Article

Acupuncture for the Treatment of Trigger Finger in Adults: A Prospective Case Series

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Abstract

Objective: To determine the effect of acupuncture performed at the synovial and ligamentous tendon sheath (A1 pulley site) on pain during snapping and the severity of the snapping phenomenon in patients with trigger finger. Methods: In this observational study, changes in the patients' condition were compared before and after acupuncture treatment. Acupuncture was performed on 19 fingers of 15 patients. Acupuncture needles were inserted into the radial and ulnar sides of the flexor tendon at the A1 pulley of the affected finger. Treatment was performed daily up to a maximum of five times. Before and after each treatment, pain during snapping and the severity of snapping were evaluated using a visual analogue scale (VAS). Results: VAS scores for pain and snapping severity were significantly improved immediately after the first treatment (p<0.001). Pain during snapping, assessed before each treatment, improved over time, reaching statistical significance from the second treatment onwards (p<0.001); similarly, a significant improvement in the severity of snapping was observed, also from the second treatment (p<0.001). Patients with clinically significant improvements (≥50%) in pain and snapping severity had a significantly shorter duration of the disorder than those with <50% improvement (p<0.05). Conclusions: Acupuncture at the impaired A1 pulley site may be an effective treatment for trigger finger. We postulate that acupuncture may reduce inflammation/swelling of the synovial membrane of the tendon sheath, which predominates when the disorder is of short duration. Further research is required to confirm the efficacy/effectiveness of acupuncture for trigger finger and its mechanisms of action.

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... At present, there are many clinical reports on the treatment of STS with acupotomy, and the clinical effect is more significant. [7][8][9] However, there are many kinds of acupotomy, and the treatment advantages are not the same. There is a lack of comparative study between different acupotomy treatments, which brings trouble to the choice of clinicians. ...
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Background: Stenosing tenosynovitis (STS) is a chronic aseptic inflammation caused by mechanical friction. The main clinical manifestations are local pain and limited activity of the affected parts, which reduce people's quality of life. The clinical effect of acupotomy in the treatment of STS is significant, and the operation is simple and the side effect is small. But there are many kinds of acupotomology, and there is a lack of comparative study between different Acupotomology. In this study, the effectiveness of 4 commonly used needle knife therapies (v-knife, oblique knife, crochet knife, flat knife) was ranked by the method of network meta. Methods: CNKI, Wanfang, VIP, Sinomed, PubMed, and Cochrane Library were searched to collect randomized controlled trials of v-knife, oblique knife, crochet knife, and flat knife in the treatment of STS. The search time limit is from the date of establishment to October 15, 2021. Revman5.3, gemtc 0.14.3, and stata14.2 were used for data analysis, and Cochrane bias risk assessment tool was used to screen and evaluate the quality of included literatures. Conclusion: Objective to provide evidence-based medicine evidence for clinical selection of the best needle knife treatment scheme for STS.
... It is believed that acupuncture needling, which penetrates the flexor tendon sheath, improves local circulation, reduces inflammatory oedema and hence improves pain and snapping severity. 3 The most common adverse events reported are local pain, slight bleeding or haematoma from needling (1.1%-6.1%). Among all the reported adverse events in a recent prospective series of acupuncture treatments for trigger finger, 3 only one specifically involved the hand. ...
Article
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It is believed that acupuncture needling, which penetrates the flexor tendon sheath, improves local circulation, reduces inflammatory oedema and hence improves pain and snapping severity. The most common adverse events reported are local pain, slight bleeding or haematoma from needling (1.1%–6.1%). Among all the reported adverse events in a recent prospective series of acupuncture treatments for trigger finger, only one specifically involved the hand. The most frequently involved traditional acupuncture point locations were Taiyang, PC6 (Neiguan) and LI4 (Hegu) in the hand. There has been lack of consensus on traditional acupuncture point selection and treatment protocols for trigger finger.
... Literatura de specialitate prezintă o multitudine de ipoteze cu privire la factorii declanşatori ai acestei afecţiuni, traumatismele repetate şi profilul activităţii profesionale fiind cei mai frecvenţi factori asociaţi cu debutul acestei afecţiuni (12)(13)(14)(15). Istoricul personal patologic pare să fie, de asemenea, un element important în ceea ce priveşte apariţia tenosinovitei stenozante, pacienţii cu diabet zaharat asociind un risc de aproximativ 10% de dezvoltare a bolii pe parcursul vieţii, un element definitoriu în acest caz fiind durata dezechilibrului metabolic şi mai puţin valorile glicemiei (16)(17)(18)(19)(20). Studiile arată că sindromul de tunel carpian, artrita reumatoidă şi tenosinovita de Quervain se asociază, de asemenea, cu un risc crescut de apariţie a degetului în resort. ...
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The current paper presents în detail the defining elements of the etiopathogeny and surgical treatment of the trigger finger. The objective of the study is to identify the particular elements that can influence the post-operative prognosis, as well as to determine the impact they have on the recovery period and the professional integration of patients. The research was based on data obtained from 52 patients who received treatment in 2015-2019. The results of the study show that the surgical treatment of the trigger finger performed by transverse incision at the level of the distal palmar fold with local anesthesia is associated with a very good result from a functional point of view, a low rate of postoperative complications and favorable aesthetic appearance.
... Just like splinting and corticosteroids, acupuncture has been shown to be more effective when TF first presents; it is believed to reduce inflammation of the synovial membrane of the sheath. 20 Physiotherapy has also been shown to be a semieffective treatment for TF. Three months following the start of treatment, 68.6% of patients found their symptoms to improve compared with 97.4% of patients receiving steroid injections. ...
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Trigger finger (TF) is a common referral to a hand surgeon, with people with diabetess being the most at-risk population. Abnormal thickening, scarring, and inflammation occur at the A1 pulley and flexor tendon, and histological changes correlate well with the clinical severity of TF. Corticosteroid injections decrease the thickness of the A1 pulley and are considered a first-line treatment. However, corticosteroids are only moderately effective, especially for people with diabetes. Patients may elect for surgery if nonoperative treatments prove ineffective; some may choose immediate surgical release instead. To release the A1 pulley, patients have the option of an open or percutaneous approach. The open approach has a greater risk of infection and scar tissue formation in the short run but an overall superior long-term outcome compared with the percutaneous approach. Methods: We critically reviewed the efficacy and cost-effectiveness of the treatment methods for TF through a comprehensive search of the PubMed Database from 2003 to 2019. Results: To reduce costs, while still delivering the best possible care, it is critical to consider the likelihood of success for each treatment method in each subpopulation. Furthermore, some patients may need to return to work promptly, which ultimately may influence their desired treatment method. Conclusions: Currently, there is no universal treatment algorithm for TF. From a purely financial standpoint, women without diabetes presenting with a single triggering thumb should attempt 2 corticosteroid trials before percutaneous release. It is the most cost-effective for all other subpopulations to elect for immediate percutaneous release.
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Fingers are vital organs for humans. What is their anatomy? Their function? What are the characteristics of traumatic finger injury? Are fingers vital for human health? What are the diseases that can afflict fingers? What are the strategies of disease management? Biblical verses that deal with the human fingers are described. This research adds to our knowledge and gives important information on the human fingers, which is an essential organ for human during much of their existence.
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To study the effectiveness of electroacupuncture of the spinal nerve root using a selective spinal nerve block technique for the treatment of lumbar and lower limb symptoms in patients with lumbar spinal canal stenosis. Subjects were 17 patients with spinal canal stenosis who did not respond to 2 months of general conservative treatment and conventional acupuncture. Under x-ray fluoroscopy, two acupuncture needles were inserted as close as possible to the relevant nerve root, as determined by subjective symptoms and x-ray and MRI findings, and low-frequency electroacupuncture stimulation was performed (10 Hz, 10 min). Patients received 3-5 once-weekly treatments, and were evaluated immediately before and after each treatment and 3 months after completion of treatment. After the first nerve root electroacupuncture stimulation, scores for lumbar and lower limb symptoms improved significantly (low back pain, p<0.05; lower limb pain, p<0.05; lower limb dysaesthesia, p<0.01) with some improvement in continuous walking distance. Symptom scores and continuous walking distance showed further improvement before the final treatment (p<0.01), and a significant sustained improvement was observed 3 months after completion of treatment (p<0.01). Lumbar and lower limb symptoms, for which conventional acupuncture and general conservative treatment had been ineffective, improved significantly during a course of electroacupuncture to the spinal nerve root, showing sustained improvement even 3 months after completion of treatment. The mechanisms of these effects may involve activation of the pain inhibition system and improvement of nerve blood flow.
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(1) Sixty-eight convergent dorsal horn neurones have been recorded at the lumbar level in anaesthetized intact rats. All cells received prominent A alpha and C fibre afferents and correspondingly could be activated by high and low threshold stimuli applied to the peripheral excitatory receptive field. (2) The activity of 67/68 of these neurones was powerfully inhibited by noxious stimuli applied to various parts of the body. Since non-noxious stimuli were ineffective in this respect, the term "diffuse noxious inhibitory controls" (DNIC) is proposed. (3) DNIC could be evoked by noxious pinch applied to the tail, the contralateral hind paw, the forepaws, the ears and the muzzle; the most effective areas were the tail and muzzle. Noxious heat applied to and transcutaneous electrical stimulation of the tail were extemely effective in eliciting DNIC as was the intraperitoneal injection of bradykinin. (4) DNIC strongly depressed by 60-100% both the C fibre response following suprathreshold transcutaneous electrical stimulation and the responses to noxious radiant heat. (5) The spontaneous activity and the responses to low threshold afferents induced either by A alpha threshold electrical or natural stimulation were also powerfully inhibited. (6) In the majority of cases, long lasting post-effects directly related to the duration of conditioning painful stimulus were observed.
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The descending pain inhibitory system (DPIS) associated with acupuncture analgesia (AA), caused by low frequency stimulation of an acupuncture point, was identified by the results of lesion and stimulation procedures previously determined to differentiate the afferent and efferent paths in rats. The DPIS starts in the posterior arcuate nucleus and descends to the hypothalamic ventromedian nucleus (HVM) from whence it divides into two pathways: one path, the serotonin mediated path, descends through the ventral periaqueductal central gray (V-PAG) and then to the raphe magnus (RM). The other, the noradrenaline mediated path, descends through the reticuloparagigantocellular nucleus (NRPG) and part of the reticulogigantocellular nucleus (NRGC). The afferent and efferent paths are both present in the RM and NRGC, and were separately identified by means of the analgesia (SPA) produced by stimulation of the separate regions in AA responders and nonresponders, because SPA of these regions in nonresponders produced only efferent pathway mediated analgesia.
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Eighty-nine A1 pulleys from 65 patients with trigger digits and 20 control A1 pulleys from fresh-frozen cadavers were studied comparatively with histology, immunohistochemistry, and transmission electron microscopy. In both normal and pathologic specimens, the A1 pulley was composed of two layers: an outer, vascularized, convex layer and an inner, concave, friction, flexor tendon gliding layer. In the latter, the cells and adjacent matrix had several characteristics of fibrocartilage, including chondrocytes. In trigger digits, the number of chondrocytes and adjacent extracellular matrix was significantly increased when compared with controls. There was no evidence of a synovial cell layer on the surface of the A1 pulleys in either normal or trigger digits. We conclude that the underlying pathobiological mechanism for triggering at the A1 pulley is characterized by a fibrocartilage metaplasia.
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Using the tibial nerves of healthy human subjects (n = 22), the muscle nerve sympathetic activity (MSA) controlling the soleus and its response to acupuncture stimulation were observed. 1. Muscle nerve sympathetic activity (MSA) is spontaneous and varies in correspondence with pulse and respiration. 2. The excitation of MSA in the left tibial nerve was observed just after acupuncture stimulation was applied (145.2 + 39.3 (SD) %, n = 12). 3. The intervals of burst discharges of MSA in the left tibial nerve were elongated (p less than 0.05) and the inhibition of MSA was observed (19.6 + 2.4 (SD) %, n = 12) during acupuncture stimulation. Gradual recovery then took place. 4. The excitation and inhibition of MSA in the tibial nerve was observed in the leg stimulated, the other leg and at the back of the neck to which acupuncture stimulation was applied. 5. Nasal respirations and pulses of plethysmography from the big toe did not change before, during or after acupuncture stimulation.
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The snapping finger condition has increased recently. And this condition is difficult to recover in most cases. The snapping finger condition was improved quite remarkably by the rehabilitation (Reha) of the leison performed immediately after acupuncture in the symmetrical part of the leison on the normal side and Chu-chih (LI-11), Shou-son-li (LI-10), Wai-kuan (TH-5), Ho-ku (LI-4) and Yang-chih (TH-4) on the normal side. But the favorable effect could not be obtained when Reha had not been performed on the leison. The effects were slight either in the combination therapy of Reha of the leison with the acupuncture of the leison and Chu-chih (LI-11), Shou-son-li (LI-10), Wai-kuan (TH-5), Ho-ku (LI-4) and Yang-chih (TH-4) on the abnormal side or in the simple treatment with Reha or with the acupuncture on the abnormal side. The acupuncture in the normal side resulted in a more remarkable result after Reha (Reha-effect) because Reha of the leison could easily contend with it. It is a valuable means of therapy as the snapping finger condition is presently on the increase.
Article
The involvement of the peripheral opioid system in modulating inflammatory pain has been well documented. This study aimed to investigate the possibility of electroacupuncture (EA)-mediated peripheral opioid release. Rats were injected with complete Freund's adjuvant in one of the hind paws to induce localized inflammatory pain. The pain behavioral changes were measured by paw withdrawal latency (PWL) to a noxious thermal stimulus. At day 5 of inflammation, rats received a second injection of saline or opioid antagonists into the inflamed paw, followed by EA at 30 Hz, 2 mA, and 0.1 ms for 30 minutes. The EA was conducted at acupuncture point GB30. A control was used in which needles were inserted at GB30 but no electrical stimulation was applied. Rats receiving EA showed a significantly longer PWL as compared with the control from 30 minutes to three hours after EA treatment. Intraplantar but not intraperitoneal injection of naloxone methiodide, a peripherally acting opioid receptor antagonist, eliminated the analgesic effect at 30 minutes after EA treatment. Intraplantar injection of an antibody against beta-endorphin and a corticotropin-releasing factor antagonist also produced a reduction in PWL in rats receiving EA. These data strongly suggest that peripheral opioids are released by EA at the inflammatory site.
The effect of electrical acupuncture to regional blood flow of the Achilles tendon in the rat
  • Inoue