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poster
one
ACUPUNCTURE
FOR HEMANGIOMA-INDUCED THORACIC RADICULAPATHY
Joanne Borg-Stein, MD
Objective
To demonstrate the
use of percutaneous nerve stimulation and
French Energetics for chronic radiculopathy.
Problem
Chronic, severe thoracic
radiculopathy (left-sided anterior/ posterior
thoracic pain for 2 years).
History
A 47-year-old male, right-handed court magistrate
and previously active golfer, had chronic intermittent left anterior
thoracic pain for 20 years. He developed acute, severe, nontraumatic
left thoracic radicular pain 2 years prior to treatment, and was found
to have a large T5 and smaller T4 and T6 hemangiomas. Treatments included
attempted embolization, physical therapy, exercise, nonsteroidal anti-inflammatory
drugs, gabapentin and amitriptyline, and massage. None of these relieved
his symptoms or allowed him to resume golfing and hiking.
Past History
His medical history
was notable for Crohn's disease and childhood
acne.
Family/Social History
Family history was
notable for depression and pulmonary embolism.
The patient's social history revealed he was
a married non-drinker, non-smoker with a stressful
job.
Allergies
The patient had no
history of allergies.
Physical Examination
The patient was a
robust-appearing, muscular man with normal
range of motion throughout, other than tight
hamstrings. Findings of the neurological examination
were normal. Myofascial examination revealed
tenderness at intercostal and costochondral,
left anterior thoracic, left medial scapular,
and rhomboid regions. In addition, SP 6 and
BL 40 areas were tender.
Diagnostic Testing
Diagnostic tests
included serial thoracic, cervical, and shoulder
magnetic resonance imaging (MRI) scans; bone
scans; x-rays; and electromyography.
Review of Systems
The patient had sinusitis
and sinus migraines, a remote history of asthma
in childhood, symptoms of anxiety and panic
induced by arnitriptyline (symptoms now resolved),
and mild pain/tenderness in the left proximal
medial tibia and left anterior rib regions.
DIAGNOSIS
Left thoracic radiculopathy
T4-T6, and left thoracic myofascial pain.
TREATMENT
Treatment included
French Energetic, neuroanatomic, and auricular
modalities. Points KI 3, SP 6, and BL 40'were
stimulated electrically at 2 Hz. Percutaneous
nerve stimulation at 16 Hz was applied to
T3-T8. Auricular therapy included Shen Men
and thoracic areas: 6 sessions in 8 weeks.
Outcome
Objective outcome
included resolution of trigger points, with
results maintained at 18 months of follow-up.
The patient reported a complete resolution
of pain, ability to play 18 holes of golf,
and ability to hike 8 miles.
Complications
None.
REFERENCE
1. Helms JM. Acupuncture Energetics:
A Clinical Approach for Physicians. Berkeley,
Calif: Medical Acupuncture Publishers; 1995:
488.
Editor's
Note: Posterpresentation as originally presented
at the 1999 AAMA Symposium in Chicago, Illinois.
Reproduced in their entirety with minor editing.
AUTHOR INFORMATION
Dr
Joanne Borg-Stein is the Medical Director
of the Spaulding-Wellesley Center, and Chief
of Physical Medicine and Rehabilitation at
Tufts Medical School. She teaches outpatient
musculoskeletal medicine to residents from
both the Tufts and Harvard residency programs
in Physical Medicine and Rehabilitation.
Joanne
Borg-Stein, MD
Newton-Wellesley Hospital
2014 Washington St
Newton, MA 02162
Phone: 617-243-6172 - E-mail: MD.BORJ@nwh.org
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