Ask an expert - muscles and bones - hands and fingers

15 questions

Q:  i severed a nerve at the base of my thumb in an accident 2 years ago which was re-attached through surgery.  i still have quite a degree of numbness and
occasionly hypher sensitivity. can acupuncture help in any way?

A: This is quite a difficult question to answer. When we asked a similar question about nerve regeneration some time ago we said:

If there has been well-authenticated damage to a nerve then the chances of restoring its conductivity are very limited. If a nerve has been damaged beyond the body's ability to repair, then this severely limits what might be possible. There is a very small amount of evidence that acupuncture may be able to help nerve regeneration but this comes from the experimental end of the acupuncture world and often involves trials on animals, or 'ratpuncture' as some of our colleagues cheerfully dismiss it.

Obviously, though, we work in a different paradigm, and there are occasions where a symptom written off by conventional medicine as permanent and untreatable responds to acupuncture treatment. As you may be aware already from our website, the theories of Chinese medicine rest on a concept of energy, called 'qi' whose flow and balance determine good function and health in the body. If the flow is disrupted, as may be the case with accident, injury and occasionally surgery, then restoring the flow can
sometimes have significant effects.

The best advice that we can give is that you contact a BAcC member local to you to arrange for a brief face to face assessment. This will give them the information they need to assess whether in your specific case there are indications which point to the possible use of acupuncture.

In your case there might be slightly more reason for hope insofar as the injury which severed the nerve is almost certainly going to have had an impact on the superficial tissue which the sharp edge penetrated, and had you asked us the same question about scarring and the symptoms which you have we might have been a little more upbeat. In a recent answer about post-operative scar tissue we said:

There are times when the simple act of cutting tissue can cause a break in the flow of energy, and we have come across many cases where even a well-healed scar has blocked the flow in a channel. When you consider that there may well be thicker keloid scar tissue and adhesions as well as surface interruptions it is possible that
acupuncture treatment may offer some hope. and this particular expert has had one or two occasions when treatment along or across scar tissue has had disproportionately great effects.

It is best to realistic, though. nerve damage can sometimes leave the sorts of symptoms which you have, and they can often take a long while to diminish as the body learns to block the signals. There would nonetheless be good reason to talk to a BAcC member local to you, and possibly having a small number of treatments, but we would suggest that if you do, the number should be tightly controlled. In our experience these sorts of problems either respond quickly or not at all, and it is best not to develop
a treatment habit which runs to a dozen sessions with no result. This does not tend to play well with the patient.

A:  We were asked about a ganglion on the thumb some time ago, and the response we gave then is equally as valid for the treatment of a wrist ganglion. We wrote:

Long gone are the days when the treatment for a ganglion was to lay the hand flat on the table and drop the family bible onto it. Current conventional medical treatment is to aspirate the rather thick, clear jelly-like content from the cyst at a GP surgery or occasionally to have a minor operation in the hospital day surgery unit. These latter are less frequent because they are regarded as relatively low priority, and also can be quite complicated if the cyst is entwined with nerves and blood vessels, as is often the case in the wrist area.  We are assuming that you have seen your GP and had the options explained to you. If you haven't this is always a worthwhile thing to do. GPs are very adept at making judgements about what may appear to be simpler conditions which in reality aren't, and having your GP take a look is a wise move.

 
From a Chinese medicine perspective any accumulation and thickening of fluids in the body points either to a local obstruction in the flow of energy, called 'qi' in Chinese medicine, or to a systemic problem which manifests in a number of problems across the body and mind as a whole. A skilled practitioner can quickly make this determination, and treat accordingly. The greater majority of cases we come across are local problems, often caused by muscular tensions which constrict the flow of fluids and blood. Treatment can help to reduce the tension and encourage flow, but can also help to disperse the thickened fluids. From a Chinese medicine point of view these are 'stuck' qi, and needling moves the qi and reduces the lump.
 
You won't, of course, find any clinical evidence for this; it is one of the least likely problems to be researched at great expense. Our experience, however, is that acupuncture may be helpful, but we always taken into account the other factors which may have contributed to the cysts' occurrence. There may be postural reasons - work stations, frequent use of the joint in a skilled operation - which mean that the cyst will return. There may also be wider tensions and stresses in the system which again may result from lifestyle. Addressing a small problem like a cyst may not work if it is part of a wider pattern of disharmony.
 
The best advice we can give you is to seek the face to face opinion of a BAcC member local to you. Our own feeling is that if you did decide to have treatment, the results would manifest relatively quickly or not at all, and you should not get tied into a long sequence of treatment. If it does work, the question then remains about how sustainable the improvement is. If treatment is only successful for a short time, then it may be worth discussing with your practitioner whether some forms of massage may be a more effective way of addressing the problem, either Chinese massage such as tui na or orthodox massage.  
 

We think that this probably remains the best advice we can offer. What we can say is that if a ganglion is going to respond to treatment it tends to do so quite quickly; this is not a cause for taking on an extended course of treatment. The one caveat is that 'easy go, easy come' occasionally applies; the ganglion can sometimes become visibly smaller during the course of a session and carry on shrinking, only to regain its original size again later. If this happens twice in a row, we would be cautious about treating over and over again, unless of course the problem was causing such an impact on someone's life that the cost of maintenance treatment over an extended period was more than offset by the gains, however temporary.

Q:  Can acupuncture possibly help relieve severe intermittent pain in a wrist/thumb osteoarthritis problem? I currently have a splint which I wear when it's really bad and take strong painkillers{prescribed}as and when needed.  I'd rather not have to have steroid injections every 6/9 months.

A:  As our factsheet shows
 
http://www.acupuncture.org.uk/a-to-z-of-conditions/a-to-z-of-conditions/osteoarthritis.html
 
there is limited but increasing evidence for the benefit of acupuncture treatment. It has to be said, however, that the bar in the West is set very high, with the randomised double blind control trial being used as the basis for makign any claims for efficacy. This is more appropriate to drug testing than for testing a dynamic and evolutionary intervention like acupuncture, and in China, where the question is not 'does it work?' but 'what works better?', there are many hundreds of studies which appear to show that acupuncture treatment can be of benefit.
 
However, a great deal depends on the extent of the deterioration of the joints. There are, from a Chinese medicine perspective, both local and systemic reasons why someone can manifest pains in a specific joint, and the art and skill of the practitioner lies in determining which this is and treating appropriately. The caution, as always in cases of osteoarthritis, is just how much the joint has been affected by crumbling of the bone or by osteophytes, bony outgrowths which often cause inflammation and aggravation. If either is significant then the treatment may be of limited value. Acupuncture is used for pain relief, this being one of the main areas of interest when research kicked off in the West, but like any pain relief the question is how much relief and how sustainable it is. If, for example, a monthly session bought continuing relief for over three weeks, then this may be an option to consider. If, on the other hand, acupuncture brought about relief for about 2 or 3 days, then unless someone has deep pockets this is not a great option.
 
We believe that there may be a limit to how many steroid injections someone can have in a single joint, so it is worthwhile exploring alternatives. Our advice would be to visit a BAcC member local to you for them to be able to give you a brief face to face assessment of whether treatment may be of value. If you did decide to go ahead we would highly recommend that you set an upper limit on treatments from the outset and then review progress. Four or five sessions would normally be enough to assess whether there was any change and how sustainable it might be.     
 

A:  It is no surprise to us that there is little or no research published in English about the use of acupuncture treatment for trigger thumb. The vast majority of case are treated rapidly and successfully with steroid injections, and the important task is to determine whether it is a single problem in itself or whether it is the tip of a much larger iceberg for a condition like rheumatood arthritis. We are sure, though, that your GP will almost certainly have made this assessment when he or she saw you.
 
We do find that many people, however, try to avoid steroid injections because while they work, they can often need to be repeated and there is usually a limit to the number of injections that one can have in a specific area of the body, usually two or three. Many people want to find a solution that is as effective and can be repeated, and there are a number routes like diet and massage which are popular complementary approaches to the problem.
 
As far as acupuncture treatment is concerned, our systems of medicine are premised on the flow of an energy called 'qi' in Chinese whose steady flow, rhythm and balance ensure the health and good functioning of both the internal organs and the musculo-skeletal structure. When the flow is interrupted or blocked for any reason, symptoms will appear, and not necessarily only at the site of the blockage. A systemic problem, for example, could lead to the appearance of a number of problems throughout the body, and the skill of the practitioner lies in being able to assess and interpret all of the information that he or she collects and determine the best way to treat a problem. If it is local this can often mean that the simple reinstatement of flow can achieve considerable change, although the note of caution is that if a local problem has already caused a structural change, like the growth of more bone or the hardening of tendons, there may be limits to what treatment may achieve.
 
It is always sensible to draw a sharp line in the sand after a number of treatments to assess progress and evaluate whether treatment in having the desired effect. It is all too easy to rack up ten or fifteen sessions without discernible change, and we always recommend that after four or five sessions there should be small signs of change at very least to encourage further work. If the practitioner can tell from diagnostic signs that change is imminent that may be reason to carry on, but the patient's experience is the most important.
 
The best advice we can give is to consult a BAcC member local to you and seek a brief face to face assessment of whether acupuncture may be of benefit, or if not, what other options they might recommend. Nothing beats seeing a problem directly to give an honest and accurate assessment of possible success.
 

Q: Since breaking an elbow in late 2009, followed by a frozen shoulder in early 2010, I have suffered chronic neuropathic pain in my hand and fingers.
 
I have see a pain management specialist and after various investigations, it has been concluded that the only problem is nerve irritation at the C6/C7 level - assumed to be related to posture and tight scalenes. I have undertaken a wide number of injections, pulsed radio frequency and taken both Pregabalin and Duloxetine. None of the injections or PRF helped; I couldn't tolerate Pregabalin and Duloxetine was only of limited help so I stopped taking it. Physiotherapy helps to some extent (primarily focuses on trigger points) and I have been taking clinical pilates sessions to help with posture. Capsaicin applied topically to my hand gave some relief.

 Since it is now nearly 4 years that the problem has been ongoing, I am becoming somewhat despondent. Is there any evidence that acupuncture might help resolve the problem or at least offer some pain relief?  If so, could you recommend an acupuncturist in London.

A:  When someone has tried, or been treated with, as many of the standard treatment options as you have and without lasting effect, we would be reluctant to make encouraging noises about the value fo acupuncture treatment where all else has failed. However, it is perfectly true to say that acupuncture in Chinese medicine is premised on an entirely different theoretical basis, and symptoms such as neuropathic pain are understood as disruptions in the flow of energy, or 'qi' as it is called in Chinese medicine. The skill and art of the practitioner lies in determining whether this disruption in the flow arises as a consequence of a local blockage or weakness in the flow, or whether it is the tip of a much larger iceberg, and is local evidence of a systemic problem. When there has been local damage, especially where there has been a broken bone, it is not uncommon to find that from a Chinese medicien perspective there has been a local restriction which, until unblocked as best possible, will continue to generate symptoms 'downstream.'
 
We do have a factsheet on neuropathic pain
 
http://www.acupuncture.org.uk/a-to-z-of-conditions/a-to-z-of-conditions/neuropathic-pain.html
 
but this does not really address the issue with which you are dealing. Our best advice to you, because of the very specific nature of the problems you have, is to visit a BAcC member local to you and let them have a look at the problems. Nothing can replace a face to face assessment in cases like yours, and we are confident that you will be given an honest view of how beneficial acupuncture treatment may be. If you were to present in our clinic we would also have in mind that cranial osteopathy might well have something to offer. The kinds of subtle disruption to the flow of energy which injuries can cause is often treated well by this form of intervention.
 
As for personal recommendations, we don't make them because there is no need to. All of our members are equally well equipped to deal with any patient who visits them, whether this involves treatment or  referrals on to other forms of treatment if they judge the problems to be best treated in other ways.
 
We hope that after your long journey so far that you find something which helps to bring the symptom under control.  

Page 2 of 3

Post a question

If you have any questions about acupuncture, browse our archive or ask an expert.

Ask an expert

BAcC Factsheets

Research based factsheets have been prepared for over 60 conditions especially for this website

Browse the facts