Rotator Cuff Tendinitis & Acupuncture
abstracted & translated by
Honora Lee Wolfe, Lic. Ac., Dipl. Ac., FNAAOM (USA)
Keywords: Chinese medicine, acupuncture-moxibustion, rotator cuff tendinitis, periarthritis of the shoulder, bursitis, Yang Ling Quan (GB 34)
Rotator cuff tendinitis, a.k.a. periarthritis of the shoulder and bursitis, is a commonly seen complaint in the acupuncture practice. In issue #5, 2003 of Tian Jin Zhong Yi Yao (Tianjin Chinese Medicine & Medicinals), Liao Hui, Li Dan-ping, and Xue Jie of the Tianjin Municipal No. 4 Medical Center published an article titled, “A Clinical Survey of the Treatment of 69 Cases of Periarthritis of the Shoulder with Mutual Motion Acupuncture Technique.” This article appeared on pages 46-47 of that journal. Because it compared two different acupuncture protocols for the same condition, a summary of its main findings are presented below.
Cohort description:
Of the 69 patients enrolled in this study, 32 were male and 37 were female aged 47-69 years, with an average age of 53.5 years. The average disease duration was 3.2 years. Thirty-seven patients were affected in their left shoulder, 30 in their right shoulder, and two bilaterally. These 69 patients were randomly divided into two groups: a treatment group of 35 patients and a comparison group of 34 patients. Diagnostic criteria were based on a 1999 book of diagnostic and outcomes criteria published in Beijing by the People’s Army Press. These two groups were considered comparable in terms of age, sex, and disease duration.
Treatment method:
The members of the treatment group were needled at Yang Ling Quan (GB 34) perpendicularly with 0.35mm x 50mm fine needles on the same side as the affected shoulder. After obtaining the qi, the needles were manipulated with twisting and turning draining technique. At the same time, the shoulder was mobilized by the patient in all directions. After manipulating the needle for 5-7 minutes, the needle was retained passively for 10 minutes. This was repeated again for a total treatment time of 30-35 minutes per session.
Members of the comparison group were needled at Jian Yu (LI 15), Jian Liao (TB 14), and Jian Zhong Shu (SI 15).These points were needled on the affected side with 0.5mm x 50mm fine needles. After obtaining the qi, they were also needled with draining technique. Every 10 minutes, the needles were stimulated, and the total treatment time per session was also 30-35 minutes. In both groups, treatment was given once per day, five days per week. This equaled one course. If the patient was not cured, 2-4 such courses were administered. Once the symptoms were eliminated, treatment was continued for two treatments per week for two more weeks to consolidate the treatment effects.
Treatment outcomes:
Cure was defined as complete disappearance of clinical symptoms with normal range of motion in all planes. Marked effect was defined as disappearance of clinical symptoms. However, depending on changes in the weather or fatigue, the patient still experienced some discomfort and there was still some slight degree of impediment to range of motion. Some effect was defined as decrease in clinical symptoms and improvement in measurable range of motion. No effect meant that, after four courses of treatment, the symptoms had not improved. Based on these criteria, 12 out of 35 cases in the treatment group were cured, 14 got a marked effect, eight got some effect, and one got no effect, for a total effectiveness rate of 97.14%. In the comparison group, seven out of 34 were judged cured, 10 got a marked effect, 14 got some effect, and three got no effect, for a total effectiveness rate of 91.17%. In addition, the effectiveness rate after the first treatment was 48.5% in the treatment group and only 17.65% in the comparison group. So, not only was the overall effectiveness rate better in the treatment group, effects were achieved more quickly in this group as well.
Discussion:
According to the Chinese authors, periarthritis of the shoulder mainly occurs in older patients whose body is debilitated and whose qi and blood are depleted and have suffered detriment. Thus the sinews have lost their moistening and nourishment. In addition, the three evils of wind, cold, and dampness take advantage of this vacuity to assail and lodge in the channels and vessels of the area. Yang Ling Quan is a point on the foot shao yang gallbladder channel and is also the meeting point of the sinews. Needling this point is in order to soothe and relax the sinews and vessels, thus remitting and eliminating tetany and cramping as well as aching and pain. When needling this point is combined with mobilization of the shoulder, the treatment time is shortened compared to more traditionally needling Jian Liao, Jian Zhong Shu, and Jian Yu, the so-called shoulder three needles. Personally, I have witnessed the efficacy of this treatment method numerous times both in China and the West. In my experience, when mobilization of the affected shoulder is combined with acupuncture on the lower limb and tui na massage on the affected area, the effect is even greater. In this case, the practitioner mobilizes the joint with one hand while massaging with the other. This is relatively easy to do with rolling technique (guen fa). The other benefit of this protocol is its seeming mystery. Patients cannot understand how needling a point on the lower leg can immediately relieve shoulder pain. Such patients typically become good proselytizers for acupuncture and often account for numerous referrals.
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