Our musculo-skeletal acupuncturist Hamish Reid suggests that Dupuytren’s contracture actually responds very well with the use of Motor Points – as all cases like this the earlier it is picked up and treated, the better.
One thing right off the bat is to check what the patients expectations are – many times when I have done this for Dupuytren’s contracture, the patient expects a few treatments to basically solve the problem.
I will let them know that we can definitely start seeing some progress in the first few sessions, however this is a condition that can often take months to get right. I will however mention that with EACH treatment, we want to be checking that we are making progress and the “arrows are pointing in the right direction” as I like to put it.
So just an explanation first…. Dupuytren’s contracture (DC from here on), basically affects the fascia of the palm, and the synovial sheath around the flexor tendons of the hand (which is also why it is known as “Stenosing Tenosynovitis” or “Trigger finger” as the characteristic progressive flexing of the tendons results.
The motor point is technically where the motor nerve innervates the muscle (neuromuscular junction).
These are areas of high electrical conductivity, so in my view it is extremely important to release the motor point in conjunction with needling your other trigger points, as this will physically have the best effect on the electrical activity of the muscle (where the muscles contraction and tenderness will indicate an upset in the electrical activity of that muscle.
These Motor points will be VERY tender on palpation and will illicit a sharpish straight out uncomfortable feeling.
So the main flexor tendons of the hand involved in DC are the:
– Flexor carpi ulnaris tendon
– Palmaris Longus Tendon and
– Flexor Carpi Radialis tendon
So when the sheath of the tendon becomes inflamed, agitated or of course has had repetitive strain (through work or hobbies – think tradesperson, gardener, admin staff using the computer mouse all day, holding objects clutched for extended periods etc), this may cause it to thicken and produce scar tissue – which as it bonds, pulls everything towards it, resulting in the contractual nature of this syndrome. Of course this interrupts the smooth gliding mechanism of the tendon.
From a medical perspective, it is speculated to be an autoimmune issue. Other contributors tend to be those who are over 50 years of age, who also smoke and also have issues with excess alcohol consumption. Also manual labour is a major factor again with a fierce gripping component (think jackhammer).
I mentioned earlier that the main tendons affected were Flexor carpi ulnaris, Palmaris Longus Tendon and Flexor Carpi Radialis.
Obviously these tendons are merely “cables” but that are controlled by the flexor muscles of the same name on the palmar aspect of the forearm. So if these muscles are contracted or jammed they will result in the pulling of their affected tendon. Given this is CRUCIAL to release the muscle that controls the tendon (See diagram).
To be honest I find this gives the best instantaneous result as the patient should have more extension straight away.
So the main points to do this are:
– Flexor carpi ulnaris: Motor point- 1/3rd the distance b/w medial epicondyle of humerus & a point on the wrist crease just on the radial side of the flexor carpi ulnaris tendon (see diagram)
– Palmaris Longus: Motor Point- 1/3rd distance between medial epicondyle of humerus & the wrist crease between the flexor carpi radialis and palmaris longus tendon (see diagram)
– Flexor Carpi Radialis: Motor Point – 4 inches distal to the middle of the cubital crease.
All of these points when stimulated should give a nice twitch release and immediately somewhat slacken the tendons connected to them.
A few extra tips:
1. Deep massage with liniment eg: tiger balm in the forearm muscles mentioned above will work wonders. Get the patient to rub this oil in themselves twice a day – or BEFORE any activity that will aggravate it.
2. I find getting the patient to roll a tennis ball on the affected muscles will help release them on a daily basis in between your treatments. (Roll in hard to release contracted fibres).
3. Treatment should be twice a week to gain momentum until substantial improvement is seen, then span to fortnightly and work on underlying pathologies.
Finally, put some measurable things in place so you and the patient can gauge improvement. I normally take a measurement of how much they can extend their fingers, so we can revisit each time to show that there is improvement.
Needle Size Requirement – DongBang Spring Metal Acupuncture Needle 0.30mm x 30mm and 0.30mm x 40mm.
– DB100 (Box of 100, single needles with tube) – CLICK HERE
– DB106 (Box of 1000, blister packs of 10 needles and tube) – CLICK HERE
By Hamish Reid (Musculo-Skeletal Acupuncturist)