Case Study: Acupuncture Treatment for Shoulder Pain

Case Study: Acupuncture Treatment for Shoulder Pain

SUMMARY:

A patient came in for an acupuncture treatment for shoulder pain that he has been suffering from for 13 years after slipping on some ice. The patient's chronic pain was completely relieved after only 5 treatments. Pain relief started after the first treatment and was achieved after 4 treatments. The patient came in for an upkeep treatment 30 days after the fourth treamtent and the pain has not recurred. Read ahead for the full case study.

Patient History

A 58 year old male patient came to the clinic with acute right shoulder pain. The patient explained that he suffers from recurring shoulder pain ever since he slipped on ice 13 years ago and injured his biceps brachii muscle and rotator cuff. Patient says that the pain is triggered by specific movements of the shoulder, specifically shoulder flexion at 90 degrees, or 180 degrees, while elbow is flexed at 90 degrees (Motion used in playing racket sports). The pain is sharp in nature and doesn’t linger. The pain is located in the medial and anterior deltoid, as well as the proximal portion of the biceps brachii. The pain occurs intermittently, depending on how much he is using his arm. Patient rates the pain as a 6/10. Patient has an active lifestyle, walking regularly and playing racket sports.

Objective Findings

Patient presents with tight rotator cuff muscles on the right, mainly the supraspinatus, and teres minor. Tension was also apparent in the right medial and anterior deltoid. Muscle testing found weakness in the right supraspinatus, medial deltoid, and anterior deltoid. Pectoralis minor shortening was also apparent bilaterally.

Red Triangles show area of pain (anterior and medial deltoids), blue circles show muscles that tested weak (anterior deltoid, medial deltoid, and supraspinatus).

The patients tongue was pale red with a blue hue. The tongue coating was thick and white, and the sublingual veins were slightly dark (tending towards a purple color). The pulse was 58 beats per minute, slippery and weak on the right, and full at the left guan position.

Diagnosis

The shoulder pain is due to Local Qi and Blood Stasis due to trauma and repetitive strain. The Qi Stasis is apparent due tot he blue hue of the tongue and the Full pulse at the left guan position. The Full pulse at left guan also can indicate some Liver Qi Stagnation. The patient also presents with high pitched tinnitus which could also be indicative of Liver Qi Stagnation. The Blood Stasis is apparent due to the dark sublingual veins. The patient also suffers from an underlying Spleen Deficiency, noted by the deep midline crack in tongue and thick, white tongue coating. The pulse is also slippery and weak on the right, which can also indicate Spleen Deficiency.

Principles of Treatment

1. Move Qi and Blood to stop pain

2. Tonify Spleen

3. Soothe Liver

Treatment Plan

The treatment plan was set at 6 treatments, once a week. Modalities: Orthopaedic Acupuncture.

Results of the first treatment

Patient Stated that he had relief of the pain for four days following the initial treatment. There was 6 days between the first and second treatment.

Results from second treatment

Patient had 10 days of 100% relief from pain after second treatment. There were thirteen days between treatment two and treatment three. The only discomfort were two small incidents of patient feeling a minor “tweak” in shoulder after 12 days.

Results from third treatment

No pain or discomfort in shoulder for two days. There were two days between treatment three and treatment four.

Results from fourth treatment

Patient noticed an increase in active range of motion following the four treatments. There was no pain or discomfort when performing the motion that initially would cause pain. When patient reaches across their body (arm fully adducted when shoulder flexed at 90 degrees) with their right arm, they do feel some mild discomfort at the end of their range of motion (AROM is not restricted). The patient also feels some tension in his biceps brachii when both the elbow and the shoulder are fully extended.There is no tension in his biceps brachii if he flexes his elbow while shoulder is fully extended. It should be noted that the initial pain that the patient sought treatment for is gone (0/10). The current discomfort and tightness occur with different movements than the one that brought the patient in for treatment. There were 4 days between treatment four and treatment five. (26 days since first treatment).

Results from fifth treatment

The patient’s shoulder has been pain free since last treatment 30 days ago, even with participating in sports activities that had previously aggravated his shoulder pain. Weakness that was apparent during initial assessment is gone. Supraspinatus, medial deltoid, and anterior deltoid all test strong.