Record of First Visit
| Date of first visit: | 9-Mar-2009 |
| Name: | ABC |
| Gender: | Male |
| Age: | 22 |
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Chief complaint: Right hand pain for 2 weeks
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Description (4 diagnosis method)
A: Asking
| Present complaint: | He has been suffering from right hand pain for 2 weeks. The right hand knuckles accidently has been injured 2 weeks ago. When he was washing his hand, the right knuckle hit the water tap hardly. The pain is mainly on knuckles but it spread to on the whole right hand. The movement of hand is not comfortable. Pain type – dull pain. Pressing makes the pain worse. The wrist also has some pain when it is used for a long time. Appetite - normal Urination - normal Defecation – normal, sometimes loose stool Sleeping -normal No thirsty – prefer cold water |
| Past history: | NAD |
| Lifestyle: | Late sleep – goes to bed 2~3 am |
| Family history: | Parents – alive – healthy 1 sister - healthy |
| Menstruation: | NAD |
| Marital&obste-trical history: | Single |
B: Inspection:
| General: | Vitality |
| Other: | NAD |
| Tongue: | Tongue body - red and purplish Tongue coating – white and thin coating. |
C: Auscultation/Olfaction
| Sound: | NAD |
| Odours: | NAD |
D: Palpation:
| Body area: | NAD |
| Pulse: | Taut and thready |
CASE SUMMARY
TCM Diagnosis: Right hand pain
Syndrome Differentiation: Blood stasis and qi stagnation in local area
Explanation:
The patient has been suffering from right hand pain. The pain was caused by injury 2 weeks ago from the first consultation. The pain is mainly on knuckles but it spread to on the whole right hand. The movement of hand is not comfortable. Pain type was dull pain. The pressing makes the pain worse. The wrist also has some pain when it is used for a long time.
The pain is caused by injury and the injury caused the blood stasis and qi stagnation. The blood stasis and qi stagnation is characterized by qi obstruction and blood obstruction.
The symptoms are manifested by pain, swollen, and movement limitation in local area.
Treatment Principles:
Remove qi blockage and blood stagnation.
Promote Qi and blood circulation.
Relieve pain.
Points and Therapies:
Baxie (Ex-LE-9)
Yangxi (LI 5)
Waiguan (SJ 5)
Explanation:
| Baxie (Ex-LE-9) | Relaxes muscles and tendons Benefits for finger joints disorder |
| Yangxi (LI 5) | Benefits for the wrist pain |
| Waiguan (SJ 5) | Promote qi and blood circulation |
THEORY
TCM:
Srain
Pathological change
*Laceration of membrane of tendon, ligament
*Over sprain, inflammation, degeneration
Diagnosis
*Injury / Over strain history
*Typical manifestation : pain, swelling, and tenderness, and limitation of movement
Differentiation
*Qi stagnation and blood stasis
Treatment principle
*Activate meridian.
*Dredge the collateral.
*Release swelling.
*Stop pain.
Treatment
*Points = local + distal
Other method
*Ear acupuncture : Shenmen + corresponding points
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WMS: Sprain
The word sprain comes from the French espraindre, which means "to wring." A sprain is damage to a ligament from excessive stretching forces. Articular ligaments are thick, semi-elastic connective tissues that connect bone to bone. The function of the ligament is to stabilize the joint and prevent movement of bones in certain directions. For example, the knuckles of the fingers are hinge joints, and interphalangeal ligaments help restrict hyperextension.
Sprains are classified as grades I, II, and III, corresponding to mild, moderate, and severe injuries. A patient may not seek medical attention for a grade I sprain because the injury is only a stretching of the ligamentous fibers, and the child may feel only mild discomfort with minimal-to-no functional loss. With a grade II sprain, ligaments are partially torn. Tenderness, swelling, and sometimes ecchymosis are present, with mild-to-moderate functional loss. A ligament is completely torn in a grade III sprain, leaving the affected joint unstable, with significant and diffuse tenderness, ecchymosis, and swelling.
It is characterized by pain and weakness over the knuckle of the hand due to injury of the tendons that straighten the joints of a finger. The extensor tendon attaches the forearm muscle to the bone that straightens the fingers. This injury involves a tear of the tendon or the tissues that hold the tendon in position. It results in a tear of the extensor tendon, the tissues that help hold the tendon in place, and occasionally injury to the tissue that surrounds the knuckle joint. This condition usually heals with splinting or surgery.
Complications include: an inability to straighten finger, finger stiffness, tendon rupture prolonged healing time, if usual activities are resumed too soon, and recurrence of symptoms and/or repeated injury.
Common Signs and Symptoms
- Pain and tenderness over the injured knuckle
- Weakness or inability to completely straighten the finger under its own power
- Full passive motion of the finger (can be straightened)
- Swelling and warmth of the injured finger over the knuckle
Risks
- Sports that involve contact or hitting with the hand, such as boxing or martial arts
- Poor physical conditioning (strength and flexibility)
- Previous or concurrent injury to the knuckle
- Previous or untreated knuckle sprain
Treatment
Initial treatment involves splinting, icing and elevation to reduce swelling. Medications may be given for pain. If splinting is the treatment, this is for variable periods. Often, surgery is recommended to repair the injured tissues. After surgery, the joint is immobilized with a cast, brace, or splint to allow the tissues to heal. After immobilization (with or without surgery), stretching and strengthening of the injured and weakened joint and surrounding muscles (due to the injury and the immobilization) is necessary. This may be done with or without the assistance of an occupational or physical therapist or athletic trainer. Return to punching is allowed after full range of motion and normal strength are achieved, usually after 4 months.
Follow up Consultations
| Treatment Number: | 2 |
| Patient Name: | ABC |
| TCM Disease: | Right hand pain |
| TCM Type: | Blood stasis and qi stagnation in local area |
| Date: | 16/Mar/2009 |
| Age: | 22 |
| Current condition/ change: | The pain symptom has got better. The movement is more comfortable. |
| Treatment Adjustment: | Add Zusanli and Sanyinjiao |
| Explanation: (If any adjustment) | The points of Zusanli and Sanyinjiao are added to promote more Qi and blood. |
| Lifestyle Advice: (If any adjustment) | |
| Treatment Number: | 3 |
| Patient Name: | ABC |
| TCM Disease: | Right hand pain |
| TCM Type: | Blood stasis and qi stagnation in local area |
| Date: | 23/Mar/2009 |
| Age: | 22 |
| Current condition/ change: | The pain symptom has gone almost. The movement is more comfortable. |
| Treatment Adjustment: | Add Zhongwan and Shangwan |
| Explanation: (If any adjustment) | The points of Zhongwan and Shangwan are added to promote more Qi and blood. |
| Lifestyle Advice: (If any adjustment) | |
| Treatment Number: | 4 (Final) – case closed |
| Patient Name: | ABC |
| TCM Disease: | Right hand pain |
| TCM Type: | Blood stasis and qi stagnation in local area |
| Date: | 6/Apr/2009 |
| Age: | 22 |
| Current condition/ change: | A little bit stiffness feeling around knuckle. Whole body tiredness. |
| Treatment Adjustment: | Add Qihai and Guanyuan |
| Explanation: (If any adjustment) | The points of Qihai and Guanyuan are added to promote more Qi and blood. |
| Lifestyle Advice: (If any adjustment) | |
Case Conclusion
The patient has been suffering from right hand pain. The pain was caused by injury 2 weeks ago from the first consultation. The pain is mainly on knuckles but it spread to on the whole right hand. The movement of hand is not comfortable. Pain type was dull pain. The pressing makes the pain worse.
The wrist also has some pain when it is used for a long time.
All together 5 treatments were done and the case was closed.
For the first treatment, the local points Baxie (Ex-LE-9), Yangxi (LI 5), and Waiguan (SJ 5) were treated in order to promote Qi and blood circulation and relieve pain. The symptoms were relieved after one treatment.
And second, third and fourth treatments were done around one week intervals. Two more local points were added in every follow-up treatment to promote more Qi and blood circulation. The symptoms got better except for the final treatment. On the final treatment day the patient complained the whole body tiredness as well. It could be the reason of it.
After all the treatment the trust feeling between the patient and me were established.
The patient said he would come back when he was sick.
I feel confident and I would use the similar treatment to the patient who shows the similar symptoms.
