Pain & Acupuncture

Treatment for Shoulder Pain

By Markov ⋅ March 6, 2009 ⋅  Print This Post ⋅ Post a comment

Introduction

Shoulder pain is generally diagnosed as pain in the shoulder, with pain of different degrees when parts around the shoulder are touched and pressed down. Often there is an accompanying loss of normal shoulder function.

The gist of what we hope to promulgate here is that TCM is just one treatment option on your way to recovery. Acupuncture and massage can help, but we need to observe principles put forward by all modalities, and with primary idiopathic Adhesive Capsulitis (aka Frozen Shoulder), moderate movement and exercise is very important.

Some Diagnostics Firsts

If a patient comes in and you think he has inflammation of the shoulder joint (肩关节炎), you can do the following as a preliminary check:

1. Are the two shoulders sitting symmetrically?
2. Is there deformity (畸形) in that scapula-acromium joint (肩锁关节) has been dislocated (脱位). If so, the collar bone is like a piano keyed when pressed down. For more on this, look up this site on different degrees of A-C separation.
3. Does the patient have square shoulders?
4. Does the patient have wing-like scapulae (翼状肩胛)?
5. Are the muscles swollen (肿胀) or atrophied (萎缩)?

The list above should take care of most serious cases. More often than not, we move on from this elimination list to plain inflammation issues — if it’s not the muscles and tendons of the rotator cuff (tendonitis), it’s likely then to be the bursae (bursititis).

An X-ray is to be taken – if none has been taken within the last two months – to eliminate other possibilities. Other possibilities include dislocation (脱位), bone fracture (骨折) or tumor from metaplasia (肿瘤转移). Less likely nowadays is a tuberculosis (结核) infection.

It is also important to differentiate shoulder inflammation from brachial plexus neuritis (臂丛神经炎) – often accompanied by pain (neuralgia). Brachial plexus neuritis is often acute, happens to young men and can have a history of infection. It can manifest as pain in the calvicular foramina (depression above the collar bone) in addition to the shoulder area. Because it’s the plexus that’s the problem, the entire arm is often affected, e.g. radiating pain, muscle atrophy or even partial paralysis of arm.

Shoulder inflammation is seen more often in ladies, especially those above their 40s. The pain is chronic and is often a numbness focused around the gleno-humeral joint and the surrounding tissue. It does not affect the entire arm in the way brachial plexus neuritis does.

Also, we can see if it’s a problem with the cervical spine using a barrage of manual tests, often showing as positive in the case of cervical spondylosis (颈椎病). Often a patient with CS will show pain but will be able to perform passive shoulder movements, whereas a patient with BPN will have impairment of passive shoulder movements (肩部被动活动功能障碍).

What can we do?

With acute injury, we need to cool down the inflammation first. This is done for the first two to three days, and while R-I-C-E is often prescribed, for many people without unusual physical trauma, it’s usually “rest” that can be complied with.

Often though, people come with what we’d call aseptic inflammation. Here, the line is difficult to draw between bringing blood – and hence oxygen, nutrients and lymphocytes – and causing inflammation in a bad way.

In our acupuncture clinics, heat lamps and moxibustion, as well as other methods akin  to counter-irritation are used. Massage can help increase blood flow to the blood-starved shoulder, but remember to yell “OUCH” even if the masseur/eusse insists that pain will help!

Massage is useful for removing adhesions and scar tissue. This can be seen as a less intrusive method than other methods that break up adhesions under local anasthesia. Our textbook on Tuina mentions using 10-20ml of 1% lidocaine (利多卡因) with 1:20000 parts epinephrine (肾上腺素) to inject into the brachial plexus. This is pretty much what is known as an interscalene block, although the book doesn’t say so. After administering the block, we do various ranges of motions on the arm, causing some damage, but at least taking care of the adhesions.

In massage it is very difficult to draw the line between “hurt” and “help.” Often, you know it’s right when you find a good masseusse/eur and don’t see further inflammation days after the massage.

So far, it’s been passive intervention. So, we’ll mention the last thing you can do to help. Even Western doctors will tell you to keep moving. My teacher would say to move until there is pain – a reminder of how important pain signals are to our health. There are numerous sites online on how to use movement to aid recovery of shoulder pain, the “spider climbing the wall” and Codman exercises for example.

Medications

Surprisingly, medication is very helpful to the healing process. The benefits of anti-inflammatories must be recognized despite their bad press. And in this vein, we must mention that blood movers and certain tonics for the liver-kidney yin (调补肝肾之阴) are very helpful in aiding recovery. More on this on another occasion. Just drop me a line, and I’ll try to answer with what I do know.

Sources and References:

1. 王中林，推拿学（南京中医药大学自编教材）
2. http://www.silverorthopedic.com/KB.php?link=KB/Shoulders/Analyzing_Shoulder_Problems.html
3. http://www.aafp.org/afp/990401ap/1843.html
4. http://www.mendmeshop.com/rotator/frozen-shoulder-information.php

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