Acupuncture Treatment of Dupuytren’s Contracture
Chief Complaint: pain in left wrist and unable to fully extend fourth digit of that hand
Western Diagnosis: Dupuytren’s Contracture (palmar fibromatosis)
Medical History: Pleasant 39 year old female. Patient’s left fourth digit was flexed 45 degrees at the PIP joint, and not able to straighten or fully flex. Surgeon explained she would need surgery for the Dupuytren’s Contracture and may want to consider it for probable Carpal Tunnel problems, for these were not responding to past anti-inflammatory and conventional physical therapy. Patient is an active female bicyclist for over 20 years. Patient also has 20 year history of Irritable Bowel Syndrome. Very stressed lifestyle, including great anxiety and physical challenges caring for a sick and elderly mother. Chronically stressed individual who generously cared for other people, but never took time for herself.
Questioning exam: Weak digestive function, irritable bowel syndrome. Affected areas better with heat. Generally fatigued. Fair appetite, but periods of constipation and diarrhea (moe towards diarrhea overall). Some knee pain, occasional night sweats and poor sleep.
Pulse exam: Pulses were generally quite wiry with weak second position on the right hand. Kidney pulses were weak bilaterally
Globally hypertonic musculature, especially the trapezius, superspinatus, infraspinatus, cervical and paraspinal musculature bilaterally.
Tongue exam: Tongue was small, red-purple, dry, yin deficient cracks, with slightly red tip. Very little coat. Moderate venous distention underneath.
OM Diagnosis: Spleen qi deficiency and liver qi stagnation. Sinews not being properly nourished. Qi stagnation in the Pericardium channel.Some yin deficiency.
Treatment Principle: Nourish Spleen, move Liver qi. Move qi stagnation in the pericardium channel.Nourish yin.
Point Prescription: ST36 bliateral needle with moxa – nourish digestion function
UB 20 – nourish spleen qi
ashi point in area of left palmar distress (below 4th MCP joint on palmar side)
Full body Tui Na, focus especially for back of neck, trapezius areas, shoulder areas.
Herbal Formula: 1) Naturopathic Roberts Formula (althea, glycyrrhiza, glutamine, Geranium, Ulmus, others)
Lifestyle Prescription: 1)Have patient take home smokeless moxa stick and cover area with castor oil and vitamin E, then perform home moxa treatment on MCP left palmar surface area for 20 minutes, 1/day
2) Stretching exercises before, during and after bicycling, including extension exercises for hand and wrist
3) refrain from coffee, wheat, dairy
4) stress management counseling
5) Acupuncture and tui na once a week
6) Referred for chiropractic work 1/week
7) Epsom salt baths after chiropractic adjustments.
Results: Patient was able to extend and flex 4th digit within 4 weeks. IBS improved within 2 weeks, with no further episodes of constipation/diarrhea unless she drank a macchiato earlier that day.
Synopsis: Patient was instructed to discontinue acupuncture after 6 weeks, but to continue on herbal formula for next two months and to use at home moxa therapy at least once a week. More moxa therapy if bicycling regimen increases. Patient was encouraged to continue diet recommendations,to discontinue chiropractic work, and to continue Epsom salt baths as needed.