Ask an expert - muscles and bones - arm

19 questions

Q:  I had subacromial decompression surgery done in December.  I am still in a lot of pain and can't sleep.  I am  ok when my arm is moving. Would acupuncture help

A:  This is quite difficult to answer without knowing a little more of the circumstances which led to the choice of a subacromial decompression as the treatment of choice. There are a number of reasons why the problem can arise, and since you are still just within the 2-6 month recovery period, a great deal will depend on whether you have been recommended to have regular physiotherapy, and whether you have done so, and whether there were predisposing factors which may have caused the problem to arise and for which you may still need to make adjustments. We are assuming that if it was a sports related problem that you have rested, but if it was to do with some repetitive action associated with your work, that may still need some adjustment.

Traditional acupuncture is primarily about treating the person, not the condition which they have, and to a large extent the work which a practitioner does in aimed at encouraging the body's natural healing ability. An operation is a wound like any other, and we have no doubt that if there has been any slowing down of your natural recovery, it is possible that acupuncture treatment may help that to happen. Such evidence as there is is relatively scarce and not that reliable, since there are a huge number of factors which can affect recovery and identifying a single one for the purposes of research is difficult. There is a paper

http://www.ncbi.nlm.nih.gov/pubmed/12798078

which offers some positive encouragement, though, but for us to claim more than that would need larger studies.

Similarly there is a study which shows an improvement in pain control and sleep through the use of acupuncture

http://www.ncbi.nlm.nih.gov/pubmed/22843248

but again we have to add the same reservations about the size of the trial. However, anecdotally it has been our experience that people do seem to recover more quickly when they have treatment after an operation, and we have a significant number of patients who have acupuncture both just before and after the operations they have to minimise the after-effects of anaesthesia and to aid recovery.

In Chinese medicine, however, every patient is unique, and a practitioner's main aim would be to establish whether there are factors affecting the system as a whole which may be slowing down your recovery. From a Chinese medicine perspective the person with the condition is as important as the condition itself, and twenty people with an identical symptom may have twenty different treatments as well as improving at twenty different rates.

The best advice we can give is to visit a BAcC member local to you to see whether with the benefit of a brief face to face assessment they are able to give you a better idea of whether acupuncture treatment may offer benefits in your particular case.

Q: I am a keen tennis player and I have been  diagnosed with tendonitis. 
I had some physiotherapy but this wasn't successful and I have been taking diclofenic pain killers for the past few months - but the pain remains. 
I read that a cortozone injection may help but should I consider acupuncture?

A:  This is one of these areas where we tread carefully in the advice we give. Our fact sheet on tennis elbow,
 
http://www.acupuncture.org.uk/a-to-z-of-conditions/a-to-z-of-conditions/tennis-elbow.html
 
if this is indeed how your tendonitis is manifesting, is rather circumspect in what it says because the evidence is not that compelling. However, if you ask any practitioner what their dozen most frequently consulted problems are these will always include tennis elbow. Since a great deal of our work comes from personal or word of mouth referral you might assume that word has got around that acupuncture is a viable treatment for this problem! This 'expert' has certainly treated his fair share of tennis elbows, many with complete success.
 
However, although there are some very clear overlaps between named conditions like this and specific Chinese medicine treatments, the skill and art of the practitioner lies in exploring why in each individual case the problem has arisen. This could simply be over-use, but not every tennis player develops the problem and there are often underlying patterns in the Chinese medicine understanding of the body which make some form of over-use or wear-and-tear injury more likely. A good practitioner will try to reduce the manifestation of the problem while at the same time address any wider issues which make its recurrence likely.
 
You have mentioned one practitioner by name but all of our members should be able to deal well with the problem, and be honest enough to say so if they believe it will not be tractable to treatment. It is always worthwhile visiting a BAcC member local to you for a brief face to face assessment of the condition and whether in their view treatment is likely to have an impact.   
 
 

Q:  I have a nerve that is irritated by a slipped disc. The surgeion  won't operate and after two x ray guided injections the pain is the same with little change after 8 months. Would accupuncture help me ?

A:  There is no doubt that acupuncture treatment can help with low back pain, and equally evidence that it may well be effective for sciatica-type pain, as our two factsheets demonstrate:

http://www.acupuncture.org.uk/a-to-z-of-conditions/a-to-z-of-conditions/back-pain.html

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

However, any BAcC member taking on a case like yours would probably want to know a little more about the exact nature of the problem. The fact that your surgeon will not operate could mean a number of things, and although acupuncture can be very effective at reducing pain, if there is permanent physical or structural damage, then its use would only have a temporary benefit. The fact that two specifically targetted injections have had no effect is also clinically significant. Random injections into an inflamed joint can miss the spot, but X-ray guided ones tend to be effective, even if only for a short while.

However, that said, we do come across situations where the interpretation of the pain someone experiences in Chinese medicine terms means that it may be amenable to treatment. Most people over the age of 60 have some deterioration of the limbar spine, but if they get chronic backache that is not necessarily proof of a causal connectio. Chinese medicine is based on an understanding of the body and mind as a flow of energy,called 'qi', and its flow and balance. Anything which obstructs or weakens this flow can cause pain, and there is not doubt that damage to the physical body can block qi - it's all one body, after all. The question is whether that flow can be restored in spite of the continuing presence of the physical damage.

The only way to find out whether acupuncture treatment is suitable for your specific problem, though, is to visit a BAcC member local to you to arrange a brief face to face assessment. Most members are happy to give up a small amount of time without charge to offer prospective patients a more informed view of whether treatment is worthwhile or whether other forms of intervention may be more appropriate.

 

Q:  I woke up with a stiff neck, after 5 days my arm would not raise (lots of pain) I have been to A&E/doctors and a specialist.  I have some nerve damage (from what I have no idea) no trauma. The pain has eased a little but my arm is like a wet fish by my side.  Could acupuncture help?

A:  A huge amount depends on the underlying problem of which this is a manifestation, and we mean that in western terms, not eastern. Although our paradigm of medicine operates on the basis of an entirely different understanding of how the body works, we recognise its limitations when dealing with some acute problems, and would do nothing to discourage a patient's further investigations within the orthodox system. Loss of function is a serious issue, and we would hope that MRI investigations are high on the agenda of those specialists whom you have seen and under whose care you are.

From a Chinese medicine perspective, the health and wellbeing of the system depends on an adequate flow of energy, called 'qi' by the Chinese, and its balance and rhythms. If these are disturbed either by some form of external trauma or by some form of internal event, then the flow may be impaired and symptoms such as you have experienced and continue to experience can result. Acupuncture, for example, is used heavily in China in the immediate aftermath of a stroke. The CVA is said to disturb the flow in the channels and a practitioner will work hard to reinstate the flow as soon as possible. There is even now more evidence becoming available that post-stroke acupuncture treatment can help recovery from the paralysis associated with stroke, and in Chinese hospitals daily treatment from the first day is the norm.

The problem with what you describe, however, is that this sounds slightly more serious than simple nerve impingement, and without sight of the problem and taking a much more detailed case history we would not want to offer a strong view either way on whether this is a suitable case for acupuncture treatment. Although it may sound like a stock response, we really do believe that the best option for you is to see a BAcC local to you and ask for their advice. Most are more than happy to give up some time without charge to assess face to face whether acupuncture is the most appropriate option. There are, indeed, other possibilities; we have heard of cranial osteopaths (a very gentle form of treatment) helping considerably in circumstances like this, and this is something which an acupuncture practitioner may recommend if he or she feels it is beyond their scope of practice.

Q: I shattered my elbow 5 years ago, i am unable to fully straighten my arm now. I am experiencing pins and needles in my fingers and aching in my elbow, also a cold sensation through my arm and wondered if acupuncture would help

A: An enormous amount depends on the extent to which these symptoms have arisen because of physical damage. To borrow the language of the retail market in sales, 'once it's gone, it's gone,' and if the damage to bone, muscle or nerve is directly causing your symptoms, then it is not likely that acupuncture treatment is going to make a great deal of difference. You may experience some pain relief, and then the question will be how much relief and how sustainable it can be.
 
However, the overlap between east and west is not a precise fit, and there are occasions when damage from a western medical perspective can cause damage from a Chinese medical perspective which can outlast the apparent recovery of the part affected. Chinese medicine has a very elaborate and sophisticated understanding of the flow of energy in the body (known  as 'qi' in Chinese medicine), and also of the functions of the Organs as the creators and movers of the body's qi. The kinds of symptoms you have could well point to blockages and to changes in the body's functioning, and acupuncture treatment may be able to help.
 
The best advice we can give you is to visit a BAcC member local to you and seek their advice based on a face to face assessment.    

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