What is the proper depth of acupoints in neck and shoulder region?

Although acupuncture therapy is safe with only minor side effect, some severe complications such as pneumothorax still happens. Such incidence could have been avoided if acupuncturists were equipped with a better understanding of the anatomical knowledge and appropriate depth of needle insertion, in particular in points scattered in the neck and shoulder regions where the risk of injuries of lung, heart, nerve and vessels are significantly high.

Recently, a group of scientists in Taiwan, China, conducted a clinical study, using magnetic resonance imaging (MRI) to (1) measure the mean depth of some frequently used acupoints around the neck and shoulder regions, and (2) understand that how variable factors such as body size (using body mass index-BMI) and gender would affect the measured depth of each acupoint. Three hundred and ninety-four participants were recruited in this study. Outcome measure included the measurement of distance of needle insertion tip (surface of skin) to any tissue that would cause possible or severe complications.

MRI analysis showed the mean depths of all participants, regardless of BMI and gender, are as follows, in centimetres: GB21=5.6, SI14=5.2, SI15=8.8, GV15=4.9, GV16=4.6, GB20=5.0, ST9=1.6, SI16=1.8, SI17=2.4, TE16=3.1, LI18=1.3. It was revealed that participants with higher BMI had greater depths and males tended to have greater depths in most of the points.

This is the first study to investigate the mean depth of acupoints around neck and shoulders. Acupuncturists should take information provided in consideration during the treatment to prevent complications.

Reference

Chou PC et al., Retrospective study using MRI to measure depths of acupuncture points in neck and shoulder region. BMJ Open 2015;5:e007819. doi:10.1136/bmjopen-2015-007819.  http://bmjopen.bmj.com/content/5/7/e007819.abstract

Acupuncture to neck may cause cerebral air embolism

A patient with homolateral cerebral air embolism, probably caused by acupuncture insertion into the left anterior neck, was recently reported in the Journal of Stroke Cerebracardiovascular Diseases.

A 64-year-old male patient with post-stroke hemiplegia had an acupuncture treatment including the needle insertion into the anterior neck, and several hours later he developed subcutaneous emphysema into his left anterior neck and chest wall. He was admitted into the hospital with early seizure followed by unconsciousness and focal neurologic deficits. Initial brain scan showed small, multiple air bubbles in the corticomedullary junction area of the left cerebral hemisphere. The patient regained consciousness 2 days later in hospital.

The second scan, taken 6 days after the event, showed no air bubbles in the cerebral hemisphere but massive cerebral edema. The patient's condition continued to improve during his hospital stay. He was discharged 3 weeks later with minimal neurologic deficits.

The report suggested the unilateral cerebral artery air embolism was thought to be caused by direct infiltration of air to the common carotid artery following acupuncture.

Although this is a rare case report it reminded acupuncture practioners that knowledge of human anatomy and acupuncture technique skill are very important for the safety of patients.

Reference:

Chang DI et al., A case of intracerebral air embolism following acupuncture. J Stroke Cerebrovasc Dis. 1995;5(4):238-40.   http://www.ncbi.nlm.nih.gov/pubmed/26486954

Acupuncture needle caused cardiac perforation, a rare complication of acupuncture

An acupuncture needle caused cardiac perforation in a 51-year-old female due to the needle left on the body following acupuncture session, according to a report published in the European Heart Journal.

Dr. O. Wigger and colleagues in the Bern University hospital, Switzerland reported a case of complication of acupuncture, in which a 51-year-old female was admitted into the hospital due to the ongoing chest pain and dyspnoea. Although ECG did not show significant changes a coronary angiography showed a needle-shaped foreign body projecting on the left ventricle. Computed tomography confirmed a presence of a needle-shaped radiopaque structure perforating the left ventricle and protruding into the left lower lobe of the lung. After discussing the finding of potential cause of symptoms patients immediately mentioned an acupuncture treatment for her chronic musculo-skeletal pain by an unprofessional and close friend.

Cardiac surgery was immediately performed including evacuation of haemothrax, completely removal of the needle. Patient recovered quickly from operation and was discharged 4 days after surgery.

This report warned us that nerve seek any acupuncture treatment from any unprofessional, non-qualified acupuncturist.

Reference:

O Wigger et al., Cardiac perforation as a rare complication of acupuncture. Eur Heart J. 2015 May 20. pii: ehv171.   http://dx.doi.org/10.1093/eurheartj/ehv171

A complication of acupuncture therapy – pneumothorax

Acupuncture has been used to effectively treat a wide range of disorders and it is a safe modality with only minor side effects when it is performed in the hands of experienced practitioners. Complications of acupuncture treatment such as pneumothorax and severe infections etc may occur if the rules of acupuncture practice are not followed.

Pneumothorax refers to a collection of air in the pleural cavity (between the lung and the chest wall) and ranks the top of major complications arising from acupuncture. It is caused by too deep insertion or wrong anger of needle insertion due to lack of anatomical knowledge or carelessness performance.

Recently Dr. Demir and colleagues in Turkey reported a case of pneumothorax following acupuncture treatment. A 24-year-old female patient with severe chest pain was admitted into the emergency room of hospital. She had a chronic neck pain caused by cervical hernia and received medical treatment for three years but did not respond well to the treatment. Then acupuncture treatment was given with needles applied on her suprascapular region by a physical therapy specialist. She started to suffer severe pain shortly after acupuncture. Chest X-ray showed a reduced density in the right upper zone of periphery. Thoracic computed tomography showed evidence of a small pneumothorax covering almost 15% of the right hemithorax. The progression of pneumothorax was monitored by means of daily X-ray. The size of pneumothorax reached 20% on third day and a chest tube was placed in pleural space. Air leakage disappeared and tube was removed on the seventh day in hospital. Then patient was discharged from the hospital.

The report suggests that acupuncturists should be well-trained and be familiar with anatomy of treatment region for avoidance of potential complications.

Reference:

Demir M et al., A rare complication of acupuncture: pneumothorax. Tuberk Toraks. 2014 Dec;62(4):316-318.    http://www.tuberktoraks.org/managete/fu_folder/2014-04/2014-62-04-316-318.pdf

Copper coil handle of acupuncture needle is more prone to buckling than plastic handle

Compared with plastic handle of acupuncture needle, copper coil handle is far more susceptible to buckling according to a study reported on the journal Acupuncture in Medicine.

When the acupuncture needle is inserted into the body, in particular with long needle, it can easily bend or buckle. One of the ways to prevent the buckling is for acupuncturist to hold the needle body to assist the needle insertion, which has potential to cause infection. So avoiding needle buckling will reduce the risk of infection and enhance patient comfort and safety. Cooper coil handle and plastic handle are the two most commonly used acupuncture needle handles. Which one is more prone to buckling?

Recently Dr. Zhang and colleagues in Australia conducted a study to assess the strength and weakness of both cooper coil handle and plastic handle for needle buckling. Using a digital scale needles with two different types of handles, of the size of 0.25 mm×30 mm and 0.25 mm×60 mm were indiscriminately selected for buckling tests of acupuncture needles. Also needle body stiffness is also measured using a Dynamic Mechanical Analysis. It was found that plastic handle showed a significantly greater buckling resistance than cooper coil handle, while the stiffness of two types of needle bodies is similar.

The study demonstrated that the difference of buckling resistance between two types of needles was in the handle design. The handle of cooper needle is comprised of a cooper coil tightly wound around the upper part of the stainless steel needle, while plastic needle handle is made of plastic stick.

Although it is suggested replacing of cooper coil handles with plastic one would save tones of cooper metal, plastic handle, at present, is not suitable for use with moxibustion and less easy to use for electroacupuncture.

Refrence:

Zhang CS et al., Relationship between buckling of acupuncture needles and the handle type. Acupunct Med doi:10.1136/acupmed-2014-010586.   http://aim.bmj.com/content/early/2014/07/14/acupmed-2014-010586

Gold acupuncture induced facial multiple epidermal cysts

Permanent placement of gold acupuncture needle for facial skin rejuvenation caused multiple epidermal cysts according to a case report in journal Annals of Dermatology.

Doctors in Korea reported a case study describing a 58-year-old woman with multiple tiny papules having comedo-like openings on her face. Three years ago patient had a facial skin rejuvenation treatment by using permanent placement of gold acupuncture needles under skin performed by an unlicensed acupuncturist. The acupuncture sites were swollen for three months following procedure. Multiple papules with pungent odour appeared at the same sites.

Punch biopsies were performed on the lesioned sites in the infraorbital and forehead. The gold needles were found on the lesion sites. Histopathological examination confirmed the diagnosis of multiple epidermal cysts associated with acupuncture gold needles. The patient was treated with relevant medications.

Inserting acupuncture needles into different facial acupoints has been used for facial skin rejuvenation. However its mechanism and safety have not been proven. The adverse effects include skin irritation, hematoma, bleeding, fainting.

The authors acknowledged that this is the first case of multiple epidermal cysts following permanent placement of gold needles.

Reference:

Park KY et al., Multiple Epidermal Cysts as a Complication of Gold Acupuncture. Ann Dermatol. June 2014; 26(3):405-406.   http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4069658/

Acupuncture needle penetrating the stomach cavity was removed by endoscopic-assisted device

In a case report, acupuncture needle penetrating the stomach cavity of a woman patient after acupuncture therapy was removed by endoscopic-assisted device according to a publication in journal Clinical Endoscopy.

Doctors in Seoul, Korea reported that a 47-year-old woman was presented with a 2-day history of abdominal pain after recently having received acupuncture treatment for abdominal discomfort in a local clinic. Her abdominal condition worsened after acupuncture and was admitted into the hospital. Her vital signs were stable; blood test and chest radiography were not found abnormal changes.

However, abdominal computed tomography revealed a high-attenuated linear image embedded in the posterior wall of stomach antrum. Esophagogastroduodenoscopy found a needle penetrating the stomach. The needle was removed and retrieved from the stomach. The patient was treated with antibiotics for 2 days and recovered completely.

Although acupuncture is a safe therapy this case report showed that complication could happen if the strict rule of treatment is not followed.

Reference:

Lee SW et al., A Needle Penetrating the Stomach Cavity after Acupuncture. Clin Endosc. May 2014; 47(3): 258–261.   http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4058545/

Acupuncture treatment is safe during pregnancy

Women during pregnancy may suffer from various conditions that may affect the pregnant women’s health and the normal development and delivery of baby. Concerns over drug-related adverse effects during pregnancy prompted increase in approaches of other non-pharmacological treatments. Among them, acupuncture as a treatment for various pregnancy conditions has attracted considerable attentions. Many studies showed its benefits in treating conditions such as pregnant-related vomit and nausea, breech position, low back and pelvic pain, delayed labour onset and labour pain. However safety issues over acupuncture treatment during pregnancy still exist.

Recently a group of scientists led by Dr. Hyangsook Lee in Korea studied the safety of acupuncture during pregnancy. They analysed 105 clinical studies concerning adverse effects of acupuncture and found that

“Detailed adverse effects were reported only in 25 studies represented by 27 articles (25.7%). Adverse effects evaluated as certain, probable or possible in the causality assessment were all mild/moderate in severity, with needling pain being the most frequent. Severe adverse effects or deaths were few and all considered unlikely to have been caused by acupuncture. Total adverse effect incidence was 1.9%, and the incidence of adverse effects evaluated as certainly, probably or possibly causally related to acupuncture was 1.3%”.

The authors conclude that “acupuncture during pregnancy appears to be associated with few adverse effects when correctly applied.” Indeed, acupuncture offers a safe, effective and drug-free option during pregnancy.

Reference:

Park J et al., The safety of acupuncture during pregnancy: a systematic review. Acupunct Med. 2014 Feb 19. doi: 10.1136/acupmed-2013-010480. http://www.ncbi.nlm.nih.gov/pubmed/24554789

Improve acupuncture needle quality is needed

Acupuncture has been used to treat many conditions in China and other Asian countries for a very long time. Acupuncture is a safe and tolerated modality and accounts for approximately 40% of all medical treatment in China and is one of the most commonly sought alternative medical treatments in Western countries. Although the quality of acupuncture needles used worldwide is high it needs to be improved to avoid many potential problems such as discomfort and pain.

Recently Professor Xie and colleagues in Australia investigated the qualities of sterilised single-use stainless steel acupuncture needles from two of the most popular brands used worldwide. They used scanning electron microscope to check the surface conditions and various other physical properties of chosen needles.

They reported that “The scanning electron microscope images revealed significant surface irregularities and inconsistencies at the needle tips, especially for needles from one of the two brands. Metallic lumps and small, loosely attached pieces of material were observed on the surfaces of some needles. Some of the lumps and pieces of material seen on the needle surfaces disappeared after the acupuncture manipulation”.  

The authors urge acupuncture manufactures to review and improve their quality control procedures for the fabrications of needles. Acupuncture needles with better quality should reduce pain and discomfort and improve safety standards.

Reference:

Xie YM et al., Examination of surface conditions and other physical properties of commonly used stainless steel acupuncture needles. Acupunct Med 2014;32:146-154 doi:10.1136/acupmed-2013-010472.  http://aim.bmj.com/content/32/2/146