An acute cervical spondylosiol case

Ms. Y, 45 2007-09-25

She has left hand tingling and numbness for two months, sharp burning pain for over 10 days.

The numbness appeared on the early August, tried western medicine but no effect. The pain started on the whole left arm on the early September, anti-inflammatory and painkiller didn’t work. She had X-ray at that time, reported degeneration on the C4, 5. Sept. 14 morning, the pain suddenly increased to unbearable, found nowhere to put the arm, and totally could not sleep. She been off work since last week, visited a chiropractor every day. After 3 days treatments, she felt a little better, and then it got even worse.

Now, there is burning pain on the ulnar side of left arm. No extension of the neck, hard to lie face down. No left triceps tendon reflex. The left ulnar skin is more sensitive. Pulse is thin and rapid, and tongue is reddish with peeled coating in the centre.

Treatment:

1) Electric therapy on lower cervical part 20’; acupuncture on right Leique, Wangu

2) Tuina on the shoulders (press Yunmen); acupuncture on left Yanglao (0.18*13mm, cold reducing); press Zhaohai

3) No spicy foods

2007-09-28

After last treatment, for half hour there was nearly no pain then came back but reduced. Now, there is sore pain on the left ulnar arm, numbness on the ulnar fingers. Neck still cannot move freely. Didn’t go chiropractor.

X-ray pictures:

C5 Luschka joint sharp (both); C4, C5 vertebra slight moved backwards, increased C6~7 rear space; Narrow right C4~5, C5~6, C7~T1 foramen, especially C4~5 reduced to half; narrow left C4~5, C5~6, C7~T1foramen, C7~T1 reduced to half.

Impression: C8 never is stimulated.

Treatment:

1) Electric therapy 25’; acupuncture on right Yanglao (0.25*25mm), Zhongzhu (0.18*13mm)

2) Tuina left shoulder and arm, Qian neck (slight crack on the middle cervical vertebrae

2007-10-01

Next day after last treatment, she went to the CT scan. After that the pain increased (posture related?). Numbness and pain on the left ulnar arm and hand, soreness on the elbow and shoulder. The lower nape is tight.

Treatment:

1) Electric therapy on both sides of C6~7; acupuncture on left Wangu, Zhongzhu, Shouwuli, right Yanglao; press Zhaohai

2) Press Quepen, Yunmen (both)

3) Tuina on neck and shoulders (face up), Qian and slight Yao (cracks on C5~6)

[No numbness on the hand, but still worrying]

2007-10-04

Pain was greatly reduced. Feels numb on the ulnar and back of left hand. The hand is easier feeling cold than the right one. There is soreness on the left elbow. Not completely comfortable during sleep. Motion is increased on the neck, but extension still causes tightness. She nearly finished her anti-inflammatory. Tight muscles on both of C7~T1, pain on lower left scapula.

Treatment:

1) Tuina on nape (face down); acupuncture on C7~T1 (both); Ganshu (both); left lower scapula

2) Electric therapy on C7~T1; acupuncture on left Yemen

3) Qian neck, Tuina on arms

[No numbness on palm, still numb on ring and little finger]

Result:

After this treatment, the pain and stiffness disappeared, she went back work later, but the numbness on the fingers remained. Got 4 more treatment, no change of numbness, others are normal.

A Lower Back Pain Case

♀ 49, 2006-09-13
Lower back pain for half day.
In the morning, just after she got up, when she banded the back, she suddenly felt the pain on the lower back. She can hardly move her back to any direction; she feels the radiation on both of her hips. There is no pain on any leg or foot. She had sciatica many years ago.
Exam: limited R.O.M. of the lumbar spine. SLR (-). The muscles on the left side of the lower back are spasm and rise up a little higher than the other side. Pressing pain and deep pressing pain (+) on L4~5 and L5~S1. Tender spots on FengFu (++), left TianZhu (++), and left WeiYang (++).

Treatment:
1) Gentle TuiNa massage 5’;
2) Acupuncture on left TianZhu, WeiYang, and FengFu (gentle reducing technique); both sides of L5 spinous process (0.5Cun, slowly puncture in 1.5Cun deep, reducing technique) 20’;
3) Cupping on lower back 5’;
4) Herbal electric stimulation with heating pad (mild) 20’.

Result:
Right after the treatment, she feels better and can move the lower back a little bit.
2 days later, called: the pain is completely gone, and can move free.

Diagnosis and Differentiations:
This case is an acute lower back pain due to wind-cold blocked the meridians (muscles). Or say myofibrositis.
The patient had no injury or big movement, no nerve pain signs. Although there was deep pressing pain on the lumbar spine (L4~5, L4~S1), but the pain feeling of the patient and touching feeling of mine was different from arthritis pain. The pressing pain is more likely coming from the deep tissues than the spinal joints. Also the time when the patient got the pain was during the weather change.
Didn’t check the tongue, because it is a meridian disorder, the tongue won’t show anything about it, and may confuse the diagnosis. Same thing happened on pulse check (unless the high pulse check skill may tell this kind of body situation).

Needle technique:
Although this is an excessive case, and the reducing technique was used, but I didn’t give strong stimulations. This is the point I’d like to discuss: reducing does not mean strong stimulation.
Reducing or tonifying, is the result of the patient’s reaction of the needle techniques. Gentle or strong stimulation is the practitioner’s choice of the needle techniques. As a practitioner, to choose to give strong or gentle stimulation is not only depending on excess or deficiency, but also on the shape (Xing) and Qi of the certain patient.
Back to this case, the lady is quite skinny, she was quite sensitive to the needles too, and the pathogen was not deep. So I decided to use gentle way, and the result proved it was right.