Part 7 of 7 in the "shoulder pain and frozen shoulder" series. The other six are listed at the foot.

This is the last part of the series, and it covers two things: the boundary of an online consultation — which step can start online and which needs someone in the room — and what else from daily life is worth telling it.

The short version

• Shoulder pain is the classic case of "start online, finish in person".
• Three things an online consultation can do: ask the right questions, triage, and explain the direction.
• Three things it cannot: examine with hands, order imaging, and make the diagnosis of frozen shoulder.
• Imaging is decided and arranged by a doctor; the AAOS states that MRI and ultrasound are not required to diagnose frozen shoulder but may help identify other soft-tissue injuries.
• Acupuncture is an in-person procedure, and HansMed Modern TCM's in-person consultations are coming soon; an online consultation can assess whether it fits and what a session involves.
• Which side to sleep on: there is no answer that fits everyone; noting which side wakes you is more use at a consultation than any general answer.
• Motorbikes, overhead sports and phones in overtime season are facts a consultation asks about, not habits to be corrected.

First, the things that cannot wait

Persistent numbness, loss of feeling or marked weakness in the arm or fingers; sudden severe pain, being unable to move the arm, or a change in shape after a fall, blow or clear injury; redness, swelling or heat in the shoulder, or persistent fever — get urgent help, do not wait.

Left shoulder pain with chest tightness, chest pain, breathlessness or a cold sweat — this is an emergency, not a consultation booking. Call 999 now, or go to the nearest hospital emergency department.

The full list, and the reason for each, are in part 6. TCM and Western medicine complement each other; it is not a choice between them.

A note: this section is general information only. For conditions like these, follow your doctor's diagnosis and treatment, and seek medical attention when you need it.

I. What an online consultation can and cannot do

Shoulder pain is the classic case of "start online, finish in person". Both sides, plainly.

What an online consultation can do:

• ① Ask the right questions: pain, or genuinely stuck; which direction is limited (forward, to the side, reaching behind the back); if you cannot lift it yourself, does it go up when someone else lifts it; does it wake you at night, which side is worse to lie on, how long the morning stiffness lasts; any numbness or weakness travelling into the arm or fingers.
• ② Triage: if anything in part 6 applies, the practitioner sends you to a doctor first rather than arranging TCM care.
• ③ Explain the direction: how TCM theory understands what you describe, what a practitioner typically considers, and where to go next.

What it cannot do:

• ① Examine with hands: "does it go up if someone lifts it?" is answered by a doctor moving your shoulder carefully in every direction and comparing passive with active range of motion — that is the method set out on the AAOS patient page. That needs someone in the room.
• ② Order imaging: the same page states that X-rays, MRI and ultrasound are tests a doctor uses to rule out other causes; they are decided and arranged by a doctor, and a TCM practitioner does not order them.
• ③ Make the diagnosis of frozen shoulder: diagnosis belongs to the doctor. What a TCM consultation does is understand the shoulder as a whole — how it hurts, which movements are limited, how long, and what it tracks with.

In-person consultations are coming soon. Until then, the online consultation's role is to understand, to triage, and to organise the clues you can observe yourself.

Parts 1 to 6 are all working towards one thing: that you can describe this shoulder precisely when the consultation comes.

II. Which side to sleep on: a clue worth writing down

There is no one answer for everyone, but the sources record two things: the AAOS lists "pain at rest and at night, especially if you are lying on the affected shoulder" among the symptoms of a rotator cuff tear; the NHS frozen-shoulder page states that frozen-shoulder pain can be worse at night and disturb sleep.

A common-sense approach is to avoid the side that wakes you.

More useful still: note which side wakes you and say so at the consultation — it is an important clue for telling the directions apart (in the table in part 3, night pain appears on two separate rows).

III. What else is worth telling a consultation

• Motorbikes and long drives: grip and steering positions, plus vibration, are worth describing at the consultation.
• Badminton and swimming: overhead sports — the AAOS lists swimming and volleyball among the overhead activities that put the rotator cuff at risk. How often, and whether that has recently increased, is information.
• Phones and tablets in overtime season: holding an arm in one position for long stretches is part of what gets asked.
• Pharmacy counters (Guardian, Watsons and the like): heat packs can be bought there (see part 5), and the pharmacist is someone you can ask about choosing a painkiller — the NHS shoulder-pain page states that a pharmacist may suggest the best one for you: tablets, or a cream or gel you rub on your skin.

None of the first three is a habit to be corrected. They are facts you can state at a consultation. A practitioner asks about them to know what this shoulder has been through lately.

A few terms from this part

All four come from the pages cited above, and you may meet them at a clinic or on a referral letter.

• Adhesive capsulitis (沾黏性肩关节囊炎) — the AAOS's formal name for frozen shoulder. The page states it is confirmed by a doctor on clinical examination and, where needed, imaging.
• Passive and active range of motion (被动与主动活动范围) — the same page's definitions: passive is the range when someone else moves your shoulder, active is the range you display moving it yourself. The page states both are limited in frozen shoulder.
• Imaging (影像检查) — the page lists X-rays, MRI and ultrasound, and states they are tests a doctor uses to rule out other causes.
• Rotator cuff tear (旋转肌袖撕裂) — the page gives it as an example of the other soft-tissue injuries MRI and ultrasound may help identify.

Frequently asked

Do I need an MRI? That is the doctor's decision. The AAOS explains that MRI and ultrasound are not required to diagnose frozen shoulder, but may help identify other soft-tissue injuries such as a rotator cuff tear; X-rays show bone clearly and may also show other problems in the shoulder, such as arthritis. A TCM practitioner does not order imaging; if you already have a report, bring it to the consultation.

Can I have acupuncture? It can be discussed. The HKU School of Chinese Medicine column gives acupuncture, tuina and topical herbal applications as examples of TCM methods; whether and how any is used is the judgement of the practitioner who has seen you. Acupuncture is an in-person procedure, and HansMed Modern TCM's in-person consultations are coming soon; an online consultation can assess whether it fits and what a session involves. If you are on Western medication, how herbs and medication are arranged is covered in "Can You Take Chinese Herbs With Western Medication?" (/chinese-herbs-with-western-medicine/); whatever the arrangement, never stop a prescription on your own. On what a first session feels like: "Does acupuncture hurt the first time?" (/does-acupuncture-hurt-first-time/).

Better not to: stop prescribed medication on your own because you have started TCM care.

The other six parts

• Part 1: What frozen shoulder is, and who tends to get it
• Part 2: How it happens, and what the exam tests
• Part 3: What else it could be: five directions in one table
• Part 4: How TCM sees it: wind-cold-damp and bi-impediment
• Part 5: What the theory advises, and heat
• Part 6: When to see a doctor first

On the overall order of a pain consultation: how TCM approaches pain.

👉 If you are not sure "where my shoulder should go next", you are welcome to bring it to an online consultation with HansMed, where a practitioner registered under the T&CM Act 2016 can assess it; if you do not yet have a firm diagnosis, or if anything in this part's "the things that cannot wait" or in part 6 applies, see a doctor first. In-person consultations are coming soon.

Sit with a licensed TCM practitioner from wherever you are.

HansMed Modern TCM

Sources

• AAOS OrthoInfo, Frozen Shoulder, re-fetched 2 October 2026 — https://www.orthoinfo.org/en/diseases--conditions/frozen-shoulder/
• AAOS OrthoInfo, Rotator Cuff Tears — https://www.orthoinfo.org/en/diseases--conditions/rotator-cuff-tears/
• AAOS OrthoInfo, Shoulder Impingement/Rotator Cuff Tendinitis — https://www.orthoinfo.org/en/diseases--conditions/shoulder-impingementrotator-cuff-tendinitis/
• NHS, Frozen shoulder, page last reviewed 24 June 2024 — https://www.nhs.uk/conditions/frozen-shoulder/
• NHS, Shoulder pain, page last reviewed 22 May 2023 — https://www.nhs.uk/conditions/shoulder-pain/
• The University of Hong Kong, School of Chinese Medicine, 〈肩周炎竟然可以自癒？〉, by TCM practitioner 康宇辰, am730 column, 4 August 2025 — https://www.med.hku.hk/zh-hk/media/knowledge-exchange/newspaper-columns/2025/aug/am730_20250804

本文是「肩膀痛与五十肩」系列的第 7 篇，共 7 篇。其余六篇列在文末。

这是系列的最后一篇，讲两件事：线上问诊的边界——哪一步可以线上先谈，哪一步一定要人在现场；以及还有哪些日常的事值得在问诊时说。

一分钟看完

• 肩痛是「线上先谈、亲诊才能做完」的典型例子。
• 线上问诊能做的三件事：问清楚、分流、说明方向。
• 做不到的三件事：用手做检查、安排影像、做「五十肩」的诊断。
• 影像由医生决定与安排；美国骨科医师学会写明 MRI 与超声波不是诊断五十肩的必要检查，但可能帮医生找出其他软组织问题。
• 针灸是亲诊的操作，汉方现代中医的线下亲诊服务即将推出；线上问诊可以先评估是否适合，以及过程会是什么样。
• 睡哪一边：没有一个适用于所有人的答案；记下「哪一侧会痛醒」在问诊时说，比通用答案有用。
• 骑摩托、过头运动、加班季的手机平板，都是问诊会问到的事实，不是要改掉的毛病。

先说不能等的几件事

手臂或手指持续麻木、失去感觉或明显无力；明显外伤、跌倒或撞击之后突然剧痛、动不了或手臂变形；肩部红、肿、热或伴随持续发烧——请马上求医，不要等。

左肩痛伴随胸闷、胸痛、气促或冒冷汗——这是急症，不要先安排问诊。请立刻拨打 999，或前往最近的医院急诊部。

完整清单与每一项的理由，见第 6 篇。中医与西医是互相补位的关系，不是二选一。

小提醒：本段仅为一般知识说明。相关情况请以西医的诊断与治疗为主，并在需要时及时就医。

一、线上问诊能做什么、不能做什么

肩痛是「线上先谈、亲诊才能做完」的典型例子。说清楚两边。

线上问诊能做的：

• ① 问清楚：是「痛」还是「卡住」；哪一个方向受限（往前、往侧边、往后背手）；自己抬不起来时，别人帮忙抬得上去吗；夜里会不会痛醒、睡哪一侧比较明显、早上僵多久；有没有延伸到手臂或手指的麻或无力。
• ② 分流：只要有第 6 篇列出的情况，医师会直接请您先看医生，而不是先安排调理。
• ③ 说明方向：中医理论怎么理解您描述的情况，医师一般会考虑哪些做法，下一步该往哪里走。

线上问诊做不到的：

• ① 用手做检查：「别人帮您抬，抬得上去吗」这一题，医生是用手把您的肩膀往各个方向带，比较被动与主动的活动范围——这是美国骨科医师学会病人资讯页上写的做法。这需要人在现场。
• ② 安排影像：该页写明，X 光、MRI、超声波是医生用来排除其他原因的检查；由医生决定与安排，中医师不开这些检查。
• ③ 做「五十肩」的诊断：诊断归西医。中医问诊做的是了解这个肩膀的整体情况——怎么痛、什么动作受限、多久了、和什么有关。

线下亲诊服务即将推出。 在那之前，线上问诊的角色是先了解、分流，并把您能自己观察的线索整理好。

第 1 篇到第 6 篇其实都在帮一件事：让您在那次问诊里说得更准。

二、睡哪一边：一个值得记下来的线索

没有一个适用于所有人的答案，但资料记录了两件事：美国骨科医师学会把「夜间痛，尤其是压着患侧睡」列在旋转肌袖撕裂的症状里；NHS 的五十肩页写明，五十肩的痛可能在夜里加重、影响睡眠。

所以常见的做法是避开会痛醒的那一侧。

更有用的是，把「睡哪一边会痛醒」记下来，问诊时说——这是分辨方向的重要线索（第 3 篇那张表里，夜间痛分别出现在两行上）。

三、还有哪些事值得在问诊时说

• 骑摩托与长途驾驶：握把与方向盘的姿势，加上震动，值得在问诊时说明。
• 打羽球、游泳：过头动作多的运动，美国骨科医师学会把游泳、排球这类过头运动列为旋转肌袖问题的风险因素之一。频率与最近有没有增加，都是资讯。
• 加班季的手机与平板：手臂长期维持同一姿势，是问诊会问到的内容。
• 药剂行（Guardian、Watsons）：热敷包可以在那里买到（见第 5 篇）；止痛药怎么选，柜台的药剂师是可以问的人——NHS 的肩痛页写明，药剂师可以给的建议包括哪一种止痛药比较合适，可能是药片，也可能是涂抹在皮肤上的药膏或凝胶。

前三项都不是「要改掉的毛病」，而是问诊时说得出来的事实。医师问这些，是为了知道这个肩膀最近经历了什么。

这篇出现的几个词

四个词都来自上面引用的页面，而且您很可能在诊所或转介单上真的遇到。

• 沾黏性肩关节囊炎（adhesive capsulitis）——美国骨科医师学会给五十肩的正式名称。该页写明它由医生依临床检查、必要时配合影像来确认。
• 被动与主动活动范围（passive and active range of motion）——同一页的定义：别人帮您动肩膀时的范围叫被动，您自己动时显示出来的范围叫主动。该页写明五十肩的人两种都受限。
• 影像检查（imaging）——该页列的是 X 光、MRI 与超声波，并写明它们是医生用来排除其他原因的检查。
• 旋转肌袖撕裂（rotator cuff tear）——该页举它为例，说明 MRI 与超声波可能帮医生找出的其他软组织问题。

常见问题

要不要照 MRI？ 由医生决定。美国骨科医师学会的说明是：MRI 和超声波不是诊断五十肩的必要检查，但可能帮助医生找出其他软组织问题，例如旋转肌袖撕裂；X 光可以清楚看到骨头，也可能显示肩膀的其他问题，例如关节炎。中医师不开影像检查，如果您已经照过，把报告带到问诊。

可以针灸吗？ 可以谈。港大中医药学院的专栏举的中医方法，例如针灸、推拿与外敷药物等；用不用、怎么用，由看过您的医师判断。针灸是亲诊的操作，汉方现代中医的线下亲诊服务即将推出；线上问诊可以先评估是否适合，以及过程会是什么样。若您正在服用西药，中药与西药怎么安排，见〈中药和西药可以一起吃吗〉（/chinese-herbs-with-western-medicine/）；无论怎么安排，切勿自行停药。第一次针灸的感受与流程，见〈第一次针灸会痛吗〉（/does-acupuncture-hurt-first-time/）。

不要这样做： 不要因为开始中医调理就自行停掉医生开的药。

这个系列的另外六篇

• 第 1 篇：五十肩是什么，谁比较常遇到
• 第 2 篇：它是怎么发生的，医生在检查什么
• 第 3 篇：还可能是什么：五个方向一张表
• 第 4 篇：中医怎么看：风寒湿与痹证
• 第 5 篇：理论给的方向，与热敷
• 第 6 篇：什么时候要先看医生

关于疼痛问诊的整体顺序，可参考：中医怎么看疼痛。

👉 如果您不确定「我的肩膀这个情况，下一步该往哪里走」，欢迎透过汉方中医的线上问诊，由依 2016 年 T&CM 法令注册的医师为您评估；若您还没有明确诊断，或有本文「先说不能等的几件事」与第 6 篇列出的情况，请先就医。线下亲诊服务即将推出。

无论身在何处，与持证中医师对坐。

汉方现代中医

资料来源

• 美国骨科医师学会 AAOS OrthoInfo，Frozen Shoulder，2026 年 10 月 2 日重新取用 — https://www.orthoinfo.org/en/diseases--conditions/frozen-shoulder/
• 美国骨科医师学会 AAOS OrthoInfo，Rotator Cuff Tears — https://www.orthoinfo.org/en/diseases--conditions/rotator-cuff-tears/
• 美国骨科医师学会 AAOS OrthoInfo，Shoulder Impingement/Rotator Cuff Tendinitis — https://www.orthoinfo.org/en/diseases--conditions/shoulder-impingementrotator-cuff-tendinitis/
• NHS，Frozen shoulder，页面最后审阅 2024 年 6 月 24 日 — https://www.nhs.uk/conditions/frozen-shoulder/
• NHS，Shoulder pain，页面最后审阅 2023 年 5 月 22 日 — https://www.nhs.uk/conditions/shoulder-pain/
• 香港大学李嘉诚医学院中医药学院，〈肩周炎竟然可以自癒？〉，康宇辰中医师，am730 专栏 2025 年 8 月 4 日 — https://www.med.hku.hk/zh-hk/media/knowledge-exchange/newspaper-columns/2025/aug/am730_20250804