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

Jeremy Lewis

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Fish oils, acupuncture and exercise: What works for shoulder pain? Lewis J  London Shoulder Clinic (, 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. Nutritional supplements are also popular methods of treating musculoskeletal symptoms. This lecture will review the clinical effectiveness of commonly used treatments in the management of shoulder pain. References Ainsworth R, Lewis JS, Conboy V (2009). A prospective randomized placebo controlled clinical trial of a rehabilitation programme for patients with a diagnosis of massive rotator cuff tears of the shoulder. Shoulder & Elbow: 1(1):55-60. Green S et al. (2005). Acupuncture for shoulder pain. Cochrane Database Syst Rev(2): CD005319. Haahr JP and Andersen JH (2006). Exercises may be as efficient as subacromial decompression in patients with subacromial stage II impingement: 4-8-years' follow-up in a prospective, randomized study. Scand J Rheumatol 35(3): 224-228. Haahr JP et al. (2005). Exercises versus arthroscopic decompression in patients with subacromial impingement: a randomised, controlled study in 90 cases with a one year follow up. Ann Rheum Dis 64(5): 760-764. Holmgren T et al. (2012). Effect of specific exercise strategy on need for surgery in patients with subacromial impingement syndrome: randomised controlled study. BMJ 344: e787. Johansson K et al. (2011). Subacromial corticosteroid injection or acupuncture with home exercises when treating patients with subacromial impingement in primary care--a randomized clinical trial. Fam Pract 28(4): 355-365. Ketola S et al. (2013). No evidence of long-term benefits of arthroscopicacromioplasty in the treatment of shoulder impingement syndrome: Five-year results of a randomised controlled trial. Bone Joint Res 2(7): 132-139. Kleinhenz J et al. (1999). Randomised clinical trial comparing the effects of acupuncture and a newly designed placebo needle in rotator cuff tendinitis. Pain 83(2): 235-241. Kuhn J et al. (2013). Effectiveness of physical therapy in treating atraumatic full-thickness rotator cuff tears: a multicenter prospective cohort study. J Shoulder Elbow Surg 22(10): 1371-1379. Kukkonen J et al. (2014). Treatment of non-traumatic rotator cuff tears: A randomised controlled trial with one-year clinical results. Bone Joint J 96-B(1): 75-81. Linsell L et al. (2006). Prevalence and incidence of adults consulting for shoulder conditions in UK primary care; patterns of diagnosis and referral. Rheumatology (Oxford) 45(2): 215-221. Molsberger A et al. (2010). German Randomized Acupuncture Trial for chronic shoulder pain (GRASP) - a pragmatic, controlled, patient-blinded, multi-centre trial in an outpatient care environment. Pain 151(1): 146-154. Paloneva J et al. (2013). Consumption of medical resources and outcome of shoulder disorders in primary health care consulters. BMC Musculoskelet Disord 14: 348. Picavet HS. and. Schouten J (2003). Musculoskeletal pain in the Netherlands: prevalences, consequences and risk groups, the DMC(3)-study.Pain 102(1-2): 167-178. Vos T et al. (2012). Years lived with disability (YLDs) for 1160 sequelae of 289 diseases and injuries 1990-2010: a systematic analysis for the Global Burden of Disease Study 2010. Lancet 380(9859): 2163-2196.
Original languageEnglish
Title of host publication13th International Conference in Mechanical Diagnosis and Therapy.
Place of PublicationKeynote
PublisherThe McKenzie Institute International
Publication statusPublished - 2015
Event13th International Conference in Mechanical Diagnosis and Therapy: With the Tide - MDT into the Future - Copenhagen, Denmark
Duration: 4 Sept 20156 Sept 2015


Conference13th International Conference in Mechanical Diagnosis and Therapy


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