Acupuncture to relieve unilateral numbness and tingling in the upper extremities: A case report KEYWORDS: acupuncture, tingling, numbness, increase, blood flow. Student/Author: Sophia Mitsiki-Murray Student Number: 234705 Clinic Supervisors: Mark Shoring, Patricia Reynolds, Charity Carleton Allocated Supervisor: Mark Shoring Clinic Session: Friday 11:30 am 14:30 pm Subject Code: CMCS421 Chinese Medicine Acupuncture Clinical Studies 7 Semester: Semester 1 2015 Due Date: Sunday 24 May 2015 Word Limit: 500 words +/- 10% (450-550) Word Count: 514 words
ABSTRACT A possible explanation for numbness/tingling in the fingers, common among computer users, is nerve compression and subclinical carpal tunnel syndrome (Overgaard et al. 2004, p.521). According to the literature review acupuncture can increase blood flow through activation of thin nerve fibres (Hsiao & Tsai 2008, p.46), dermatomes and acupuncture points have functional associations via viscerocutaneous reflexes and (Molano et al. 2014, pp.10-11) and dermatomes partly determine the therapeutic efficacy of acupuncture (Ferreira & Luiz 2013, p.11). Furthermore, needling specific points such as LR3 can increase circulation in the upper limbs (Takayama et al. 2012, pp.4,7) and potent analgesic effect on the extremities can be induced with electroacupuncture (Leung et al. 2008, p.11). This case study illustrates that acupuncture except an analgesic effect can also reduce numbness and tingling on the upper extremities. Future high quality research could focus on the specific mechanism behind numbness and tingling and how acupuncture alleviates these symptoms. 122 INTRODUCTION / CASE HISTORY DESCRIPTION A 61-year-old female office worker from Denmark, presented with pain on the wrist and continuous numbness and tingling initiating from the shoulder till the tips of the fingers on the right arm. Condition was 6 days old, the pain and numbness caused frequent waking at night and symptoms were aggravated by computer use or wrist overuse. Patient hadn t visited the doctor and stated she was not willing to do so. Carpal tunnel tests (Phalen s and Tinel) gave negative results. Palpation revealed extremely tight shoulders and initial diagnosis suggested possible nerve compression on the C7 level and dermatome affecting middle and ring fingers. Treatment plan: acupuncture twice/week for 3 weeks (end of semester). Expected outcome: relieve pain, numbness and tingling to obtain uninterrupted sleep. Actual outcome: pain totally alleviated, numbness and tingling close to totally alleviated, sleep was uninterrupted. Recommendations: tui na massage, neck stretches during office hours, light exercise.149 Session Table of Presentation & Treatment Signs & Symptoms Examinations: Diagnosis & Treatment principle Treatment Formula 1
Questioning, listening, observation & palpation: Continuous tingling and numbness from shoulder to fingers on right hand Continuous pain/soreness that wakes her up at night Feels a lot of tension and tightness on the neck due to computer work at office Symptoms are worse for 1 driving, typing on the computer for a long time, using the wrist a lot, Blood pressure t times rises but no medication, Not willing to visit doctors for BP or this condition Three soft lumps without defined edges around wrist area, that reduce in size after rubbing or pressure Tongue: slightly pale with purple in the middle, flabby with distinct ST crack, thin white moss. Pulse: 62beats/min, regular, slippery, weak and KI wiry. 2 Did not wake up during sleep for 4 days after treatment, the rest of the days was able to go back to sleep after waking Pain/soreness was reduced a lot Numbness and tingling very light, moved to the 3 rd and 4 th finger and slight on the wrist only D: Blood xu due to qi stagnation along the Du + GB channels of the neck affecting mainly the RHS arm, wrist and fingers TP: Move Qi along the Du & GB channels of the neck, relieve pain and numbness, build blood Same as previous week GB20 Fengchi GB21 Jianjing GB40 Qiuxu LI4 Hegu TE4Yangchi MBW35 Huatuojiaji at C7 level GB34 Yanglingquan Strong stimulation during needling Feedback: pain, numbness and tingling were alleviated straight after treatment Repeat previous treatment additional point: HT7 Shenmen 2
Daughter had operation and week was quite emotional causing some anxiety and HT palpitations First treatment had the most potent effect Tongue: middle crack till the tip of the tongue, pale some serrations, flabby, thin white moss. Pulse: 68beats/min, regular, slippery, a little thin. Very light tingling only on the middle and ring fingers, nearly hard to notice, worsens with excessive computer work at times 3 No pain/soreness, Not waking at night any more and has a very restful sleep Able to lift full kettle, this was quite painful prior to treatment Very happy with progress, which feels life-hanging Stress and energy are both 7/10 Week very stressful with D: Qi Stagnation causing blood xu on right 3 rd and 4 th finger, underlying Sp qi xu with damp heat T: move qi tonify Sp qi and resolve damp heat MBW35 Huatuojiaji at C7 level GB20 Fengchi GB34 Yanglingquan LI4 Hegu TE4 Yangchi HT7 Shenmen PC6 Neiguan LR3 Taichong SP9 Yinlingquan serious health issues in two members of immediate family Explosive stools this week with odour, 2-3 times per day, and 2-3 hours after meals Tongue: middle crack till the tip of the tongue, pale overall with slight 3
purple hue in middle, thin white moss Pulse: 70beats/min, slippery with middle jiao full on both sides LITERATURE REVIEW Table of Literature Review Search Database Keywords Limitations Results Cochrane Library Acupuncture, numbness and - 1 tingling Cochrane Library Acupuncture, blood flow - 2 Ebsco Host Acupuncture, numbness full text 58 Ebsco Host Acupuncture, numbness, - 7 tingling Ebsco Host Acupuncture, blood flow full text 152 scholarly peer reviewed 2000 to 2015 Ebsco Host Acupuncture, increase, same as above 65 blood flow Pub Med Acupuncture, numbness - 67 Pub Med Acupuncture, blood flow free full text 96 Pub Med Acupuncture, blood flow, increase free full text 35 Literature review findings: acupuncture increases blood flow as it activates thin nerve fibres, which release vasoactive neuropeptides and Nitric Oxide causing vasodilation and increased blood flow (Hsiao & Tsai 2008, p.46) clear anatomical and functional associations between dermatomes and acupuncture channels and points due to common viscerocutaneous reflexes (Molano et al. 2014, pp.10-11) 4
dermatomes partly determine the therapeutic efficacy of acupuncture (Ferreira & Luiz 2013, p.11) acupuncture can increase blood flow in peripheral circulation and needling LR3 can affect the circulation in the upper limbs (Takayama et al. 2012, pp.4,7) Possibly 15-min electroacupuncture stimulation provides optimal analgesic results as tested for the lower extremities (Leung et al. 2008, p.11). 84 DISCUSSION / CASE PRESENTATION / TREATMENT OUTCOME Despite recommendations as per duty of care patient did not want to visit western medical practitioners for her numbness/tingling or her fluctuating blood pressure, her wishes were respected. During the first session of needling when points on the same channel were needled patient felt them connecting strongly with each other and she was very responsive to acupuncture. The course of illness was only a week long prior to treatment therefore the course of treatment was not expected to be too long. There were no adverse reactions in this case, strong needle stimulation was used and working with dermatomes from first treatment appeared very successful Since semester ended on third week of treatment client was provided with details of two different acupuncturists to chose from and visit close to her home. This case was very inspiring and proved the big difference correct diagnosis makes. 143 CONCLUSIONS / SUMMARY Acupuncture can have an analgesic effect and significantly reduce numbness and tingling in the upper extremities. 16 REFERENCES 1. Ferreira, AS & Luiz, AB 2013, Role of dermatomes in the determination of therapeutic characteristics of channel acupoints: a similarity based analysis of data compiled from literature, Chinese medicine, vol. 8, no. 24, pp.1-12, viewed 19 May 2015, <http://ncbi.nlm.nih.com>. 5
2. Hsiao, SH & Tsai, LJ 2008, A neurovascular transmission model for acupuncture-induced Nitric Oxide, Acupuncture meridian studies, vol. 1, no.1, pp. 42-50, viewed 20 May 2015, <http://ncbi.nlm.nih.com>. 3. Leung, AY, Kim, SJ, Schulteis, G & Yaksh, T 2008, The effect of acupuncture duration on analgesia and peripheral sensory thresholds, BMC complementary and alternative medicine, vol. 8, pp. 1-11, viewed 20 May 2015, <http://ncbi.nlm.nih.com>. 4. Molano, BML, Bonilla, PLB, Dussan, BEH & Londono, VCA 2014, Anatomo-functional correlation between head zones and acupuncture channels and points: a comparative analysis from the perspective of neural therapy, Evidence-based complementary and alternative medicine, no. 836392, viewed 19 May 2014, <http://www.ncbi.nlm.nih.gov>. 5. Overgaard, E, Brandt, LPA, Ellemann, K, Mikkelsen, S & Andersen, JH 2004, Tingling/numbness in the hands of computer users: neurophysiological findings from the NUDATA study, vol. 77, no.7, pp. 521-525, International Archives of occupational and environmental health, viewed 19 May 2015, <http://www.ebscohost.com>. 6. Takayama, S, Watanabe, M, Kusuyama, H, Nagase, S, Seki, T, Nakazawa, T & Yaegashi, N 2012, Evaluation of the effects of acupuncture on blood flow in humans with ultrasound color doppler imaging, Evidence-based complementary and alternative medicine, vol. 2012, no. 513638, pp. 1-8, viewed 20 May 2015, <http://www.ebscohost.com>. 6