Shoulder Points Flashcards
SI 9: JIANZHEN Upright Shoulder
This point lies on the posterior inferior margin of the deltoid muscle. Highlight this muscle by asking the patient to lift his arm out from his side against your resistance. Then keeping your finger on the posterior inferior border, allow the arm to relax before marking the point.
Very roughly, with the patient’s arms hanging loosely at his sides, the point is found 1 cun directly above the inferior end of the crease that is formed at the back of the armpit (posterior axillary crease). Run your finger up by about 1 cun
from the inferior end of the crease until you are pressing up onto the posterior and inferior margin of the deltoid muscle.
SI 10: NAOSHU Upper Arm Shu Point
Feel up from SI 9, until you arrive just below the lower border of the scapular spine. Holding your finger here, ask the patient to abduct and adduct their arm and check
that you are in the deepest part of the hollow that is found at the latteral end of the scapular spine.
SI 10 is a key landmark of the shoulder joint. This point is in a group of three that are roughly equidistant from one another, and encircle the extremity of the shoulder joint, forming a little epaulette. SI 10 - TB 14 - Li 15. Of the three, SI 10 is often the easiest to feel and by locating this point first will help you to identify the horizontal level of TB 14 and Li 15.
SI 11: TIANZONG Heavenly Ancestor
This point lies in the centre of the large dish shaped hollow (the infra- scapula fossa), of the shoulder blade and is found directly below the widest part of the scapular spine. The point lies 1 cun below the lower edge of the widest part of the scapular spine. To locate the lower border, with your patient’s arm relaxed, from SI 10 place your finger and thumb on either side of the scapular spine and edge along the spine medially until you reach the widest part, roughly in the middle of the shoulder blade. Drop down approximately 1 cun and feel for the point.
The point lies roughly midway between the medial and lateral borders of the scapula, at about 1/3 of the distance from the inferior edge of the scapular spine to the bottom tip (the inferior angle) of the scapula. It is in the centre of the large dish- shaped hollow (the infra-scapular fossa) of the shoulder blade. The point is roughly on a level with the tip of the 4th thoracic vertebra. SI 11 is at the apex of an isosceles triangle with SI 9 and SI 10 or on a level with the halfway point on a line from SI 9 to SI 10.
SI 12: BINGFENG Grasping the Wind
This point can be found in the center of the supraspinatus fossa, directly above SI-11 (tian zong), in the depression found when the arm is raised.
This point lies above the upper border of the scapular spine. Find the middle and widest part of the scapular spine as described for SI 11. Feel for the point in the groove that lies above the spine. SI 12 forms a parallelogram with SI 9, SI 10 and SI 11.
SI 13: QUYUAN Crooked Wall
The point lies at the medial end of the supra-scapular fossa, above the upper border of the scapular spine, and about 1 cun lateral to the medial edge of the shoulder blade.
The point is in the depression above the medial end of the scapular spine where it meets the medial edge of the shoulder blade. It is roughly midway between SI 10 and the midline of the spine.
SI 14: JIANWAISHU Outside of Shoulder Shu Point
3 cun lateral to the intervertebral space T1 / T2(Du13). The point lies above bl 41 a continuation of the line of the Outer Bladder Line.
SI 15: JIANZHONGSHU Centre of Shoulder Shu Point
2 cun lateral to the intervertebral space C7 / T1 (Du 14).
LI 15: JIANYU Shoulder Joint
LOCATION
Anterior and inferior to the acromion process, in the ante- rior depression that is formed when the arm is abducted on the level of the shoulder.
LOCATION GUIDE
Abduct the patient’s arm to the level of the shoulder. Locate the point in the depression that lies anterior to the lateral border of the acromion and the greater tuberosity of the humerus, at the origin of the deltoid muscle. This point is most easily felt when the patient completely relaxes, while the practitioner holds and abducts the upper arm, and the arm is moved passively.
Sit at the side of the person so that you can see the front and the back of him. The point is found on the most lateral part of the shoulder – if you find that you have marked the point either towards the front or the back of the body and not strictly half-way in between, then you must reconsider your location.
The point lies in the joint between the acromion and the greater tuberosity of the humerus, in the deltoid muscle. Ask the patient to raise his arm out sideways, to a horizontal position (abducted). Now as the person moves his arm up and down, feel for the hollow that is just inferior to the ridge of bone the anterior end of the acromion. The point lies here, where a needle may slip into the shoulder joint, at the most lateral extremity of
the shoulder. Take into account the curve of the shoulders, so that the lateral edge may in fact be anterior to the frontal plane.
LI 16: JUGU Clavicle
The point lies in the hollow between the acromion and the scapular spine. Find these two bones and then feel for the dip that is about 1/2 cun medial to the place where they meet. The hollow is slightly posterior to the topmost ridge of the shoulder.
TB 14: JIANLIAO Shoulder Foramen
When the person’s arm is raised horizontally (abducted), this point lies in the posterior of the two hollows that form at the shoulder joint (where LI 15 is in the hollow at the lateral extremity of the shoulder). It is thus on the posterio-lateral corner of the shoulder (or at the line of a ‘just about to fall off the shoulder’ Edwardian ball gown).
When the arm is relaxed at the person’s side, then the point is found between the acromion and the greater tuberosity of the humerus, in the deltoid muscle. Feel along the spine of the scapula to the extremity of the shoulder and find the point just inferior to the ridge of bone that is thelateralpartoftheacromion.TB14istherefore located in the hollow that is inferior to the posterior border of the acromion and is roughly 1 cun posterior to LI 15 and 1 cun lateral to SI 10.
Alternatively you may wish to slide your finger up the Triple Burner Channel, on the posteriolateral surface of the arm, until you bump up against the ridge of bone at the posteriolateral corner of the shoulder. Then palpate gently for the point.
TB 15: TIANLIAO Heavenly Foramen
Midway between Du 14 and the extremity (or lateral tip) of the acromion. The point lies posterior to the top of the ridge of the trapezius muscle. The point is thus midway between GB 21 and SI 13.
On a person with rounded or hunched shoulders, take care when finding the halfway position between the tip of the acromion and the mid-line of the spine. You must make allowances for the bowed contour of the shoulder.
GB 21: JIANJING Shoulder Well
Find the midway
point between Du 14 and the extremity of the acromion. The point lies just anterior to the crest of the trapezius muscle. It forms a line like a shoulder strap, with SI 13 and TB 15. Pinching GB 21 and TB 15 together is liable to feel quite tender on many people.
NB: When needling caution should be taken due to the close proximity to the apex of the lung. A safe method is
to needle from the front angling the needle posteriorly, and remembering not to press down on the trapezius muscle in the process.
