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Ask the Expert
Ask an expert - muscles and bones - hands and fingers
A: De Quervain's syndrome or disease can be alarmingly painful. Conventional treatment ranges from steroid treatment, for which the evidence is quite poor, surgery, for which the outcomes are unclear, or simply splinting and rest. The condition is self-limiting, but can flare up again because the evidence suggests that it may be degenerative and therefore likely to recur.
From a Chinese medicine point of view, all sorts of focused ostearthritic pains or tenosynovitis pains such as this represent blockages or interruptions in the flow of energy, called 'qi' in Chinese medicine, and the use of acupuncture restores the natural flow and with it addresses the pain which the blockage causes. Obviously if the cause is osteoarthritis of the first metacarpo-phalangeal joint, acupuncture treatment cannot repair physical damage, and the best that could be achieved is a temporary reduction in the pain or inflammation. This may, however, enable the spiral of pain - inflammation means compression means pain means inflammation - to be broken to let the area recover. If the problem is to do with inflammation of the tendons, the same may well apply. As our fact sheet on arthritis shows
there are a number of encouraging studies, as indeed there are with similar conditions like tennis elbow and carpal tunnel syndrome.
In our experience the majority of cases like these are usually local rather than systemic problems, although in most people there are often underlying systemic weaknesses as a backdrop for why such specific problems develop, and if the condition is going to respond to treatment it will respond very quickly. This is our roundabout way of ensuring that you should not get locked into a long course of treatment. If treatment works, it is a matter of assessing how much improvement there is and how sustainable it can be. If there is no improvement within three or four sessions, then it is better to draw a line.
The best advice is to seek a brief face to face assessment with a local BAcC member to give you a better sense of whether your specific problem my be benefited by acupuncture treatment.
Q: About two or three years ago I trapped by middle finger of my right hand in a door. It was caught between the jam and the door it swung shut. After the initial pain and surface injury had gone I thought everything was ok.
As the months have passed since I have been left with what I can only describe as excruciating pain that shoots up my forearm when I knock or bend this finger in the wrong way. It seems to be triggered when I hit it anywhere from the tip of the nail to the middle knuckle along the top edge of the finger. It used to just make my finger hurt, which I could live with, but it has slowly got worse so that now, as a said, the pain shoots up my forearm and leaves me gasping for breath and feeling sick. It is such horrible pain. I am not at the end of my tether.
I have consulted the GP, which checked for bone damage using X-rays, but no damage was found. They suspect nerve damage now and have prescribed some cream that I should rub in after taking a shower when the skin is softest. They also prescribed strong pain killers that will enable me to massage the area. I have been doing these for a few months now and I struggling to see any change.
I have looked into acupuncture out of desperation, but my understanding of it so far it that it is mainly used for back pain, and can only be applied to certain parts of the body. So my simple question is: could acupuncture help me?
A: We're sorry to hear of your problem.
First, we'd like to be clear that acupuncture is used for a wide variety of problems, not simply back pain. In its 2500 year history every symptom you can think of has been treated, written about and discussed, and the only problem we have in getting that message across is that the current advertising restrictions mean that we can only refer to those conditions where a very specific kind of research has been done. The fact that such research is expensive and that the model doesn't really fit with how we practise acupuncture means that we are very limited in what we can say on our websites and in our leaflets. Back pain is an area where the research has been done, and the NICE guidelines now include a recommendation for the use of acupuncture.
This means, of course, that there are acupuncture points all over the body, and many which are used locally as well as systemically. Much of Chinese medicine is premised on the restoration of balance to the whole system, and this can dictate that points which are not necessarily near where a symptom exists may need to be used. Most points are paired, with one on each limb and each side of the trunk or back, and in some cases a practitioner may needle a point at the same place on the opposite side, particularly if treating someone in a cast. Some points are used locally, i.e. where it hurts, especially if there is blockage or local damage. The underlying theory of Chinese medicine is based on the flow of energy, called 'qi', and any damage to a part of the body has the potential to hinder the patterns of flow. Needles are used to restore flow.
Acupuncture is often used for neuropathic pain, as our factsheet shows please click here
although as you can see it is most often researched in relation to specific problems like trigeminal neuralgia or peripheral neuropathy rather than specific injury. The results, while far from conclusive, are encouraging, and we would be happy to suggest that it is worth considering as an option to bring you some relief from the pain. Sight unseen it is difficult to say more than this, and we would advise you to visit a BAcC member local to you to get the benefit of a face to face assessment of whether treatment may help. Given the nature of the injury, however, we would expect there to be some evidence of improvement relatively quickly if the treatment was effective, and if you did decide to go ahead we would recommend being very clear about the outcome measures and the point at which a line is drawn if nothing happens. Our experience is that people can sometimes find themselves ten or a dozen treatments down the line with no improvement and if this has just crept up because a 'treatment habit' has developed it can cause discontent.
One area where acupuncture has been used is in the treatment of phantom limb pain, where an amputation can leave a lasting unpleasant and occasionally severe reaction where the nerves have been severed. Some of the more recent studies have shown good evidence that acupuncture can be used to great effect in this situation, and the kinds of symptoms which people report are not dissimilar to yours. This may be a cause for some hope that treatment may prove beneficial. You can check some of the papers for yourself by googling 'ncbi acupuncture phantom limb pain'. This will access most of the PubMed research network and give you an idea of the kinds of results which researchers have reported in small studies.
Q. I am suffering from 1 trigger finger in each hand. Whilst one almost seems to be improving, the other is definitely getting worse. I am not over-keen to have a cortisone injection and wondered if acupuncture might help. If so, it would be helpful to have a guide as to how many sessions might be required.
A. The evidence for the use of acupuncture in the treatment of trigger finger is very thin, not because it doesn't work, but simply because it has not been well researched. The kind of problem which it represents can be described in the concepts and language of Chinese medicine, and this may offer a range of possible interventions. The majority of these will involve local needling but may also involve the treatment of the whole system if this is seen to be a specific occurrence of a much more widespread condition which causes tightness in tendons across the body.
For cases such as yours there is no substitute for visiting one of our members local to you to see exactly how your particular problem presents and whether in their view it may be treatable. We are certainly aware of members who have used direct treatment of the affected digits and stretching exercises to good effect but some cases may be more likely to respond than others, and it would require someone to see the finger before giving an informed assessment.
There is no easy way to estimate how many sessions will be required. What we ask members to do is to set measurable outcomes and to make sure that they review progress regularly to ensure that the patient is happy continuing treatment. Most practitioners set four or five sessions as the point at which to take a good look at progress and to decide how sustainable any achieved changes are.
The fact that one of the two problem fingers has started to mend is a very positive sign. However, there is no doubt that cortisone can be very effective, and there may come a point where it might be unwise not to seek the relief that this may offer.