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Concerned point of needle has been left in my wrist

Q:  I have had 10 treatments from an acupuncturist who treats your 'element'.It has had mixed results and her decision on which element I am has changed. Although I pay for an hour my treatment typically now takes 10 minutes and consists of one needle being put into and out of my wrist very quickly and then inserted into the back of my wrist the same way using the same needle. When removing the needle she uses a piece of cotton wool to press against the needle as it is taken out. 6weeks ago I had a treatment and left with great pain in my right wrist where the last needle point was. It didn't go away and got worse so that if I moved my hand in a certain way I experienced a tearing sensation inside my wrist. I felt there was a piece of needle left inside my wrist. I went to my next appointment two weeks later and asked if there was a possibility of a piece of needle being left inside me. I was pretty much dismissed and told there was nothing wrong. (There clearly is as I am frequently in agony). A month passed and I have made an appointment to see my gp. I have waited several weeks for the appointment and still have another 4 days to go but my wrist is still really bad. I don't know whether to go to casualty and if so whether an X-ray would show up a tine fragment of needle or if I would need an ultrasound? I am now very scared and worried as the point the needle went in is in line with major arteries and nerves. Can you advise best course of action and if you think anyone will take me seriously? There is no inflammation and my wrist looks entirely normal from the outside. 

A:  This sounds very distressing for you, but we can say straight away with some confidence that it is highly unlikely that you have a piece of broken needle embedded under the skin of your wrist. Although all practitioners are trained in what to do if a needle breaks, in modern times this is virtually unheard of. The most recent report of a possible break to the BAcC was over fifteen years ago. The main cause of needle breakage, rare as it was even then, was when needles were autoclaved to sterilise them for re-use. Modern needles are used once only and then disposed of, so the constant heating and cooling which made the steel brittle does not happen.

The most likely cause of your discomfort is that there has been some bruising beneath the skin surface which has caused a hard clot to form and which impinges a nerve when you move in certain ways. We have seen this before, and it can take several weeks for something like this to clear. There is a small possibility of damage to a tendon, which might also account for the symptom, but the needling would have to be rather more vigorous than sounds was the case for this to happen. If the practitioner is using the style of practice which we believe they are, then very fine needles are the order of the day, and damage from the needle itself would be unlikely.

We think that going to your GP is a very wise move. He or she may have a precautionary X-ray or ultrasound done - just because needle breakage is rare doesn't mean that it can't happen - but there will be a number of investigations they can undertake on the spot in terms of range of movement and pain on movement which should alert them to the probable cause.

As far as the style of practice is concerned, this sounds like the Five Element system which is one of the two more common  styles in use in the UK. The diagnostic certainties of this are open to re-assessment and change, and for all sorts of complex reasons a person might be initially treated on one element and then find that another element presents itself as the core of the problem. This is the not the difference between right and wrong so much as between good and better. All treatment will have a beneficial effect because in a closed system of energy any attempts to improve the flow will have impact everywhere. Treating the heart of an imbalance, though, will get better results and can lead to much more profound change. It is heartening to hear that the practitioner is making adjustments; it is often said that immediate certainty is not always a sign of good diagnosis. People are very complex.

In terms of technique, the schools which teach this system tend to use mainly 'in and out' needle insertions which can take up a very small amount of a treatment session. We occasionally hear rumblings of discontent from patients who think that this doesn't seem quite right, and we have to explain to them that the time spent up to that point is all a part of the diagnostic process. All of this preceding work -  investigation, pulses and conversation - refines the diagnosis so that when the points are chosen their effect can be all the greater.

Having said all of this it is a concern to us that the practitioner appears to you to have made light of what you have experienced. We try our hardest to ensure that practitioners pay particular attention to what their patients experience and to respect what they have to say. While we would probably not consider something like this actionable under our professional codes it is certainly something which the practitioner would benefit from knowing so that they can look at how they have addressed the issue. Unfortunately the only person who can really address this is the patient, who is not always inclined to get involved in setting a practitioner right and more likely to want to walk away from the situation. If you do raise it with her, however, we hope that your concerns are properly addressed.

Just to re-iterate what we said above, we think that it is highly unlikely that a needle tip has broken off in the wrist, but we are happy to know that you have a GP appointment within the next few days to make the necessary investigations. We hope that you understand that we have taken your account very seriously, and we are a little disappointed that you do not feel as though you have been listened to. For us acupuncture is a daily way of life, and we are used to what happens. For most patients it is still a largely unknown area, and for this reason we have to remember to acknowledge that in what is already an unusual situation anything untoward which happens is likely to cause great anxiety.

We hope that it is as we a transient adverse event which resolves soon without the need for any medical intervention.