Ask an expert - muscles and bones - arm

18 questions

We are sorry to hear that you are faced with such a long wait for a specialist opinion. All we can say with certainty is that acupuncture is very probably not going to make things any worse and may well help to address the symptoms and reduce the pain.

The theory of acupuncture, as you have probably read, is about the flow of energy, which we call 'qi', and its correct balance and flow within the body. Essentially all of the theory boils down to techniques to understand how and where blockages and imbalances arise, and skills with needles and moxa to reinstate the normal flow. The simple underlying premise is that where energy flows as it should then everything should function as it is supposed to.

When people have accidents there is often inflammation and deep bruising which from a Chinese medicine perspective can mean a blockage in the flow of energy which is more than the body can correct. Sometimes this is a local problem, but at other times it may be indicative of a general weakening of the system which means that there isn't enough energy to sort out the body's more peripheral problems . The great strength of Chinese medicine is that it can look at the overall context rather than simply picking off symptoms one at a time.

Soaking your hands in ice cold water no doubt does help, mainly by providing a temporary deadening of the sensation, but we would advise any patient to be cautious about doing this for too long after an injury. It is always helpful to apply ice straight away to stop excessive swelling, but after a while the repeated cooling actually starts to work against the body, causing the stuck energy to become even more stuck. If you are going to use cold we suggest that you alternate with some heat to try to encourage flow as well. Alternating hot and cold is the option many physios will recommend to people with injuries.

The best advice that we can give is that you visit a BAcC member local to you for an informal assessment of whether acupuncture might be a good idea. Most members are happy to give up a little time without charge to see a problem in the flesh and advise on whether acupuncture treatment might help, and this is your best route. It's a pity we don't know more about the nature of your accident, whether it results from a sprain or a fall. However, the fact that the pain is referring up the arm could be indicative either of nerve impingement (from a western medicine perspective) or a blockage in the flow of energy in the channels (from a Chinese medicine perspective), both of which are more encouraging in terms of potential recovery. we certainly hope so.

File under muscle and bone - arm

As you might imagine, we have been asked questions about tennis elbow on a number of occasions and a typical answer has been:

Tennis elbow is one of the more frequent conditions with which people present at our practices.

 The BAcC has a factsheet which outlines some of the research which has been unertaken

 http://www.acupuncture.org.uk/a-to-z-of-conditions/a-to-z-of-conditions/tennis-elbow.html

 although it would be fair to say that the results are not as clear as for some other conditions for which we prepare factsheets. 

 Our clinical experience is that many people do benefit from having treatment but we are always very careful with conditions like this. If someone has four for five sessions without any apparent benefit we tend to draw a sharp line in the sand and look for alternative options for treatment. If treatment is likely to be successful there is usually some improvement, even if it reverts to being not so good again, and the improvements are incremental, i.e they get a little more pronounced each time. If nothing happens or there is a similar temporary burst of better times each time, then the chances are that acupuncture is not the best option.

 The key thing is to set measurable targets: how far can someone turn the arm without pain or restriction, how much weight can they sensibly bear, and so on. There is often also 'homework' - it is remarkable how many people want to carry on playing golf or windsurfing while they are being treated, and the concept of 'two steps forward, one step back' is difficult to get across sometimes.

 Best advice, as always, is to visit a local BAcC member for an informal assessment of what may be possible. Most BAcC members are happy to spare a few minutes without charge to see what may be possible, and this way you get to meet the practitioner and see where they work before committing to treatment.

This is still the essence of what we would say now. Further evidence keeps on being generated, as for example in this trial published last year

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4783565/

but the overall weight of evidence is not enough at present to make firm recommendations.

We are not quite sure what to make of your GP's suggestion. Certainly without sight of your problem we are a little in the dark. If there is strong clinical evidence suggesting that surgery is the best option then it would be wise to follow the advice you are being given. Cutting is usually only done as a last resort, and if that is what the scans and X-rays show then acupuncture may not work. However, it can certainly be said that it won't make things worse, and it might well be worth having three or four sessions to see what can be achieved to head off surgery if this is at all possible.

 

 

Q: i suffer from severe tennis elbow.  I've had 6 steroid injections and that only helps it for a few months a time.  I was just wondering weather acupuncture would have a bit more success?

A:Tennis elbow is one of the more frequent conditions with which people present at our practices.

 The BAcC has a factsheet which outlines some of the research which has been unertaken

 http://www.acupuncture.org.uk/a-to-z-of-conditions/a-to-z-of-conditions/tennis-elbow.html

 although it would be fair to say that the results are not as clear as for some other conditions for which we prepare factsheets. 

 Our clinical experience is that many people do benefit from having treatment but we are always very careful with conditions like this. If someone has four for five sessions without any apparent benefit we tend to draw a sharp line in the sand and look for alternative options for treatment. If treatment is likely to be successful there is usually some improvement, even if it reverts to being not so good again, and the improvements are incremental, i.e they get a little more pronounced each time. If nothing happens or there is a similar temporary burst of better times each time, then the chances are that acupuncture is not the best option.

 The key thing is to set measurable targets: how far can someone turn the arm without pain or restriction, how much weight can they sensibly bear, and so on. There is often also 'homework' - it is remarkable how many people want to carry on playing golf or windsurfing while they are being treated, and the concept of 'two steps forward, one step back' is difficult to get across sometimes.

 Best advice, as always, is to visit a local BAcC member for an informal assessment of what may be possible. Most BAcC members are happy to spare a few minutes without charge to see what may be possible, and this way you get to meet the practitioner and see where they work before committing to treatment.

Q:  I suffer from severe tennis elbow.  I've had 6 steroid injections and that only helps it for a few months at a  time.   I was just wondering whether I would have more success with acupuncture? 

A:  Tennis elbow is one of the more frequent conditions with which people present at our practices.

The BAcC has a factsheet which outlines some of the research which has been unertaken

http://www.acupuncture.org.uk/a-to-z-of-conditions/a-to-z-of-conditions/tennis-elbow.html

although it would be fair to say that the results are not as clear as for some other conditions for which we prepare factsheets. 

Our clinical experience is that many people do benefit from having treatment but we are always very careful with conditions like this. If someone has four for five sessions without any apparent benefit we tend to draw a sharp line in the sand and look for alternative options for treatment. If treatment is likely to be successful there is usually some improvement, even if it reverts to being not so good again, and the improvements are incremental, i.e they get a little more pronounced each time. If nothing happens or there is a similar temporary burst of better times each time, then the chances are that acupuncture is not the best option.

The key thing is to set measurable targets: how far can someone turn the arm without pain or restriction, how much weight can they sensibly bear, and so on. There is often also 'homework' - it is remarkable how many people want to carry on playing golf or windsurfing while they are being treated, and the concept of 'two steps forward, one step back' is difficult to get across sometimes.

Best advice, as always, is to visit a local BAcC member for an informal assessment of what may be possible. Most BAcC members are happy to spare a few minutes without charge to see what may be possible, and this way you get to meet the practitioner and see where they work before committing to treatment.



A: As far as the condition itself is concerned, as our factsheet shows:

http://www.acupuncture.org.uk/a-to-z-of-conditions/a-to-z-of-conditions/tennis-elbow.html

there is a small amount of fully researched evidence that acupuncture can provide short-term relief for the problem. The criteria for quotable research set the bar very high by employing research requirements more suitable for drug testing, the randomised double blind control trial. In daily practice tennis elbow is one of the more frequent named conditions for which people seek help from acupuncturists. Our usual recommendation to patients is to have two, three or four sessions along with trying as much as possible not to have to do the sorts of things which brought the condition on. 

We tend to look for regular reviews after four or five sessions and measurable outcomes - range of movement, weight bearing etc - to ensure that a pattern does not develop of ten or more sessions without any result. This tends to make unhappy patients, so we are very clear about drawing a line if there is no discernible change after the first few sessions.

On balance we think that the best advice we can give you is to visit a BAcC member local to you to see what they make of the problem that you have and by virtue of a face to face assessment offer you a very clear idea of what may be possible for you. 

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