Fish oils, acupuncture and exercise. What works for shoulder pain?

Fish oils, acupuncture and exercise: What works for shoulder pain? Lewis J  London Shoulder Clinic (www.LondonShoulderClinic.com), Centre for Health and Human Performance, London UK.  Central London Community Healthcare NHS Trust, London, UK.  Professor of Musculoskeletal Research, Clinical Therapies, University of Limerick, Ireland.  Reader in Physiotherapy, School of Health and Social Work, University of Hertfordshire, UK. Abstract The shoulder and elbow function to place the hand to permit divergent upper limb function that includes; writing, dressing, attending to personal hygiene, as well as high powered explosive upper limb activities common place in sport such as; playing tennis, swimming, athletics and gymnastics. An essential requirement for optimal upper limb function is pain free movement at the shoulder. Musculoskeletal disorders have been identified globally as the second most common healthcare condition for ‘years lived with disability’(Vos et al. 2012), and of these, shoulder conditions are amongst the most common and in a number of studies only low back pain was reported to be more common (Picavet and Schouten 2003). Pain is the most common symptom described by people experiencing musculoskeletal shoulder conditions and the most common reason for seeking treatment. The main treatment for subacromial pain syndrome is exercise. Evidence exists that exercise is beneficial in reducing pain and improving function for people diagnosed with the range of conditions encompassing subacromial pain syndrome including; subacromial impingement (Haahr et al. 2005; Haahr and Andersen 2006; Holmgren et al. 2012), partial thickness rotator cuff tears (Kukkonen et al. 2014) and full thickness tears (Kuhn et al. 2013) as well as massive irreparable rotator cuff tears (Ainsworth et al 2009). Although exercise is the main treatment for the majority of musculoskeletal shoulder conditions and has been demonstrated to be as effective as surgery (Ketola et al. 2013; Kukkonen et al. 2014), both exercise and surgery are frequently not fully curative and are often associated with recurrence and ongoing morbidity and pain (Linsell et al. 2006; Paloneva et al. 2013). As such many clinicians incorporate other treatments to reduce symptoms. Acupuncture and electro-acupuncture are other common and popular methods of treating shoulder pain. Although very popular (Kleinhenz et al. 1999; Molsberger et al. 2010; Johansson et al. 2011), research findings investigating acupuncture in the treatment of shoulder pain have proven to be equivocal (Green et al. 2005) as well as controversial (e.g. http://www.dcscience.net/?p=6089). Nutritional supplements are also popular methods of treating musculoskeletal symptoms. 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