4.         Complications part 2

4.1       Upper or lower arm pain

            The pain at the arms can be very disturbing, very painful. The pain is perceived at   certain locations on the arm. Sometimes it is the rotator cuff pain. Often, there is tension and pain along the meridian of Large Intestine. Points like LI 10, LI 12, LI14, LI 15 are frequently the most painful. Needle these points or moxa these points are helpful. However, the culprit is the Small Intestine and San Jiao meridians. Palpating these meridians and very painful spots can be found.   These spots need be addressed. The best way is to moxa these spots until the pain level is reduced. Stretching the elbow to make sure free movement is also important. Do not  forget to address the neck shoulder as well.

            The spots to Moxa : Ashi points, especially near SI 9 on the painful arm. Moxa in the painful spots along the SI is very important. This is because these pain are of deficiency type, not excess. Sometimes,  H3, Lu 5 and LI 10 can also be used.

4.2       Carpel tunnel

Carpel tunnel syndrome is a painful disorder at the wrist. Moving the wrist can send a shocking pain toward the hand. It is caused by long duration of hand use; computer keyboard, checkout counters, washing, mopping or any other type of repetitive works with hands.  These activities can overly stress the muscles in the arms and hands. Overtimes, the nerve under the wrist become sensitive, resulting in severe pain.

Standard practice of treatment is based on treating the tendon at the wrist. The general Western medical approach is to fix the tendon-nerve in this area. Injection of pain killing medicine or surgically reduce/remove the wrist tendon are commonly done. Pain killer injection works for a short time. Surgery seems to be an overkill. It also resulted in weakened wrist, which would be permanent. It should be considered as the last resort.

The secret of treating carpel tunnel syndrome lies in treating the source of the problem. They are the upper arm and forearm.  Very frequently, neck and shoulder are involved as well. Do not over look these locations. Over- used muscles in these areas are the culprit. When these musculatures become problematic, they would be tender and inflexible. The hand motion become difficult and very easily over loaded. With time , the tendon at the wrist become overly stressed.

            So the treatment is very similar to treating arm pains. First, treat the neck shoulder as previously described, treat the arm by palpating the most painful spots, most often along the SI, small intestine meridians and LI, large intestine meridians. Treat them either with acupuncture or moxibustion. Then, do a little TLC at the hands and wrists, with moxa or massage. The pain will be significantly reduced. A few treatments coupled with physical exercise to strengthen the arms and hands muscles, the problem will be resolved.

4.3       Numbness in the arms and fingers

Whenever sensory nerves are squeezed, it will turn numb. We all have experience of numbing sensation after sitting at the same position for a long time. This is caused by nerves being squeezed. If the squeeze is tight enough, the blood flow would also be stopped. When this happens, the limbs turn cold and pale. This is a common phenomenon called pinched nerve.

SO, the goal is to resolve the squeezing. Most of the time, it is the musculature related events. Such is the case with so called thoracic outlet syndrome which is produced by abnormally tight scalene muscle which runs from cervical spin to the ribs. The solution is to get the muscle to restore its flexibility. Again, first relax the neck and shoulder following the above protocol (N-S protocol). Then, check a few spots for tenderness and treat them accordingly: Lu 1 or 2, St 11, St 12.

-Reynaud’s syndrome

            Some people have this kind of “genetic predisposition “that when their hands are exposed to extreme cold, their fingers will turn icy cold and blue. The best approach is prevention by avoiding exposure of the limbs to extreme cold.

4.4      Rotator cuff pain and frozen shoulder

4.4.1        A 75 year old male called in for treating his rotator cuff problem. He complained about weakness and soreness of his left rotator cuff. Raising up his left arm caused pain. He had to use right hand to comb his hair.

            He was on Levastatin and Prostrate.  He had an appendectomy six years ago. From time to time, his back would “act” up and he would be unable to move the shoulder. Otherwise, he appeared healthy.

            The pain was at the front of left shoulder joint. Although he did not complain about the neck, when I asked him to turn neck from side to side, he could only turn about 30 degree toward either direction. He confessed that he had some neck problem and had gone through physical therapy for a while but it never got anywhere.

            I put a heat lamp over his left shoulder and insert needle following the above N-k protocol. His neck loosened a bit, the range of motion increased to about 50 degree, tighter on the right. He became a little concerned when his triceps on the right arm started to twitch. It was not painful.  I assured him it was alright. Now the pain seemed to shift from shoulder joint to the muscle between the shoulder blades. I inserted needles in Tiao Kou, St 38 at the left lower leg and add Ren 24, Cheng Jiang Midway below the lower lip. The pain subsided.

            To enhance the effect on the shoulder joint, I added LI 12, on Large Intestine meridian, 2 finger width above the elbow on the Large intestine meridian.

            Because he had a chronic backache (though he felt alright at this time.), I added a few needles to address this issue following the protocol for low back pain (refer to Dr. Wang’s method for treating low back). This is part of the philosophical approach  of treating the possible future disease.

            After 35 minutes, the problem totally disappeared. However, this was not a typical of rotator cuff pain. It was a case of overwork of muscle. He tried to cut down a tree a month ago. It was a hard work; He was tired but insisted on finishing the job. The pain started to creep up and he was not able to get rid of it all this time.

4.4.2    A 48 year old female complained about shoulder pain which kept her awake at night. She was diagnosed as having frozen shoulder. The pain started after a surgery a few months ago to fix the broken clavicle from an accident. A steel pin was used to stabilize the clavicle.  She needed to use left hand to assist raising right arm above shoulder level.   She was told that the encapsulation of the joint caused the frozen shoulder. She also had another operation which fused C6-C7.

She appeared healthy, trim.  She had some bad mood frequently. Her neck’s sideway rotation range was restricted somewhat, worse turning toward right. Palpation indicated that her chest under the right clavicle was tender.

Analysis: Encapsulation may be the cause for her inability to raise arm normally. However, since the “frozen shoulder” happened after the surgery, encapsulation was not a long drawn out issue and should be easily reversed. Therefore, this type of frozen shoulder is much easier to treat, in contrast with typical “frozen shoulder” that is due to aging, like most people over 50 who have weakened Qi from aging process. In TCM, this is a Qi problem- Qi is stuck, which does not allow the arm to move. Qi got stuck as the result of surgery.

To move the Qi, points which move the neck /shoulder were used (refer to N-S protocol). In addition, St 38, Tiao Kou on the right leg and SI 6 on the right arm were used. I also applied moxibustion over the upper chest near the shoulder and the area posterior to the shoulder joint below SI 9.

Patient  was amazed at the result. She was able to raise the right arm over the head without the assistance of left hand.

She came in the next week saying that not only she was happy, everybody in the family was also happy because she was not as cranky any more. She had no pain using right arm during the week after the treatment.

She still had minor pain in the upper chest and left neck upon palpation. The chest pain is related to the surgery. It needs time to heal. In TCM, This is a blood stasis issue. Using heating pad or moxibustion over the affected area on daily bases for a period of time is the best remedy for such problem.

Smokeless Moxibustion

Moxibustion is as important acupuncture. As a matter of fact, in Chinese terminology, acupuncture and moxibustion goes together.  Typical Moxibustion uses mugwort stick and produces strong fragrant and thick smoke. It works great for the purpose. Unfortunately, in modern clinic, particularly in US, it is over powering and not practical with central air.

There s a good alternative called smokeless moxa.  Most clinicians do not know like it because they do not use it properly and therefore do not think it is effective. This is not true. Use it properly, it is better than the regular smoking moxa in terms of effectiveness and safety.   Remember, do not use sparrow pecking method with smokeless moxa. It won't work.

As important as it is, insurance companies no longer pay for moxibustion procedure. They rather pay more acupuncture visits. Or, just allowed for a fix number of acupuncture therapy per year.

 

4.4  Trigger finger

Some people develop such finger issues. They can bend the problematic finger but can’t straighten it back. The finger appears like been locked in position like in rifle shooting.

The culprit is the tendons associated with the finger joint become too tight preventing the bones to slide against each other to extend the finger.

Moxa the surrounding of the joints.  Remember the guiding principle in moxibustion-“Moxa until the patient feel pain”. Pay special attention to painful spots adjacent to the joint. Stretch the affected finger regularly for a period of time. The problem would be improved.