Shoulder Pain

Shoulder is a shallow ball and socket joint, it provides good flexibility but vulnerable to instability.

Shoulder region basic anatomy

The shoulder joint is made up by four joints, including Sterno-clavicular joint, acromio-clavicular joint, gleno-humeral joint and scapula-thoracic joint. The first three joint are true synovial joint while scapulo-thoracic joint is the articulation between scapula and thoracic without synovial structure.

Shoulder joint permits six direction of motion, including flexion, extension, abduction, adduction, internal and external rotation. Scapula-thoracic rhythm is important for its role of rolling scapular, in order to maximise space of arm flexion or abduction. In clinical practice, patient need to learn regain scapula-thoracic rhythm by strengthening rotator cuff muscle.

 

Shoulder Pain Common Causes

• Sub-Acromial Impingement: sub-acromial space narrowing by tendonitis or bursitis
• Frozen Shoulder: known as Adhesive Capsulitis
• Long Head Biceps Tendonitis
• Acromioclavicular Joint Separation
• Scapular Joint Dysfunction
• Rotator Cuff Tears
• Multidirectional Instability
  
  

 

Frozen Shoulder

Frozen Shoulder is known as adhesive capsulitis, it is characterised by gradually increase of shoulder pain and shoulder stiffness in both active and passive range of glenohumeral joint motion. Early exercises are suggested until signs of acute inflammation have already subsided. In very early stage, active exercises, such as pendulum exercise, can be initiated to preserve shoulder joint flexibility. In later stage, gleunohumeral and scapulothoracic range of motion and strength exercises will also be emphasized daily training.

Reference:

1. Yin, C., Buchheit, T.E., Park J.J.. (2017, October). Acupuncture for chronic pain: an update and critical overview. Current Opinion in Anaesthesiology , 30(5), 583-592. doi:10.1097/ACO.0000000000000501.
2. Saha , F. J., Schumann, S., Cramer, H., Hohmann, C., Choi, K. E., Rolke, R., . . . Lauche, R. (n.d.). The Effects of Cupping Massage in Patients with Chronic Neck Pain - A Randomised Controlled Trial. Complementary Medicine Research, 24(1), 26-32. doi:10.1159/000454872.
3. Nakajima, M., Inoue, M., Itoi, M., & Kitakoji, H. (2013). Clinical effect of acupuncture on cervical spondylotic radiculopathy: Results of a case series. Clinical Trial Acupunct Med, 31(4), 364-367. doi:10.1136/acupmed-2013-010317(Read)
4. Callejas-Marcos I, Torrijos-Bravo A, Torres-Chica B, Ortiz-Gutiérrez RM. Eficacia de la punción seca en la cervicalgia en comparación con otras técnicas de fisioterapia: una revisión sistemática [Efficacy of dry needling in neck pain compared with other physiotherapy techniques: A systematic review]. Rehabilitacion (Madr). 2019 Jul-Sep;53(3):189-197. Spanish. doi: 10.1016/j.rh.2018.11.004. Epub 2019 Jul 9. PMID: 31370946.(Read)
5. Witt, C. M., Jena, S., Brinkhaus, B., Liecker, B., Wegscheider, K., & Willich, S. N. (2006). Acupuncture for patients with chronic neck pain. Pain, 125(1), 98–106. https://doi.org/10.1016/j.pain.2006.05.013 (Read)
This was a combined study design, incorporating randomized and cohort studies. 14161 patients with chronic neck pain from German multi-medical centres were enrolled. Usual medical treatment was given as a control group while additional acupuncture for 15 sessions was given as an intervention group. Subjects given acupuncture performed significant improvement in Neck Pain and Disability (NPAD Scale by wheeler) outcome measure. It is believed that acupuncture improves pain relief in addition to conventional medical treatment. 
6. Liu, S., Wang, Z., Su, Y., Qi, L., Yang, W., Fu, M., Jing, X., Wang, Y., & Ma, Q. (2021). A neuroanatomical basis for electroacupuncture to drive the vagal–adrenal axis. Nature, 598(7882), 641–645. https://doi.org/10.1038/s41586-021-04001-4

Commonly seen related pain conditions