16 Repetitive Motion Disorders

Repetitive motion syndrome is a malady that affects millions of people. Its clinical manifestations include numbness or tingling (with or without pain) in the forearm, wrist, hands, or fingers. Weakness in thumb abduction may be present as well as tendon inflammation and swelling. It may present unilaterally or bilaterally. It is named as such because its etiology is due to repetitive motions such as typing, computer work, or other labor involving repetitious motion or the overuse of the tendons.

Carpal tunnel syndrome is a painful wrist disorder caused by compression of the median nerve. It is commonly thought of as being caused by repetitive motion and sometimes it is. It is the leading compensable occupational illness, surpassing back injuries since 1990. However, a correct diagnosis of carpal tunnel syndrome requires adherence to strict electro-physiological data. Many of the studies that have supported the notion that carpal tunnel syndrome is a repetitive motion disorder have not used exact clinical data and have rarely included electro-diagnostic information.¹

Carpal tunnel syndrome specifically, and repetitive motion syndrome in general, have always been viewed as being treated well with Oriental medicine, especially with acupuncture. Standard treatments revolve around treating points such as PC-7 (da ling), PC-9 (zhong chong), LI-11 (qu chi), TB-5 (wai guan), and LI-4 (he gu), which are local to the affected areas. Although this treatment is viable as well, my treatment approach is somewhat different and has yielded excellent clinical results for me. It is described below.

From an observational point of view, the problem of carpal tunnel syndrome and repetitive motion syndrome is confounded by the simultaneous presence of repetitive motions, the neurovascular compression of nerves coming from the shoulder area, and arterial compression. Painters, artists, computer technicians, cashiers, or assembly-line workers who type or perform repetitive motions of the wrist also develop a postural accommodation that leads to shoulder and neck tension.

When the shoulders slouch forward and the chest becomes slightly concave, abnormal compression of the subclavian artery or the axillary, and/or the brachial plexus may result. This compression produces a series of signs and symptoms such as pain and numbness in the distal extremities of the forearm, wrist, hands, and fingers, which is termed neurovascular compression. Patients with this problem typically have stiff neck, shoulders, and back, and often headaches. My typical treatment style revolves around alleviating the compression and removing the stagnation that manifests in the signs and symptoms of carpal tunnel and repetitive motion syndromes.

In my treatment repertoire, the most importantpoint to alleviate the neurovascular and arterial compression is ST-12 (que pen). Stomach 12 is located in midpoint of the supraclavicular fossa 4 cun lateral to the ren channel. Treating it can loosen up the tissue and muscles of the supraclavicular fossa, which are tight or constrained due to posture, stress, or tension. Consider this point to be more of an area that encompasses the discrete point as well as about 1.5 to 1 in above it.

Stomach 12 is a highly underutilized point in many practitioners’ repertoire of points. However, it possesses powerful and unique energetics, which account for its efficacy. Firstly, ST-12 is the point of intersection of many channels. It is the union of the stomach, small intestine, triple burner, and gall bladder channels. It is its unique anatomical position that accounts for its therapeutic usefulness. Anatomically it is directly above the supraclavicular portion of the brachial plexus. Its traditional indications center on cough, asthma, sore throat, and pain in the supraclavicular fossa, stiff neck, and neck spasms.

Even if the repetitive motion syndrome or the carpal tunnel syndrome is only one-sided, treat the point bilaterally. If needling is done for this treatment, the patient should recline in the lateral recumbent position (on their side). Gently insert a #1 gauge 30mm needle perpendicularly 0.3 to 0.5 cun posterior to the sternocleidomastoid muscle. Note this is not the usual Chinese method of needling ST-12, which is perpendicularly downward, but rather a Japanese technique. Do not obtain qi, nor tonify, nor disperse; that is, do not manipulate, turn, lift, thrust, or use any other technique with the needle. See Figure 11.2 in Chapter 11, which illustrates the regional anatomy as well as the needle placement for ST-12.

Needle with caution. Carefully monitor the angle and depth of insertion due to proximity to the apex of the lung so it is not in danger of being punctured. Retain the needle for 10 to 15 minutes and then reverse sides. Additionally, I add distal points along the channels that may be involved such as LI-1 (shang yang), LU-11 (shao shang), LI-11 (qu chi) and PC-9 (zhong chong). The jing (well) points can be needled perpendicularly 0.1 cun or bled by using a bleeding technique to remove the stasis and smooth the course of qi and blood in the channels. Obtain one to two drops of blood. Large Intestine 11 can be needled perpendicularly 1.0 to 1.5 in.

Moxibustion is an added modality that can be integrated into the treatment. Apply gentle moxa in the form of a moxa pole to ST-12 and LI-11 for approximately 3 minutes on each point until the patient reports radiating warmth. If massage is performed, gently massage the point for about 20 seconds on each side.

This treatment can be performed once a week for three to five treatments. At the end of this course of treatment the problem is usually alleviated. Additionally, I tend to augment the treatment with a generous application of the liniment Zheng Gu Shui, the best Chinese liniment for qi and blood stasis. Apply it along the course of the affected channels with a cotton ball. I recommend that the patient apply it to the same areas before going to bed every evening. Use caution not to get the liniments into mucous membranes or the eyes.

Lifestyle counseling should also be provided to eliminate these as etiological factors. The person should cultivate a sense of their posture, take frequent breaks from repetitive motions, obtain massage, do gentle neck exercises like rotations, and use ergonomically designed seating, wristpads, and keyboards if their use is indicated. Sometimes a vitamin B6 vacuity may account for improper neurological functioning and unless otherwise contraindicated, a good-quality multivitamin can assist in restoring and maintaining proper nerve functioning.

Reference

1. Kirschberg G, Fillingim R, Davis VP, Hogg F. Carpal tunnel syndrome: classic clinical symptoms and electrodiagnostic studies in poultry workers with hand, wrist, and forearm pain. South Med J. March 1994;87(3).