A Critical Analysis of the Clinical Effect and Application of Acupuncture Treatment for Shoulder Pain Disorders in Adults

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DOI: 10.21522/TIJAR.2014.10.01.Art001

Authors : Murukesu M Margapandu


The study’s objective is to evaluate the clinical effect and application of acupuncture treatment for shoulder pain disorders in terms of effectiveness and safety. A narrative review of RCTs in which acupuncture was used as an intervention for patients with shoulder pain disorders (SPD) was conducted. All randomised controlled trials that evaluate the effects of acupuncture for shoulder pain disorders compared with controls were included. The primary outcomes were pain and shoulder function. Based on the inclusive and exclusive criteria, 22 randomised control trials involving 1801 participants that evaluated the effects of acupuncture for various shoulder pain disorders were retrieved from various databases, and the intervention and results were examined. Eleven studies found that acupuncture treatment had significantly greater effects when compared with other therapies or treatments. Nine studies showed that, when combined with other therapies or treatments, the acupuncture group showed a better therapeutic effect than the therapy group itself. The results also show that acupuncture treatment can produce the same therapeutic effects as physical therapy, manual therapy, the uses of tropical NSAIDs, oral medications, and corticosteroid injections. No serious adverse events were observed. The findings indicated that acupuncture could be a safe and effective treatment for shoulder pain disorders by reducing pain and restoring shoulder functions. The results are consistent with those of past literature reviews. Although there is some evidence for the effectiveness and safety of acupuncture for shoulder pain disorders, the level of evidence is still low. Due to several limitations and heterogeneity, the results are inconclusive, and therefore the findings need to be interpreted with caution. Future large-scale studies should be more rigorous and well-designed RCTs with high-quality studies, a longer study duration with more subjects, an ideal standardised treatment regimen, and transparent reporting.

Keywords: Acupuncture, Shoulder pain, Shoulder disorders, Acupuncture safety, Alternatives therapies, Traditional Chinese medicine, Pain relief.


[1] Svendsen, S. W., Bonde, J. P., Mathiassen, S. E., Stengaard-Pedersen, K., & Frich, L. H. (2004). Work related shoulder disorders: quantitative exposure-response relations with reference to arm posture. Occupational and environmental medicine, 61(10), 844-853.

[2] Tidy, C. (2021, Oct 18). Shoulder Pain Causes, Assessment, and Treatment. https://patient.info/doctor/shoulder-pain-pro.

[3] Schwarzkopf, R., Oron, A., & Loebenberg, M. (2008). Shoulder pain: assessment, diagnosis, and treatment of common problems. Harefuah, 147(1), 71-6.

[4] Cadogan, A., Laslett, M., Hing, W. A., McNair, P. J., & Coates, M. H. (2011). A prospective study of shoulder pain in primary care: prevalence of imaged pathology and response to guided diagnostic blocks. BMC musculoskeletal disorders, 12(1), 1-18.

[5] Artus, M., Holt, T. A., & Rees, J. (2014). The painful shoulder: an update on assessment, treatment, and referral. British Journal of General Practice, 64(626), e593-e595.

[6] Murphy, R. J., & Carr, A. J. (2010). Shoulder pain. BMJ clinical evidence, 2010.

[7] Luime, J. J., Koes, B. W., Hendriksen, I. J. M., Burdorf, A., Verhagen, A. P., Miedema, H. S., & Verhaar, J. A. N. (2004). Prevalence and incidence of shoulder pain in the general population; a systematic review. Scandinavian Journal of Rheumatology, 33(2), 73-81.

[8] Pribicevic, M. (2012). The epidemiology of shoulder pain: A narrative review of the literature. Intech Open.

[9] Gutierrez, D. D., Thompson, L., Kemp, B., & Mulroy, S. J. (2007). The relationship of shoulder pain intensity to quality of life, physical activity, and community participation in persons with paraplegia. The journal of spinal cord medicine, 30(3), 251-255.

[10] Struyf, F., & Meeus, M. (2014). Current evidence on physical therapy in patients with adhesive capsulitis: what are we missing? Clinical rheumatology, 33(5), 593-600.

[11] Laumonerie, P., Dalmas, Y., Tibbo, M. E., Robert, S., Faruch, M., Chaynes, P., ... & Mansat, P. (2020). Sensory innervation of the human shoulder joint: the three bridges to break. Journal of Shoulder and Elbow Surgery, 29(12), e499-e507.

[12] Palmer, A. (2012). Introduction to marketing: Theory and practice. Oxford University Press.

[13] Cho, C. H., Bae, K. C., & Kim, D. H. (2019). Treatment strategy for frozen shoulder. Clinics in orthopedic surgery, 11(3), 249-257.

[14] Askari, A., Gholami, T., NaghiZadeh, M. M., Farjam, M., Kouhpayeh, S. A., & Shahabfard, Z. (2016). Hyaluronic acid compared with corticosteroid injections for the treatment of osteoarthritis of the knee: a randomized control trail. Springerplus, 5(1), 1-6.

[15] Villars, P., Dodd, M., West, C., Koetters, T., Paul, S. M., Schumacher, K., ... & Miaskowski, C. (2007). Differences in the prevalence and severity of side effects based on type of analgesic prescription in patients with chronic cancer pain. Journal of pain and symptom management, 33(1), 67-77.

[16] Marks, J. L. (2015, November 25). What Is an Analgesic? https://www.everydayhealth.com/analgesic/guide/.

[17] Rogers, E., Mehta, S., Shengelia, R., & Reid, M. C. (2013). Four strategies for managing opioid-induced side effects in older adults. Clinical geriatrics, 21(4).

[18] Ghlichloo, I., & Gerriets, V. (2019). Nonsteroidal anti-inflammatory drugs (NSAIDs).

[19] Dunkin, M.A. (2021, April 27). Hyaluronic Acid Injections for Osteoarthritis. https://www.webmd.com/osteoarthritis/hyaluronic-acid-injections-for-osteoarthritis.

[20] Jancuska, J., Matthews, J., Miller, T., Kluczynski, M. A., & Bisson, L. J. (2018). A systematic summary of systematic reviews on the topic of the rotator cuff. Orthopaedic journal of sports medicine, 6(9), 2325967118797891.

[21] Pieters, L., Lewis, J., Kuppens, K., Jochems, J., Bruijstens, T., Joossens, L., & Struyf, F. (2020). An update of systematic reviews examining the effectiveness of conservative physical therapy interventions for subacromial shoulder pain. Journal of orthopaedic & sports physical therapy, 50(3), 131-141.

[22] Tick, H., Nielsen, A., Pelletier, K. R., Bonakdar, R., Simmons, S., Glick, R., & Zador, V. (2018). Evidence-based nonpharmacologic strategies for comprehensive pain care: the consortium pain task force white paper. Explore, 14(3), 177-211.

[23] Kligler, B., Teets, R., & Quick, M. (2016). Complementary/integrative therapies that work: a review of the evidence. American family physician, 94(5), 369-374.

[24] Xiang, A., Cheng, K., Shen, X., Xu, P., & Liu, S. (2017). The Immediate Analgesic Effect of Acupuncture for Pain: A Systematic Review and Meta-Analysis. Evidence-based complementary and alternative medicine, 2017, 1-13.

[25] Yuan, Q. L., Wang, P., Liu, L., Sun, F., Cai, Y. S., Wu, W. T., & Zhang, Y. G. (2016). Acupuncture for musculoskeletal pain: A meta-analysis and meta-regression of sham-controlled randomized clinical trials. Scientific Reports, 6(1), 1-24.

[26] Flecha, O. D., Douglas de Oliveira, D. W., Marques, L. S., & Gonçalves, P. F. (2016). A commentary on randomized clinical trials: How to produce them with a good level of evidence. Perspectives in clinical research, 7(2), 75–80.

[27] Chen, M., Yan, M., & Li, Z. (2019). Clinical Observation of Electroacupuncture on Rotator Cuff Injury of Volleyball Players. Fujian Sports Sci. Tech, 2019(38), 55-58.

[28] Zhang, H., Sun, J., Wang, C., Yu, C., Wang, W., Zhang, M., & Wan, Y. (2016). Randomised controlled trial of contralateral manual acupuncture for the relief of chronic shoulder pain. Acupuncture in Medicine, 34(3), 164-170.

[29] Chai. W. (2019). Clinical Observation of Shock Wave Combined with Flurbiprofen Gel Paste in the Treatment of Supraspinatus Tendonitis. Heilongjiang (China): Heilongjiang University of Chinese Medicine.

[30] Lu M. (2019). Observation on Therapeutic Effect of Acupuncture Combined with Joint Mobilization on Rotator Cuff Tears of Qi Stagnation and Blood Stasis Type. Fujian (China): Fujian University of Traditional Chinese Medicine.

[31] Lu, H. (2019). The Clinical Observation of Electroacupuncture Combined with Extracorporeal Shock Wave in the Treatment of Supraspinatus Tendinitis. Nanjing (China): Nanjing University of Chinese Medicine.

[32] Shi, Y., Yu, L., Mao, J., & Tang, L. (2019). Effect of electroacupuncture combined with joint mobilization on pain and joint function of patients with rotator cuff injury. World J Integr Tradit West Med, 14, 1575-1578.

[33] Zhang, M., Fan, C. X., Zhu, P. Y., Nie, W. T., & Hai, Q. I. N. (2019). Regular acupuncture at combined with join valley needling at ashi point for scapulohumeral periarthritis: a randomized controlled trial. World Journal of Acupuncture-Moxibustion, 29(4), 269-273.

[34] Shang, Y. J., Wang, Z. D., & Zhang, Y. (2012). Acupuncture accelerating gi-flow along meridians for treating periarthritis of shoulder. World Journal of Acupuncture-Moxibustion, 22(2), 17-21.

[35] Gao, Z.Z., Xu, D.M., Li, C.Y., & Guo, H.Y. (2014). “Observation on the effect of acupuncture combined with shoulder rehabilitation training on post-stroke shoulder pain,” Chinese Journal of Rehabilitation Medicine, 29(4), 370–372.

[36] Sheng, L. I. U., & Shi, Z. Y. (2013). Observation on the therapeutic effect of scalp acupuncture and body acupuncture in combination with rehabilitation exercise for hemiplegia and shoulder pain after stroke. World Journal of Acupuncture-Moxibustion, 23(1), 21-26.

[37] Ni, H.H., Wu, Y.C., Bao, X.Y., et al., (2013). Observations on the efficacy of superficial needling plus rod exercise in treating poststroke shoulder pain,” Shanghai Journal of Acupuncture and Moxibustion, 32(12), 1001–1003.

[38] Bao, Y. H., Wang, Y. W., Chu, J. M., Zhu, G. X., Wang, C. M., & Hou, H. M. (2012). Clinical observation of electroacupuncture combined with rehabilitation in pain and improvement of upper limb motor function after stroke in patients with hemiplegic shoulder pain. Chinese Journal of Traditional Medical Science and Technology, 19(1), 59-60.

[39] Garrido, J. C. R., Vas, J., & Lopez, D. R. (2016). Acupuncture treatment of shoulder impingement syndrome: a randomized controlled trial. Complementary Therapies in Medicine, 25, 92-97.

[40] Arias Buría, J. L., Fernández-de-Las-Peñas, C., Palacios-Ceña, M., Koppenhaver, S. L., & Salom-Moreno, J. (2017). Exercises and dry needling for subacromial pain syndrome: a randomized parallel-group trial. The Journal of Pain, 18(1), 11-18.

[41] Vas, J., Ortega, C., Olmo, V., Perez-Fernandez, F., Hernandez, L., Medina, I., ... & Aguilar, I. (2008). Single-point acupuncture and physiotherapy for the treatment of painful shoulder: a multicentre randomized controlled trial. Rheumatology, 47(6), 887-893.

[42] Johansson, K. M., Adolfsson, L. E., & Foldevi, M. O. (2005). Effects of acupuncture versus ultrasound in patients with impingement syndrome: randomized clinical trial. Physical therapy, 85(6), 490-501.

[43] Johansson, K., Bergström, A., Schröder, K., & Foldevi, M. (2011). Subacromial corticosteroid injection or acupuncture with home exercises when treating patients with subacromial impingement in primary care—a randomized clinical trial. Family practice, 28(4), 355-365.

[44] Ma, T., Kao, M. J., Lin, I. H., Chiu, Y. L., Chien, C., Ho, T. J., ... & Chang, Y. H. (2006). A study on the clinical effects of physical therapy and acupuncture to treat spontaneous frozen shoulder. The American journal of Chinese medicine, 34(05), 759-775.

[45] Lo, M. Y., Wu, C. H., Luh, J. J., Wang, T. G., Fu, L. C., Lin, J. G., & Lai, J. S. (2020). The effect of electroacupuncture merged with rehabilitation for frozen shoulder syndrome: a single-blind randomized sham-acupuncture controlled study. Journal of the Formosan Medical Association, 119(1), 81-88.

[46] Kibar, S., Konak, H. E., Evcik, D., & Ay, S. (2017). Laser acupuncture treatment improves pain and functional status in patients with subacromial impingement syndrome: a randomized, double-blind, sham-controlled study. Pain Medicine, 18(5), 980-987.

[47] Asheghan, M., Aghda, A. K., Hashemi, E., & Hollisaz, M. (2016). Investigation of the effectiveness of acupuncture in the treatment of frozen shoulder. Materia socio-medica, 28(4), 253-257.

[48] Papadopoulos, D. V., Koulouvaris, P., Aggelidakis, G., Tsantes, A. G., Mavrodontidis, A.,
& Papadopoulos, G. (2019). Electroacupuncture for the treatment of supraspinatus calcific tendonitis. Journal of clinical orthopaedics and trauma, 10(3), 624-628.

[49] Green, S., Buchbinder, R., & Hetrick, S. E. (2005). Acupuncture for shoulder pain. Cochrane Database of Systematic Reviews, (2).

[50] Hermoso, F. E., & Calvo, E. (2009). Shoulder pain in the elderly. Aging Health, 5(5), 711-718.