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Understanding and Treating Tendon Sheath Inflammation, Trigger Finger, and Tendon Sheath Cysts with Acupuncture

Tendons typically glide within a sheath, lubricated by synovial fluid for smooth movement during muscle contraction and relaxation. Prolonged, repetitive movements can deplete this fluid, increasing friction between the tendon and sheath, leading to tendonitis and tenosynovitis. The latter condition narrows the space allowing tendon glide, leading to a type of tendonitis known as stenosing tenosynovitis. A classic example is trigger or snapping finger, primarily involving the tendons that control finger movement, such as the extensor pollicis and flexor tendons. When extensor pollicis tendons are primarily affected, the main symptoms include radial wrist pain and limited thumb flexion; when flexor tendons are affected, it may cause difficulty in extending the corresponding finger. This condition is stubborn and often challenging to heal quickly without treatment. Combining acupuncture with local massage and other rehabilitation therapies can significantly improve treatment outcomes.

Tendon sheath cysts, most commonly found in the wrist and hand, can also occur in other areas. They typically arise near joint capsules or tendon sheaths. When they are small or newly formed, acupuncture combined with local pressure can effectively reduce or even eliminate them. However, recurrence is possible.

The principle of acupuncture treatment for tenosynovitis is to target spontaneous pain or tender points. First, the stimulation sites must be determined according to the affected tendons, locating corresponding pain points or acupoints. For example, pain points for affected extensor pollicis tendons are often near Yangxi and Lieque; for affected extensor tendons, the points are Hegu and Yangchi. Pain points for affected flexor tendons might appear near Yuji and Taiyuan, and for other finger flexor tendons, the pain or hard nodules usually appear on the palmar side of the respective metacarpophalangeal joints.

Additionally, tender points along the affected tendon's extension, such as Wai Guan, Zhigou for extensor pollicis; Pianli, Wenliu, Kongzui, Sanlian for extensor tendons; and Laogong, Daling, Neiguan for flexor tendons, can be targeted.

During the acute phase of tenosynovitis, pain often spreads, making it difficult to pinpoint the primary site. In such cases, the healthy side method, where acupoints on the corresponding healthy limb are needled, is used until the pain localizes or slightly relieves, and then the primary pain points are stimulated.

In treating tendon sheath cysts, the encircling needling technique is often employed, inserting several needles around the root of the cyst towards its center, and one vertically at the top. Regardless of needle sensation, the needling technique can be used to enlarge the needle holes, facilitating the escape of the cyst's contents. After needle removal, the cyst is massaged forcefully for a few minutes.

Local massage is an excellent adjunct therapy for tenosynovitis and tendon sheath cysts. For tenosynovitis, patients can be taught to massage the local pain points or hard nodules themselves, especially important for trigger finger sufferers. The massage should be moderately intense, feeling a distinct soreness, and performed 2-3 times daily for 3-5 minutes each. For tendon sheath cysts, post-acupuncture compression can sometimes immediately reduce or eliminate small, soft cysts, and regular local pressure can also prevent or reduce recurrence.

In treating tenosynovitis, either the affected area's acupoints or the healthy side's corresponding points can be stimulated alone or in combination. For diffuse pain or tender areas without clear hard nodules, the healthy side corresponding point method is used. However, it's important to note that the main effect of healthy side acupuncture is pain relief, allowing patients to exercise the affected finger for normal activity recovery. For patients with clear hard nodules, direct stimulation of the local pain points is indispensable. Sometimes, direct needling on the local pain points can initially worsen the pain for a few days, improving gradually with continued treatment or after a few days' break. This temporary symptom exacerbation, a kind of counter-therapy, should be correctly understood, and the interval between stimulations should be appropriately controlled.

When local pain is not easily alleviated by acupuncture, moxibustion or other heat therapies can also be considered as alternative treatments.


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