Neck and shoulder pain: Pain in the shoulder region should be distinguished from pain in the shoulder joint.

Shoulder joint pain is due to problems associated with the joint and the structures immediately adjacent to it. It may involve tendons around the joint, and the (subacromial) bursal sac. It may also involve the adjacent (acromio-clavicular) joint, which connects the collar bone to the shoulder blade. The joint capsule of the shoulder joint may be involved and this leads to pain and restriction of shoulder movement.

Pain in the shoulder region involves muscles in the vicinity of the shoulder-blade and upper back. It can be associated with shoulder joint pain, or with upper back or neck pain. Localised inflammation of joints, bone and soft-tissue in the upper back and neck may act as a trigger. Chronic repetitive work can bring on symptoms as may acute injury e.g. whiplash injury. Pain may also be associated with headaches, ear aches and jaw pain. The latter may be associated with clenching of the jaw and grinding of teeth (bruxism), necessitating the use of dental splints at night. Other symptoms may include chest tightness, and pain extending down the arm. On rare occasions, the latter may cause excruciating pain in the hands associated with pallor and sweating. Chest and arm pain may mimic heart pain, and exclusion of an underlying heart condition is important. Complaints of visual blurring at the end of the day and dizzy spells or giddiness may be volunteered. When causative or precipitating factors are not identified, a diagnosis of “fibromyalgia” or “fibrositis” is commonly made.

In addition to acupuncture, management of regional shoulder pain will involve dealing with factors which predispose to chronic muscular pain. This includes modifications to the working environment, stress-management, dietary modification, the use of supplements and a graded self-exercise program to stretch and strengthen muscles in the region.