Shoulder Pain Diagnostic Approach: View Of East-Western  Medicines

Lagshmaa B; Gerel E; Lkhagvasuren Ts

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Shoulder Pain Diagnostic Approach: View Of East-Western Medicines

Author: Lagshmaa B ¹ ; Gerel E ¹ ; Lkhagvasuren Ts ¹
Author Information

1. School of Traditional Medicine, Health Sciences University of Mongolia
Publication Type:Journal Article
Keywords: Shoulder pain
From: Journal of Oriental Medicine 2012;3(2):46-47
CountryMongolia
Language:Mongolian
Abstract: Introduction: Shoulder pain is quite common complaint worldwide, studied and described in many trials evaluating the effects of different treatment methods. Generally, shoulder complains managed by general practitioners and as a result of these studies many countries developed guidelines for management of shoulder complaints for general practitioners. In Oriental Traditional Medicine shoulder pain syndromes is a part of "Bi" syndromes and explained as quite common syndrome and one of the oldest afflictions. It is classified, as well as other joint complaints, as Complicated diseases, and many textbooks give the explanations on diagnostics and treatments of joint pain. In our days, when Traditional Oriental treatment methods becoming popular for the treatment of the shoulder complains, there is need to compare diagnostic approaches of two Medicines and try to develop integrated methods, which could be used by oriental medical doctors (OMD) as well as medical doctors. Taking into account the popularity of acupuncture for pain management in Mongolia we made a literature review and wanted to develop integrative understanding of the patho-mechanism of shoulder complaints and diagnostic guidelines for OMD. Diagnosis of the shoulder complaints should be done in combination of modern medicine view and theory of Channels and collaterals. Objectives: To develop the chronic shoulder pain diagnostic principles for OMD, basing on 10th international disease classification, diagnostic methods used in GP practice, and theory of Pathogens, Channels and Collaterals, TCM. Methods: We did a literature review on diagnostic methods of chronic shoulder pain in modern medicine and Oriental medicine. By the shoulder pain we mean pain located in the region of deltoid muscle, the acromioclavicular joint, the superior part of the trapezoid muscle and the scapula. We excluded rheumatic disorders, severe traumas, tumors, shoulder complains due to internal and neurological diseases because it needs different treatment principles. In TCM, the joint problems are caused by invasion of Wind, Cold and Dampness into the body, which leads to obstruction or "Bi" syndrome. No doubt, that there are many other factors, such as weakness of defensive energy or insufficient energy of certain organs, but patho-mechanism describes that, pathogenic factors invade the body and obstructs Channels and Collaterals and lead to insufficient flow of Qi and Blood. There are five painful joint "Bi" syndromes such as Wind, Cold, Damp, Heat, and Bony Painful Obstruction Syndrome. Three of them (Cold, Damp, Bony syndromes) could be classified as chronic conditions, so we emphasized out attention on them. From the modern medicine view we take diagnostic groups according to the 10th International disease classification: adhesive capsulitis of shoulder (frosen shoulder)M75, Rotator cuff syndrome M75.1, Bicipital tendinitis M75.2, Calcific tendinitis of shoulder M75.3, Impingement syndrome of shoulder M75.4, Bursitis of shoulder M75.5, Other shoulder lesions M75.8. Shoulder lesion, unspecified M75.9. These diagnosis could include into three general groups of complains, which has different therapeutic principles: 1) Synovial group - consisting of patients with pain and /or limitation of motion in one or more directions of the range of active or passive motion of the glenohumeral joint. This complains originate from disorders of the subacromial structures, the acromioclavicular joint, the glenohumeral joint or combinations. 2) A shoulder girdle group - the pain and limitation of the range of active motion of the glenohumeral joint are not related to synovial structures. Instead, pain or limitation of one or several directions of the range of motion of the cervical spine, upper thoracic spine or the upper ribs is found. 3) Patients with combinations of synovial and shoulder girdle disorders - patients with pain and sometimes with slight limitations in the active or passive range of motion of the glenohumeral joint together with pain or limitation of the range of motion of the cervical, upper thoracic spine and/or the upper ribs. Both the synovial structures and the structures of the cervical spine, the upper thoracic spine and the upper ribs may cause the complains. For the diagnosis of the diseases which cause the shoulder pain, it is recommended to use examination tests developed by Cyriax, and then modernized by Sobel and Winters. It is useful to examine Dowborn test, Howkins' test, drop-arm test, empty-can test, the cross-body adduction test, and the external rotation tests used for diagnosis of shoulder complains. Conclusion: The mechanism of shoulder pain in TCM could be adopted in Modern medicine diagnosis, as well as guidelines' examination items could be adopted in Traditional medicine. Pathological changes in shoulder joint and shoulder girdle could be integrated into the diagnostic items used in Traditional medicine. It will improve the quality of acupuncture treatment for shoulder pain.