Browsing articles tagged with " shoulder rotator cuff tendonitis"

67. Dr. Jun Xu’s calling from West Africa

Mar 5, 2017   //   by drxuacupuncture   //   Blog, Case Discussions, Uncategorized  //  No Comments

Dr. Jun Xu went to Leprosy village in 2013, 2014 and 2016, soon he will go to the leprosy village on March 31, 2017.

In 2013, there was no a single room being used for treatment in the leprosy village, Dr. Xu and his team had to use a tent. The temperature was around 125 Fahrenheit degrees.

The leprosy patients were waiting for their turn to be attended. Dr. Jun Xu saw about 200 patients a day.

Typical leprosy patient:
Early Stages
Spots of hypopigmented skin- discolored spots which develop on the skin
Anaesthesia(loss of sensation) in hypthese opigmented spots can occur as well as hair loss
“Skin lesions that do not heal within several weeks of and injury are a typical sign of leprosy.” (Sehgal 24)

Progression of disease

“Enlarged peripheral nerves, usually near joints, such as the wrist, elbow and knees.”(Sehgal 24)
Nerves in the body can be affected causing numbess and muscle paralysis
Claw hand- the curling of the fingers and thumb caused by muscle paralysis
Blinking reflex lost due to leprosy’s affect on one’s facial nerves; loss of blinking reflex can eventually lead to dryness, ulceration, and blindness
“Bacilli entering the mucous lining of the nose can lead to internal damage and scarring that, in time, causes the nose to collapse.”(Sehgal 27)
“Muscles get weaker, resulting in signs such as foot drop (the toe drags when the foot is lifted to take a step)”(Sehgal 27)

Long-term Effects
“If left untreated, leprosy can cause deformity, crippling, and blindness. Because the bacteria attack nerve ending, the terminal body parts (hands and feet) lose all sensations and cannot feel heat, touch, or pain, and can be easily injured…. Left unattended, these wounds can then get further infected and cause tissue damage.” (Sehgal 27)
As a result to the tissue damage, “fingers and toes can become shortened, as the cartilage is absorbed into the body…Contrary to popular belief, the disease does not cause body parts to ‘fall off’.” (Sehgal 27)

Every year, Dr. Jun Xu and his team bring around $300,000 worth of medicine donated from his team members and Americares in Stamford, CT to treat the leprosy and other patients in Senegal and Guinea Bissau. http://www.americares.org/, in 2017, his team also received medicine donation from Direct Relief in California, https://www.directrelief.org/.
Dr. Jun Xu and his team finally established a clinic in the leprosy village, one building for the clinic, and another building for the living of doctors and nurses.

Leprosy village people were celebrating the opening of the clinic.

There are 8 wards, which could hospitalize the patients if it is medically necessary.

Dr. Jun Xu’s team usually stay in Senegal for 10 to 14 days, these are the foods his team brought from US in order to keep them health and safe. They do not dare to eat street food.

The above are the coolants contained food Dr. Jun Xu’s team brought from US

Dr. Jun Xu and his team from US in 2006.
If you are interested in joining Dr. Jun Xu’s team or donating to his work in Senegal, please address your check payable to AGWV, and send to
Jun Xu, MD, 1171 E Putnam Avenue, Riverside, CT 06878, USA.
Dr. Xu promises that all your donation 100% will go to Senegal and his team will nerve use a penny from your donation. You will receive the tax deductible receipt. Any amount is a great help for Africa patients.
For more info, please visit our websites at
http://www.drxuacupuncture.co/ and http://www.africacriesout.org/

59. Frozen Shoulder and Acupuncture Treatment

Oct 23, 2014   //   by drxuacupuncture   //   Blog, Case Discussions, Uncategorized  //  No Comments

News Letter, October, 2014, © Copyright

 

Jun Xu, M.D. Lic. Acup., Hong Su, C.M.D., Lic. Acup.

James Olayos, DPT, CSCS

www.rmac.yourmd.com; www.drxuacupuncture.co

Rehabilitation Medicine and Acupuncture Center

1171 East Putnam Avenue, Building 1, 2nd Floor

Greenwich, CT 06878

Tel: (203) 637-7720

 

Frozen Shoulder and Acupuncture Treatment

 From: www.1thing.info/50kata/gojukata1.gif   

 

Martha T. is a 50-year-old woman with a long history of diabetes.  Approximately two months before consulting me, she felt a slight pain in her right shoulder when she tried to lift a heavy object.  Though the pain was not severe for the first few weeks, she gradually noticed a decrease in the mobility and function of that shoulder, coupled with more severe pain.  After the incident, she had trouble lifting her arms for tasks such as combing her hair and dressing with ease, especially when putting clothes on her right arm or fastening her brassiere.  Hoping the pain would go away, she did not consult a doctor.

When the pain became too severe, she came to me.  By physical examination, I noted that there was moderate tenderness at the right frontal and posterior shoulder.  Through palpation, I noted tenderness in her upper arm and lateral elbow.  She had difficulty raising her right shoulder up to her head and with movements that crossed the body’s middle line.  The pain was constant and she was unable to sleep on the right side of her body. Her right arm was weak due to the pain. There was no numbness or a tingling sensation.

 

Martha suffers from a “frozen shoulder,” or, in medical terminology, adhesive capsulitis.

Fig. 1

 

 

This usually occurs after the age of 40, and about 20% of patients who suffer from this disorder have a history of diabetes and most of them have also been involved in some form of accident.  When these patients begin to feel shoulder pain, they try to compensate by limiting the normal range of motion in the injured shoulder.  Unfortunately, this makes some normal tasks such as brushing the hair, dressing, reaching for objects above the head, etc., more difficult.  By this stage, the patient usually realizes it is necessary to seek medical treatment for the condition.

Frozen shoulder is usually exhibited in three stages:

  1. Painful stage: A gradual onset associated with a vague pain. Unknown specific date of onset.  Lasts roughly 8 months.
  2. Frozen stage: The pain may begin to diminish during this stage. However, the shoulder becomes stiffer and the range of motion decreases noticeably, which causes the patient to avoid extreme movements that exacerbate the pain during this phase.  Usually lasts from six weeks to nine months.
  3. Thawing stage: The shoulder movement gradually returns to normal and the pain lessens.  Lasts from five months to two years.

 

Though the causes of frozen shoulder are still unclear, these are some noted possibilities:

  1. Injury resulting from surgery or any traumatic accident.  Most patients have a history of an injury that causes pain and causes the patient to decrease his/her range of movements.
  2. Diabetic patients have a tendency to have frozen shoulder. In those patients who are diabetic (about 20%), this condition worsens the symptoms.
  3. Autoimmune, inflammatory, and any procedures that immobilize the shoulder will increase the chances of frozen shoulder.

 

Western medicine treatments:

  1. Anti-inflammatory medications: The use of anti-inflammatory medications such as ibuprofen, naproxen, etc. However, these oral medications are not a very effective treatment.
  2. Corticosteroid injection: Using a corticosteroid (i.e. 40 mg of Kenalog and 5 cc of 1% lidocaine injected directly into the shoulder bursa) will greatly decrease the intensity of the pain. However, there are some side effects of corticosteroid injections such as blood sugar elevation, fragile shoulder tendons, osteoporosis, etc. I usually do not recommend using corticosteroid injections unless it is absolutely necessary (i.e. when there is severe pain, largely decreased range of motion, and handicapped daily activities).
  3. Physical therapy: Using heating pads, stretching, performing wheel range of motion exercises, muscle strengthening, electrical stimulation, ultrasound, electrophoresis, etc.  The dual treatment of corticosteroid injection and physical therapy can be very effective.

 

In some cases, surgery may be necessary.  There are two common types of surgery used to treat frozen shoulder:

  1. Manipulation under general anesthesia: forces the shoulder to move.  This process can unfortunately cause the capsule to stretch or tear.
  2. Shoulder arthroscopy: The doctor makes several small incisions around the shoulder capsule.  A minute camera and instrument are inserted through the incision and the instrument is used to cut through the tight portion of the joint capsule.  Often, manipulation and arthroscopic surgeries are used together and many patients have good results form this type surgery.

Physical Therapy Treatment for Frozen Shoulder:

 

Physical Therapy treatment generally begins in the first stage of the “frozen shoulder” progression. Upon initial PT evaluation of the effected shoulder, the therapist will begin with gentle passive and active range of motion activities within the patient’s pain tolerance. The primary goal in stages 1 and 2 of the frozen shoulder progression is to reduce pain and begin to regain normal joint motion. Passive stretching of the shoulder in all planes and manual joint mobilization techniques are indicated. Pain relieving modalities such as heat, electric stimulation, and short-wave diathermy can be used when it is at the therapist’s disposal. In addition, basic postural re-education exercises such as scapular retraction and pectoral stretching should be introduced.

Fig. 2

 

Fig. 3

 

 

Fig. 4

 

 

As the patient progresses from the “freezing” stage of the condition, more aggressive joint mobilization and stretching techniques are introduced to regain full motion of the shoulder joint. This stage can be painful at times, but it is necessary for long term results and return of normal function. Therapeutic exercises (shoulder elevation, rotation, scapular retraction against resistance, etc.) are progressed to allow for shoulder stabilization within the new ranges of motion achieved with stretching and joint mobilization.

During the final stage of the frozen shoulder progression, the therapist will introduce functional activities to ensure that the effected shoulder is prepared for daily tasks. Pain level should be decreased at this point in treatment.

 

 

Traditional Chinese Medicine Treatment:

 

The following points were selected:

 

LI 15 Jian Yu, SI 9 Jian Zhen, SJ 14 Jian Liao, SI 10 Nao Shu, SI 11 Tian Zhong, LI 16 Ju Gu, St 38 Tiao Kou penetrating to UB 57 Cheng Shan, SJ 5 Wai Guan and LI 4 He Gu, LI 11 Qu Chi.

 

Table 1

Points Meridian/No. Location Function/Indication
1 Jian Qian Extrapoints 23 Midway between the end of the anterior axillary fold and LI 15, Jian Yu Pain in the shoulder and arm, paralysis of the upper extremities
2 Jian Yu LI 15 See table 5-1/Pic 5-1 See table 5-1
3 Jian Zhen SI 9 Posterior and inferior to the shoulder joint. When the arm is adducted, the point is 1 inch above the posterior end of the axillary fold Pain in the scapular region, motor impairment of the hand and arm
4 Jian Liao SJ 14 Posterior and inferior to the acromion, in the depression about 1 inch posterior to LI 15 Jian Yu, when the arm is abducted. Pain and motor impairment of the shoulder and upper arm
5 Nao Shu SI 10 When the arm is adducted, the point is directly above SI 9 Jian Zhen, in the depression inferior to the scapular spine Swelling of the shoulder, aching and weakness of the shoulder and arm
6 Tian Zhong SI 11 See table 5-1/Pic 5-2 See table 5-1
7 Ju Gu LI 16 In the upper aspect of the shoulder, in the depression between the acromial extremity of the clavicle and the scapular spine Pain and motor impairment of the upper extremities, pain in the shoulder and back
8 Tiao Kou St 38 2 inches below St 37 Shang Ju Xu, midway between St 35 Du Bi and St 41 Jie Xi. Numbness, soreness and pain of the knee and leg, weakness and motor impairment of the foot, pain and motor impairment of the shoulder, abdominal pain
9 Cheng Shan UB 57 Directly below the belly of m. gastrocnemius, on the line joining UB 40 Wei Zhong and tendo calcaneus. About 8 inches below UB 40. Low back pain, spasm of the gastrocnemius, hemorrhoids, constipation, beriberi
10 Wai Guan SJ 5 See table 5-1/Pic 5-3 See table 5-1
11 He Gu LI 4 See table 3-1/Pic 3-4 See table 3-1
12 Qu Chi

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Fig. 5

 

 

Fig. 6

 

 

Fig. 7

 

 

Fig. 8

 

 

 

To treat Martha, I applied the heating pad to her right shoulder for approximately 20 minutes.  This increased the flexibility of the tendon underneath. Then, I inserted the needles into the above acupuncture points. After 30 minutes of acupuncture treatment, I gave her a deep massage, and she was told to raise her shoulder and perform other range of motion exercises. The patient underwent my treatment for a total of 10 visits.  Afterwards, she reported that her right shoulder pain and range of motion had improved greatly.

 

 

Tips for acupuncturists:

  1. Instruct the patient to sit down and relax.  First, insert the needle into the Qu Chi tips toward to the shoulder about 1.5 inches deep, causing the energy to transmit up to the shoulder.  Then insert the needles into the points of Jian Yu, Jian Zhen, Jian Liao, and Tian Zhong. Insert the needle into Tiao Kou so that it penetrates to Cheng Shan.  During the treatment, scratch the handles of needles, and make sure the patient feels this energy sensation from the needle tips spreading to the shoulder.
  2. Tell the patient to slowly raise his/her arm up to the head, and move the arm around. Usually, the patient will feel instant relief from the pain.

Tips for patients:

  1. Do range of motion exercises for 20 minutes every morning taking a hot bath or shower. The hot water increases the blood circulation and energy flow and will allow for the best range of motion and the least pain when doing these exercises.
  2. Purchase a heating pad and apply it to the shoulder for 20 minutes. Do the range of motion exercises again.
  3. The main goal is to increase the range of motion of the shoulder.  The second goal is to decrease the pain in the shoulder.
  4. Try to get an acupuncture treatment as soon as possible; do not wait.  Without treatment, it may take a few years for natural recovery, and in some cases range of motion will never fully return.

18. Acupuncture and Rotator Cuff Tear-Shoulder Pain 2

Jun 27, 2010   //   by drxuacupuncture   //   Blog, Case Discussions, Uncategorized  //  1 Comment

 

News Letter, Vol. 2 (6), June, 2010, © Copyright

Jun Xu, M.D. Lic. Acup., Hong Su, C.M.D., Lic. Acup.

www.rmac.yourmd.com; www.drxuacupuncture.co

Rehabilitation Medicine and Acupuncture Center

1171 East Putnam Avenue, Building 1, 2nd Floor

Greenwich, CT 06878

Tel: (203) 637-7720

ROTATOR CUFF TEAR

Matthew P., a 45-year-old man, injured himself after pitching a few baseballs to his son.   He felt a sudden onset of right shoulder pain, which was so severe that he could not raise his arm, and this considerably interfered with his daily activities.

When I questioned him, Matthew told me he had experienced this pain on and off for more than six months, but it was mild enough that he did not feel it was necessary to see a doctor.  This pain was present both during daily activities and at night, radiating from the front of the shoulder to the side of the arm.  It had been steadily worsening, and the injury was exacerbated by the fact that his son had just returned from boarding school two weeks before and they began playing baseball together again.  Within those couple of weeks, Matthew’s condition had worsened and he was no longer able to raise his arm to a 90-degree angle.

When I performed the physical examination, I found that his right shoulder was moderately swollen and very tender to the touch at the front and back of the deltoid area.  He also had a painful arc of movement between 60 and 120 degrees.  I had to help him raise his arm from 60 to 90 degrees, which caused him pain, but once he got it past the 120 degree mark he could do it himself and the pain subsided.  I also tried a drop arm test—I lifted his right arm passively up to 90 degrees, then let go—and he had difficulty maintaining the arm at this position on his own.

Based on the above observations, I concluded that Matthew had most likely torn his rotator cuff.  This condition has different names: rotator cuff tendonitis, rotator cuff inflammation, shoulder impingement syndrome, rotator cuff bursitis, etc.  The most common symptom is that patients experience gradual onset of shoulder pain with difficulty in raising the arms up to 120 degrees.  The impingement of the rotator cuff tendons is the most common cause of shoulder pain.

The rotator cuff is a group of tendons composed of four muscles: the supraspinatus, infrapinatus, subscapularis and teres minor.  These muscles cover the head of the humerus, and combined with the deltoid muscle, they form the bow of the shoulder.   The muscles’ function is to rotate and lift the shoulder.

http://www.achesandjoints.com/images/anj4/RotatorCuff-s.jpg

The acromion is the front edge of the shoulder.  It normally sits over and in front of the humeral head when the arm is lifted and in most cases will not rub the tendons of the rotator cuff.  However, in some cases, the acromion might wrap or impinge on the surface of the rotator cuff, which causes pain and limits the shoulder movement; this is called impingement syndrome.  There are three stages of rotator cuff impingement syndrome:

  1. Stage one: edema or hemorrhage stage. This usually occurs when a patient is under 25 years old. The shoulder shows acute pain, edema or hemorrhage with signs of inflammation. This stage is reversible and surgery is rarely used to treat the condition.
  2. Stage two: fibrosis and tendonitis stage.  The inflamed rotator cuff tendons continue to get worse, and develop to fibrosis and tendonitis.  This most often occurs between age 25 and 40. Conservative treatment and surgery should both be considered, depending on the severity of the patient’s condition.
  3. Stage three: arcomioclavicular spur and rotator cuff tear.  This stage occurs because of continuous mechanical disruption of the rotator cuff tendon between the arcomioclavicular and humoral head. Surgical anterior acromioplasty and rotator cuff repair is usually required.

Matthew appeared to have stage two (rotator cuff tear). In order to make a clear diagnosis of the disease, I ordered X-rays.  They showed a  anterior spur, which caused the impingement of the rotator cuff and the pain.

When Matthew played ball with his son, he had traumatized his shoulder, causing the rotator cuff to partially tear.

Treatment:

Western medicine is usually administered in four stages:

  1. Nonsurgical treatment: the patient takes a course of oral prednosone or some form of non-steroid, anti-inflammatory medication.
  2. The patient avoids strenuous activity and puts an ice pack on the injured shoulder.
  3. Injection of a local steroid into the affected area.
  4. Physical therapy: this can take from several weeks to a number of months.  Many patients experience gradual improvement and a return to normal function.

Surgical treatment is usually indicated for full thickness or partial tears that failed to improve with conservative treatment.  There are two kinds of surgical techniques.

  1. Arthrosopic technique: two or three small puncture wounds are made and a small instrument is inserted to remove the surface of the arcomion and clean out the injured tissue of the rotator cuff.
  2. Open technique: open surgery that cuts into the shoulder and allows direct visualization into the acromion and rotator cuff.

Matthew was offered all these options, but because of his work, he could not afford to take off time, and thus opted for a conservative treatment.

I first combined physical therapy with acupuncture, and advised him to put an ice pack on his shoulder immediately, and rest his arm as much as possible, strictly avoiding any activities that might aggravate the symptoms.

I then introduced acupuncture to decrease the pain.  I used  “the three famous shoulder needles” technique: Jian Qian, Jian Yu, and Jian Zhen.  All of these must be inserted 2-3 inches deep into the respective anatomic points: the rotator cuff including bicepital, supraspinator tendons, and acromial bursa etc.  Then, a strong electrical stimulation should be used to bring a large amount of blood flow to the shoulder and wash away the inflammation to gradually diminish the sensation of pain and improve the range of shoulder motion.

The ancillary points include LI 14 Bi Nao, SJ 5 Wai Guan, LI 4 He Gu and LI 11 Qu Chi.  The patient was treated for about three months and, after passing through the acute stage, I gradually strengthened his rotator cuff muscle and after six months his shoulder had returned to normal.  His range of motion also returned to normal, and there was no need for surgery.

Table 8-1

Points Meridian/No. Location Function/Indication
1 Jian Qian Extra 23 Midway between the end of the anterior axillary fold and LI 15, Jian Yu Pain in the shoulder and arm, paralysis of the upper extremities
2 Jian Yu LI 15 Antero-inferior to the acromion, on the upper portion of m. deltoideus. When the arm is in full abduction, the point is in the depression appearing at the anterior border of the acromioclavicular joint Pain in the shoulder and arm, motor impairment of the upper extremities, rubella, scrofula
3 Jian Zhen SI 9 Posterior and inferior to the shoulder joint. When the arm is adducted, the point is 1 inch above the posterior end of the axillary fold Pain in the scapular region, motor impairment of the hand and arm
4 Bi Nao LI 14 On the line joining Qu Chi (LI 11) and Jian Yu (LI 15), 7 inches above Qu Chi (LI 11), on the radial side of the humerus, superior to the lower end of the m. deltoideus Pain in the shoulder and arm, rigidity of the neck, scrofula.
5 Wai Guan SJ 5 See table 5-1/Pic 5-3 See table 5-1
6 He Gu LI 4 See table 3-1/Pic 3-4 See table 3-1
7 Qu Chi LI11 See table 4-1/Pic 4-2 See table 4-1

Pic 8-1

Tips for both acupuncturists and patients:

1.   If the patient has rotator cuff tendonitis or impingement, and is less than 25 years old and in the acute stage, an ice pack on the shoulder to decrease both the edema and inflammation, followed by acupuncture, is usually a sufficient cure.

2.   If the patient has stage two fibrosis and tendonitis, and is between the ages of 25 and 40, acupuncture should start as soon as possible, as described above.  This is usually sufficient treatment at this stage.

3.   If the patient has stage three acromioclavicular spur and rotator cuff tear, and is over the age of 40, doctors should cautiously examine treatment options.  The patient should have an X-ray and MRI without contrast to discover if the patient has a partial or complete tear, and he should consult an orthopedic surgeon to see if surgery is necessary.  If the patient is young and the injury is related to sports, the torn rotator cuff should be sutured as soon as possible in order to accelerate a complete recovery.

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