Browsing articles tagged with " herniated disks"

67. Dr. Jun Xu’s calling from West Africa

Mar 5, 2017   //   by drxuacupuncture   //   Blog, Case Discussions, Uncategorized  //  No Comments

Dr. Jun Xu went to Leprosy village in 2013, 2014 and 2016, soon he will go to the leprosy village on March 31, 2017.

In 2013, there was no a single room being used for treatment in the leprosy village, Dr. Xu and his team had to use a tent. The temperature was around 125 Fahrenheit degrees.

The leprosy patients were waiting for their turn to be attended. Dr. Jun Xu saw about 200 patients a day.

Typical leprosy patient:
Early Stages
Spots of hypopigmented skin- discolored spots which develop on the skin
Anaesthesia(loss of sensation) in hypthese opigmented spots can occur as well as hair loss
“Skin lesions that do not heal within several weeks of and injury are a typical sign of leprosy.” (Sehgal 24)

Progression of disease

“Enlarged peripheral nerves, usually near joints, such as the wrist, elbow and knees.”(Sehgal 24)
Nerves in the body can be affected causing numbess and muscle paralysis
Claw hand- the curling of the fingers and thumb caused by muscle paralysis
Blinking reflex lost due to leprosy’s affect on one’s facial nerves; loss of blinking reflex can eventually lead to dryness, ulceration, and blindness
“Bacilli entering the mucous lining of the nose can lead to internal damage and scarring that, in time, causes the nose to collapse.”(Sehgal 27)
“Muscles get weaker, resulting in signs such as foot drop (the toe drags when the foot is lifted to take a step)”(Sehgal 27)

Long-term Effects
“If left untreated, leprosy can cause deformity, crippling, and blindness. Because the bacteria attack nerve ending, the terminal body parts (hands and feet) lose all sensations and cannot feel heat, touch, or pain, and can be easily injured…. Left unattended, these wounds can then get further infected and cause tissue damage.” (Sehgal 27)
As a result to the tissue damage, “fingers and toes can become shortened, as the cartilage is absorbed into the body…Contrary to popular belief, the disease does not cause body parts to ‘fall off’.” (Sehgal 27)

Every year, Dr. Jun Xu and his team bring around $300,000 worth of medicine donated from his team members and Americares in Stamford, CT to treat the leprosy and other patients in Senegal and Guinea Bissau. http://www.americares.org/, in 2017, his team also received medicine donation from Direct Relief in California, https://www.directrelief.org/.
Dr. Jun Xu and his team finally established a clinic in the leprosy village, one building for the clinic, and another building for the living of doctors and nurses.

Leprosy village people were celebrating the opening of the clinic.

There are 8 wards, which could hospitalize the patients if it is medically necessary.

Dr. Jun Xu’s team usually stay in Senegal for 10 to 14 days, these are the foods his team brought from US in order to keep them health and safe. They do not dare to eat street food.

The above are the coolants contained food Dr. Jun Xu’s team brought from US

Dr. Jun Xu and his team from US in 2006.
If you are interested in joining Dr. Jun Xu’s team or donating to his work in Senegal, please address your check payable to AGWV, and send to
Jun Xu, MD, 1171 E Putnam Avenue, Riverside, CT 06878, USA.
Dr. Xu promises that all your donation 100% will go to Senegal and his team will nerve use a penny from your donation. You will receive the tax deductible receipt. Any amount is a great help for Africa patients.
For more info, please visit our websites at
http://www.drxuacupuncture.co/ and http://www.africacriesout.org/

23. Acupuncture and Chronic Low Back Pain-Herniated Disks and Pinch Nerves

Nov 14, 2010   //   by drxuacupuncture   //   Blog, Case Discussions, Uncategorized  //  No Comments

News Letter, Vol.2 (11), November, 2010, (C) Copyright

Jun Xu, M.D. Lic. Acup., Hong Su, C.M.D., Lic. Acup.

www.drxuacupuncture.co

Rehabilitation Medicine and Acupuncture Center

1171 East Putnam Avenue, Building 1, 2nd Floor

Greenwich, CT 06878

Tel: (203) 637-7720

 

Chronic Low Back Pain-Herniated Disks and Pinch Nerves

Jason W is a 46-year-old male who has suffered low back pain, on and-off, for about six months.  He is a teacher for special education who caught a student when the student was falling and about to hit the corner of a desk, at which moment he felt sudden onset low back pain.  The pain was so severe he was unable to stand, and felt weakness with the pain radiating to his left leg and causing a tingling and numbness sensation there.  When he was brought to my office, he was unable to stand but had to talk to me from a prone position on an examining table.

About one year ago Jason had a similar experience with a student and, at that time, felt the same sensations of low back pain, which radiated to his left leg, and accompanied with tingling, tenderness, numbness and heaviness of his left leg.  He consulted his primary care physician who diagnosed acute low back sprain, and prescribed anti-inflammatory medication and bed rest.  After two days he felt a little better however, since then, he has experienced pain off and on and also feels his lower back is weak.

At present, he finds it difficult to hold his low back, and his left leg is heavy and he has difficulty raising it, he cannot bend forward with any ease and has trouble donning his pants.  He also has difficulty picking up objects such as a pen from the floor and is experiencing a bit of urinary incontinence.

The patient is moderately obese and has a somewhat large abdomen, so I asked him to stand straight then bend forward.  He was unable to  perform this maneuver and immediately felt back weakness, and had difficulty bending forward more than 40 degrees.  When I asked him to walk on his tiptoes and heels, he was unable to do so, and he reported when he walks on his heels he feels low back pain radiating down the left leg, especially around the lateral of the knee and lateral to lower leg.  I also performed a straight leg raising test.  On the right side the patient could do straight leg raising by about 80 degrees, however, only 50 degrees on the left side, at which point he feels the pain radiating again down to the leg and knee.  I used a pinprick to check the patient’s response to sharpness and cotton ball to check his light touch sensation. Both tests showed decreased sensation along the left lateral thigh and leg.  I also checked his deep tendon reflexes, which showed the left knee jerk and left ankle jerk to be about 1+.  By examining the strength of his left leg, his ankle dorsal flexors are 3/5 and the ankle plantar flexors are 4/5, the knee flexors and extensors are 3/5, The rest are 5/5.

Because of the severity of his condition, I ordered a lumbar sacral MRI which showed severe L4/L5 herniated disc with a left protrusion.

Pic 17-1

Pic 17-2

From that above MRI pictures, you may see the arrows indicate the herniated disc from Jason’s Lumbar spine.

Jason appeared to have left L5 radiculopathy.  Because the above image showed severe herniated disc between L4/L5, he was immediately referred to a neurosurgeon.

After careful examination by a neurosurgeon, he was advised to have emergency surgery for discectomy, i.e. a small incision to cut off part of his herniated disc,  based on his emergency symptom, such as, severe low back pain radiating to left leg with numbness and tingling sensation, and slightly urinary incontinency.  Jason agreed the surgery.

However, the insurance companies’ argument prevented him from immediate surgery. He went through two similar episode of the low back injury during work as I described above, the second worker’s compensation company requested the first worker’s compensation company to pay the medical expenses, they believed the second injury was the consequence of first injury. But the first worker’s compensation company refused the request. Therefore, Nobody would like to pay the expenses, and Jason was so painful, he could not wait for  the final decision between the two worker’s compensation companies, Jason thought it would take months to solve the problem. The patient then called me and said, “ I am stuck here, nobody would like to pay for the expenses, I can not have surgery right now, could you please help me with acupuncture, I might avoid the surgery if it is possible?” I decided to accept the challenge then and I started to treat him right away.

Low back pain is the secondary most common injury to cause workforce loss in the US and almost everyone has experienced this kind of pain sometime in lifetime.

Low back pain has many different manifestations, the causes of which follow:

1.     Myofascial or tendon ligament sprain.  This is acute pain in the muscles that can come from poor posture, tendon ligament injury, or from overuse or overstretching.

2.     Radiculopathy which is a pinched nerve, usually originated from a herniated or slipped disc pinching one of the lumbar sacral roots as indicated from above MRI pictures.

3.     Spinal stenosis and narrowing of the nerve opening either around the spinal cord or nerve roots that cause symptoms similar to pinched nerve.

4.     Overuse and overstretch of ligaments of facet and sacroiliac joints.

5.     Fracture of the vertebrae caused by significant force such as an automobile or a bicycle accident, or a fall.

6.     Scoliosis or kyphosis, i.e. the spine curves changed in a wrong way.

7.     Compression fracture, which is common among postmenopausal women with osteoporosis.

There are also some less common spinal conditions capable of causing low back pain, including:

1.     Ankylosing spondylitis, which is a severe bony fusion of lumbar sacral spine and pelvic bone with unknown reasons, the patients have difficulty straight their back, and sometimes, are unable to look at sky.

2.     Bacteria infection such as osteomyelitis, etc.

3.     Spinal tumors.

4.     Paget disease: a bone disease in which the bone is unable to keep the balance of remodeling process, i.e. to lay down new bone and take up old bone for the purpose of rebuilding the bone. As a result, the bone  formation is abnormal with loose bone structure, and enlarged and low density bone, which are brittle and prone to fracture.

5.     Scheurmann’s disease, in which bones of the spinal vertebrae develop wedge-shaped deformities, i.e. the vertebrae grow unevenly, that is, the anterior angle is often greater than the posterior, results in the wedging shape of the vertegbrae and kyphosis.

Diagnosis:  The symptoms and physical exam usually give a good idea as to the correct diagnosis.  However, it is important to also have the following tests performed:

1.     X-rays will give evidence of the lumbosacral osteoarthritis and sacroiliac osteoarthritis and any degenerative changes of the disc.

2.     MRI will indicate the hernia disc and nerve impingement, facet joint osteoarthritis and also give a clear view of degenerative changes of the disc.

3.     Electromyograph (EMG) which is divided into two parts.  The first is nerve conduction study in which electrical stimulation is used to stimulate the nerves in one extremity.  The machine then checks the velocity of the nerve travel and the amplitude of each individual nerve, which is then compared to the opposite or paired extremity.  If there is any difference in the velocity and amplitude, as well as the latency, it is possible to differentiate among the nerves and determine which are injured  The second part consists of an electromyography, during which a small needle is inserted into certain muscles of the spine and extremities, if the muscle is injured, it will show up on the screen, which will pinpoint which nerve roots are injured.

4.     Lumbar myography.  This is radiographic examination of the lumbar spinal canal with  intrathecal injection of contrast medium.  After injection, X-rays are taken and show if any nerve roots are impinged.

Based on the clinical symptoms and physical examination plus one or all of the above tests, a clear diagnosis of lower back pain can be made.

Treatment by western medicine:

Generally speaking, lower back pain is categorized into two major types:

1.     Nonsurgical.  Most physicians recommend non-surgical treatment before resorting to surgery.  The following are usually recommended:

a.     Anti-inflammatory medications such as acetaminophenm Advil, naproxen, etc. and muscle relaxants such as Valium, Skelaxin, etc. which probably help relax lower back muscles.

b.     For a more severe condition, a lumbosacral brace or binder is usually recommended, which gives the patient support in the lower back.  However, continued use of the brace can lead to muscle weakness of the lower back and should therefore only be used for such activities as driving, lifting the baby or some heavy object, etc.

c.      Traction.  If the patient is diagnosed with a herniated disc, the usual treatment would be traction.  The patient is placed on a folding bed, then the an attempt is made to slightly pull apart the patient’s vertebral body.  It is possible for the herniated disc to return to its original position. The traction is not indicated for other lower back pain such as myofascial sprain, spinal stenosis, or spondylolithesis, and the traction must be guided by a physician.

d.     Physical therapy, which helps the patient strengthen the abdominal and leg muscles, which will alleviate the back pain; a strong abdominal muscle helps in holding the entire trunk.

Treatment by acupuncture:

All the acupuncture points are chosen along the nerve distribution and it is typical to stimulate these points with electrical stimulation and combine this with Moxibustion and massage, all of which greatly helps the patient.

Hua Tuo Jia Ji points are sets of specially designed points used to treat disc disease. By palpation, you should feel the herniated disc spinal process, then insert the needles into the disc about 0.5 inch deep and one up and one lower levels of the herniated disc, plus 0.5 inch of the lateral sides of the three levels,  i.e. total 9 needles inserted into the herniated disc and adjacent area. For Jason’ treatment, I inserted the needles to L4, also extended this Hua Tuo Jia Ji to L3 and L5 levels.

I also selected the following points: Sheng Shu, Qi Hai Shu, Chi Bian, Huan Tiao, Yang Ling Quan, Fei Yang, Jue Gu, and Cheng Fu.

Pic 11-3

Pic 11-4

Table 4-1

Points Meridan/No. Location Function/Indication
1 Hua Tuo Jia Ji ExperiencedPoints Along the spine, use the most painful vertebral spinal as midpoint, then locate the upper and lower spinal process and 0.5 inch on the either side, you may choose two spinal process as the starting points. See Pic 4-1 Specifically treat for local neck and low back pain, and pain along the spine.
2 Sheng Shu UB 23 1.5 inch lateral to midline of spine at the level of the lower border of the spinous process of the second lumbar vertebrta Nocturnal emission, impotence, enuresis, irregular menstruation, leucorrhea, low back pain, weakness of the knee, blurring of vision, dizziness, tinnitus, deafness, edema, asthma, diarrhea
3 Qi Hai Shu UB 24 1.5 inch lateral to midline of spine at the level of the lower border of the spinous process of the third lumbar vertebra Low back pain, irregular menstruation, dysmenorrheal, asthma
4 Zhi Bian UB 54 Lateral to the hiatus of the sacrum, 3 inch lateral to the midline of spine Pain in the lumbosacral region, muscular atrophy, motor impairment of the lower extremities, dysuria, swelling around external genitalia, hemorrhoids, constipation
5 Huan Tiao GB 30 At the junction of the lateral 1/3 between the great trochanter and the hiatus of the sacrum. Pain of h elumbar regiin and the thigh, muscular atrophy of the lower limbs, hemiplegia
6 Yang Ling Quan GB 34 In the depression anterior and inferior to the head of the fibula Hemiplegia, weakness, numbness and pain of the knee, beriberi, hypochondriac pain, bitter taste in the mouth, vomiting, jaundice, infantile, convulsion
7 Jue Gu( Xuan Zhong) GB 39 3 inch above the tip of the external malleolus, in the depression between the posterior border of the fibula and the tendons of peronaeus longus and brevis Apoplexy, hemiplegia, pain of the neck, abdominal distension, pain in the hypochondriac region, muscular arophy of the lower limbs, spastic pain fo the leg, beriberi
8 Cheng Fu UB 36 In the middle of the transverse gluteal fold Pain in the lower back and gluteal regioin, constipation, muscular atrophy, pain, numbness and motor impairment of the lower extremities


 

If the above noninvasive treatment does not help the patient, then epidural injections are indicated.  Epidural injections under fluoroscope and X-ray guided injections inject steroid and lidocaine into the facet joint or nerve root in order do decrease the nerve root inflammation as well as decrease the pain.

Surgical treatment:

Surgery is the last resort and there are several surgical options.

1.     Discoctomy surgically cuts into the herniated disc to decrease the compression of the nerve root.

2.     Laminectomy is used if the discetomy is not successful; in this surgery a piece of the bone is out to release the impinged nerve root.

3.     Fusion. If the vertebral body is unsteady, and cannot hold together, it is necessary to use a rod or bone chip to fuse the vertebrae which protects the nerve from further impingement.

Jason was diagnosed with left L5 radiculopathy. He was treated with me with the combination of both western and Chinese medicines. I first used Hua Tuo Jia Ji with 9 needles and other adjunct points as above, I also used heating pad, massage, traction machine for 90 lbs 20 min, for stabilizing his low back, I prescribed customized lumbosacral corset, i.e. back brace. He was treated with me three times per week for 8 weeks.

Gradually the pain subsided, Jason felt less weakness on the leg and the burning and tingling sensations went away and eventually he returned to work but continued his visits with me for maintenance once every two weeks or once a month.  After 6 months, he then consulted the neurosurgeon again who felt surgery was no longer indicated, based on the low intensity of his lower back pain.

Tips for acupuncturist:

1.     It is absolutely necessary to make a clear diagnosis, Differentiate acute and chronic lower back pain, differentiate muscle sprain from herniated disc and spinal stenosis and radiculopathy, because only in this way can the prognosis be predicted.  For example, if the diagnosis is muscle spasm, acupuncture can make the patient experience a quick recovery and greatly lessen the pain, and he/she can  most probably return to work after only one or two days.  However, if the patient has a herniated disc or spinal stenosis, acupuncture probably will help, but it will be a long recovery, probably two or three months.

2.     Treatment:  Most patients opt for non-surgical treatment first.  However, if the pain radiates down the leg, with numbness, tingling down the leg, combined with urinary incontinence, it is very important to have an MRI and CT scan or X-ray to make sure there is no significant herniated disc or spondylolisthesis or spinal stenosis.  If a severe medical condition is confirmed, then it is best to refer the patient to a neurosurgeon.

3.     Acupuncture can treat a herniated disc, especially if combined with traction and massage.

4.     A lumbosacral corset is also a great tool to help a patient move around with less pain.

Tips for patients:

1.     Identifying the symptom, if you feel your low back pain radiating down to the leg with numbness, tingling sensation and weakness, sometimes accompanied with slightly urinary incontinency, you have to make your doctor to order MRI to make a clear diagnosis.

2.     If it is acute or chronic low back sprain, you may need a few acupuncture treatments with massage and heating pad, if it is low back pinch nerves or herniated disks with above symptom, you have to ask your acupuncturist to use Hua Tuo Jia Ji points accompanied with massage, heating pad, even traction machine, if they are legally allowed to do so.

3.     Low back brace always helps  you to reduce your pain, however, you can not use it for 24 hours a day, you should be aware that the brace has side effects, which may weak your low back and abdomen muscles if you use it too long time. You only can use it intermittently. While you are at home, do not use it.

15. Acupuncture and Severe Neck Pain and Hernic Disc

Mar 25, 2010   //   by drxuacupuncture   //   Blog, Case Discussions, Uncategorized  //  3 Comments

News Letter, Vol. 2 (3), March, 2010, © Copyright

Jun Xu, M.D. Lic. Acup., Hong Su, C.M.D., Lic. Acup.

www.rmac.yourmd.com; www.drxuacupuncture.co

Rehabilitation Medicine and Acupuncture Center

1171 East Putnam Avenue, Building 1, 2nd Floor

Greenwich, CT 06878

Tel: (203) 637-7720

Neck Pain and Herniated Disc

Jeffrey S. is a 35-yearold man who was involved in a motor vehicle accident from which he sustained a neck injury. He was stopped at a red light when another car rear-ended him.  He did not lose consciousness, and though he was aware that his neck had shifted backward, he felt the injury was only minor at the time. When the police officers at the scene of the accident suggested that he go to the hospital for evaluation, he did not feel sufficient pain to warrant this; plus, he had a meeting scheduled.

About two weeks later, the initial neck pain had radiated down to his right shoulder, elbow and hand, and he also felt numbness and tingling. The pain occurred on and off, especially during the night.  In the mornings when he woke up, his neck felt very stiff; the pain was severe and he could not lift heavy objects.  At this point, he visited his primary care physician, who ordered an MRI and X-ray.  These tests showed a herniated disc at C5 and C6 but no fracture.  The patient was referred for physical therapy and to a neurosurgeon.  The neurosurgeon prescribed two months of physical therapy, then a follow-up visit.

The patient attended physical therapy three times a week, but after a few weeks, the pain worsened, not only radiating down his right arm, but also between his shoulder blades.  In addition, he felt stiff and had difficulty moving his head forward and backward. His neurosurgeon gave Jeffrey a neck collar, which also did not help.  The doctor suggested that, since physical therapy had not worked, the patient should consider surgery.  Jeffrey did not want surgery.  He was a self-employed car dealer and could not afford to take the month off required for surgery and the recovery period.

He was subsequently referred to a pain-management physician who gave him epidural injections at C5-C6.  These greatly alleviated Jeffrey’s neck pain; however, a month later the pain returned and was much more severe and Jeffrey did not know what to do next.  He was referred to me for help and I was able to offer him an alternative treatment.

Common neck injuries:

Since the neck is very flexible and supports the head, it is extremely vulnerable to accidents and associated injuries.  Car accidents, sports-related accidents, contact sports and force can result in different degrees of cervical (i.e. neck) injuries.  The most common neck injuries after a car accident are:

  1. Soft tissue injury: involves the muscles and ligaments.  Usually there is no pain radiating down to the shoulder and arm, and no numbness or tingling sensation; however, the patient feels neck pain localized on the cervical spine and posterior shoulder and experiences pain and neck weakness when he/she wakes up each morning.
  2. Herniated disc injury/cervical radiculopathy: caused by moderate to severe neck injury. The most common is C5-C6 herniated discs, which impinge the cervical nerves causing the pain to radiate down to the shoulder, arm and sometimes, wrist, making the injured sides feel heavy and weak.  Very often, the patient feels pins, needles and burning sensations (cervical radiculopathy).
  3. Neck fractures or dislocations: severe neck injury will cause fractures or dislocations of the neck, which will in turn damage the spinal cord with more severe symptoms similar to the above.  Often may cause paralysis.

Jeffrey’s injury falls into the second category: cervical radiculopathy with herniated disc.

 

Western medicine: diagnosis and treatment

If a patient experiences severe neck pain after a car accident, the doctor usually orders the following tests:

  1. X-ray: most common test.  Checks for bone fractures. If the pain is not severe this test usually suffices.
  2. MRI: studies the spinal cord and nerve roots.
  3. CT scan: allows careful evaluation of the bony structure of the cervical spine.
  4. Myelography: dyed liquid is injected into the spinal cord to evaluate it and the nerve roots.
  5. EMG (electromyography): evaluates nerve and muscle function.

Jeffrey underwent the majority of these western medicine treatments, except surgery, including:

  1. Anti-inflammatory medication: Naproxen, Tylenol, Advil, etc. are administered to decrease neck inflammation. However, these medications usually just mask the pain, and incur many other side effects, such as stomach upset, peptic ulcer, and increased chance of blood clots. They cannot be expected to specifically treat the cause of the cervical herniated disc.
  2. Immobilization: most patients only need a soft collar, which gives psychological support to immobilize the neck.   In other words, if the patient feels he/she can depend on the collar for some support, the perception of pain is usually decreased to a certain degree.  In some cases, a solid cervical orthotic device might be used for unstable fractures of the cervical spine.
  3. Physical therapy: heating pads, ultrasound technology, stretching and strengthening exercises coupled with massages and range of motion exercises of the cervical spine.  This helps if the patient has soft tissue injury without a severe herniated disc.
  4. Epidural injection: the patient is put under a specific, C-arm X-ray machine. Then, a trained physician injects the steroid into the herniated area and nerve root, which decreases the inflammation and pain.  This treatment relies on the experience of the physician and the severity of the herniated disc and pinched nerve.  If the injury is too severe, epidural injection might not help, especially if the physician cannot inject the steroid into the specific point.
  5. Surgery: there are two possible surgeries for this condition:
    1. Discectomy.  The neurosurgeon might cut out only the injured portion of the disc, which will remove the pressure of the herniated disc from the nerve root.  This may cause the symptoms to decrease or disappear.  Sometimes, the entire herniated disc will disappear because of the degenerative changes in the disc tissue.
    2. Laminoctomy.  Sometimes the disc degenerates or the nerve root impingement is very severe.  In these cases, removing a part of the herniated disc through discectomy is not sufficient to relieve the pain. Thus, the surgeon may cut off a piece of the bone to open the nerve root outlet.
  6. Traction: recommended by doctors when the patient wants to avoid surgery.  This treatment pulls and slightly separates the vertebrae of the neck so that the herniated disc might return to its original place, thus relieving the pain. The neck position is extremely important in this course of treatment, The neck should not be hyperextended and pressure must be tested before flexing the neck as this could cause further damage to the cervical vertebrae.

Traditional Chinese Medicine: diagnosis and treatment

Jeffrey underwent most of the treatments listed above, without experiencing significant improvements.  Before undergoing surgery, he decided to consult me.  After a thorough physical examination, I concluded that the patient had the symptoms of right C5 and C6 nerve distribution and the herniated disc was impinged at C5-C6 nerve roots. The following table is a description for the pathophysiology of the cervical radiculopathy, i.e. the neck nerve root impingement at different root levels.

Nerve Root Disc Lesion Muscle involved Reduced Reflex Weakness Numbness
C3/C4 C2/C3 Posterior and lateral scalp, temporal muscles None None None
C5 C4 Rhomboids, Deltoid,Biceps brachii,

Supraspinatus,

Infrasponatus, Brachilis, etc.

Biceps brachii Elbow flexion Lateral arm
C6 C5 Deltoid,Biceps brachii, Brachioradialis

Supraspinatus,

Infraspinatus,

Supinator,

Pronator teres

FCR

EDC

Paraspinals

Brachioradialis Wrist extension Lateral forearm
C7 C6 Pronator teresFCR

EDC

Triceps brachii

Paraspinals

Triceps brachii Elbow extension Middle finger
C8/T1 C7 TricepsBrachii

FCU

FDP

ADM

PQ

APB

Paraspinals

None Finger flexion Middle finger

Abbreviations:

FCR: Flexor Carpi Radialis

EDC: Extersor digitorum communis

FCU: Flexor Carpi Ulnaris

FDP: Flexor Digitorum Profundus

ADM: Abductor digiti minimi

PQ: Pronator quadratus

APB: Abductor pollicis brevis

An MRI of the cervical spine without contrast (i.e. there is no contrast material injected into the blood circulation; this type of MRI decreases the amount of toxic substances injected into the body and the subsequent side effects) was ordered for Jeffrey, and is pictured below:

From the above films, it is evident that there was a herniated disc at C4, which impinged the C5 nerve root and caused the symptoms Jeffrey complained of.

I employed acupuncture to treat the injury, following the cervical spine from C5-C6 up into the lateral portions of the shoulder, upper arm and forearm.  Hua Tuo Jia Ji points are a set of specially designed points used to treat disc diseases. By palpation, you should feel the herniated disc spinal process, then insert the needles (about 0.5 inches deep) into the herniated disc, and the discs one level above and one level below the level of the herniated disc.  Then, insert needles 0.5 inches from the lateral sides of each of the three initial needles.  Thus, a total of 9 needles are inserted into the herniated disc and adjacent area.

For this particular case, I also extended this Hua Tuo Jia Ji to C4 and C7 levels. For the other parts of the body, I selected LI 15 Jian Yu, LI 11 Qu Chi, SJ 5 Wai Guan, and LI 4 He Gu.  The C5-C6 nerves connect to the lateral shoulder and the lateral upper arm; all the above acupuncture points follow these nerve roots locally.  The local acupuncture points will increase blood flow in the area, wash away inflammatory factors, and decrease the muscle spasms and inflammation. Distal acupuncture points such as the bilateral Tai Chong and He Gu should also be selected.  These largely increase the amounts of endorphins secreted in the brain, which help to decrease pain.

Pic 4-1 Hua Tuo Jia Ji Points


Table 4-1

Points Meridian/No. Location Function/Indication
1 Hua Tuo Jia Ji ExperiencedPoints Along the spine, use the most painful vertebral spinal as the midpoint, then locate the upper and lower spinal process and points located 0.5 inches on either side. You may choose two spinal processes as the starting points. See Pic 4-1 Specifically treat for local neck and low back pain, and pain along the spine.
2 Tai Chong Liv 3 See table 1-1/Pic 1-3 See table 1-1
3 He Gu LI 4 See table 3-1/Pic 4-2 See table 3-1
4 Qu Chi LI 11 Flex the elbow. The point is in the depression of the lateral end of the transverse cubital crease. Sore throat, toothache, redness and pain of the eye, scrofula, urticaria, motor impairment of the upperextremities, abdominal pain, vomiting, diarrhea, febrile disease.
5 San Yin Jiao Sp 6 3 inches directly above the tip of the medial malleolus, on the posterior border of the medial aspect of the tibia. Abdominal pain and distention, borborygmus, diarrhea, dysmonorrhea, uterine bleeding, morbid leucorrhea, prolapse of the uterus, delayed laboour, nocturnal emission, impotence, enuresis, dysuria, edema, hernia, pain in the external genitalia, muscular atrophy, motor impairment, paralysis and pain of the lower extremities, headache, dizziness and vertigo, insomnia.
6 Jian Yu LI 15 Anterior-inferior to the acromion, on the upper portion of m. deltoideus. When the arm is in full abduction, the point is in the depression appearing at the anterior border of the acromioclavicular jointSee Pic 4-2 Shoulder and arm pain, motor impairment of the upper extremities, rubella, scrofula
7 Wai Guan SJ 5 2 inches above outer wrist transverse crease; midpoint between the radius and ulnaSee Pic 4-2 Febrile diseases, headache, pain in the cheek, strained neck, deafness, tinnitus, pain in the hypochondriac region, motor impairment of the elbow and arm, pain of the fingers, hand tremor

Pic 4-2

Pic 4-3 The patient underwent my treatment for a total of 20 visits (twice a week for ten weeks).  Gradually, his pain decreased, the neck spasms and right-side arm weakness decreased, and the patient felt a large overall improvement.

Tips for both patients and acupuncturists:

I have found that the most efficacious treatment involves a combination of acupuncture, heating pads, massage and physical therapy.  I do not recommend that a patient undergo surgery immediately.  Studies have shown that surgery for this condition may show a marked improvement for about six months; however, after this period, the pain usually returns.  After two years, the patients with or without surgery may have the same level of pain (patients who did not undergo surgery were instead treated with acupuncture, physical therapy, massage and chiropractic therapy). Therefore, I recommend that patients explore other options before jumping into surgery.

A clear diagnosis is the most important factor in these cases.  For any acupuncturist to treat neck pain, he/she must first understand the mechanism of the pain.  If the pain is moderate, acupuncture treatment alone may help.  If it is more severe, it is important to refer the patient to a western doctor for evaluation.  If there is a fracture, the patient could become paralyzed and it is therefore absolutely necessary to first employ MRIs, X-rays, and CT scans to rule out skeletal instabilities.

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