CASE HISTORIES
PATIENT A
Patient A is a 45 year old lady who presented for physiotherapy with a 3
month history of right sided temporomandibular joint pain. She attributed the
original onset of pain to biting into a crusty bread roll. She felt a clunk in
her jaw at this time and a sharp pain. She reported that her bite was affected
and that the side of her face became swollen. She went to her GP and was
prescribed anti-inflammatories. She was referred for X-Ray which was reported as
normal. Her initial pain settled after a few days, but she still complained of
tenderness over the right side of her face and an inability to fully open her
mouth. She reported soreness after eating a meal. She rated her pain as 6 on the
V.A.S.
On initial assessment there appeared to be no asymmetry in her facial contours
between right and left. She had 75% mouth opening ability. She had pain on side
to side movement of her lower jaw There was tenderness on palpation over the
temporomandibular joint line.
A diagnosis of temporomandibular joint strain was made.
Following consent the patient was treated using acupuncture.
The points selected were along the symptomatic area: TH21, SI 9 and GB 2.
LI 4 on both sides were also selected.
The condition in question was categorized as a chronic syndrome.
The needles were inserted by guide tube technique and the RF method using the
rotatory technique applied.
A small amplitude (1/4 turn of needle) at fast speed (3 oscillations per second)
was used.
Procedure was repeated every 2 – 4 minutes during the treatment.
During each session the patient reported a needle sensation “DeQi” when the
needles were in situ. This sensation was described as a warm tickly sensation.
Following two sessions of acupuncture the patient reported a 70% improvement
in her facial pain. She felt that she could fully open her mouth. She didn’t
have the same level of discomfort after eating but still experienced pain if she
bit into a hard food. Her pain level had dropped to 2 on the V.A.S.
Because she was making significant progress it was decided to continue with
acupuncture for a further 3 – 4 sessions using the same technique.
Following 6 sessions of acupuncture the patient reported a complete
resolution of her symptoms. She was no longer aware of any pain on the side of
her face and could fully enjoy her meals again without pain afterwards. Her pain
levels were reported as 0 on the V.A.S.
Objectively the patient could fully open her mouth. There was no pain on side to
side jaw movements. There was no tenderness along the joint line of the
temporomandibular joint.
Case History B:
Patient B is a 48 year old male who has worked for the past 25 years as a
painter. He is right handed. He presented with right shoulder pain which has
prevented him from working for the past 6 weeks. He stated that this pain has
been niggling at him for the past two years but had become worse recently as he
was doing a lot of over head painting. He stated that his pain was made worse if
hi lifted his arm up in front of him and would get a dart of pain on sudden
movements. Placing his hand behind his back pocket had become painful. Over the
past 6 weeks he reported waking two to three times at night because of pain. On
a pain diagram he
reported a deep ache on the anterior and lateral shoulder referring to the
deltoid insertion. He described his pain as 7 on V.A.S. He had attended his GP
who started him on anti- inflammatories and referred him for X-Ray. This showed
some degenerative changes. He is otherwise fit and healthy with no other medical
history and not taking other medication.
Objectively the patient had quite a protracted shoulder posture. He reported
pain at 90degrees of flexion and abduction actively. He had pain on resisted
abduction. He had full strength of the rotator cuff. He was positive on Neers
test. Examination of his cervical spine showed no abnormality. He had no pins
and needles or numbness.
A diagnosis of a Stage 2 sub acromial impingement was made. Following consent
the patient was treated using acupuncture.
The following points were selected:
Local points LI 15, SJ 14 (eyes of the Shoulder), SI 10, SI 9 AR 1
Are selected to form an arc.
LI 11 as the He-Sea point and LI 4.
The mechanical approach of the rotary technique was applied using the RF method.
A small amplitude (1/4 turn of the needles diameter) at a fast speed (3
oscillations per minute was used). This procedure was repeated every 2 – 4
minutes during the treatment.
During the first treatment session the patient experienced De Qi as
distension and warmth around the joint. Following 3 sessions of acupuncture he
reported a slight reduction in pain levels and described his pain as 6 on the
V.A.S. He was waking slightly less frequently at night. He remained in pain at
90 degrees of abduction and flexion and positive on Neers test.
At this point some different acupuncture points were selected. In addition to
the arc of the shoulder LI 14, SI 11, SI 12 were needled.
Following 3 further sessions of acupuncture the patient reported a further
reduction in his pain levels and felt his arm could go “further”. He reported
not waking during the night but would still have pain in the shoulder first
thing in the morning. He described his pain as a 4 on the V.A.S. Objectively his
active range of motion had increased to 120 degrees before pain in flexion and
abduction.
At this point it was decided to continue with acupuncture, whilst adding in
other approaches – i.e. glenohumeral taping, rotator cuff strengthening,
frictions.
Treatment remains ongoing at present and making steady progress.
Patient C:
Patient C is a forty year old lady who presented for physiotherapy with a
three month history of right elbow pain. She is a full time house wife. She
started playing tennis with her husband 4 months ago, having never played
before. Her reported symptoms were pain on the lateral aspect of her elbow. She
also reported a feeling of weakness I her lower arm .Her pain was aid to be
aggravated by playing tennis, carrying heavy bags, and working at her computer.
She scored her pain as 6 on the V.A.S. Initially she was waking at night with
the discomfort. She is right handed. She was prescribed anti inflammatories by
her GP which provided short term relief. She has no other relevant past medical
history. She was taking no other medication.
Objectively she has full range of motion in all directions of her cervical
spine. She had no pins and needles. Examination of the shoulder joint revealed
no abnormalities. Pain was reproduced by resisted extension of her wrist and
passive wrist flexion. She was found to be tender on palpation along the lateral
joint line. Her grip strength was reduced compared to the left.
Following consent the patient was treated using acupuncture.
The points selected were LI 10, LI 11, LI 12 LU 5, SI 8 and LI 4.
The condition was categorized as a chronic syndrome.
The. The needles were inserted into selected points by guide tube technique and
the needle advanced slowly to the required depth. The technique selected for
treatment was the Reinforce/Supply method (RF) using the rotary technique. On
insertion of the needles a smallish amplitude (1/4 turn of needles diameter) at
a fast speed (3 oscillations per second) was used. This caused the production of
the needle sensation i.e. Deqi feeling. This procedure was repeated every 2 – 4
minutes during the course of the treatment duration. The patients progress was
monitored in between each session. Following 4 to 6 sessions it is expected that
some manner of response would be observed. Following the third session the
patient reported a definite improvement in her pain level. She also reported
that her arm did not feel as heavy. Objectively her pain on resisted extension
and passive wrist flexion was not as sharp. Due to her positive response to
treatment we extended the length of treatment from 20 to 30 minutes.
Whilst the needles were in situ the patient reported various different
sensations. During most treatment he reported of heaviness in her arm. On
needling the LI4 point she found it to be initially sharp followed by a numbing
effect. Often the patient found that area around the needles would seem itchy.
Following 10 sessions of acupuncture the patient reported her pain level on the
VAS to be 1. This was provoked if she carried heavy bags. She no longer woke at
night due to pain. Her grip strength was almost equal to that of the
contralateral side.
Patient D:
Patient D is a 17 year old male who sustained an ankle injury whilst playing
Gaelic hurling 1 week previously. The patient described how his foot turned
inwards as he went over on his ankle. Immediately his ankle became painful. He
was able to tale weight through his leg but enable to continue playing .His
ankle became quite swollen and bruising appeared over the lateral aspect. He was
taken to A + E where X-ray showed no fracture. He applied ice to his ankle
regularly over the following 2 days. On initial assessment he described his pain
as 4 on the V.A.S. He was unable to get his shoe on because of swelling. He
reported a similar episode I year ago.
Objectively the patient walked unaided with a moderate limp. All active ROM of
the ankle joint was restricted by 75%. There was pain on active inversion,
eversion and plantarflexion. There was moderate swelling around the ankle joint
and marked bruising over the lateral joint. There was tenderness on palpation of
his anterior talofibular ligament and calcaneofibular ligament.
A diagnosis of a grade 1 sprain of the lateral ankle ligament was
established.
Following consent the patient was treated using acupuncture.
The following points were selected: GB 34, GB 39, GB 40, SP 6,B 60 AND B 62.
The condition was categorized as an acute condition. The needles were inserted
using the applicator technique. The technique selected was the draining/sedate
method where a largish amplitude (1/2 turn of the needles diameter) at a slow
speed (2 oscillations per second) was used, this was repeated every 10- 15
minutes during the course of the treatment. The patient was seen twice weekly.
During treatment the patient reported a feeling of De-Qi and described it as an
itchy warm feeling.
Following 3 sessions of acupuncture there was a considerable reduction in the
amount of swelling around the ankle joint. The patient walked with a normal gait
pattern. There was still some bruising over the lateral aspect of the ankle.
Objectively there was full ROM of all ankle movements, with still some pain at
the end of range inversion and plantarflexion, with lateral tenderness.
Because of the benefits experienced it was decided to continue with the same
acupuncture treatment approach and to add proprioreception, and strengthening
work. Following 6 session the patient reported a full resolution of pain. He had
full active range of motion in all directions.
Patient E:
Patient E is a 24 year old female who presented for physiotherapy with a 2 month
history of shoulder pain. Miss E is a guitar teacher and reported that she is
finding it increasingly hard to play the guitar as this is the biggest
aggravating factor of her pain. She is right handed. She reports that her
shoulder is fine 90% of the time but when she has been playing the guitar her
pain starts. She also reported a dart of pain on certain activities such as
reaching out to the side. She recalled no history of injury to the shoulder. She
has no other medical history and not taking any medications.
On initial examination the cervical spine revealed no dysfunction.
There was full active range of all shoulder joint movements with a dart of pain
reported at 30 degrees of abduction.
The patients pain was brought on by resisting shoulder abduction at 30 degrees.
There was tenderness over the supraspinatus tendon.
A diagnosis of supraspinatus tendinites was made.
Following consent the patient was treated using acupuncture.
The following acupuncture points were selected: LI 14, LI 15, LI 16, SI 12, LI
4.
The condition was categorized as a chronic syndrome. The needles were inserted
into selected points by guide tube technique and the needle advanced slowly to
the required depth. The technique selected for treatment was the
Reinforce/Supply method (RF) using the rotary technique. On insertion of the
needles a smallish amplitude (1/4 turn of needles diameter) at a fast speed (3
oscillations per second) was used. This caused the production of the needle
sensation i.e. Deqi feeling. This procedure was repeated every 2 – 4 minutes
during the course of the treatment duration. The patients progress was monitored
in between each session. Following four sessions of acupuncture the patient
reported a definite improvement in her shoulder pain. She reported that she
could play the guitar for longer without experiencing pain. Resisted abduction
was pain free. The patient was commenced on a rotator cuff strengthening
program.
