Shoulder Pain

Shoulder Pain

The shoulder is a marvelous joint. The complex structure of the shoulder joint allows for an incredible range of motion.  We are able to move arms the way we do largely due to this flexibility.  Unfortunately, the shoulder joint has a relatively poor blood supply, so it is slow to heal when it is injured. Prevention is the best medicine for shoulder injuries.

Another checkmark in the “fortunately” column is that acupuncture is really good at improving circulation wherever it is applied.  In Chinese medicine speak, we say acupuncture promotes the circulation of Qi and Blood.  Qi and Blood are the healing regenerative forces of the body.  Free-moving Qi and Blood also stop pain.  Regardless of how you phrase it, acupuncture treats shoulder pain by invigorating the area, relaxing muscles and promoting healing.

What are the different types of shoulder pain treated by acupuncture?

Shoulder bursitis

Shoulder bursitis is inflammation of the bursa in the shoulder joint. Bursa is small sacs filled with fluid that cushion the joint and allow for smooth movement of the bone, tendons, and muscles. vThe causes of shoulder bursitis include injury, repetitive motion (athletics or manual labor), and impingement syndrome leading to inflammation. vThe symptoms of shoulder bursitis include pain with overhead activities, pain while sleeping at night, joint stiffness, swelling, and redness. vPain from shoulder bursitis is often felt over the outside of the shoulder/upper arm.

Rotator cuff tendinitis

The rotator cuff refers to all the muscles and tendons in and around the shoulder that work to stabilize the shoulder joint (glenohumeral joint). vThe four muscles of the rotator cuff are the supraspinatus, infraspinatus, teres minor and subscapularis muscles keep the bone of the upper arm (humerus) in the shoulder socket (glenoid fossa). Rotator cuff tendinitis is the swelling and inflammation of the tendons of these muscles.  Some of the causes of rotator cuff tendinitis include overuse, especially through athletic (throwing sports, tennis) or other physical (overhead lifting) activities.  The symptoms of a rotator cuff injury are a pain at rest or at night, especially upon lying on the affected shoulder, pain when raising and lowering your arm in specific ways, weakness when lifting and turning your arm, noises in the shoulder joint when moving in certain ways.

Shoulder impingement syndrome

Shoulder impingement syndrome is the combination of shoulder bursitis and rotator cuff tendinitis.  Typically, both causes of shoulder pain are present, but the degree of one versus the other may vary. Regardless, the swelling and inflammation of the tendons and bursa cause a narrowing of the space of the shoulder joint.  This leads to pain and restricted movement.  Supraspinatus tendonitis is another part of shoulder impingement syndrome.

Frozen shoulder (adhesive capsulitis)

Connective tissue forms a “capsule” around the bones, ligaments, and tendons of the shoulder.  If this capsule thickens or tightens, frozen shoulder can occur.  The inflammation associated with frozen shoulder causes severe pain and restricted range of motion.  Most of the time, there isn’t a cause of frozen shoulder, but it has been noticed that people with cervical spine (neck) injuries, diabetes, those who have had shoulder or open heart surgery, and hyperthyroidism are at an increased risk for frozen shoulder.  The symptoms of frozen shoulder are ranged by stage:

  • Stage One (painful stage): pain with movement, decreased range of motion
  • Stage Two (frozen stage): less pain but more stiffness, further decrease in range of motion
  • Stage Three (thawing stage): improved range of motion

Shoulder instability

If the ligaments and tendons that hold the shoulder together become stretched out or weakened in any way, the shoulder may easily separate or dislocate.  This is called shoulder instability, and the shoulder can be partially (subluxated) or fully dislocated forward or backward.  The causes of shoulder instability include direct injury, post-traumatic instability, joint laxity (hypermobility, as seen in the very flexible and pregnant women), and overuse, especially through swimming or throwing.  The symptoms of shoulder instability include frequent dislocations or separations without direct trauma.

Shoulder arthritis

One of the ways our body has to protect its joints is to cover the ends of bones in cartilage.  This prevents the bones from directly rubbing together.  When the protective cartilage breaks down with age, osteoarthritis results.  Rheumatoid arthritis is an autoimmune disease that causes inflammation and swollen joints.  Direct injury may also be a causative factor in the development of shoulder arthritis.  The symptoms of arthritis include pain, tenderness, stiff and inflexible joints and possibly bone spurs.

Biceps tendinitis

The biceps muscle connects to the shoulder bones to the arm via tendons.  When this tendon becomes inflamed, irritated, or torn, pain can result.  The pain of biceps tendinitis is felt in the front of the shoulder.  The causes of biceps tendinitis include overuse (especially due to overhead activities like swimming, tennis, and baseball) and an underlying rotator cuff injury.  The symptoms of biceps tendinitis disorders include pain and swelling in the front of the arm.

Labral Tear

The labrum of the shoulder lubricates and absorbs shock within the shoulder joint.  If it detaches from the tendons and tears, a pain will occur.  This is also known as a glenoid labrum tear or informally as a shoulder joint tear.  The causes of labral tears are overuse, especially in athletes using overhead motion (throwing, swimming), falling on an outstretched arm, direct trauma to the shoulder, and sudden pulling motions (a dog pulling on a leash or lifting a heavy object).  The symptoms of labral tears include pain on overhead activities, catching or locking of the shoulder joint, popping or other sounds in the shoulder joint, shoulder instability, decreased the range of motion and loss of strength.

How is shoulder pain diagnosed by my doctor?

Your doctor will diagnose your shoulder pain after evaluating your shoulder by:

  • Taking a medical history
  • Performing physical exam
  • Imaging tests, including X-ray, MRI, or computerized tomography (CT)

How does my doctor treat shoulder pain?

Your doctor will likely prescribe some of the following treatments for shoulder pain:

  • Icing and resting the shoulder
  • Drugs to ease pain (analgesics and NSAIDs)
  • Drugs to decrease inflammation
  • Physical therapy and stretching
  • Steroid Injections
  • Surgery and/or joint replacement

How does an acupuncturist evaluate and treat shoulder pain diagnosis?

The body is covered by a network of acupuncture meridians.  When a patient is experiencing pain, my first step in evaluating that person is to determine which of the meridians is affected, that is which ones cross over the areas of pain.  Pain from an acupuncture perspective is a blockage in the meridian, so acupuncture is applied to remove those blockages.  I can also use herbal medicine to help unblock the meridians from the inside out.

In addition to acupuncture and Chinese herbal medicine, I use Tuina medical massage, cupping, Guasha and other adjunct techniques.

I also take time to evaluate a patient’s overall health.  By improving general health, so Chinese medicine theory says, problems like shoulder pain are less likely to arise.  From another perspective, you can fix the shoulder, but if the shoulder pain is being caused by something else, the pain will come back when treatments are stopped.  So, it’s important to treat the symptoms but also treat the underlying root cause.  This is why we always treat the whole person in Chinese medicine.