Evidence behind this recommendation.
Selected studies from our library that inform the recommendations on this page. Evidence grade shown when available.
Single-point acupuncture and physiotherapy for the treatment of painful shoulder: a multicentre randomized controlled trial
“A multicenter RCT in shoulder pain related to subacromial syndrome suggested that acupuncture combined with physiotherapy produced greater pain relief and functional improvement than physiotherapy alone in the short term — findings specific to the inflammatory/bursal component of the subacromial syndrome. Heterogeneity across protocols limits generalization.”
Effect of acupuncture treatment on chronic neck and shoulder pain in sedentary female workers: a 6-month and 3-year follow-up study
“The scientific article in question investigated the effects of acupuncture in the treatment of chronic neck and shoulder pain in sedentary female workers, with long-term follow-up. This is a question of great medical and social relevance, as the d...”
What Is Subacromial Bursitis?
Subacromial bursitis is the inflammation of the bursa located between the rotator cuff (mainly the supraspinatus) and the coracoacromial arch. This small serous sac functions to reduce friction between the supraspinatus tendon and the acromion during shoulder movements — especially arm elevation.
It almost always coexists with subacromial impingement syndrome: when the subacromial space narrows (due to inadequate posture, cuff weakness, hypertonia of the upper trapezius, or structural alterations of the acromion), the bursa is repeatedly compressed, generating inflammation and characteristic pain when elevating the arm between 60° and 120°.
Pain typically localizes to the lateral shoulder and radiates to the deltoid, worsening with arm elevation above the head, when sleeping on the affected side, and during overhead activities. Medical acupuncture addresses both the inflammation of the bursa and the muscle imbalance that narrows the subacromial space.
Most Common Cause of Shoulder Pain
Subacromial impingement/bursitis syndrome accounts for 44%–65% of all cases of shoulder pain in adults.
Dominant Muscular Component
Hypertonic upper trapezius and levator scapulae reduce the subacromial space — the main target of needling.
Rotator Cuff Involved
Weakness of the infraspinatus and supraspinatus allows cephalic migration of the humeral head, compressing the bursa.
Why Are Conventional Treatments Not Always Sufficient?
Subacromial corticosteroid injection offers rapid relief in 70%–80% of cases, but in approximately 50% of patients pain recurs within 4 to 12 weeks. The corticosteroid treats inflammation but does not correct the narrowing of the subacromial space — the structural cause of the problem.
NSAIDs control pain and inflammation in the short term but do not address the muscular hypertonia of the trapezius and the imbalance of the scapulothoracic rhythm. Without correcting these factors, bursitis recurs as soon as the patient resumes the activities that narrow the subacromial space.
APPROACHES IN SUBACROMIAL BURSITIS
| TREATMENT | IMMEDIATE EFFECT | APPROACH TO THE CAUSE |
|---|---|---|
| Subacromial corticosteroid | Rapid (70%–80%) | No (only inflammation, not impingement) |
| Oral NSAIDs | Moderate | No (only inflammation) |
| Physiotherapy alone | Slow | Yes (cuff strengthening) |
| Acupuncture (trapezius/cuff) | Moderate-rapid | Partial (deactivates trigger points) |
| Acupuncture + PT | Rapid and lasting | Yes (complete approach) |
How Does Medical Acupuncture Work in Subacromial Bursitis?
The primary mechanism of acupuncture in subacromial bursitis is relaxation of the muscles that narrow the subacromial space: hypertonic upper trapezius, levator scapulae, and pectoralis minor. By deactivating trigger points in these muscles, the scapulothoracic rhythm normalizes, elevating the acromion and relieving compression on the bursa.
Complementarily, needling of trigger points in the supraspinatus and infraspinatus reduces the tension that pulls the humeral head cephalically, expanding the subacromial space. Segmental neuromodulation in the C4–C6 dermatomes reduces the nociceptive signal and breaks the pain-spasm cycle that perpetuates the narrowing.
Mechanism of Action in Subacromial Bursitis
Needling of the upper trapezius and levator scapulae
Relaxation of these muscles that pull the scapula upward and medially, improving the scapulothoracic rhythm.
Needling of the pectoralis minor
Release of the scapular anteversion that reduces the subacromial space, allowing greater clearance of the rotator cuff.
Needling of the supraspinatus and infraspinatus
Reduction of tension in the rotator cuff that compresses the humeral head cephalically against the acromion.
C4–C6 neuromodulation
Inhibition of the nociceptive shoulder signal in the dorsal horn, breaking the pain-spasm-pain cycle.
Improvement of scapulothoracic rhythm
With balanced musculature, arm elevation normally widens the subacromial space, reducing repetitive impingement.
What Does the Research Show?
Randomized clinical trials and meta-analyses confirm that acupuncture and dry needling are effective in reducing pain and improving function in subacromial bursitis and impingement syndrome. The results are especially robust when acupuncture is combined with rotator cuff strengthening physiotherapy.
What Is Different About the Modern Approach?
The medical acupuncturist performs a complete postural assessment before treatment, identifying which muscles most contribute to subacromial narrowing in each patient. The protocol is personalized: in patients with head-forward posture and scapular anteversion, the focus is more on the pectoralis minor and upper trapezius; in athletes, the focus may be more on the infraspinatus and supraspinatus.
High-frequency electroacupuncture (100 Hz) can be used over the shoulder for its anti-edematous effect and reduction of bursal inflammation. Low-level laser therapy is an especially useful option over the bursa itself, with anti-inflammatory effect demonstrated in studies and the advantage of being completely non-invasive.
When to See a Physician?
If you feel pain when elevating the arm (especially between 60° and 120°), when sleeping on the shoulder, or during overhead activities, seek medical evaluation. Accurate diagnosis — differentiating bursitis from rotator cuff tendinopathy, adhesive capsulitis, or acromioclavicular osteoarthritis — is essential for correct treatment.
Frequently Asked Questions
The standard protocol is 8 to 12 sessions, with a frequency of 1 to 2 sessions per week. Acute cases respond more quickly (4-6 sessions). Chronic cases with a history of repeated injections may require 12 to 15 sessions combined with rotator cuff strengthening physiotherapy.
Yes, and this is the most effective approach. Acupuncture reduces pain and muscle spasm that prevent execution of the cuff strengthening exercises. Physiotherapy consolidates the gains in range and strength. The combination of the two produces results superior to any isolated intervention.
In cases of functional impingement (without cuff rupture), complete conservative treatment — which includes acupuncture, physiotherapy, and, when indicated by the orthopedist, injection — allows most patients to avoid surgery. Surgical indication is usually reserved for cases with partial or total cuff rupture, or those refractory to an adequate period of conservative treatment, as evaluated by the specialist.
Indirectly yes. Long hours at the computer with rounded-forward shoulder posture lead to scapular anteversion, shortening of the pectoralis minor, and weakness of the scapular retractor muscles — all factors that narrow the subacromial space and predispose to bursitis over time.
It depends on the stroke and the phase of treatment. In the acute phase, swimming generally must be reduced — especially crawl and butterfly, which require repetitive overhead elevation. In more advanced phases of treatment, backstroke may be allowed and even therapeutic. The physician will guide according to evolution.