Browsing articles tagged with " wrist pain"

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/

52. Acupuncture and Rheumatoid Arthritis

Apr 29, 2013   //   by drxuacupuncture   //   Blog, Case Discussions, Uncategorized  //  No Comments

News Letter, Vol. 5 (4), April, 2013, © Copyright

 

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

Robert Blizzard III, DPT

www.drxuacupuncture.co

Rehabilitation Medicine and Acupuncture Center

1171 East Putnam Avenue, Building 1, 2nd Floor

Greenwich, CT 06878

Tel: (203) 637-7720

Fax: (203)637-2693

 

Acupuncture and Rheumatoid Arthritis

 

Fig. 1 Hang RA http://www.fsb555.com

Sandy, a 45 year-old woman, complained of bilateral hand and wrist pain on-and-off for many years. Recently for a month now, she felt both hands had constant pain and were tender, warm and swollen.  She woke up with morning stiffness that may last for hours and felt firm bumps of tissue under her both forearm accompanied with fatigue, mild fever and gradually weight loss. She visited her PCP and was given naproxen to reduce her inflammation and pain, however, she felt no improvement. She was referred to a rheumatologist, who ordered x-ray images and rheumatoid factor test.  Both were positive for Rheumatoid Arthritis, therefore, the diagnosis was confirmed. The patient was given methotrexate and felt better for morning stiffness and swelling, however, she had many side effects, such as, nausea, vomiting, hair loss, etc. Because of above complaints, she came to me for evaluation and treatment.

 

Rheumatoid Arthritis (RA) is a chronic, long-term disease that causes pain, stiffness, swelling and limited motion and function of many joints. While RA can affect any joint, the small joints in the hands and feet tend to be involved most often. Inflammation sometimes can affect organs as well, for instance, the eyes or lungs. As the disease progresses, symptoms often spread to the knees, ankles, elbows, hips and shoulders. In most cases, symptoms occur in the same joints on both sides of your body.

The stiffness seen in active RA is most often worst in the morning. It may last one to two hours (or even the whole day). Stiffness for a long time in the morning is a clue that you may have RA, since few other arthritic diseases behave this way. For instance, osteoarthritis most often does not cause prolonged morning stiffness.

Other signs and symptoms that can occur in RA include:

Loss of energy

Low grade fever

Loss of appetite

Dry eyes and mouth from a related health problem, Sjogren’s syndrome, etc

Firm lumps, called rheumatoid nodules, which grow beneath the skin in places such as the elbow and hands

Fig .2 Synovium  http://www.rheumatology.org/practice/clinical/patients/diseases_and_conditions/ra.asp

The normal joint structure appears on the above left. On the right is the joint with rheumatoid arthritis. RA causes synovitis, pain and swelling of the synovium (the tissue that lines the joint). This can make cartilage (the tissue that cushions between joints) and bone erode, or wear away.

RA is an autoimmune disease. This means that certain cells of the immune system attack healthy tissues — the joints in RA, cause the inflammation in the synovium, the tissue that lines the joint. Immune cells release inflammation-causing chemicals. These chemicals can damage cartilage (the tissue that cushions between joints) and bone.

Rheumatoid arthritis affects the wrist and the small joints of the hand, including the knuckles and the middle joints of the fingers.

 

Fig. 3 RA Hand Deformity  www.eastlady.cn

Rheumatoid arthritis signs and symptoms may vary in severity and may even come and go. Periods of increased disease activity, called flares, alternate with periods of relative remission — when the swelling and pain fade or disappear. Over time, rheumatoid arthritis can cause joints to deform and shift out of place.

Diagnosis of RA depends on the symptoms and results of a physical exam, such as warmth, swelling and pain in the joints. Some blood tests also can help confirm RA. Telltale signs include:

Anemia (a low red blood cell count)

Rheumatoid factor (an antibody, or blood protein, found in about 80% of patients with RA in time, but in as few as 30% at the start of arthritis)

Antibodies to cyclic citrullinated peptides (pieces of proteins), or anti-CCP for short (found in 60–70% of patients with RA)

Elevated erythrocyte sedimentation rate (a blood test that, in most patients with RA, confirms the amount of inflammation in the joints)

X-rays can help in detecting RA, but may not show anything abnormal in early arthritis. Even so, these first X-rays may be useful later to show if the disease is progressing. Often, MRI and ultrasound scanning are done to help judge the severity of RA.

 

Fig. 4 Normal Hand X-ray http://gb.123rf.com/photo_751289_hands-on-x-ray-film.html

Fig 5.  RA hand x-ray

There is no single test that confirms an RA diagnosis for most patients with this disease. (This is above all true for patients who have had symptoms fewer than six months.) Rather, a doctor makes the diagnosis by looking at the symptoms and results from the physical exam, lab tests and X-rays.

There is no cure for RA. The goal of treatment is to lessen your symptoms and poor function. No single treatment works for all patients. Many people with RA must change their treatment at least once during their lifetime. The treatment must start as earlier as  possible.

A goal of physical therapy is to help make the muscles stronger and the improve the motion of the joints.  Warming up painful joints is very important in managing pain and priming the body for more exercise.  This can be accomplished with moist heating pads, a whirlpool or warm shower.  Following the warm-up, aerobic exercise such as a stationary bike, elliptical, or even arm bike will continue to work the body.  Other arthritis friendly options are aquatic exercises, tai chi or yoga routines.

 

Fig. 6 http://www.tospt.com/aquaticTherapy

It is important to be flexible with the workout routine, as if after the warm-up and aerobic exercise the joints are still very sore, change to strengthen a body part with less discomfort.  However, do not get in a habit of skipping the warm-up and light aerobic exercise if a joint is tender, as often just these two steps will greatly improve how the joint is feeling.  Below are a few range of motion and light strengthening exercises to help the hand that can be performed daily.

Fig. 7 http://morphopedics.wikidot.com/physical-therapy-management-of-rheumatoid-arthritis

West Medicine Treatment:

Good control of RA requires early diagnosis and, at times, aggressive treatment. Thus, patients with a diagnosis of RA should begin their treatment with disease-modifying antirheumatic drugs — referred to as DMARDs. These drugs not only relieve symptoms but also slow progression of the disease. Often, doctors prescribe DMARDs along with nonsteroidal anti-inflammatory drugs or NSAIDs and/or low-dose corticosteroids, to lower swelling, pain and fever. DMARDs have greatly improved the symptoms, function and quality of life for nearly all patients with RA.

Common DMARDs include methotrexate (brand names include Rheumatrex® and Folex®), leflunomide (Arava), hydroxychloroquine (Plaquenil) and sulfasalazine (Azulfidine). Older DMARDs include gold, given as a pill — auranofin (Ridaura) — or more often as an injection into a muscle (such as Myochrysine). The antibiotic minocycline (e.g., Minocin, Dynacin and Vectrin) also is a DMARD, as are the immune suppressants azathioprine (Imuran) and cyclosporine (Sandimmune and Neoral). These three drugs and gold are rarely prescribed for RA these days because other drugs work better or have fewer side effects.

Patients with more serious disease may need medications called biologic response modifiers or “biologic agents.” They can target the parts of the immune system and the signals that lead to inflammation and joint and tissue damage. These medications are also DMARDs. FDA-approved drugs of this type include abatacept (Orencia), adalimumab (Humira), anakinra (Kineret), certolizumab (Cimzia), etanercept (Enbrel), golimumab (Simponi) infliximab (Remicade), rituximab (Rituxan) and tocilizumab (Actemra). Most often, patients take these drugs with methotrexate, as the mix of medicines is more helpful.

The best treatment of RA needs more than medicines alone. Patient education, such as how to cope with RA, also is important. Proper care requires the expertise of a team of providers, including rheumatologists, primary care physicians, physiatrist and physical and occupational therapists. You will need frequent visits through the year with your rheumatologist. These checkups let your doctor track the course of your disease and check for any side effects of your medications. You likely also will need to repeat blood tests and X-rays or ultrasounds from time to time.

Living with rheumatoid arthritis

 

It is important to be physically active most of the time, but to sometimes scale back activities when the disease flares. In general, rest is helpful when a joint is inflamed, or when you feel tired. At these times, do gentle range-of-motion exercises, such as stretching. This will keep the joint flexible.

 

When you feel better, do low-impact aerobic exercises, such as walking, and exercises to boost muscle strength. This will improve your overall health and reduce pressure on your joints. A physical or occupational therapist can help you find which types of activities are best for you, and at what level or pace you should do them.

 

Acupuncture Treatment:

 

Acupuncture is an excellent alternative way to treat your symptoms. It has no side effects and can be combined with traditional western medicine to relieve your symptoms. The choice of acupuncture treatment of RA  is as following,

Fig 8. Common used acupuncture  points on hands for RA patients

1.         Common used body points: Du20 Bai Hui,  GB8 Shuai Gu, UB9 Yu Zhen, Ht7 Shen Men, GB20 Feng Chi, UB15 Xin Shu, UB20 Pi Shu, UB18 Gan Shu, UB23 Shen Shu, St6 Zu San Li, Sp6 San Yin Jiao, Lv3 Tai Cong, UB2 Zan Zhu, Kid3 Tia Xi.

2.         Arthritis: Shoulder: LI 15 Jian Yu, SI 9 Jian Zhen, SJ 14 Jian Liao, SI 10 Nao Shu, SI 11 Tian Zhong, LI 16 Ju Gu  Wrist: LI5 Yang Xi and SJ 4 Yang Chi.  Hand: L11 Shao Shang, L10 Yu Ji, LI 1 Shang Yang, LI 2 Er Jian, Ht 9 Shao Chong, Ht 8 Shao Fu, SI Shao Ze, SI 2 Qian Gu, SI 3 Hou Xi, SI 4 Wan Gu, PC 9 Zhong Chong, PC 8 Lao Gong.   Knee: LI 4 He Gu, LI 11 Qu Chi, St 35 Du Bi, Nei Xi Yan, Sp 10 Xue Hai, St 34 Liang Qiu, He Ding, UB 40 Wei Zhong. Feet: St 45 Li Dui, St 44 Neiting, Sp 1 Yin Bai, Sp 2 Da Du Sp3 Tai Bai, Sp 4 Gong SunUB 66 Zu Tong Gu, UB 65 Zhi Yin, UB 65 Shu Gu.

3.         Neurological Symptoms: Fatigue, Depression and Poor Sleep: Major points: St 36 Zu San Li, PC6 Nei Guan,  LI4 He Gu, Ht7 Shen Meng, Sp6 San Yin Jiao, GB20 Feng Chi, Du20 Bai Hui, EX-HN1 Si Shen Cong, assistant points: Du14 Da zhui, Ren12 Zhong Wan, Ren14  Ju Que, Ren6 Qi Hai, Ren4 Guang Yuan, UB21 Wei Shu and UB23 Shen Shu.

4.         Heart Palpitation: PC6 Nei Guan, Ht7 Shen Men, UB15 Xin Shu, Ren14 Ju Que, UB14 Jue Yin Shu

5.         Dizziness: Si Shen Chong, Du20 Bai Hui, Du12 Shen Zhu, UB12 Feng Men, UB43 Gao Huang, Sp6 San Yin Jiao, St36 Zhu San Li, LI11 Qu Chi.

Sandy’s Treatment:

Sandy was treated with me for 2 x per week for 8 weeks. I first try to decrease her pain at the joints and body with the points of group 1 and 2 , then, I used the group 3 and 4 points to help her to improve her fatigue and depression, after about 2 month’s treatment, Sandy was put on maintenance treatment program once a week for 4 weeks, and she  felt much improved. Her pain scale decreased from 7/10 to 2/10. Her swelling at both hands is much relieved.

Tips for Patients:

1. Multiple Therapies are the best way to treat RA with combination of medicine, PT and Acupuncture.

2. Newer treatments are effective. RA drugs have greatly improved outcomes for patients. For most people with RA, early treatment can control joint pain and swelling, and lessen joint damage.

3. Seek an expert in arthritis: a rheumatologist. Expertise is vital to make an early diagnosis of RA and to rule out diseases that mimic RA, thus avoiding unneeded tests and treatments. A physiatrist who is an expert in RA also can design a customized treatment plan that is best suited for you. Therefore, the rheumatologist, working with the primary care physician and other health care providers, should supervise the treatment of the patient with RA.

4. Start treatment early. Studies show that people who receive early treatment for RA feel better sooner and more often, and are more likely to lead an active life. They also are less likely to have the type of joint damage that leads to joint replacement.

Tips for Acupuncturists:

1. Treat your patients as a whole person and long-term treatment is necessary. You should encourage your patient perform exercise, which will keep your patients’ mobility of hands and other joints.

2. Encourage your patients to have at least 8 weeks treatment. It is very important to have a long-term treatment to achieve the best results.

 

46. Acupuncture and Fibromyalgia

Oct 25, 2012   //   by drxuacupuncture   //   Blog, Case Discussions, Uncategorized  //  No Comments

News Letter, Vol. 4 (10), October, 2012, © Copyright

 

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

Robert Blizzard III, DPT

www.drxuacupuncture.co

Rehabilitation Medicine and Acupuncture Center

1171 East Putnam Avenue, Building 1, 2nd Floor

Greenwich, CT 06878

Tel: (203) 637-7720

Fax: (203)637-2693

Fibromyalgia

Helen is a 46 years old female, who complains of pain all over the body for about one year. Her husband lost his job about one year ago and has tried his best to find one.  However, he has had no such luck. Helen started to worry about her family financial situation and very often could not sleep well. She always feels sluggish as sleep is not replenishing her energy. She wake up feeling very stressed out and moody and worrying about everything.  She gradually developed pain all over the body, feeling tenderness at symmetric points, such as neck, upper back, shoulders, elbows, middle back, low back, hip, knee and calf. The pain is getting worse, now even moderate touch could make her feel pain. She was forced to move out of her house because she was unable to pay her mortgage and moved in an apartment recently. This made her symptom worse,  she went to her primary care physician, who checked her blood work, chest x-ray and EKG, all were normal, and  prescribed Ambien and pain medication, such as Oxycodone, she felt temporarily  relief, however, she had constipation, headache, sometimes diarrhea, felt very tired when waking up. Because the symptoms were getting worse, therefore, she came to me for evaluation  and treatment.

Upon examination, she looked very tired and fatigue, spoke with a low tone, she was found to have many tender points along the spine, chest ribs, shoulders, elbows, hips and knees, when she was touched by my fingers.

This patient might have fibromyalgia, a common syndrome, most often occurring in middle age women.  Symptoms are long-term, body-wide aches, pains and tenderness.  Typically symmetric in the joints, muscles, tendons, and other soft tissues, very often with accompanying fatigue, depression, insomnia, and anxiety.

Causes

The cause is unknown. Possible causes or triggers of fibromyalgia include:

  1. Genetics: the mode of inheritance is currently unknown, but it is common to see patients in one family, especially mother and daughter.
  2. Stress: an important precipitating factor, Fibromyalgia is frequently found with stress-related disorders, such as chronic fatigue syndrome, posttraumatic stress syndrome, irritable bowel syndrome, and depression.
  3. Physical or emotional trauma
  4. Poor sleep.

Among the above possible causes, the most important are stress and poor sleep,   stress and poor sleep make a noxious cycle: Stress causes poor sleep, poor sleep enhances stress, both stress and poor sleep make muscles unable to relax, for a long time period, the muscles nerve get chance to relax, then it twists together and forms the tender points and bends, which are symmetric and long term.

Fibromyalgia is most common among women aged 20 to 50.

Symptoms-Pain

Widespread pain, fatigue, and severe pan in response to light pressure, numbness and tingling sensation, muscle spasm and weakness in all 4 extremities, nerve pain, muscle taut band, twitching, chronic sleep disturbances, and irritable bowel syndrome.

Fibromyalgia patients tend to wake up with body aches and stiffness, pain improves during the day and gets worse at night. Some patients have pain all day long. Pain may get worse with activity, cold or damp weather, anxiety, and stress.

Fatigue, depressed mood, and sleep problems are seen in almost all patients with fibromyalgia. Many say that they can’t get to sleep or stay asleep, and they feel tired and stiffness when they wake up.

Many patients experience impaired concentration, poor memory, inability to multi-task, poor attention span, anxiety and depression.

The American College of Rheumatology preliminary diagnostic criteria for fibromyalgia New Diagnostic Criteria and measurement of symptom severity.

Arthritis Care Res (Hoboken). 2010 May;62(5):600-10.

The new criteria keep the requirements that other causes be ruled out and that symptoms have to have persisted for at least 3 months.  They also includes 2 new methods of assessment, the widespread pain index (WPI) and the symptom severity (SS) scale score.

The WPI lists 19 areas of the body and you say where you’ve had pain in the last week.  You get 1 point for each area, so the score is 0-19.

                                                                         http://www.home-health-care-physical-therapy.com/Fibromyalgia-Tender-Points.html

For the SS scale score, the patient ranks specific symptoms on a scale of 0-3.  These symptoms include:

  • Fatigue
  • Waking unrefreshed
  • Cognitive symptoms
  • Somatic (physical) symptoms in general (such as headache, weakness, bowel problems, nausea, dizziness, numbness/tingling, hair loss)

The numbers assigned to each are added up, for a total of 0-12.

This next part is really interesting to me.  Instead of looking for a hard score on each, there’s some flexibility built in, which recognizes the fact that fibromyalgia impacts us all differently, and that symptoms can fluctuate.

For a diagnosis you need EITHER:

  1. WPI of at least 7 and SS scale score of at least 5, OR
  2. WPI of 3-6 and SS scale score of at least 9.

Treatment

The goal of treatment is to improve impaired function, help a person mentally and physically cope with the symptoms, and to help relieve pain and other symptoms,

The first type of treatment may involve:

  • Physical therapy
  • Exercise and fitness program
  • Stress-relief methods, including light massage and relaxation techniques

Physical Therapy is aimed at treating the disease consequences of fibromyalgia including pain, fatigue, deconditioning, muscle weakness and sleep disturbances among others.

Modalities such as ultrasound and TENS machines will help reduce localized and generalized musculoskeletal pain in fibromyalgia patients.

Massage is great to reduce muscle tension and spasms which prevent efficient muscle motion.  Techniques such a joint mobilizations and deep tissue massage prescribed with other therapeutic interventions such as stretching will help your muscles more effectively.

Physical Therapy consult is very beneficial to address sleeping disturbances affecting about 80% of all patients.  Positioning while sleeping and relaxation techniques prior to sleeping can help correct this serious problem.

Fitness machines such as exercise bikes or elliptical machines will improve important measures of cardiovascular fitness, subjective and objective measures of pain.  Also improving is subjective energy levels, work capacity along with physical and social activities.

Focusing on core stability will reduce overloading of the muscle system by supporting the muscles of your spine.  There is a great impact on conditioning weak muscles for improving postural fatigue and positioning.  With a strong core, your body will have a stable, center point.

There is great evidence based research for Whole Body Vibration use on patients with fibromyalgia.  A 6-week study published in 2008, in The Journal of Alternative and Complementary Medicine, by Alentorn-Geli et al reports that WBV safely reduces pain and fatigue while also improving physical function in patients with fibromyalgia.  Here at Rehab Medicine & Acupuncture Center, we have been using this evidence based device in successfully treating symptoms of fibromyalgia.

Another study looking at the benefits of WBV with fibromyalgia performed by Sanudo et al in 2010 was published in Clinical and Experimental Rheumatology. This study examined women with fibromyalgia performing exercise training 2 times a week along with WBV three days a week compared with an exercise only group over a 6-week period with a focus on strength and quality of life.  Significant improvements in all outcomes measured were found from baseline in both groups though additional health benefits were observed with the supplementary WBV.

The second line of treatment is medications, such as antidepressant or muscle relaxant in order to improve sleep and pain tolerance, Duloxetine (Cymbalta), Pregabalin (Lyrica) and Milnacipran (Savella) are very often prescribed.

However, many other drugs are also used to treat the condition, including:

  • Anti-seizure drugs
  • Other antidepressants
  • Muscle relaxants
  • Pain relievers
  • Sleeping aids

Cognitive-behavioral therapy is an important part of treatment. This therapy helps you learn how to:

  • Deal with negative thoughts
  • Keep a diary of pain and symptoms
  • Recognize what makes your symptoms worse
  • Seek out enjoyable activities
  • Set limits

Acupuncture treatment for Fibromyalgia

Acupuncture points mainly are selected from meridians of Tai Yang and Sao Yang, plus cupping.

UB9 Yuzhen, UB16 Dushu, UB18 Ganshu, UB23 Shenshu, Ren6 Qihai, Du20 Baihui, GB13 Bensheng, GB21Jianjin, GB34 Yanglingquan, LI15 Jianyu, ST 36 Zusanli, Sp8 Diji, Ki8 Jiaoxin, UB59 Fuyang, Arshi, etc.

 

Helen’s Treatment:

Helen underwent our treatment about 3 months. I first helped her improve her sleep. According to Chinese Medicine, the key factor was sleep, if the patient can have better sleep, her noxious cycle will be broken, and along with her improvement of sleep, her muscles was gradually relaxed and her pain was gradually reduced. She also was encouraged to have physical therapy to improve her functional abilities and join the entertainment activities,  she had difficulty playing tennis at beginning, after a few treatments, her performance of tennis was getting better, and after all the treatment for three months,  her pain is almost gone and quality of life is much better.

Tips for patients:

    1. Keep a peaceful mood, and you have to realize that your worrying does not take away your stress, but adds stress to you.
    2. Try to get a good sleep nightly, take hot shower before go to bed and avoid TV in order to have a nice sleep routine.
    3. Massage sleep points 5 mins before you go to bed.
    4. Force yourself  to attend the entertainment activities

Tips for Acupuncturists:

  1. Try to help patients to have good sleep by selecting Baihui, An Mian, etc.
  2. Try to help patients to have stress reduction by selecting Shen Men, Shen Shu, etc.
  3. Encourage patients attend all the activities.
  4. Cupping along UB meridian is very helpful.

 

36. Acupuncture and Wrist Pain After Bike Riding-Ulnar Nerve Impingement

Dec 11, 2011   //   by drxuacupuncture   //   Blog, Case Discussions, Uncategorized  //  1 Comment

News Letter, Vol. 3 (12), December, 2011, © Copyright

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

Robert Blizzard III, DPT

www.drxuacupuncture.co

Rehabilitation Medicine and Acupuncture Center

1171 East Putnam Avenue, Building 1, 2nd Floor

Greenwich, CT 06878

Tel: (203) 637-7720

Wrist Pain after Bike Riding- Ulnar Nerve Entrapment


 

photography.nationalgeographic.com

Derek is 43 year-old male, who likes to cycle cross country.  He has regularly biked 100 miles per week for over 10 years.  On weekends he will get up early in the morning and get in a very intensive bike ride. About 2 months ago, he started to feel both hands had weakness and tenderness along with numbness and a tingling sensation bilaterally at the 4th and 5th fingers. He even felt coldness at the 4th and 5th fingers.  He sometimes has difficulty typing, and has to shake his hands to rid of numbness after waking up from sleep. He visited his primary care physician, and was given Advil for his pain and told that after a few weeks the pain and numbness might go away. However, he still feels it and is getting worse, therefore, he comes to me for evaluation and treatment.

Because the 4th and 5th fingers are supplied with ulnar nerve, therefore, his symptom made me think ulnar nerve entrapment, i.e. Guyon’s canal syndrome. By physical examination, the patient had weakness to make a full fist, and weaker to spread out his 5 fingers.

The ulnar nerve is one of the three main nerves in the arm. Ulnar nerve is located underneath the shoulder, arm and little and ring fingers. Along its pathway, there are a few locations the ulnar nerve is easily trapped. As indicated at this figure.

Fig 12.1

The ulnar nerve functions to give sensation to the little finger and the half of the ring finger that is near the little finger. It also controls most of the little muscles in the hand that help with fine movements, and some of the bigger muscles in the forearm that help to make a strong grip.

Fig 12.2

 

 

Fig 12.3


 

  1. The cubital tunnel: Ulnar nerve travels from under the collarbone and along the inside of the upper arm. It passes through a tunnel of tissue (the cubital tunnel) behind the inside of the elbow. While holding your elbow on the desk such as answering your phone, or when lying on your stomach by holding your arm face down, one sometimes feels the funny sensation commonly called the “funny bone.”

Fig 12.4

 

  1. Guyon’s canal : Beyond the elbow, the nerve travels under muscles on the inside of the arm and into the hand on the side of the palm with the little finger. As the nerve enters the hand, it travels through another tunnel (Guyon’s canal). The most common injury is by riding a bicycle for long time, like the above case.

 

Fig 12.5

http://www.hughston.com/hha/a_15_3_2.htm

Presenting symptoms of ulnar nerve entrapment can vary from mild transient pins and needles sensation, i.e. paraesthesias in the ring and small fingers to clawing of these digits and severe intrinsic muscle atrophy.The patient may report severe pain at the elbow or wrist with radiation into the hand or up into the shoulder and neck. Patients may report difficulty opening jars, spreading out hand and fingers or turning door knobs. The patients may feel early fatigue or weakness after repetitive hand motions, such as typing, sorting mails, etc. increasing numbness and paraesthesias may be noticed throughout the day.

Ulnar neuropathy can be caused by nerve damage, which can result from inflammation or compression along the pathway of ulnar nerve:

  • Ulnar nerve at or near the elbow
    • Compression at work, sleep or during general anesthesia
    • Blunt trauma
    • Malnutrition leading to muscle atrophy and loss of fatty protection across the elbow and other joints
    • Deformities (eg, rheumatoid arthritis, fracture of elbow bones)
    • Metabolic derangements (eg, diabetes)
    • Venipuncture
    • Hemophilialeading to hematomas
  • Ulnar neuropathy at or distal to the wrist (ie, at Guyon’s canal)
    • Bicycle
    • Tumors
    • Ganglionic cysts
    • Blunt injuries with or without fracture
    • Idiopathic
Diagnosis:
Proper diagnosis of ulnar nerve entrapment depends on an experienced physician:
·         Clear medical history taken, your physician should ask you in detail, including when, where, how, the symptom started, etc.
·         A comprehensive medical examination, including, inspection of any muscle atrophy, palpation of the tender area,  range of motion, sensitivity, special muscle strength test, etc.
  • Electrodiagnostic studies (EMG) to study nerve conduction within your hands and wrists, which is a gold standard for final diagnosis of ulnar neuropathy
Treatment:

The choice of treatment depends on the severity of your symptom. For mild to moderate ulnar neuropathy, conservative treatment, such as physical/occupational therapy, non-steroidal anti-inflammatory medicine, splints and acupuncture are recommended.

  • Physical Therapy to stretch, strengthen and remove adhesions in the ligaments and tendons in the hands and elbows
    • Ulnar Nerve Gliding: perform this maneuver till the hand is upside down with the fingers around the eye as shown below.  Hold for 20 seconds x 3 reps.

Fig 12.6

 

 

  • The daily use of nonsteroidal anti-inflammatory drugs, such as aspirin, ibuprofen, and other nonprescription pain relievers to help reduce pain and inflammation
  • Wearing splints to help immobilize and protect the elbow and wrist

Fig 12.7

 

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  • Acupuncture

The most commonly used points are the following:

SI 4 Wan Gu, SI 5 Yang Gu, SI 6 Yang Lao, SI 7 Zhi Zheng, SI 8 Xiao Hai

Points Meridian/No. Location Function/Indication
1 Wan Gu SI 4 On the ulnar side of the palm, in the depression between the base of the fifth metacarpal bone and the triquetral bone Febrile diseases with anhidrosis, headache, rigidity of the neck, contracture of the fingers, pain in the wrist, jaundice
2 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 ulnar and the triquetral bone. Swelling of the neck and submandibular region,  pain of the hand and wrist, febrile diseases
3 Yang Lao SI 6 Dorsal to the head of the ulna. When the palm faces the chest, the point is in the bony cleft on the radial side of the syloid process of the ulna. Blurring of vision, pain in the shoulder, elbow and arm
4 Zhi Zheng SI 7 On the line joining SI 5 Yang Gu and SI 8 Xiao Hai, 5 inch above Yang Gu Neck rigidity, headache, dizziness, spasmodic pain in the elbow and fingers, febrile diseases, mania
5 Xiao Hai SI 8 When the elbow is flexed, the point is located in the depression between the olecranon of the ulna and the medical epcondyle of the humerus Headache, swelling of the cheek,  pain in the shoulder, arm and elbow, epilepsy

 

 

Fig 12.8

 

  • Surgery: for severe cases and after the above conservative treatment, the following methods are considered:
  1. At the elbow. Your surgeon will make an incision at the elbow and perform a nerve decompression. Or your surgeon may choose to move the nerve to the inner part of the arm so that it is in a more direct position.
  2. At the wrist. If the compression is at the wrist, the incision is made there and the decompression is performed.

Tips for Acupuncturists:

  1. Make a clear diagnosis, check the causes of ulnar neuropathy, acupuncture may not  change the causes of the disease
  1. Early treatment will help the course, however, acupuncture only may help for the symptom, patients have to change their practice of sports or working

Tips for Patients:

  1. Avoid press your elbow and wrist during sports or work.
  2. Temporary numbness and tingling sensation at ring and little fingers usually will disappear without treatment. However, if you constantly press your elbow and wrist, you may have permanent damage.

 

20. Acupuncture and Wrist Pain

Aug 22, 2010   //   by drxuacupuncture   //   Blog, Case Discussions, Uncategorized  //  No Comments

News Letter, Vol. 2 (8), August, 2010, © 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

Wrist Pain




Margaret D., a 45-year old pianist and professor at a music school in New York, had been preparing for a European concert for a year and was thus practicing more than usual.  A month before she was due to depart for Europe, she began experiencing a constant and severe pain in her left wrist. The pain, which was sharp, originated near the base of her thumb and gradually spread farther back into her forearm.  When she played the piano or tried to grasp or pinch an object, she felt a sharp pain in her wrist.  She also felt some numbness at the back of her thumb and index finger, and found a fluid-filled cyst on her left wrist.  Overall, she had difficulty moving that thumb and wrist.  She was extremely nervous and upset when she consulted me, fearing she might have to cancel her European concert.

Upon examining her, I found that her left wrist was swollen and extremely tender, especially at the base of the thumb.  Margaret was unable to bend her wrist or grasp a book or a cup.  Believing that she had de Quervain tenosynovitis, I performed the ‘Finkelstein test’ to determine the source of Margaret’s pain.  I asked her to hold her thumb in the palm of her hand and bend her wrist toward the little finger.  Margaret felt immediate exacerbation of the pain, which confirmed my diagnosis of de Quervain tenosynovitis.

De Quervain tenosynovitis affects two tendons: the extensor pollicis brevis and the abductor pollicis longus, which are located on the lateral side of the wrist.  These run parallel to each other and pass through the wrist in the synovial sheath.  This sheath enables the tendons to exercise their function: i.e. flexing and extending the thumb, like when you make a fist.

Some doctors believe the cause of de Quervain tenosynovitis is unknown.  Others believe that it can be caused by repetitive exercise such as playing piano, like in Margaret’s case.  Overuse of the two tendons can cause wrist pain, swelling, numbness or a tingling sensation when the nerve is pinched.  The differential diagnosis also includes osteoarthritis of the first scarpometacarpal joint: i.e. the osteoarthritis at the base of the thumb.

There are various ways of treating this condition:

  1. Western medicine:
    1. Non-steroid anti-inflammatory drugs such as ibuprofen, naproxen, Aleve, etc.
    2. Steroid injections, which are often extremely effective, however, the side effect is that steroid might cause the tendon become fragile and easily reinjuried.
    3. Natural treatment:
      1. Immobilization of the thumb by using a spica splint, which fixes the thumb in place, promotes total rest, and avoids any thumb movements. 2. Hot/cold compresses can be effective.  First apply a heating pad to the affected area to induce blood flow to the                  affected thumb and wrist, which will flush away the inflammatory factors.  Next, apply ice packs to drive away the                  inflammatory fluids.

2.Acupuncture.  The three most important points to utilize in this treatment are

  1. Large Intestine 4 He Gu, which serves to increase the endorphin secretion in the brain. It can thus synchronize with local points to decrease the pain signals from the brain.
  2. Large Intestine 5 Yang Xi and San Jiao 4 Yang Chi.  LI 5 is the point located exactly in-between the tendons of the extensor pollicis brevis and the abductor pollicis longus of the distal insertion.  SJ 4 is adjacent to the LI 5, and will help the healing effects of LI5. Heating this area will increase the amount of blood flow and wash away the inflammation.  Electrically stimulating the two needles will continually increase the energy flow to the area to decrease the feeling of pain.
  3. Large intestine 11 Qu Chi. LI 11 is the point along the same meridian of LI5 and helps decrease the pain by activating energy from the distal meridian.
Points Meridian/No. Location Function/Indication
1 He Gu LI 4 See table 3-1/Pic 3-4 See table 3-1
2 Yang Xi LI 5 On the radial side of the wrist, when the thumb is tilted upwards, it is in the depression between the tendons of m. extensor pollicis longus and brevis Headache, redness, pain and swelling of the eye, toothache, sore throat, pain of the wrist
3 Yang Chi SJ 4 On the transverse crease of the dorsum of wrist, in the depression lateral to the tendon of m. extensor digitiorum communis. See Pic 11-1. Pain in the arm, shoulder and wrist, malaria, deafness, thirst.
4 Qu Chi LI 11 See table 4-1/Pic 4-2 See table 4-1

Pic 8-3

Margaret received acupuncture treatment three times a week for four weeks then came in twice a week for an additional six visits with the electrical stimulation and heated needle treatments.  She also wore the spica splint and used an ice massage treatment immediately after practicing piano.  Her pain decreased significantly and she went to Europe for her piano tour.  As a reward to me, she brought her CDs recorded in her Europe trip to me. She had very successful performance.

Tips for acupuncturists:

  1. In addition to the above points, you may add a few Arshi points along the insertional tendons of extensor pollicis brevis and abductor pollicis longus. Note that the distal tendons are located in the lateral wrists, and are also called the “snuff box”.
  2. Recommend that the patient wear the spica splint, which will immobilize the patient’s wrist and accelerate the healing process.

Tips for patients:

  1. The sooner treatment is commenced, the better chance you have of recovering; you should not wait to consult the doctor.
  2. Resting and immobilization are necessary.  Many physicians think the cause of this condition is idiopathic (unknown), but my observation is that mechanical repetitions of the thumb cause this condition.
  3. After acupuncture and heating and electrical stimulation, it is best to apply ice to the wrist, which in turn helps decrease the inflammation.

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