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TREATMENT OF HAND PAIN AND CARPAL TUNNEL SYNDROME
USING PRECISE DRY NEEDLING
UNDER ULTRASOUND GUIDANCE - RELEVANCE OF SUPINATOR SYNDROME
R. Bubnov1, L. Kalika2.
1Clinical Hospital "Feofaniya", Ultasound; Institute of Microbiology and Virology, NAS of Ukraine , Kyiv, Ukraine
2New York Dynamic Neuromuscular Rehabilitation & Physical Therapy,
https://nydnrehab.com/, New York, USA.
ABSTRACT RESULTS
METHODS
CONCLUSIONS
REFERENCES
We included 46 patients (32 females), avarage age was
37±6 years old, with symptoms of carpal tunnel syndrome
(CTS) and pain in hand. The treatment approach by R.
Bubnov (PMID:23088743) [2,3] was applied that included
ultrasound identification of myofascial trigger points, precise
neuromuscular ultrasound; with following dry needling under
US guidance using steel fine needles (28 gage) to elicit the
local twitch response (LTR) effect verified on M-mode
ultrasound. Visual analogue scale data (0 to 10) were
measured before, immediately after and 24 hours after the
intervention. A decrease in pain as measured by a VAS of
50% or more one week after treatment was considered as
success.
1.Clinical definition zone of possible trigger point—pain
syndrome with typical referred pain pattern registration.
2.Trigger point palpation. Palpation of a hypersensitive bundle
or nodule of the muscle fiber of harder than normal
consistency. Localization of a trigger point is based on the
sense of feel, assisted by patient expressions of pain, and by
visual and palpable observations of local twitch response [1,2].
3.Using precise physical tests, extensive neuromuscular
ultrasound using M-mode to evaluate muscle thickness, CSA
and motion , different patterns of decreasing motility,
contractility (muscle contracted / rested thickness), etc. [5].
4.When the affected muscle is detected, ultrasonography
examination is performed for myofascial trigger point
visualization using gray-scale, Doppler, and sonoelastography
[2-4].
5.After the visual identification of the trigger point, dry needling
was performed—acupuncture needles were inserted into MTrP
to elicit the LTR effect. The needle was held in the tissue until
complete disappearance of the LTR which considered similar to
the phenomenon of the ‘needle grasp,’ which has been
attributed to the muscle fibers contracting around the needle,
and was held tightly in place to increase the resistance to
further move the inserted needle [2-4].
6.Ultrasound control after procedure [2-4].
7.Visual analog scale (VAS) scores (0–10) were recorded
throughout the study period before, immediately after, and 24 h
after the procedure.
Dry needling trigger points under ultrasound guidance is
effective for treatment carpal tunnel syndrome and
myofascial hand pain.
1.Simons DG, Travell JG, Simons LS. Travell and Simons‘ myofascial pain and dysfunction; the trigger point manual. 2 ed. Baltim ore: Williams & Wilkins; 1999.
2.Bubnov R. V. The use of trigger point dry needling under ultrasound guidance for the treatment of myofascial pain (technological innovation and literature
review) // Lik. sprava - 2010. - №5 - 6 (1106), p. 56-64.
3.Bubnov RV. Evidence-based pain management: is the concept of integrative medicine applicable? EPMA J. 2012;3(1):13.
doi: 10.1186/1878-5085-3-13.
4.Bubnov R. Trigger Points Dry Needling Under Ultrasound Guidance for Low Back Pain Therapy. Comparative Study. Annals of the
Rheumatic Diseases 2015;74:624. http://dx.doi.org/10.1136/annrheumdis-2015-eular.2323
5.Bubnov R, Kalika L. WIP18-0450 DRY NEEDLING UNDER ULTRASOUND GUIDANCE EFFECTIVE FOR HAND PAIN AND CARPAL
TUNNEL SYNDROME. Pain Pract. 2018; 18(S1):54.
6.https://nydnrehab.com/what-we-treat/wrist-pain/carpaltunnel/
7.https://nydnrehab.com/what-we-treat/wrist-pain/
Introduction/Background
Myofascial pain is a widespread problem, considered as reliable cause of hand pain and carpal tunnel
syndrome. Precise dry needling of muscle trigger points under ultrasound (US) guidance is proved and
effective method for treatment pain in many anatomical sites.
Material and Method We included 46 patients (32 females), avarage age was 37±6 years old, with symptoms
of carpal tunnel syndrome (CTS) and pain in hand. The treatment approach by Bubnov [PMID:23088743] was
applied that included ultrasound identification of myofascial trigger points, precise neuromuscular ultrasound;
with following dry needling under US guidance using steel fine needles (28 gage) to elicit the local twitch
response (LTR) effect verified on M-mode ultrasound. Visual analogue scale data (0 to 10) were measured
before, immediately after and 24 hours after the intervention. A decrease in pain as measured by a VAS of
50% or more one week after treatment was considered as success.
Results Active active trigger points were diagnosed in deep forearm muscles, mostly in supinator muscle,
potnetially compressing radial nerve branches (posterior interosseous nerve, PIN entrapment near arcade of
Frohse). Additional needling was conducted in thenar area (flexor pollicis brevis) and small muscles in hand
and forearm when neccessary . In one session 1-3 needles were inserted. Retention of needles in muscles
depended of accuracy of needle position in spastic area and LTR detection. All patients demonstrated
decreasing pain as measured by a VAS of 90 %, the difference was significant in this group (p<0.01) and pain
relief outcome after month observation.
Conclusion Dry needling trigger points under ultrasound guidance is effective for treatment carpal tunnel
syndrome and myofascial hand pain.
Keywords:
carpal tunnel syndrome; myofascial trigger points; supinator syndrome; ultrasound, arcade of Frohse; PIN
dr.rbubnov@gmail.com
drlevkalika@gmail.com
Active active trigger points were diagnosed in deep forearm
muscles, mostly in supinator muscle, potentially
compressing radial nerve branches (posterior interosseous
nerve, PIN entrapment near arcade of Frohse). Additional
needling was conducted in thenar area (flexor pollicis
brevis) and small muscles in hand and forearm when
neccessary. In one session 1-3 needles were inserted.
Retention of needles in muscles depended of accuracy of
needle position in spastic area and LTR detection. All
patients demonstrated decreasing pain as measured by a
VAS of 90 %, the difference was significant in this group
(p<0.01) and pain relief outcome after month observation.
https://nydnrehab.com/
Case presentation
Approach [2-5]
After needling, note symetric supinator muscles
