Treatment of the Overuse of the Upper Extremities, Part III
By Alejandro Katz, MD, OMD, LAc, QME
Editor's note: Parts I and II of this series appeared in the October 2000 and December 2000 issues of Acupuncture Today, respectively.
This article will deal with a diagnosis of carpal tunnel syndrome (CTS) with a different approach to treatment.
The patient's symptoms are pain/tingling/burning of the forearm/hand/fingers (second, third and fourth fingers). The usual cause will be repetitive motion. The pain medications prescribed are ibuprofen (600-800 mgs. 2/3 times a day); naproxen (500 mgs. two times/day); vioxx (12.5/25/50 mgs) or celebrex (100/200 mgs.). Too many times the patient will complaint of secondary effects (upper GI disorders) such as nausea, vomiting, heartburn and diarrhea.
A diagnostic test for CTS is a NCS (Nerve Conduction Study), which will show whether an abnormality is present or not. (Sometimes the symptoms are present but the NCS is normal.)
When examining the area, I prefer light tapping on the groove (PC 6, with the elbow flexed at 90 degrees) to reproduce the patient complaints (pain, numbness, burning or tingling radiating from the elbow toward the wrist and hand, following a PC channel pattern).
The acupuncture point combination used is a Master Tong approach: local point PC 6 with a contralateral point; either ST 41, Liv 4 or both (Master Tong balances the upper part with the lower part, the right with the left and vice versa). In order to know which combination is best, I use Acutron probes in a polarized mode, with the positive (+) on PC6 and the negative (-) on either ST 41 or Liv 4. If both points are effective, I will stimulate both points. The effectiveness of the points is determined by the patient palpating the PC 6 area before and after probe stimulation. If the sensitivity (pain/tingling/burning) is less, it will assist in the decision of which point(s) to use, eliminating the guessing process. Note: When I am referring to PC 6, my reference is to the point or points in the area of PC 6 that are active and that will, during the examination, radiate pain, numbness or tingling -- symptoms the patient complains of. In some cases (frequently), PC6 will be a group of 1-4 points located next to the palmaris longus muscle.
Technique used: Chinese acupuncture needles, #38 gauge #38.
Treatment frequency is 1-3 times a week for four weeks. The acupuncture needles are inserted with a slant direction (subcutaneous), with the microcurrent stimulation pads on top of the needles. The direction of the needles does not affect the treatment results.
The Acutron Mentor pads (polarized, with an output of 50-75 microamps for 20 minutes) are applied directly on top of the needles. The positive pad is applied on PC 6; the negative pad is placed on ST 41 and/or Liv 4. In the majority of cases, the use of microcurrent is subsensational (the patient does not feel the electric stimulation); some patients will feel a subtle sensation.
Improvement is usually obtained with 6-8 treatments: pain, burning and tingling is reduced; the range of motion of the elbow is increased; pain medication is reduced or discontinued; and the level of activities is increased.
The proper stretching exercises are also recommended to the patient to assist with the recovery of the muscles and tendons. Many of these patients are so sensitive in the PC 6 area that initially, only the use of a microcurrent device with pads (without needles) allows us to treat the patient.
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