Acupuncture for Shoulder Pain from Rotator Cuff Syndrome

Rotator cuff tendonitis, bursitis and impingement are common causes of shoulder pain, particularly in middle-aged patients. Injuries range from acute strains, swelling and bruising, to chronic inflammation and fibrotic thickening and weakening of the rotator cuff tendon. Swelling of the bursa and thickening of the rotator cuff can push the tendon up into the bony arch of the scapular acromion, creating a vicious cycle of tendon injury that can eventually lead to complete tears of the rotator cuff.

Please note: the following is for informational and education purposes, and is not intended as a substitute for professional diagnosis and treatment. Persons experiencing shoulder pain should seek diagnosis from a primary health care professional (physician or acupuncturist).

Common symptoms of rotator cuff tendonitis, bursitis, impingement

Gradual onset of pain, swelling and weakness at the side and front of the shoulder and upper arm, made worse by overhead motions such as reaching and throwing.
Pain at night when resting on the affected side.
Sharp twinges and painful catches in the shoulder during arm elevation.

Other common conditions which may cause symptoms similar to rotator cuff tendonitis, bursitis, impingement:

Shoulder or acromioclavicular arthritis
Cervical nerve root impingement, typically from disc herniation or arthritis in the neck
Frozen shoulder (adhesive capsulitis)
Suprascapular nerve entrapment

Acupuncture treatment of rotator cuff tendonitis, bursitis, impingement: my approach to clinical treatment

Shoulder pain is described in Traditional Chinese Medicine as stagnation or obstruction of the flow of qi and blood in the tendons and muscles of the Large Intestine, Small Intestine, and Internal Membrane acupuncture meridians. Treatment is aimed at stopping pain, decreasing inflammation, and restoring range-of-motion and strength by moving qi and blood, clearing heat and obstruction, and draining dampness from the shoulder region.

I use local electroacupuncture treatment at acupuncture locations ("points") such at LI 14, 15, and 16; TW 14; and SI 10, 11, 12, 13, and 14, as well as extra point jianneiling. Careful assessment of shoulder range-of-motion, muscle strength, and joint stability is essential to identify which acupuncture locations to use for maximum benefit. Precise knowledge of shoulder orthopedic anatomy is necessary to safely and effectively stimulate these acupuncture points and the underlying muscles, tendons and ligaments to promote tissue healing effects.

I also find that some patients respond equally well or better to treatment of the related acupuncture zones/meridians on the calf and wrist, instead of locally. These distal acupuncture effects are mediated primarily through fascial planes and the nociceptive and proprioceptive nervous systems.

Suction cupping, gua sha and acupressure or deep tissue massage can be helpful if the condition is chronic. Postural correction with scapular stabilization exercises, kinesiotaping and ergonomic modifications are often important to correct the underlying faulty biomechanics that put the shoulder at risk of injury.

Evidence basis for acupuncture for shoulder tendonitis, bursitis, impingement

The largest study of acupuncture treatment of shoulder pain to date (424 subjects), published in October 2010 in Pain, showed significant improvement in shoulder range-of-motion 3 months after treatment and documented:

"65% response rate at 6 weeks compared with 24% with sham acupuncture and 37% with standard conservative orthopaedic treatment...Chinese acupuncture is an effective alternative to orthopedic treatment of CSP" (chronic shoulder pain)."

Another recent study of acupuncture for shoulder impingement syndrome in Family Practice found benefits comparable to cortico-steroid injection.

My clinical experience with acupuncture for rotator cuff injuries

Shoulder pain is the third most common specific reason U.S. patients seek acupuncture treatment. Personally I have treated over 200 cases of shoulder injuries. In general, I find that rotator cuff injuries respond very well to acupuncture, with full recovery possible in many cases. I believe this is because the shoulder is mostly composed of muscles and tendons, and acupuncture triggers powerful muscle relaxation/re-balancing, anti-inflammatory, and soft-tissue healing responses.

Some other causes of shoulder pain may require additional treatment beyond acupuncture, including recurrent shoulder dislocation from large cartilage tears (TUBS lesions), severe joint degeneration, and complete rotator cuff tears. I generally refer to orthopedic physicians for further evaluation if I suspect any of these conditions (while continuing to manage pain with acupuncture).

True Frozen Shoulder can also respond poorly to conservative therapies; however some cases mis-diagnosed as Frozen Shoulder are actually rotator cuff impingement and can be treated successfully with acupuncture. The relative safety of acupuncture for shoulder pain makes it worthy of trying in almost all cases.

Self-care and exercise for rotator cuff tendonitis, bursitis, impingement

Caution: patients with shoulder pain should be evaluated by a primary health care professional (physician or acupuncturist) prior to beginning a home exercise program. Home exercises performed without professional diagnosis and supervision may not yield intended results and may have adverse consequences.

Minimize overhead activity, especially repetitive or forceful motions
Avoid sleeping on affected side
Stretch chest muscles
Maintain good posture (shoulder blades down and back, chin tucked in, spine kept upright), especially when working at computers
Cold may be applied following acute injury, or heat for chronic pain

Risks of delayed or non-treatment of rotator cuff impingement

Untreated or under-treated rotator cuff impingement can lead to complete tears of the rotator cuff, shoulder joint degeneration (arthritis), frozen shoulder, and neck and arm pain. Pain and disability may become chronic.