Updated: Feb 17
Shoulder pain is very common: about 3 in 10 adults are affected by them at any one time. Frozen shoulder and rotator cuff disorders are most common in middle-aged and older people.
Frozen shoulder is a painful condition in the shoulder. The medical term for frozen shoulder is adhesive capsulitis. It presents a painful persistent stiffness of the shoulder joint that it is difficult to carry out everyday tasks such as dressing, driving and sleeping comfortably. Some people are unable to move their shoulder at all. This is caused when the capsule surrounds the shoulder joint becomes inflamed. The capsule that surrounds your shoulder joint becomes swollen, thickened and tightened This leaves less space for your upper arm bone in the shoulder joint, and makes the movement stiff and painful. The symptoms of frozen shoulder can vary greatly, but tend to get worse slowly over the time. They are usually felt in three stages spread over a number of months or years. This is a common condition affecting about 2% of adults.
The most common symptoms are pain and stiffness in the shoulder. Also the amount of movement in affected shoulder joint is reduced. In severe cases, the shoulder may not be moved at all. Though it is a common condition, the treatment remains challenging. Jain and Sharma from University of Kansas Medical Center USA reviewed current best evidence for the use of physical therapy intervention for frozen shoulder. Therapeutic exercises and mobilization are strongly recommended for reducing pain, improving range of motion and function in patients with stage 2 and 3 of frozen shoulder. Low level laser therapy is strongly suggested for pain relief and moderately suggested for improving function but not recommended for improving range of motion. Corticosteroid injections can be used for stage 1 frozen shoulder. Acupuncture is an option of treatment. Acupuncture with therapeutic exercises is moderately recommended for pain relief, improving range of motion and function.
Many case reports were published showing effectiveness of acupuncture in reducing pain on frozen shoulder. For example, Wang XH et al observed 60 cases with frozen shoulder. These patients were divided into two groups for acupuncture or acupuncture plus moxibustion treatments. The acupuncture points selected were Jianyu (LI15), Jianliao (TE14) and Jianzhen (SI9). Tender points were also selected in acupuncture-moxibustion group. They found that acupuncture alone or acupuncture plus moxibustion were effective for frozen shoulder. Acupuncture combined with moxibustion may have better cured rate, but the effective rate has no significant difference. Some clinical trials suggest that acupuncture may improve recovery in patients with a frozen shoulder, either when used alone or in combination with physiotherapy. Acupuncture has effect of frozen shoulder in reducing pain, inflammation muscle and joint stiffness. This is because acupuncture stimulates nerve ends releasing analgesic substances such as endorphins; it reduces inflammation and improves local blood flow. The meridians involved in treating frozen shoulders are muscle meridian of Hand-Yangming, Hand-Shaoyang, Hand-Taiyang, and three yin meridians of hand appeared at proximal points of shoulder joint. A research investigated the short and medium-term effects of acupuncture on pain relief and improvement of shoulder function for frozen shoulder. 21 patients with frozen shoulder participated the study. They received 18 sessions of treatments over 6-9 weeks. Follow-up check at 1, 3 and6 months was carried out. The result has show that Significant pain reduction was observed; shoulder flexion and abduction movement was increased. Acupuncture is effective to reduce pain from frozen shoulder like any other chronic pain condition.
Rotator cuff disorders
The rotator cuff is a group of tendons and muscles in the shoulder, connecting the upper arm to the shoulder blade. The rotator cuff tendons provide stability to the shoulder; the muscles allow the shoulder to rotate. The rotator cuff keeps the joint in the correct position, allowing it to move in a controlled way. It keeps the upper arm bone in the shoulder socket and it raises and twists the arm. If it is irritated or damaged, rotator cuff disorders occur. Rotator cuff disorders include inflammation of the tendons or a bursa; impingement in which a tendone is squeezed and rubs against bone, calcium buildingup in the tendons, tears of the tendons. Rotator cuff disorders are common cause of shoulder pain. Most rotator cuff disorders are caused by a combination of normal wear and tear and overuse. Using the shoulder for many years slowly damages the rotator cuff. As ageing, everyday activities can lead to changes in the rotator cuff, such as thinning and fraying of the tendons and reduced blood supply. Activities in which you use your arms above your head a lot-such as tennis, swimming, or house painting-can lead to rotator cuff problems. Even normal motions made often over a long period can stress or injure the rotator cuff. A simple movement like lifting a suitcase can cause a rotator cuff tear in an older adult or someone whose shoulder is already damaged. Symptoms of a rotator cuff disorder include pain and weakness in the shoulder. Most often, the pain is on the side and front of the upper arm and shoulder. It may hurt or be impossible to do everyday things, such as comb hair, tuck in shirt, or reach for something. You may have pain during the night and trouble sleep. It is important to treat a rotator cuff problem. Without treatment, it may get weaker and lifting up your arm could be a problem. Acupuncture is very effective to treat rotator cuff disorder and helps reducing the inflammation and pain, relaxing rotator cuff muscles and improving blood supply.
New research shows that acupuncture is effective for shoulder pain
Recently a report has shown the effectiveness of acupuncture for shoulder impingement syndrome. In this report the effect of acupuncture in decreasing the intensity of short- and mid-term pain in the injured shoulder was studied. 68 participants with a mean age of 33.4 years were divided into two groups: one group received true acupuncture and the other received acupuncture at sham points. The treatment was carried out over 4 weeks, with the participants receiving a session every week. The result has shown significant difference in pain reduction between two groups both after treatment and 3 months after treatments. No side effects were reported.
Acupuncture is effective for shoulder pain. Here is a study showing this. In this study, 30 patients with age from 38-73 with shoulder pain were selected. Average shoulder pain duration was 3.8 years. 50% received medical treatments at least before 6 months but the pain was still there. These patients received 10 sessions of acupuncture. The result has shown that pain score was decreased significantly on the sixth session (-27.3%) and tenth session (-43%). The muscle stiffness was reduced for all patients. The improvement in shoulder function at the tenth acupuncture session reached 44%. The response of acupuncture therapy was variable among patients. It changed according to patients' age and symptoms duration. Of course a good response was statistically correlated with younger age and recent pain.This study provides additional data on the potential role of acupuncture in the treatment of shoulder pain. Acupuncture is beneficial and effective for relieving pain and improving shoulder function. It can be a good alternative, especially, for patients developing adverse effects related to drugs. Wang et al has analysed some clinical trial to study the acupuncture points for shoulder pain and they assessed the effectiveness of Ashi points stimulation on response rate compared with conventional acupuncture. They have found that there was a significantly greater recovery rate in group of Ashi points stimulation. The conclusion was Ashi points stimulation might be superior to conventional acupuncture, drug therapy and no treatment forshoulder pain. Another study compared the effect of trigger point acupuncture (TrP), with that of sham (SH)acupuncture treatments, on pain and shoulder function in patients with chronic shoulder pain. After treatment, pain intensity between pretreatment and 5 weeks after TrP decreased significantly. Shoulder function also increased significantly between pretreatment and 5 weeks after TrP. Compared with SH acupuncture therapy, TrP therapy appears more effective for chronic shoulder pain.
References Wang XH Zhongguo Zhen Jiu (2010) 30:364-6
Jain TK and Sharma NK J Back Musculoskelet Rehabil (2013) Nov 27
You Z et al Zhongguo Zhen Jiu (2014) 34:565-8
Wang et al Chin Integr Med (2015) Jun 30
Itoh K et l J Acupunct Meridian Stud (2014) 7:59-64
Rueda Garrido JC et al Complement Ther Med (2016) 25:92-7
J Formos Med Assoc. 2019 May 13. pii: S0929-6646(18)30923-9. doi: 10.1016/j.jfma.2019.03.012. [Epub ahead of print]