Would acupuncture help rotator cuff tear?

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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