Browsing articles tagged with " neck osteoarthritis"

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/

16. Acupuncture and Cervical Spondylosis-Neck Pain

Apr 28, 2010   //   by drxuacupuncture   //   Blog, Case Discussions, Uncategorized  //  4 Comments

News Letter, Vol. 2 (4), April, 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

 

Cervical Spondylosis (neck pain)

Thomas W. is a 65-year-old man who woke up one morning with neck pain that appeared seemingly out of nowhere.  He told his doctor the pain was extremely severe: a shooting pain that traveled downwards from his stiff neck to his shoulder blade.  He was unable to move his neck forward or backward, and had trouble turning it from side to side.  His condition made it dangerous for him to drive as he could not check for cars coming up beside him, and could not change lanes.  The pain was constant, sometimes dull, sometimes sharp, but with no associated burning sensation, numbness or tingling in his arms.  Occasionally, the pain radiated up to his scalp.

His primary care physician referred him to an orthopedic doctor.  This doctor ordered an X-ray, which showed that Thomas had cervical spondylosis.

He was prescribed physical therapy as his sole treatment.  He underwent physical therapy three times a week for five weeks, which alleviated the stiffness to some degree, but did nothing for the pain.

Thomas then came to me for evaluation and treatment.

Cervical spondylosis is a degenerative change that affects the spinal process, causing degeneration in the discs and joints between the vertebrae, i.e. arthritis in the neck.  It usually affects people over the age of 40; men are more prone to cervical spondylosis than women.  When the vertebral body and disc, as well as the different ligaments along the cervical spine, go through degenerative change, the patient gradually begins to experience neck stiffness.  Those affected usually try to adjust their own neck functions and flexibility to the stiffness; however, at some point they will feel severe pain because their bodies can no longer accommodate the changes.

The severity of symptoms depends on the location of the degeneration. If the compression affects the discs and ligaments, the patient will feel stiffness and have a limited range of motion, with difficulty turning the head backward and forward, and difficulty looking over his/her shoulder.  If the cervical nerve roots are compressed, inflammation and impingement of the nerve roots may result.  The patient may feel neck pain radiating to the shoulder, arm and hands, associated with numbness, weakness, headaches, and urinary and bowel incontinency.

Western medicine treatments for Cervical Spondylosis:

  1. Cervical collars: to stabilize the neck, and prevent additional neck instability, which might lead to paralysis of the legs and/or arms, a doctor will usually prescribe a soft cervical collar.  If a soft collar is not sufficient, the doctor may try a more rigid brace for the neck; however, these collars will restrict the patient’s range of movement of the neck and may, in the long run, exasperate the patient’s stiffness and pain further.  Thus, this method is not very effective.
  2. Physical therapy: involves the use of a heating pad, electrical stimulation, ultrasound technology, massages, and cervical stretches.  These treatments can often be very helpful to the patient.
  3. Surgery: if the above treatments do not work, surgery may be for the next best option. Surgery is based on the following criteria:
    1. The conservative measure of a cervical collar does not work.
    2. There is severe pain.
    3. There is significant neurological damage, such as difficulty in raising the arm, weakness, or bladder problems.
    4. There is a compression of the spinal cord.

There are two main types of surgery used to treat cervical spondylosis:

  1. Laminectomy: a spine operation to remove the portion of the vertebral bone called the lamina, which will release the pressure to the pinched nerves.
  2. Discectomy: a surgical removal of the central portion of an intervertebral disc, the nucleus pulposus, which causes the pain by stressing the spinal cord or radiating nerves.

Thomas underwent physical therapy and used a cervical collar.  Though he felt some improvement, he was not cured.  At this point, he consulted me for further treatment.  I treated Thomas with the following traditional Chinese medicine method.

First, I applied a heating pad to the patient’s neck for 15 minutes. Then, I inserted the acupuncture needles at the: Hua Tuo Jia Ji points at the C4, C5, C6, and C7; Arshi points; Du 14 Da Zhui; LI 15 Jian Yu, LI 11 Qu Chi, SJ 5 Wai Guang, and LI 4 He Gu.  I also used the small intestine meridian points, such as SI 3 Hou Xi, SI 5 Yang Gu, SI 8 Xiao Hai, SI 12 Bing Feng, and SI 11 Tian Zong to balance the energy of the entire upper extremity region.

Table 5-1

Points Meridian/No. Location Function/Indication
1 Hua Tuo Jia Ji ExperiencePoints Cervical, thoracic and Lumbar sacral spine. See Pic 4-1 Local neck, thoracic and low back pain
2 Arshi ExperiencePoints Any tender points in the body Decrease the pain in any tender points of the body
3 Da Zhui Du 14 Below the spinous process of the 7th cervical vertebra, approximately at the level of the shoulders Neck pain and rigidity, malaria, febrile diseases, epilepsy, afternoon fever, cough, asthma, common cold, back stiffness
4 Jian Yu LI 15 Antero-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 joint Pain in the shoulder and arm, motor impairment of the upper extremities, rubella, scrofula
5 Qu Chi LI 11 See table 4-1/Pic 4-2 See table 4-1
6 Wai Guang SJ 5 2 inches above Yangchi between the radius and ulna Febrile diseases, headache, pain in the cheek, neck sprain, deafness, tinnitus, pain in the hypochondriac region, motor impairment of the elbow and arm, pain of the fingers, hand tremor
7 He Gu LI 4 See table 3-1/Pic 3-4 See table 3-1
8 Hou Xi SI 3 When a loose fist is made, the point is on the ulnar side, proximal to the 5th metacarjpophalangeal joint, at the end of the transverse crease and the junction of the red and white skin Pain and rigidity of the neck, tinnitus, deafness, sore throat, mania, malaria, acute lumbar sprain, night sweating, febrile diseases, contracture and numbness of the fingers, pain in the shoulder and elbow.
9 Yang Gu SI 5 At the ulnar end of the transverse crease on the dorsal aspect of the wrist, in the depression between the styloid process of the ulna and triquetral bone Swelling of the neck and submandibular region, pain of the hand and wrist, febrile diseases
10 Xiao Hai SI 8 When the elbow is flexed, the point is located in the depression between the olecranon of the ulna and the medial epicondyle of the humerus Headache, swelling of the cheek, pain in the neck, shoulder, arm and elbow, epilepsy
11 Bing Feng SI 12 In the center of the suprascapular fossa, directly above Tian Zong. When the arm is lifted, the point is at the site of the depression Pain in the scapular region, numbness and aching of the upper extremities, motor impairment of the shoulder and arm
12 Tian Zong SI 11 In the infrascapular fossa, at the junction of the upper and middle 3rd of the distance between the lower border of the scapular spine and the inferior angle of the scapula Pain in the scapular region, and in the lateroposterior aspect of the elbow and arm, asthma

Pic 5-1

Pic 5-2

Pic 5-3

Pic 5-4

The acupuncture was coupled with strong electrical stimulation, after which the patient was treated with ultrasound and massage.  After six weeks of treatment, his neck function had improved greatly and he was able to turn his head while driving without difficulty.  He therefore avoided surgery, and, while he still experienced minimal pain, the acupuncture alleviated his condition and strengthened the main function of his cervical spine.

Acupuncture alone cannot cure cervical spondylosis because degenerative changes of the cervical spine severely affect both ligaments and joints.  For people over the age of 40, it is common for calcium to be released from the bones and begin circulating in the blood.  This circulated calcium begins to affect the body’s joints, and if it reaches the cervical spine, it will cause cervical spondylosis and degeneration in the surrounding ligaments, discs and joints.  After a while, the condition will restrict the neck’s range of motion.  Acupuncture may help relieve some of the symptoms, mainly pain, but the physical degeneration cannot be reversed through this method.

Since this condition is ongoing, and can lead to difficulty in walking, numbness and tingling sensations in the arms and hands, weakness of the arms, and urinary tract incontinence, the earlier it is treated, the better.  These symptoms can quickly worsen, causing permanent loss of nerve function; in this case, surgery will be absolutely necessary.

Tips for acupuncturists:

  1. Always apply a heating pad to the patient’s neck for about 15 minutes before inserting the acupuncture needles. The heating pad will improve the energy circulation.
  2. Hua Tuo Jia Ji is a group of excellent acupuncture points; you should always use it when treating patients with neck pain.

Tips for patients:

  1. You may use a heating pad at home to help with the healing.
  2. You may adjunct the acupuncture treatment with massages and range of motion exercises for your neck.

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.

12: Acupuncture and Cervical Dystonia

Dec 24, 2009   //   by drxuacupuncture   //   Blog, Case Discussions, Uncategorized  //  No Comments

Dear Patients and Friends:

Happy Holidays!

Year 2009 will be ending soon. We wish everybody happy holidays and a prosperous 2010.

Please find the following news letter 12. We hope you will enjoy to read it.

Dr. Jun Xu recently started to take photos; one is attached here. We hope to hear your comments.

Happy Holidays and Happy New Year!

Best,

Jun Xu and Hong Su


News Letter, Vol. 1 (12), December, 2009, © 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

Cervical Dystonia

Lisa L. is an 18-year-old female.  Lisa’s mother brought her in for treatment because she had been complaining of neck pain for the past six years.  The patient reports that, six years ago, when she woke up, she suddenly realized that her neck jerked to the left. The jerk happened very often; her neck would jerk two or three times every 5-10 minutes.  The jerk was involuntary and occurred more frequently especially when she was tired or under stress. However, if she had a good night’s rest, felt energized, and focused on something (e.g. her favorite sports), she would not experience the sudden, involuntary neck movements. Only when she sat still, did her neck start to jerk.

Lisa’s neck muscle always feels very tight, and the tightness can be very painful. She has been to many doctors and has tried everything, such as physical therapy and multiple medications, without any improvement. She therefore came to me for evaluation and treatment. Upon physical examination, I noted that the left side of the patient’s sternocleidomastoid muscle had hypertrophied. It felt like a thick rope on the left side of her neck. I also noted that other muscles had undergone hypertrophy: the levator scapular and splenius capitis at the cervicals. Throughout the entire physical examination, there was no jerk or involuntary contraction on the left side of the patient’s neck.

What Lisa is suffering from is called cervical dystonia, which is the most common form of focal dystonia.  Cervical dystonia is characterized by abnormal and spasmodic squeezing of the muscle that leads to muscle contractions in the head and neck area. The movements are involuntary and are sometimes very painful, causing the neck to twist repetitively, resulting in abnormal posture.  Overall, this may affect a single muscle, a group of muscles, such as those in the arms, neck, and legs, or even the entire body.  Patients with dystonia often have normal intelligence and no associated psychiatric disorders.

The causes of cervical dystonia are currently unknown.  There are two types of cervical dystonia:

Primary cervical dystonia: This type of cervical dystonia is not related
to any identifiable, acquired disorders affecting the brain or spinal cord such
as stroke, infection, tumor, or trauma. In some cases, primary cervical dystonia
is genetic, caused by abnormal genes such as dystonia DYT1. However,
because not all carriers of the DYT1 gene develop cervical dystonia, it
is likely that other genes or environmental factors may play a role in the
development of cervical dystonia.

Secondary cervical dystonia: Unlike primary cervical dystonia, secondary
cervical dystonia has obvious causes such as stroke, tumor, infection in the
brain or spinal cord, traumatic brain injury, toxins, birth defect, etc.  There
may be a period of months between the injury and the onset of the dystonia.

Tests and diagnosis:

The first step when diagnosing cervical dystonia is to determine if any of the causes that may lead to secondary dystonia are evident.  The following tests may be used to screen and/or diagnose for secondary cervical dystonia:

1.Toxins and infections screening: blood or urine samples will confirm the presence of toxins and infections.

2.Tumor screening: an MRI will identify and visualize tumors of the brain or spinal
cord.

3.Genetic testing: can be used to identify DYT1, which is critical to the diagnosis
of primary cervical dystonia.

4.Electromyography (EMG) testing: measures electrical activity of muscles.  An EMG can help diagnose muscle or nerve disorders.

Medications:

Many different medications have been used to treat cervical dystonia but most are not effective:

1.Cogentin and Kemadrin are examples of drugs that decrease the level of acetylcholine. These have helped some patients but have sedating side effects.

2.Valium, Ativan, Klonopin, etc., regulate the neurotransmitter GABA.

3.Sinemet, Laridopa, etc. either increase or decrease dopamine levels.

4.Carbamazepine is an anticonvulsant.

Botox injections:

Botox injections can usually stop the muscle spasms by blocking acetylcholine, relieving the symptoms for approximately three months. Very experienced doctors should administer the Botox injections. If Botox is used for more than a one-year period, it will gradually become less effective because the patient’s body will begin producing auto-antibodies against it.

Other treatments:

In some severe cases, surgery may be an option.  Surgery is the last resort and is used to selectively denervate the nerve supplying the muscle.

Another treatment option is deep brain stimulation.  This involves implanting an electrode in the brain connected to a stimulated device in the chest that generates an electrical pulse.  These electrodes will temporarily disable nerve activities by damaging
small areas of the brain.

Chinese medicine:

According to traditional Chinese medicine, cervical dystonia is caused by excessive liver wind. The liver controls the movement of all tendons, muscles and joints in the human body. Excessive liver wind overstimulates the tendons, muscles and joints, constantly activating the muscles.

The principle acupuncture treatment used to treat cervical dystonia reduces the excessive liver wind and thereby decreases the activities of the tendons, muscles and joints. The acupuncture points are along the meridians of the liver and gall bladder, such as the Feng Chi and Tai Chong points.

In addition, because patients with cervical dystonia have abnormal head and neck movements, acupuncture must also be used along the Du meridian, which controls head movement. The Du meridian supplies the entire brain. If the energy of the Du meridian is excessive, the entire head will move abnormally. Therefore, the acupuncture treatment should also include the Da Zhui and Hou Ding points from the Du meridian.  These points will adjust and regulate the Du meridian, the yang, activate the tendon function, and balance the input and output of the energy of the Du meridian.

The acupuncture treatment should also include the Xin Shu, a direct outlet acupuncture point from the heart and the Shen Shu, a connecting point from the kidney. Sheng Men, Tai Xi and the points listed above are involved in the circuitry of the heart and kidney, and will decrease the fire surrounding these organs, keeping the yin and yang in harmonious balance. Some local points in the neck and head such as Tian Chuang, Tian Rong, Tian Ding, and Fu Tu, should also be used for their localized calming functions.

This combination of local and distal acupuncture points will greatly decrease the symptoms associated with cervical dystonia.


The patient was treated with acupuncture at the above points for approximately two months, three times a week. After the last treatment, the number of neck contractions had significantly decreased. Now, she only experiences mild neck jerks and contractions, allowing her to perform her daily activities in a normal manner.

Tips for acupuncturists:

1.Acupuncture cannot treat all forms of cervical dystonia. The milder the disease, the better the treatment results.

2.Using heating pads and massages after the acupuncture treatment increases its
effectiveness.

Tips for patients:

1.The earlier the treatment, the better the treatment results.

2.Help yourself with massage and heating pad.

Case Discussions