The shoulder is a complicated joint since many muscles are involved in movement and different structures become active at different ranges of movement. For example, when the arm is raised, the first 90 degrees is performed by the shoulder and the next 60 degrees is rotation of the scapula (shoulder bone). Problems will occur with contractile structures, i.e., muscles & tendons, or non-contractile structures such as ligaments, the capsule and bursa. By palpating the shoulder & surrounding areas and testing range of movement in different directions it is possible to evaluate what is causing pain and restricted movement within the shoulder.

Generally acupuncture is very effective in the treatment of shoulder problems. Acupuncture needles are inserted into the most tender areas and other needles further down the arm may be used to move energy along the affected acupuncture channel. The insertion of acupuncture needles is not painful, although some sensation will be felt; sometimes a dull achiness or heaviness in the arm, all signs that the needles are doing their work. Most pain is felt when palpating for painful areas, rather than the acupuncture itself.

The term 'frozen shoulder' is a generic terms that covers a multitude of conditions. I take it to mean a shoulder that cannot be slept on. In most cases the condition referred to is 'capsulitis' and this can be felt as a 'clunk' in the joint as the arm is moved up to maximum elevation. If the capsulitis starts as the result of an accident the result is a traumatic arthritis of the joint affected. Most cases I see in the clinic have been going on for a long time and are a mixture of muscle spasm and capsular involvement.

Case History - Elderly lady aged 81(1st December 2002)

This patient was suffering from right shoulder pain after being mugged one year ago. Her handbag was violently pulled off her shoulder by a young man riding a bike. She had had three injections of steroids, which gave very limited relief. The hospital could not help her any further since it is not advisable to give repeated steroid injections. She had an MRI scan done privately which revealed torn muscles fibres in her shoulder muscles. Her pain was worse first thing in the morning.

Treatment involved massaging the affected area (front/ back of shoulder, right arm) and needling points of tenderness on the affected acupuncture channels. Treatment was twice weekly for a couple of months. Progress was slow, with good pain relief for 1-2 days only.

After two months of treatment I felt that a change of approach was needed since she wasn’t getting any permanent pain-relief. Treatment involved carefully selecting points of maximum tenderness in principal muscles and needling until I felt a ‘twitch’ within the muscle. This type of acupuncture is also known as ‘trigger point therapy’. (You can read more about this in the general introduction of ‘All Musculo-Skeletal Pain and Restricted Movement’). Immediately there was a marked improvement. At this stage treatment was weekly and she continued to improve after each acupuncture treatment. I am still treating this patient on a fortnightly basis and her shoulder is almost back to normal.

This shoulder needed a lot of treatment since it had been painful for one year, had repeated steroid injections (these deplete the energy in the joint, in Traditional Chinese Medicine), and due to the age of the patient.