Ask an expert - muscles and bones - hands and fingers

15 questions

Q: I have focal dystonia affecting the middle finger of my right hand brought on by repetitive strain as I have been working as a secretary for about 40 years. Physiotherapy has not really made any improvement. Would acupuncture help?

A:  Focal dystonia is an unusual problem. We are not sure how much you have been told about its causation, but although it has the characteristics of a repetitive strain injury it actually has a great deal more to do with the wiring in the brain brought on by the repeated actions. Musicians are particularly prone to focal dystonia, and sometimes the patterns are very predictable. In guitarists, for example, the third finger is most often affected.

 This may explain to some degree why the physiotherapy hasn't been particularly helpful. However, although one might think that acupuncture would be similarly ineffectual, this is where the entirely different theoretical basis of the system of traditional acupuncture may yet offer some hope. As you have probably read, acupuncture treatment is based on using needles to influence the energy of the body, called 'qi'. It is the rhythm, balance and flow of this energy which determines the health and efficient function of the system as a whole and all the individual parts of it. When the flow is impaired for any reason pain and changes in function result.

 Had this been an RSI type of problem we would have said with some confidence that acupuncture treatment could well help to restore the local flow and reduce the impact of the problem. This may well still be the case; the diagnosis of this condition can be rather imprecise and unless you have had a scan it might well be an RSI-related problem. If, however, it has a more systemic root then treatment may well be effective on a slightly wider basis, helping to improve overall function.

 With conditions like this, however, it is very difficult to say that this remove whether treatment will be of possible benefit. This is why we always recommend that someone visits a local BAcC member for advice and guidance. Most are more than willing to give up a little time without charge to give a face to face assessment of what may be possible. The only thing we would say is that if you do decide to go ahead it is important to set clear review dates for progress and try to sort out an objective measure of improvement. 

 

Q:  I think I may have nerve damage in my hand from having acupuncture 2 weeks ago. My practitioner needled two points on the outer side of my hand - my wrist and under my little finger. A day or so later I noticed that my hand felt painful and I started to get shooting pains running up the side of my hand. It is painful when it is rested, and is painful when I touch it. Also certain positions that I put my hand in, make the pain much worse. There is also numbness. I'm not able to pick up anything, or even do something simple such as tie my hair back as the pain shooting down my hand is so intense. Obviously I am very concerned about permanent nerve damage and I am not sure what I can do. Can permanent nerve damage happen?

A:  Permanent nerve damage could, in theory, happen, but it is a very rare outcome from treatment. We have always carefully monitored adverse event data from across the world, and this does not appear at all in most cumulative studies.

 In fact, in order for there to be nerve damage you would invariably have felt some extremely unmistakable pain as the needle hit the nerve. There is no room for doubt, as this expert can attest from a rather interesting attack on his median nerve back in the 1980s. What is more likely to have happened is that there has been some deep bruising where the needles have been inserted which has formed small but solid clots near to where nerves and blood vessels pass. The way that you describe the way that the problems occur sounds very much like the sorts of things you would expect - pain and numbness on specific movements aggravating a persistent background pain. The impingement which this has caused and continues to cause will generate pain and numbness of the kind you describe for a short while.

 How long this short while may be is difficult to determine. We would expect there to be a week or two, but in your case this has already passed. If the problems continue at their current level of intensity and annoyance for another fortnight then it would be wise to visit your doctor for an assessment. If he or she performs some fairly routine and simple tests they can determine whether you might need a referral to a neurologist.

 We suspect, however, that the problem will resolve before that becomes necessary.

We have to be honest and say that not only is there no research evidence that we can find to support a claim for helping Dupuytrens, but there is also a shortage of the usual first hand accounts which abound on the internet. Although there is rarely something which works for everyone, everything works for at least someone, and the web is full of stories of people who have used a therapy with success. The ones we have been able to locate for acupuncture treatment and Dupuytrens suggest that where it works it tends to slow down the progress of the condition rather than reverse it.

However, from a Chinese medicine perspective it should in theory be possible to do something about the problem. As you may have read on our website acupuncture is based on a theory of energy, called qi, and the use of needles to affect the rhythms, flow and balance of energy in the system. This means that every manifestation of the physical body reflects qi in a material form, and in theory where this gets blocked or changes in character it should be possible to unblock or restore the usual flow. 

This expert, though, has tried on several occasions to have an impact on the problem, but usually only at the point where the fingers are starting to pull inwards, most patients only mentioning this alongside another problem with which they present and usually only as a last resort and afterthought. Few people resort to treatment at the first point of manifestation, and it may well be that this might bear more positive fruit. Our experience, however, is that most people find the problem a mild curiosity until they realise that the fingers are starting to pull inwards, by which time the condition is well established.

Always optimistic, though, we can say that there would be no harm in trying treatment, and it may well be that there are systemic issues which are reducing the overall energetic flow and which have allowed the energy to coalesce at this point. Popping along to a local BAcC member may be a good option. Most are willing to give up a short amount of time without charge to see whether a problem is likely to be helped by treatment, and they will be honest in their assessment. The only problem is that even if it is successful treatment might take a while, but evidence of success may be slow in coming.

What we try to avoid is people buying into long courses of treatment which may have no successful outcome. Nothing is more guaranteed to create an unhappy patient. If you did decide to go ahead we would highly recommend trying to find an objective measure (degree of bend, etc etc) which would enable you to assess whether there really was a change, and also very regular reviews of progress.

This, of course, all depends on the extent to which the problem is troubling you. Many people find it an irritant but not to the extent that it is worth spending hundreds of pounds trying to get rid of it. There are those, though, whose work or hobbies are affected, and we have a responsibility to ensure that their distress at not being to able to do what they did before is not converted into limitless treatment. 

Q: My husband met with an accident.there is no movement of his right hand(braichal plexus injury)whether acupuncture will be helpfull?

A: We have to be honest and say that if there has been serious damage to the nerves in the brachial plexus then we would be very surprised if acupuncture treatment could make a difference. There is a small amount of research literature about nerve regeneration, but this mainly involves experiments carried out on animals, and certainly not on the major nerve bundles of the body.

You may no doubt have read about acupuncture treatment being used after someone has had a stroke, and there is growing acceptance of the fact that the Chinese approach, to start acupuncture treatment within hours of the event, does seem to speed up the recovery of movement. When there has been real damage to the wiring, though, not simply a case of the signal going haywire, it might be more difficult.

However, without knowing more about the accident itself it is impossible to be 100% certain, and there may be factors involved which suggest that there may be some residual function. It may still be worth your husband's while to visit a BAcC member local to you to get a face to face assessment of what may be possible. We have to say, though, that we would only embark on treatment of a problem like this if we could find enough evidence that there was still a good flow of energy to the affected hand and even then we would only offer to try three or four sessions at most before reviewing progress and making a decision about whether to continue.

What we don't like to see is someone in desperation run up a huge bill for treatment which is having no real benefit at all. This is not good for anyone. 

A:  A great deal depends  on the extent of the damage when you broke your wrist. If a plate was necessary this probably indicates a quite serious break. If so, there may have been attendant nerve damage in the accident itself or in the subsequent repair which has been done. This may mean that the numbness may be a permanent feature, although there is a small body of evidence suggesting that nerves can regenerate or re-route in these circumstances so the outlook may not be too gloomy. Stiffness after a repair of this type is not at all unusual, and should improve with time. People are often give a number of physiotherapy exercises to help them to regain full function in these circumstances.

However, having said that, the theory underpinning traditional acupuncture does offer a small amount of hope that things may improve. Traditional Chinese medicine is premised on an understanding of the body as a flow of energy called 'qi', and its flow, rhythm and balance determines someone's overall state of health. At the very superficial level it is the flow of qi which maintains feeling and movement in the musculature, but any damage to the physical body can also impact on the flow of energy as it is expressed in this way. We find this particularly with scar tissue, but the kind of damage done by fractures and fracture repairs with plates is not far behind.

At this remove it is difficult to say whether or not treatment may be of any value. However, we are sure that if you pop along to a BAcC member near where you live they are likely to offer you a few moments, usually without charge, to assess whether acupuncture may be able to help based on a close look at what has happened. We have certainly treated people with fractures of this kind, and some do respond well. However, each person is different, and while the fractures in several people can be almost identical the context against they have happened, i.e. someone's overall health, may have a considerable impact on the potential for healing. This is why a face to face assessment is the only realistic way of telling what may work.

Treatment would certainly do no harm, though.

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