatment: clinical evaluation and laboratory analysis. Lasers Med Sci. 32:485–94. DOI: 10.1007/s10103-016-2135-0. PMID: 28127644.

9. Dominguez-Vidal A, Kaun N, Ayora-Cañada MJ, Lendl B. 2007; Probing intermolecular interactions in water/ionic liquid mixtures by far-infrared spectroscopy. J Phys Chem B. 111:4446–52. DOI: 10.1021/jp068777n. PMID: 17408256.

10. Akasaki Y, Miyata M, Eto H, Shirasawa T, Hamada N, Ikeda Y, et al. 2006; Repeated thermal therapy up-regulates endothelial nitric oxide synthase and augments angiogenesis in a mouse model of hindlimb ischemia. Circ J. 70:463–70. DOI: 10.1253/circj.70.463. PMID: 16565566.

11. Oh JH, Oh CH, Kim SH, Kim JH, Yoon JP, Jung JH. 2012; Clinical features of partial anterior bursal-sided supraspinatus tendon (PABST) lesions. J Shoulder Elbow Surg. 21:295–303. DOI: 10.1016/j.jse.2011.07.025. PMID: 22036541.

12. Oh JH, Kim SH, Lee HK, Jo KH, Bin SW, Gong HS. 2008; Moderate preoperative shoulder stiffness does not alter the clinical outcome of rotator cuff repair with arthroscopic release and manipulation. Arthroscopy. 24:983–91. DOI: 10.1016/j.arthro.2008.06.007. PMID: 18760204.

13. Kocher MS, Horan MP, Briggs KK, Richardson TR, O'Holleran J, Hawkins RJ. 2005; Reliability, validity, and responsiveness of the American Shoulder and Elbow Surgeons subjective shoulder scale in patients with shoulder instability, rotator cuff disease, and glenohumeral arthritis. J Bone Joint Surg Am. 87:2006–11. DOI: 10.2106/00004623-200509000-00014. PMID: 16140816.

14. Beaton DE, Richards RR. 1996; Measuring function of the shoulder. A cross-sectional comparison of five questionnaires. J Bone Joint Surg Am. 78:882–90. DOI: 10.2106/00004623-199606000-00011. PMID: 8666606.

15. Codsi MJ, Rodeo SA, Scalise JJ, Moorehead TM, Ma CB. 2014; Assessment of rotator cuff repair integrity using ultrasound and magnetic resonance imaging in a multicenter study. J Shoulder Elbow Surg. 23:1468–72. DOI: 10.1016/j.jse.2014.01.045. PMID: 24751529.

16. Lin CC, Chang CF, Lai MY, Chen TW, Lee PC, Yang WC. 2007; Far-infrared therapy: a novel treatment to improve access blood flow and unassisted patency of arteriovenous fistula in hemodialysis patients. J Am Soc Nephrol. 18:985–92. DOI: 10.1681/ASN.2006050534. PMID: 17267744.

17. Yu SY, Chiu JH, Yang SD, Hsu YC, Lui WY, Wu CW. 2006; Biological effect of far-infrared therapy on increasing skin microcirculation in rats. Photodermatol Photoimmunol Photomed. 22:78–86. DOI: 10.1111/j.1600-0781.2006.00208.x. PMID: 16606412.

18. Lin YH, Li TS. 2017; The application of far-infrared in the treatment of wound healing: a short evidence-based analysis. J Evid Based Complementary Altern Med. 22:186–8. DOI: 10.1177/2156587215623436. PMID: 26703225. PMCID: PMC5871200.

19. Arany PR, Nayak RS, Hallikerimath S, Limaye AM, Kale AD, Kondaiah P. 2007; Activation of latent TGF-beta1 by low-power laser in vitro correlates with increased TGF-beta1 levels in laser-enhanced oral wound healing. Wound Repair Regen. 15:866–74. DOI: 10.1111/j.1524-475X.2007.00306.x. PMID: 18028135.

20. Breivik H. 1998; Postoperative pain management: why is it difficult to show that it improves outcome? Eur J Anaesthesiol. 15:748–51. DOI: 10.1097/00003643-199811000-00022. PMID: 9884866.

21. Owen H, McMillan V, Rogowski D. 1990; Postoperative pain therapy: a survey of patients' expectations and their experiences. Pain. 41:303–7. DOI: 10.1016/0304-3959(90)90007-Z.

22. Rhee SM, Chung NY, Jeong HJ, Oh JH. 2018; Subacromial local anesthetics do not interfere with rotator cuff healing after arthroscopic repair. Am J Sports Med. 46:1097–105. DOI: 10.1177/0363546517753827. PMID: 29470095.

23. Fredrickson MJ, Ball CM, Dalgleish AJ. 2010; Analgesic effectiveness of a continuous versus single-injection interscalene block for minor arthroscopic shoulder surgery. Reg Anesth Pain Med. 35:28–33. DOI: 10.1097/AAP.0b013e3181c771bd. PMID: 20048655.

24. Warrender WJ, Syed UAM, Hammoud S, Emper W, Ciccotti MG, Abboud JA, et al. 2017; Pain management after outpatient shoulder arthroscopy: a systematic review of randomized controlled trials. Am J Sports Med. 45:1676–86. DOI: 10.1177/0363546516667906. PMID: 27729319.

25. 1989; Regulation of the acute phase and immune responses: interleukin-6. Ann N Y Acad Sci. 557:1–583.

26. Oh JH, Kim WS, Kim JY, Gong HS, Rhee KY. 2007; Continuous intralesional infusion combined with interscalene block was effective for postoperative analgesia after arthroscopic shoulder surgery. J Shoulder Elbow Surg. 16:295–9. DOI: 10.1016/j.jse.2006.04.015. PMID: 17321159.

27. Martin P. 1997; Wound healing--aiming for perfect skin regeneration. Science. 276:75–81. DOI: 10.1126/science.276.5309.75. PMID: 9082989.

28. Yu W, Naim JO, Lanzafame RJ. 1994; Expression of growth factors in early wound healing in rat skin. Lasers Surg Med. 15:281–9. DOI: 10.1002/lsm.1900150308. PMID: 7830474.

29. Masuda A, Koga Y, Hattanmaru M, Minagoe S, Tei C. 2005; The effects of repeated thermal therapy for patients with chronic pain. Psychother Psychosom. 74:288–94. DOI: 10.1159/000086319. PMID: 16088266. PMCID: PMC7368217.

30. Ou SM, Hu FH, Yang WC, Lin CC. 2014; Far-infrared therapy as a novel treatment for encapsulating peritoneal sclerosis. Am J Gastroenterol. 109:1957–9. DOI: 10.1038/ajg.2014.352. PMID: 25470591.