Peripheral nerve injury
Acupuncture damage peripheral nerves, including cranial nerves and spinal nerve II . Among them, the acupuncture -induced cranial nerve injury to the facial nerve injury more common , some cause oculomotor and trigeminal nerve injury cases. Acupuncture caused by spinal nerve injury involving a wide range , the existing reports, including the sciatic nerve, peroneal nerve , deep peroneal nerve, radial nerve , median nerve, ulnar nerve and the phrenic nerve , causing a variety of peripheral nerve disorders . About acupuncture Early reports of peripheral nerve damage seen in 1963 [ 1 ] , to date , China’s publicly reported cases of peripheral nerve damage acupuncture has reached as many as 85 cases . Most of which spinal nerve damage.
[ Injury ]
Acupuncture -induced peripheral nerve injury , most due to improper acupoint injection , few are caused by needles . Mainly due to the following types .
An acupoint reason : all points deep neural stem or main branches have been , are subject to damage, such incidents have occurred over the points are: Yifeng, Shimonoseki , ring jump , the full three years, Yang Ling Quan, Qu pool , the customs, the door of God , missing out and so on.
Shimonoseki : a 50 -year-old female patient , swelling and pain due to periodontal and Ⅲ degree loose , need I extraction treatment . Shimonoseki hole on its right side , with 2.5 milli-inch needle into underwent acupuncture anesthesia , after the gas continues to twist the needle , the patient had right lower alveolar and electric shock -like lips numbness , 3min then successfully remove Bingya , but the patient on the right facial numbness persists one week did not disappear . Then to the clinic . Check: The site activity is acceptable but insensitive . Consider acupuncture mandibular nerve palsy caused by improper , that is to take the ipsilateral big welcome , to warehouse hole, light stab, each time the needle 5min. 1 day, 5 days after the numbness subsided [ 2 ] .
Missing out : If a 40 -year-old male patient receiving acupuncture treatment of hepatitis . When acupuncture points missing out , the patient immediately felt soreness and numbness and shock -like feel to the upper arm radiation , and release your thumb . Check: thumb abduction , dorsiflexion function poorly , the skin between thumb and index finger pain and tactile lost. Radial nerve injury caused by heat, electrical stimulation , oral vitamin B treatment, a month after the gradual improvement [ 1 ] .
Neiguan : According to reports, two patients were in the treatment process, the healer of the 28th with a 1.5 -inch Neiguan acupuncture needle , the needle 1.2 inches, dramatically improves the plug Twist line and a ” sense of shock .” , ” burning ” , but did not cause doctors who noted that the line is still repeated needle , and the needle 15min. One patient after the needle finger flexion , extension difficulties , the moxa moxibustion , electric massage to restore normality after 30min . Another case occurred after the needle finger stiffness, buckling fist, not extensor , limited mobility, skin temperature and limb pain and temperature sensation was significantly lower than the healthy limb , the moxa moxibustion , acupuncture Hegu through after the river , and with the active and passive movement , enhance functional exercise , therapy one week behind the more [ 3 ] .
Zusanli : If a 1 -year-old male children in the right lower limb line Zusanli acupuncture after the third day found that children drooping right foot , ankle swelling, by the use of heat, acupuncture, massage, vitamin B and other comprehensive treatment, symptoms gradually improved [ 1 ] .
Jump ring : a 54 -year-old female patient , leg discomfort due to an individual physician , please needle governance. I Huantiao the right needle , needle sense of shock after radiation along the lower limbs . Healer complex to put plug Twist strong stimulation , acupuncture and feeling right leg numbness in patients sour weakness, which lasted two years have not completely disappeared [ 4 ] .
Second, the drugs cause: In point injection process, the damage has been caused by drugs : dipyrone, promethazine , co neomycin , alcohol , compound quinine , chlorpromazine, cortisone acetate , penicillin , alcohol Pu procaine , alcohol, glucose, and 10% sodium amytal .
Damage reason may be related to the following factors :
( A ) , the drug itself irritation . Needle commonly used antipyretic analgesic drugs, such as dipyrone, and chlorpromazine , compound quinine itself on the skin, muscle great local irritation of the nerve irritation is even greater . If a female child , 4 years old. Due to high fever with quinine compound underwent bilateral Quchi injection, per hole 1ml, when the injection point when the children left crying very much, the next day found in the left wrist droop. Check: drooping left wrist , left thumb adduction, not dorsiflexion and outreach , the radial side of the forearm and the lower side of the thenar hyperesthesia . Given infrared, massage , intermittent direct current treatment, and galantamine intramuscular , oral Fursultiamine , methimazole , etc., after a half months recovered after treatment [ 5 ] .
( Two ) , the pH is too high, such as the pH value of 5.4 to dipyrone 5.9 , chlorpromazine ( chlorpromazine ) had a pH of 4.3 to 4.5 , promethazine pH of 4.5 to 5.5, and the pH of human blood ( 7.35 ) compared to larger gap . PH is too high , but also allows protein denaturation or coagulation . Results physicochemical cause nerve damage. Others, such as alcohol ( ethanol ) to make protein coagulation, can directly lead to nerve tissue damage. So the use of cortisone injections should also be cautious, because cortisone injections are generally divided into hydrocortisone acetate suspension and hydrocortisone alcohol solution , the former can be used for intramuscular use , the latter due to contained ethanol can make or break the protein coagulation , therefore, only diluted intravenous drip , otherwise it can lead to nerve damage.
( Three ) , the drug concentration is too high or too low. On the human body , usually with a higher or lower molecular weight 0.3g injection drug concentration , are irritating . This solution isotonic with human tissue related to the different points . Such as vitamin B1 [C12H17ON4SCl-HCI] is the gram molecular weight of 337g, isotonic concentration of about 1ml of 100mg, the concentration of vitamin B1 commercially 2ml containing 100mg, diluted twice , i.e. below isotonic point , the injection stimulate pain . Another example dipyrone ( Luo Waer fine ) [C13H1604N3Sna • H20] g Weight 351g, isotonic concentration 1ml of 0.105g, while commercial 1ml solution containing 0.25g, clearly higher than the isotonic point . Therefore irritation increases.
In summary, both the concentration of the drug itself or a strong irritant pH is too strong or too high , the overall result is the cause tissue protein denaturation, so that three reasons physicochemical properties can cause nerve damage. As one hundred were given injection composition is mainly heterosexual protein , easy to cause allergic reactions.
In addition, some herbal extracts made of injection , in addition to the above reasons , but also how relevant and organic acid , such as Selaginella injection containing a large number of organic acids, so when there is a strong irritant intramuscularly .
In addition to the above-mentioned clinical medicine , there are the following drugs acupoint injection accident occurred .
Promethazine : If a 22 -year-old male patient suffering from allergic urticaria. With promethazine 250mg, closed in Quchi . The next day appeared right wrist joint weakness, can not lift his right hand , right hand thumb, food two finger numbness , biceps , triceps reflex surviving , vertical wrist strongly positive, examination, see the radial nerve area insensitive . Diagnosis of acupoint injection caused the right radial nerve injury . By the use of acupuncture, physiotherapy and other comprehensive therapy, about six months or so, the radial nerve function was restored , the basic elimination of symptoms [ 6 ] .
Luminal : If a 58 -year-old female patient , October 5, 1989 appointment. Left hemifacial spasms due to three years , in order to point injection method , the election Yifeng point therapy, with the 5th needle to extract luminal 0.1g ( dissolved in water for injection 1ml ) and 2 % procaine 0.5ml, quickly after routine disinfection points 1 ~ 1.5cm deep stab people , until there is a sense of needle slowly into the liquid about 1ml . After injection of 6 ~ 7min facial paralysis occurs , given after physiotherapy, vasodilators , and vitamin B complex , oral medicine Qianzheng Powder , half recovery [ 7 ] .
Vitamin B1: a case of left knee pain in patients injected with vitamin B12ml suffering case Zusanli points, 3rd point injection , the patient felt pain points localized and diffuse to the dorsum of the foot , appears limp , suspension points after injection, the use of vitamin B1 100mg plus vitamin B120.5mg intramuscular injection , with local heat, Oral traditional Chinese medicine , lameness disappeared more than a month after three [ 8 ] .
Aminopyrine : A 38 -year-old male patient with a fever two days , the local doctor Quchi compound aminopyrine injection 2ml, and feeling the patient during injection wrist weakness, can not be raised, thumb flexion, can not be straightened . Check: See wrist forearm raised when the state was sagging , and the tiger’s mouth at the back of the forearm skin was sensory disturbances , muscle atrophy seen the thumb can not be straightened . Diagnosis: radial nerve injury [ 2 ] .
NS : A 42 -year-old female patient , because severe headache attacks, local doctors hands of God in the door , foreign relations , too deep hole closed with saline points per hole injection fluid about 2ml. Unharmed right after injection , the left was that sense of numbness , after three months later, the pain from extinction , but the numbness persists, winter color bruising , weakness, cold, without treatment . A year later, the following from the wrist , skin cyanosis, edema micro was like, sensation, muscle strength nearly Ⅳ °, left hand held straight , flat, drooping , neither cyanosis disappeared, left ulnar artery touched, while the right side of the touch and the radial arterial pulse was also weak [ 2 ] .
Angelica injection : If a 67 -year-old female patient suffering from blood stasis type headache , to give Angelica injection 1ml syringe left Yifeng ( needle on the 5th ) , about 2min later, the patient consciously left cheek numbness, eye and mouth Wai oblique and not for drum gills and other activities. Immediately after giving facial massage , one day return to normal [ 9 ] .
Berberine injection : one case of acute enteritis, berberine by the local doctor with needle 1ml ( containing berberine 10g) was injected into the bilateral Zusanli and Tianshu , 2 patients after lower extremity claudication found , right- left light weight, with right foot down, lateral leg and foot 1,2 toe feeling disappeared, anterolateral leg muscle atrophy. At a higher level hospital diagnosed peroneal nerve palsy after symptomatic treatment a month after the disappearance of the left lower extremity claudication , right lower limb muscle atrophy , lameness is not reduced, plus acupuncture, massage and Chinese medicine more than six months of continuous treatment , but still right lower extremity claudication , legacy lifelong disability [ 8 ] .
Third, the operation Cause: There are neural stem or main branch distribution points on the needle the needle way too heavy , prolonged stimulation , or acupuncture point injection in order to obtain a better sense of qi , repeated mention plug explore , thicker needles in pediatric patients, the more likely. If one case of 45 -year-old male patient with insomnia treatment, some doctors use acupuncture treatment by Shenmen oblique deep puncture , approximately through to too deep caves , in the process of acupuncture BOC strong thorns pound twist method , the patient was pain can not forbearance , requiring back needle . Sense of malaise after the needles , a moral one , walked slowly after 1h by rest home . Since self- inductance palms and fingers right wrist following are numb. Activities fair. 3 days after the numbness gradually diminishes, leaving only the outside of the little finger and ring finger numbness lasted in January , is still not restored [ 2 ] .
Clinical manifestations
Acupuncture mistakenly foreign peripheral nerves, immediately there is a relief to not shoot the hemp inductance , once damage in the nerve distribution sensory disturbances can occur , including numbness, fever, pain , touch and temperature hypoalgesia and so on.
Meanwhile , there are different degrees of dysfunction, its specific performance:
Ipsilateral facial nerve injury can occur expression of muscle paralysis , can not be drum gills , towering nose, forehead wrinkles and other actions ; oculomotor nerve injury, diplopia , ptosis , eye adduction can not wait ; trigeminal nerve injury , there may be facial sensory disturbances ; radial nerve injury ( such as improper Quchi point injection ) may be vertical wrist ; median nerve injury ( such as improper Neiguan acupoint injection ) can affect the thumb abduction , flexion and right palm ; ulnar nerve injury ( such as the door of God acupuncture improper ) may appear obvious hypothenar atrophy, little finger and ring finger movement disorders ; sciatic nerve injury , can cause hyperextension knee stiffness when walking , weakness ; tibial nerve injury ( such as Zusanli acupuncture improper ) appear adequate and not toe flexion , foot adduction limitation, Achilles tendon reflex and plantar reflexes, foot heel when walking , can not stand toe . If peroneal nerve injuries , the main symptoms of foot drop and can not stretch enough , mentioning Yang toe and foot pronation stretch , walking foot can not lift , was walking across the threshold .
[ Prevention ]
First, select the appropriate point injection drugs : drugs in order to reduce physical sexual stimulation, deep in the hole and the surrounding area there are neural stem or branch office for injection, to try to avoid the use of those drugs mentioned above . Use moderate and less irritating concentration , pH range close neutrophils drugs . If you must choose these drugs may be appropriate to reduce the dose or concentration of the liquid phase close to the tissue fluid osmolality . In general, the solution concentration is too high, diluted with water for injection ; concentration is too low, add the appropriate concentration with saline ( but note that incompatibility ) . In addition there should be attention to drug solvent such as an alcohol solution , it is not suitable for point injection .
Second, pay attention to operations and acupuncture situation : use needles or needles should be fine, needle to the 28th or above is preferred ; hypodermic needles, with the 4th superficial , deep with 5 dental needle.
Patients who appear hole pain, fever and shock on the pass issued to the flu, avoid indiscriminate trouble plug, but rather put the needle on until after the disappearance of such phenomena , practices or re- injection of drugs . It is worth noting is that we must distinguish stabbed in neural stem or branch and inspire propagated sensation along meridian difference between ; along by a sense is a special acid, swelling, numbness , feeling of heat , according to a certain route ( multi- through classical meridian ) , slowly moving ( speed 20cm/min around ) , and rapid conduction along nerve lines , characterized by tingling hemp nerve conduction heat is significantly different , not to be confused .
[ Processing Method]
Within 24h after injury should take immediate measures . Point injection cause who can use moist heat or DC iontophoresis to promote drug absorption. Aims to improve blood circulation, promote drug absorption. But be careful in the local hyperthermia injection site with or without sensory disturbance adjacent to prevent burns. Needle-stick injuries , the choice of local hyperthermia treatment and DC iodine iontophoresis treatment, according to symptoms, can be taken to massage , physical therapy, herbal therapy. At the same time , should be compatible with vitamin drugs , coenzyme A and adenosine triphosphate . At this point should not have been stimulated by the strong limbs and then strong stimulation ( such as injection, strong electrical stimulation , etc. ) so as not to deepen the nerve tissue ” shock ” state. In late nerve damage is mainly to promote nerve regeneration and recovery of physiological functions , available DC iodine iontophoresis , electric gymnastics, gymnastics and other medical treatment . Should ask the patient to enhance functional exercise , for a speedy recovery .