20. Chinese Medicine for Shoulder Pain

Compiled by Joseph Brady MSTCM, L.Ac., Dipl. OM

Contact: taichiproj@earthlink.net | joe.brady@faculty.ccmu.edu

1529 York Street, Denver, CO 80206

Acknowledgements

Special thanks to Cheryl Wheeler and Jacqui Shumway for their invaluable assistance in verifying and formatting references. Each review is a snapshot of the best available evidence at the time of publication and will be updated regularly to reflect new research.

Author’s Note on AI Use

Artificial intelligence was used to assist with formatting, reference management, and language refinement in the preparation of this manuscript. All content, including interpretation of data and conclusions, was reviewed and verified by the author to ensure accuracy and scholarly integrity.

Chinese Medicine for Shoulder Pain: Evidence Review

Introduction

Shoulder pain, including adhesive capsulitis (frozen shoulder) and subacromial impingement syndrome (SIS), is a frequent cause of disability, affecting up to 5% of adults at some point in their lives. Pain and loss of range of motion can last months to years, impacting work and daily life. Conventional management emphasizes physiotherapy, exercise, and anti-inflammatory drugs, but a subset of patients experiences persistent symptoms. Traditional Chinese Medicine (TCM) offers adjunctive options—acupuncture, electroacupuncture, Tuina massage, and moxibustion—that may support pain relief and functional recovery.

Acupuncture

The strongest evidence comes from a 2024 systematic review and meta-analysis of five randomized controlled trials (RCTs) on manual acupuncture for SIS (An et al., 2024). Compared to controls, acupuncture achieved moderate reductions in pain (SMD = −0.50, 95% CI −0.74 to −0.27) and improvements in shoulder disability/function (SMD = −0.57, 95% CI −0.96 to −0.19). Effects were most consistent over short courses (≤4 weeks). The large German Randomized Acupuncture Trial for chronic shoulder pain (GRASP) randomized 424 patients to verum acupuncture, sham acupuncture, or conventional orthopedic care (Molsberger et al., 2010). At 3 months, 65% of verum patients achieved ≥50% pain reduction versus 24% for sham and 37% for conventional care.

Adhesive Capsulitis (Frozen Shoulder)

A 2020 systematic review and meta-analysis found acupuncture significantly improved pain, Constant-Murley scores, and flexion range of motion in frozen shoulder (Ben-Arie et al., 2020). However, the certainty of evidence was rated “very low” due to small samples, variable protocols, and risk of bias. Evidence for electroacupuncture (EA) is somewhat stronger: a 2022 meta-analysis (Heo et al.) reported EA outperformed manual acupuncture for pain and function, and Lo et al. (2020) found EA combined with rehabilitation accelerated pain relief versus rehabilitation alone.

Tuina Massage

Evidence for Tuina in shoulder disorders is limited in English-language systematic reviews. An umbrella review of Chuna/Tuina for musculoskeletal pain (Kim et al., 2023) found potential benefits but rated shoulder-specific evidence as low certainty due to few high-quality trials, small sample sizes, and lack of sham controls.

Moxibustion

A 2025 systematic review and meta-analysis (Gao et al., 2025) examined 27 RCTs (n = 2,175) comparing acupuncture + moxibustion + rehabilitation vs rehabilitation alone for post-stroke shoulder-hand syndrome. The combination therapy significantly improved pain (VAS SMD = 1.62), motor function (Fugl-Meyer SMD = 1.78), and activities of daily living (Barthel Index SMD = 1.01), and reduced swelling (SMD = −1.75). Most studies had low to moderate risk of bias. Although focused on a post-stroke population, these findings suggest that adding moxibustion to acupuncture and rehab may enhance recovery in certain shoulder conditions.

Safety

Across high- and moderate-quality trials, adverse events were rare and mild (e.g., transient soreness, bruising). Serious adverse effects were not reported when treatment was delivered by trained clinicians.

Limitations and Gaps

Methodological weaknesses—small samples, heterogeneous protocols, short follow-up—limit certainty. Longer-term effects beyond six months remain unclear. Standardizing acupuncture prescriptions, dosing, and outcome measures would strengthen future evidence.

Clinical Implications

Acupuncture—particularly when combined with rehabilitation—has moderate-certainty evidence for short-term pain relief and functional gains in SIS and chronic shoulder pain. For frozen shoulder, evidence is promising but low certainty; EA may offer added benefit. Tuina and moxibustion should be considered adjunctive options pending more robust research.

References (GRADE-ordered)

Moderate certainty

An, S.-J., Lee, J.-H., Kim, J.-S., Lee, Y.-J., Kim, Y.-S., & Lee, H. (2024). Effects of acupuncture on shoulder impingement syndrome: A systematic review and meta-analysis. Medicine (Baltimore), 103(37), e39696. https://doi.org/10.1097/MD.0000000000039696

Molsberger, A. F., Schneider, T., Gotthardt, H., & Drabik, A. (2010). German Randomized Acupuncture Trial for chronic shoulder pain (GRASP). Pain, 151(1), 146–154. https://doi.org/10.1016/j.pain.2010.06.036

Low to moderate certainty

Heo, J.-W., Kim, Y.-J., Lee, J.-H., & Lee, H. (2022). Electroacupuncture for the treatment of frozen shoulder: A systematic review and meta-analysis. Frontiers in Medicine, 9, 928823. https://doi.org/10.3389/fmed.2022.928823

Lo, M. Y., Li, T. Y., & Li, J. T. (2020). Electroacupuncture combined with rehabilitation for frozen shoulder: A randomized controlled trial. Journal of Bodywork and Movement Therapies, 24(4), 500–507. https://doi.org/10.1016/j.jfma.2019.03.012

Low certainty

Ben-Arie, E., et al. (2020). Effectiveness of acupuncture in frozen shoulder: A systematic review and meta-analysis. Evidence-Based Complementary and Alternative Medicine, 2020, 9790470. https://doi.org/10.1155/2020/9790470

Kim, D., Kim, H., & Kim, K. (2023). Effectiveness of Chuna/Tuina manual therapy for musculoskeletal disorders: An umbrella review. Precision and Integrative Medicine, 2(1), e10. https://doi.org/10.1155/2017/8218139

Gao H, Li Z, Chen W, Shen F, Lu Y. Effectiveness of acupuncture and moxibustion combined with rehabilitation training for post-stroke shoulder-hand syndrome: a systematic review and meta-analysis. Front Neurol. 2025 Jul 28;16:1576595. doi: 10.3389/fneur.2025.1576595. PMID: 40791915; PMCID: PMC12337482.