Ask an expert - muscles and bones- shoulder

17 questions

As our factsheet shows

https://www.acupuncture.org.uk/a-to-z-of-conditions/a-to-z-of-conditions/frozen-shoulder.htmlthere is some fair evidence that acupuncture can be helpful. This is far from conclusive, so we can't make specific claims, but the evidence does suggest some benefit as well as some reduction in pain. The only problem is that it is difficult to stop someone using the shoulder while it improves, so progress can often be hampered by unintended setbacks when people reach out automatically and trigger pain and discomfort.Our fact sheets have been around for some while, and we always research what other papers have been published since the ones we referenced there. There isn't a great deal that's new, and indeed an interesting review of treatment optionshttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC4363808/

only mentions acupuncture as an adjunct to interventions like physiotherapy. There is a reference to a study from Iranhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC4363808/which looks like it has been translated word by word using a dictionary, but allowing for the rather odd language there have clearly been some good results. However, a 2012 systematic reviewhttps://www.ncbi.nlm.nih.gov/pubmed/22405512was rather downbeat about most treatment options.The great strength of Chinese medicine, however, is that it treats the person, not simply the condition. A hundred people presenting with a frozen shoulder may be treated in a hundred different ways because each person is unique in the balance of their energies, and the practitioner will be working to establish what it is about the overall balance which has impaired someone's ability to recover. Many people will damage their shoulders but be fine again within a week. When the damage takes longer to hear the obvious question, apart from the severity of the cause, is what is blocking healing. Sometimes this is outside the practitioner's control; as we said above it is a very difficult joint to immobilise in order to help recovery. Often, though, there is an underlying imbalance which means that a person is getting the best from their own system.This means it can be rather difficult to generalise, and the advice we invariably give is to visit a local BAcC member for an informal chat about what may be possible. Most members are happy to give up a little time without charge to assess whether treatment may be of benefit, and many prospective patients value this chance to meet the practitioner before committing to treatment. 

We think that the first thing you might want to do is to see your GP to rule out any other underlying conditions for which this might be a presenting symptom. The fact that you are unable to lie or sit comfortably suggests something quite a deal more problematic than a simple muscle strain, and there are a number of health issues, like niggling gall bladder problems, which can generate referred pain in the shoulder area. On the surface these feel like muscular pains but actually aren't, so you need someone with an expert medical eye to have a good look first to exclude anything which needs conventional treatment. This is unlikely, but it is probably what we would recommend if you came to treatment.

If it is a simple muscle spasm then it is quite possible that acupuncture might well be able to relieve the pain and also reduce or remove the cause. All versions of acupuncture, both traditional and medical, have ways of understanding this kind of symptom and clearly defined protocols for dealing with the problem. Obviously we believe that traditional acupuncture offers slightly more, because in our experience a symptom is usually the outward manifestation of a more deep rooted imbalance. While in many cases treating the symptom will clear it for good there are often times where not looking at the overall picture will just offer temporary relief, and when the symptom returns the patient will conclude that the acupuncture hasn't worked, which is a shame.

Generally speaking, though, traditional acupuncture is premised on the good flow of energy, called 'qi' by the Chinese' and treatment is aimed at adjusting the flow and balance of energy to ensure good function. There are some occasions, though, where other interventions, like chiropractic and osteopathy, can deal with structural problems very directly, if these are the cause of the problem, and we often work alongside colleagues in both traditions to ensure that structure and function are treated together.

Without more detail, though, there isn't much more that we can say. The best advice we can give is that you visit a local BAcC member so that they can actually see the problem and talk in a little more depth about how it started and what works in relieving your discomfort. This will give you a far better idea of what may be possible. Most members are only too happy to give up a little time without charge to prospective patients so that they can offer a more balanced view of whether acupuncture treatment might help.

Q: I've wrenched a muscle in the top of my right arm pushing something? I get pain when I lift my arm shoulder height.  I have no pain below or above, just at shoulder height?

A: As you may be well aware, the shoulder can be affected in some very specific ways from injury which restrict movement in one direction only while leaving everything else unaffected. The glenoid cavity in which the head of the humerus sits is a very 'open' socket, and its stability comes from several groups of muscles whose tendons insert in and around the joint. The main issue for you is whether there has been a tendon strain or actual tendon damage.

 You do not mention whether you have seen your GP, but we would advise that it is probably a good idea to follow this route anyway in order to line up a consultant if need be. Our experience has been that if there are tears in the tendons these do not always heal spontaneously, mainly because it is very difficult to immobilise the joint. If there is a need for microsurgery, then you would be well advised to find out sooner rather than later.

 If it is a tendon or muscle strain, it would not take the practitioner very long to determine which groups of muscles and tendons are involved. Although we are committed to treating the individual, not simply the problem with which they attend, some problems are what they are. There may be a background against which one could anticipate that tendon tears were more likely (some people have their muscles at straining point for much of the time) but in the average case attending to the problem directly can be a viable option. This will very often involved needles where the problem is located and along the channels with which these areas connect.

 We tend to take the view that it may be necessary to supplement acupuncture treatment with exercises, and a considerable number of our members are trained in treating sports injuries. We don't keep separate listings of these, but it is usually fairly easy to track down a BAcC member who is suitably trained.

 The best option, and one which we invariably recommend, is to contact a BAcC member local to you and seek an informal face to face assessment. Most members are happy to give up a little time without charge to prospective patients to determine whether acupuncture is the best option. It might also be in your case a way of locating someone known to the local network as a 'go to'person for musculo-skeletal problems. It also has the advantage that you can meet the practitioner and see where they work before committing to treatment.


Q:  Can acupuncture be used with someone who has muscular dystrophy, not to help with the condition, but with a pinched muscle in the shoulder. 

A:  There is no reason of which we are aware that someone with muscular dystrophy should not have acupuncture treatment.

 We are always extremely careful as a professional body to set down clear guidelines to our members about when it would be unwise or even contra-indicated to use acupuncture. We do this both from a western medical perspective and also from a Chinese medicine perspective (there are, for example, good reasons to avoid some points in pregnancy, and other points which can cause a rapid drop in blood pressure which might affect some patients). We have never come across anything which suggested that acupuncture treatment would be a problem for someone with muscular dystrophy.

 As an aside we did come across this article, of which you may already be aware, which suggests that acupuncture may be a useful adjunct in treatment packages to help with the common symptoms of DMD.

 http://musculardystrophynews.com/2015/08/10/traditional-chinese-medicine-used-help-dmd-patients-study/

The Chinese undertake hundreds of thousands of trials every year on almost every health problem you can imagine, and as interesting results emerge the studies then tend to be translated and circulated more widely. 

 Even where the treatment is used for a specific purpose, like a pinched muscle, proper traditional acupuncture treats the person, not simply the condition, and we have sometimes found that with chronic degenerative problems the rate of deterioration appears to slow down. This is impossible to verify experimentally because conditions like this are so variable anyway, but we have seen several patients whose problems seem to plateau for longer when they are having regular treatment. However, we would never encourage people to have treatment on this basis, and in this case we would suspect that treatment for a pinched nerve may well be beneficial in itself, however the rest of the system reacts.

 

Q:  I have been diagnosed with a rotator cuff tear. Whilst I wait for a operation I am thinking about trying some acupuncture for the pain and deferred  pain after my recent cortisone injection. I have had 2 injections and they have helped with my shoulder pain but not stopped the deferred  pain.

A:  There are two questions here: is acupuncture any good for deferred pain in rotator cuff injuries and can it be done alongside cortisone injections.

As far as the deferred pain is concerned, a great deal depends on what is causing it. In answering a question on rotator cuff injuries a while ago we said:

There are a number of trials which have shown encouraging results, two of which can be found at

http://www.ncbi.nlm.nih.gov/pubmed/10534595
and
http://www.ncbi.nlm.nih.gov/pubmed/19489707

but a review of all the trials was less than conclusive

http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0013397/

Acupuncture has been used as a form of pain relief in both eastern and western/medical traditions for many decades, and there is no doubt that there is sufficient evidence to demonstrate efficacy in relieving pain. The question, however, is whether that relief is sustainable and for how long, and whether it promotes eventual healing or simply operates as a non-pharmaceutical alternative for pain relief. If it is the latter then it may be a prohibitively expensive option unless someone cannot use conventional pain-killing medication.

Having said that, the theory of Chinese medicine treatment is based on the premise that pain arises from malfunction or blockage, and pain is treated not so much as a thing itself but as a symptom of a failure of function or flow in the system. By restoring flow or balance the practitioner would hope both to encourage healing and reduce pain.

There are a number of strategies involving both local needling and systemic treatment, depending on the nature of the pain and the injuries or strains which people have experienced. There is no real alternative, though, than to seek face to face advice from a BAcC member who can give you an accurate assessment based on the specific presentation you have.  
 

From a Chinese medicine perspective we would normally be classifying deferred pain in terms of blockages or disruptions in the flow of energy to the area where the pain occurs. This may have been caused by the injury or may in some cases result from the cortisone injections themselves. It would be extremely important to have sight of the areas of pain to make sense of them, and be able to offer a more definitive view. If it is a case of blockage or change in the flow, then there is a good chance that treatment may have an impact. However, if this is really a case of referred pain in the conventional sense it means that the pain trigger still exists elsewhere, and until that is resolved the pain may continue.

As far as cortisone injections are concerned, there is no definitive answer from the research literature or from conventional medicine about the use of acupuncture after a cortisone treatment. There is nothing which indicates that it should not be done, but you will probably find that most practitioners will not needle in the area directly around the injection site until a week or more after an injection. This is mainly for energetic reasons, with most practitioners taking the view that until the area has stabilised again it is better to wait and see what effect the injection has both on the primary condition and on the tissue in the area itself. Once everything has settled down, there is no reason not to have acupuncture treatment.

We strongly recommend having a face to face chat with a BAcC member before committing to treatment. In our experience rotator cuff injuries can present unique challenges, not least in that it is a very difficult joint to immobilise and lead an ordinary life, so continued aggravations of the initial injury are quite common. Most BAcC members are happy to give up a little time without charge to assess a problem and give a more balanced view than we can offer at a distance.

 

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