(By Brian Yang, LAc) Since I’ve been working lately with several cases of shoulder pain I thought I would offer some insights into how we approach common shoulder problems as acupuncturists. The shoulder allows for many of the movements that we use an everyday basis, and has an incredibly broad range of motion compared to other major joints-– something that allows a healthy shoulder to hang, reach, climb and throw with ease. Some of the incredible mobility of the shoulder comes from the shallowness of the ball-and-socket portion (the glenohumeral joint), and the fact that it has three other joints in addition to that ball-and-socket: the sternoclavicular joint (where your collar bone meets the breast bone), the scapulothoracic joint (where your shoulder blade glides close to the ribcage), and the acromioclavicular joint (where your shoulderblade meets your collarbone). In other words, the shoulder joint is actually four joints!
Similarly, the “rotator cuff” (or “rotator cup” as some are fond of saying) is not just one muscle but four (supraspinatus, infraspinatus, teres minor, and subscapularis)-- forming a “cuff” that helps “rotate” your upper arm in all different dimensions. In addition to your rotator cuff muscles, we could mention several muscles involved in scapular movement, upper and lower arm movements, and the relational movements between the neck and shoulder, not to mention muscles that impact the brachial plexus (innervation to the shoulder). Shout-out to the lats, biceps, triceps, pecs, scalenes, levator scapula, serratus, and don’t forget everyone’s favorites, the upper trapezius and rhomboids!
With such a complex “joint” there are many types of pathologies that can cause pain and loss of range of motion in the shoulder: tendonitis, tendinopathy and degeneration, arthritis, adhesive capuslitis (“frozen shoulder”), bursitis, impingement, fracture, radiculopathy, neurovascular compression, dislocation and more. Due to the complexity of the shoulder it’s helpful to narrow in on the origin of pain.
Sometimes a differential diagnosis can be made with simple manual palpation or strength testing. Seeing an orthopedic specialist for examination and imaging can also be helpful from a diagnostic perspective. The first line of care at orthopedic practices often involves NSAIDs and steroid injections. The assumption of this approach to pain is that inflammation is a driver, and artificially suppressing inflammation will be therapeutic. In addition to the possible side-effects of these methods being a possible turn-off, there is research that indicates artificially suppressing inflammation at times can impede normal tissue healing. It’s challenging to know exactly when that will be the case, so it requires approaching these standard interventions with caution.
Moreover, at times there are other factors contributing to the development of pain in the shoulder region–not just localized inflammation.
According to the traditional Chinese medical view, various meridians run through the shoulder joint. “Blockages” of qi and blood along these channels can be dispersed by needling points on the affected channels, even in areas as far away as the hand and leg. This can be thought of as akin to releasing lines of myofascial tension and other disturbances to proper healing that run along chains of relationship throughout the body.
Some types of shoulder pathology may also involve what we would consider “blood deficiency,” or not enough nourishment reaching the area. This can be due to old scar tissue, postural habits or accumulated metabolic waste, or even systemic under-nourishment (subclinical or clinical). The task of the acupuncturist in this case is to nourish the tissue by promoting both nutrient assimilation via the digestive system, and blood flow to and from the symptomatic area. This can involve “local” needling (near the site of pain/dysfunction), techniques like moxibustion, cupping, and gua sha, mobilization exercises, and the application of herbal liniments at home.
Furthermore, compression of the brachial plexus (shoulder nerve complex) due to tight scalenes and pectoralis muscles (very common in desk workers!) can precipitate poor tissue healing and an acceleration of tendon and bursa wear-and-tear. When this is the case we target those muscles with needles and moxa and get great results, reducing pain fairly quickly.
Unmanaged systemic inflammation can certainly drive poor tissue healing anywhere in the body, leading to repetitive strain problems like tendinopathy and bursitis. In these cases we attempt to diagnose inflammatory drivers and support the modulation of inflammation in order to promote tissue repair. Metabolic stress, chronic infections, microbiome or other digestive imbalances, poor food choices, stress and poor sleep are just a few examples of inflammation drivers that we try to identify and support through acupuncture, herbs and supplements, dietary and lifestyle counseling.
This is just a small window into how I might approach your “shoulder issue” as an acupuncturist. As you can see, it’s quite a bit more comprehensive of an approach than just hitting it with an NSAID drug or a steroid injection. Of course, certain complex or advanced shoulder pathologies may require a visit to an orthopedist, physical therapy or other medical interventions, but next time you get some shoulder pain cropping up please give your humble acupuncturist a call!
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