Shoulder Pain-Impingement Syndrome, How We Treat It

Do you have it?

Your shoulder hurts when you raise your arm overhead. You notice your normal range of motion is reduced because of the pain, and your shoulder feels weak. The shoulder hurts when you try to sleep on your side. You can feel the pain in the front or side of the shoulder. If you experience all of this, you might have shoulder impingement syndrome. It is one of the most common shoulder problems that patients complain of when they visit a doctor or acupuncturist.

Who gets it?

People who are involved in activities that require repetitive overhead motions. Baseball and tennis players, swimmers, weight lifters. I’ve also seen it in manual laborers who frequently have to lift things over their head.

What is it? 

The shoulder is a ball and socket joint. The ball is called the humeral head. Above the humeral head is the acromion, a projection of the scapula, and impingement syndrome occurs when certain tissues are compressed between the humeral head and the acromion as well as the coracoacromial ligament. Normally, the rotator cuff muscles keep the humeral head centered in the socket, but when there is an imbalance in these muscles, with some too weak and others too tight, the humeral head moves superiorly, compressing the tissues—specifically the supraspinatus tendon, the subacromial bursa, and sometimes the tendon of the long head of the biceps. 

In some less common cases, the patient has a hook-shaped acromion which decreases the space in which the supraspinatus tendon moves, and this can cause the problem.

The main point to get out of this is that these compressed tissues become inflamed, swollen and painful, hurting the most when the arm is raised overhead and internally rotated. In its earlier stages, the problem is more easily reversed. If allowed to progress, it can develop into a stubborn tendinopathy, and in some cases an eventual tearing of the supraspinatus tendon. If the tear is grade 3, completely torn, it will have to be repaired surgically. Acupuncture might help with the pain, but it will not heal a grade 3 tendon tear.

What to expect from acupuncture

In most cases, acupuncture is very helpful. Naturally the number of treatments and the outcome depend on how chronic the problem is, or whether the supraspinatus tendon is torn and how severely. In general, the patient should notice a decrease of pain and an increased range of motion after 4-6 visits. There should be a more significant improvement in 8-12 treatments.(1) I should mention that I never do over 4 treatments if the patient is showing unsatisfactory progress, but sometimes 3 or 4 treatments are needed to judge whether the patient is responding.

What is the treatment strategy?

  1. Needling local points that directly affect the supraspinatus tendon, as well as the tendon of the long head of the biceps, if it is involved. This is important.
  2. Certain muscles of the rotator cuff and others related to shoulder movement will be too tight. Releasing trigger points to loosen these muscles is necessary, and stretching the muscles with a technique called proprioceptive neuromuscular facilitation (PNF) is very helpful. The weak muscles can be strengthened with exercise.
  3. Along with the more modern orthopedic techniques listed above, I also employ traditional acupuncture techniques for two reasons: to balance the flow of healing energy in the acupuncture meridians that traverse the affected shoulder; and to balance the energy of the whole body, which I believe facilitates the healing process.

 (1) Matt Callison, L.Ac., Sports Medicine Acupuncture, San Diego, CA. Acusport Education, 2019, p 334

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