Shiheng Wang,1,2 Fengxia Zhang,3 Jing Chen,4 Guilong Fu2 

1School of Traditional Chinese Medicine, Binzhou Medical University, Yantai, Shandong, 264003, People’s Republic of China; 2Department of Rehabilitation Medicine, People’s Hospital of Ningxiang City, Hunan University of Chinese Medicine Affiliated Ningxiang Hospital, Ningxiang City, Changsha, 410600, People’s Republic of China; 3Institute of Basic Theory for Chinese Medicine, China Academy of Chinese Medical Sciences, Beijing, 100700, People’s Republic of China; 4College of Medical Imaging Laboratory and Rehabilitation, Xiangnan University, Chenzhou, Hunan, 423000, People’s Republic of China

Correspondence: Jing Chen, College of Medical Imaging Laboratory and Rehabilitation, Xiangnan University, No. 25, West Renmin Road, BeiHu District, Chenzhou, Hunan Province, 42300, People’s Republic of China, Tel +8618075537186, Email chenjing010@126.com Guilong Fu, People’s Hospital of Ningxiang City, Hunan University of Chinese Medicine Affiliated Ningxiang Hospital, No. 209, First Ring Road, Yutan Street, Ningxiang City, Hunan, 410600, People’s Republic of China, Tel +86 15273181245, Email 1085611364@qq.com

Background: Frozen Shoulder (FS), a debilitating stage of scapulohumeral periarthritis (SP), significantly impairs daily life and working capacity. Compared with pharmacological treatments and surgical interventions, Tuina offers the advantages of being non-invasive and safe. Although substantial clinical evidence supports the efficacy of Tuina in treating FS, most studies involve its combination with other therapeutic modalities. The effectiveness and safety of various Tuina combinations remain unclear. Therefore, a network meta-analysis is warranted to provide a more comprehensive evidence-based foundation for clinical decision-making.
Methods: Randomized controlled trials (RCTs) investigating Tuina for Frozen Shoulder were systematically retrieved from PubMed, Web of Science, Embase, Cochrane Library, CNKI, VIP, Wanfang, and SinoMed. The search was conducted up to May 20, 2025. Data analysis was performed using R 4.2.0 and Stata 16.0.
Results: A total of 23 RCTs involving 11 intervention measures were included. Network meta-analysis results indicated that the effective rates of Tuina combined with Acupotomy, Tuina combined with external application of traditional Chinese medicine, Tuina combined with acupuncture, and Tuina combined with Leverspin Technique were significantly higher than those of Tuina alone (P < 0.05). The top three rankings based on Surface Under the Cumulative Ranking Area (SUCRA) were as follows: Tuina combined with Leverspin Technique (0.81), Tuina combined with acupuncture (0.75), and Tuina combined with Acupotomy (0.64). Regarding Visual Analog Scale (VAS) scores, Tuina combined with Acupotomy demonstrated superior efficacy compared to Tuina alone (P < 0.05). The top three SUCRA rankings for VAS were: Tuina combined with Acupotomy (0.70), Tuina combined with Fu’s subcutaneous needling (0.66), and Tuina combined with acupuncture (0.65). Considering all factors, Tuina combined with acupuncture and Tuina combined with Acupotomy are the optimal intervention strategies for scapulohumeral periarthritis (Frozen Shoulder).
Conclusion: Based on the available evidence, Tuina combined with acupuncture and Tuina combined with Acupotomy represent the most effective interventions for scapulohumeral periarthritis (Frozen Shoulder). However, there is the possibility of heterogeneity and publication bias.further high-quality research is required to validate and refine these conclusions.

Keywords: Tuina, scapulohumeral periarthritis, frozen shoulder, network meta-analysis