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.
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
Shoulder impingement syndrome which is the common cause of shoulder pain presents pain and weakness in the shoulder especially when you raise your arm. This will limit the movement of the shoulder making daily life difficult. This syndrome involves the rotator cuff tendon which connects the muscles in the shoulder to the top of the arm. You may experience a constant aching in the shoulder and pain at night. It can start suddenly after an injury or it can come on gradually without any obvious causes. The pain tends to be worse when you raise your arm over the head.
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. Shoulder pain is a common reason for patients to visit an acupuncturist. If you have had acupuncture for this, do you know the effect of acupuncture for shoulder pain is closely related to the acupuncture points chosen? 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.
Muscles related to shoulder pain
There are many muscles that surrounded shoulder for shoulder movement.
Trapezius muscle is a broad triangular muscle at neck and upper back, one of the largest superficial muscles at the back. It attaches to the base of the skull and extends down to the neck, the upper back until mid back; laterally it inserts to the shoulder blades. There are three functional regions to the muscle: the Upper, middle, and lower trapezius, and each region has its own function: upper region moves the shoulder blades and support the arms; the middle region retracts the shoulder blades and the lower region rotates and depresses the shoulder blades.
Pain caused from this muscle may be on the top of the shoulder, neck, mid back and/or upper shoulder pain; pain at the back of the shoulder blade which could go down the inside of the arm to the ring and little fingers.
Latissimus dorsi is the largest flat muscle at the back. This muscle is involved in adducting the arms, extending the shoulders and rotating shoulder joints medially. It also plays a role in extension and lateral flexion of the lumbar spine. The latissimus dorsi originated from the lumbodorsal fascia of the lower back, arising from the inferior thoracic and lumbar vertebrae, sacrum, iliac crest, and the four most inferior ribs, it runs laterally up through the back, inferior part of shoulder blades and insert on the humerus at the upper front of the upper arm. Tight latissimus dorsi and the trigger points on the muscles could be one of the causes of chronic mid back pain, shoulder pain, forearm pain, pain between shoulder blades, shoulder blades and pain in front of shoulder. The characteristic of pain is at lower shoulder blade and mid back and also the pain can go down the backside of the arm or the inner side of the arm and reach the hand and 4th and 5th fingers. Pain can be present at the front of the shoulder and to the side of the body just above the hip.
Rotator cuff comprises four muscles which are supraspinatus muscle, the infraspinatus muscle, teres minor muscle, and the subscapularis muscle. They all originate from the scapula and insert into humerus. They connect scapula to the head to humerus , stabilize shoulder joint and contribute to shoulder joint movement including abduction, internal rotation, and external rotation of the shoulder.
Rotator cuff disorder is one of the problems that cause shoulder pain. The main symptoms are pain around the shoulder and reduced shoulder joint movement. Acupuncture can help reduce the pain.
Teres major muscle
Teres major muscle is the muscle that connects shoulder blades to the upper arms. It starts from lower angle of the shoulder blade and ends at the upper arm in the front of the shoulder. The teres major muscle adducts the arm, extends the shoulder and rotates it inwardly. It also helps stabilize the humeral head. The pain caused in the teres major trigger is the back of your shoulder and also this pain can radiate to the front and side of the shoulder and down the backside of the arm. The trigger points for this muscle can be found at the lower angle of shoulder blades. Acupuncture can help release the pain.
How many muscles connect the humerus (upper arm) to the scapula (shoulder blade)?
There are muscles that connect the upper arm to the shoulder blades and help the movement of the shoulder. Do you know how many of them? There are seven muscles that connect the upper arm to the shoulder blades. They are coracobrachialis muscle, four rotator cuff muscles including infraspinatus, subscapularis, supraspinatus and teres minor muscles, teres major muscle and deltoid muscle. Overuse or injury to these muscles can cause shoulder and arm pain. Acupuncture can help release the pain.
The deltoid muscle is the big muscle on the shoulder which forms the rounded contour of the shoulder. It has three parts; the front or anterior, middle and back or posterior. The anterior fibers are involved in flexing the shoulder and internally rotating the arm. The posterior fibers are involved in extending the shoulder and externally rotating the arm. The lateral fibers are involved in shoulder abduction. Deltoid muscle strain is less common than rotator cuff muscles strain.
Pectoralis major and minor muscles and shoulder pain
The perctoralis major muscle is a muscle located at the chest. Underneath the pectoralis major is the pectoralis minor muscle- a small triangular muscle.
The pectoralis muscle originated from inner half of the clavicular bone, sternum as well as the cartilage of the sixth or seventh rib and the aponeurosis of the abdominal muscle. The muscle run laterally and insert into the upper humerus. It adducts the arm and rotates the shoulder inwardly, pull down the shoulder joint and elevated the arm in front of you. The muscle trigger points contribute to the shoulder pain and upper and inner side of the forearm.
Pectoralis minor originates from the third, fourth and fifth ribs and it runs upward and laterally and inserts to the surface of the coracoids process of the scapula. It pulls the shoulder blade downward, forward and inward towards the ribs, stabilizes the shoulder, prevents the shoulder blade from being pushed backwards. The trigger point of themuscle contributes to the pain in front of the shoulder, that could radiate to your chest and all the way down the inner arm.
Biceps and the shoulder, arm and elbow pain
In the upper arm, there is a muscle called biceps brachii or biceps. This muscle is two headed lies on the upper arm between the shoulder and the elbow. The two heads start from the scapular of the shoulder and join together to one muscle on the upper arm (humarus) and attach to the bones radius and ulnar in the front of the elbow. The biceps turn the arm outward, turn the palm upward, flex the elbow and flex the shoulder (bring the shoulder forward and upwards). The biceps can contribute to the pain on the front of the arm, the elbow and the shoulder. Also it contributes to the medial rotation of the shoulder.
The triceps brachii muscle or three headed muscle of the arm is the large muscle on the back of the upper limb. The three heads include long head, medial head and lateral head. The long head originates from the top of the scapula (the infraglenoid tubercle of the scapula). The medial head originates from the upper part of the limb (the groove of the radial nerve, the dorsal surface of the humerus, the medial intermuscular septum and the lateral intermuscular septum). The lateral head originates from the back of the upper limb (the dorsal surface of the humerus, lateral and proximal to the groove of the radial nerve, the greater tubercle down to the region of the lateral intermuscular septum. The three heads join together, form a tendon and attach to the elbow (the olecranon process of the ulna). The triceps extend the elbow and shoulder joint to straighten the elbow and move the arm backwards and also pull the arm towards the body. If the triceps contain trigger points, you can experience pain on the shoulder, arm, elbow or the pain can radiate to the forearm.
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
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