Symptoms and resolution of cutaneous nerve entrapment

Definition of cutaneous nerve entrapment syndrome

The nerve dysfunction caused by chronic entrapment of the cutaneous nerve in its course due to certain reasons and showing a series of sensory dysfunction, phytovagal dysfunction, trophic dysfunction and even motor dysfunction of varying degrees in a series of nerve distributions is collectively known as cutaneous nerve entrapment syndrome. The syndrome is collectively referred to as cutaneous nerve entrapment syndrome.

Cutaneous nerve entrapment syndrome, the main clinical manifestations of pain, pressure pain, muscle tension, sensory abnormalities, such as sensory hypersensitivity, hyperalgesia, sensory loss, sensory hyperalgesia and other common symptoms, in the motherland medicine, belongs to the category of paralysis, the traditional medicine of paralysis, in the cause of the disease is nothing more than wind, cold, dampness, heat, and the pathological products of phlegm, blood stasis for the patient, in the mechanism of the Zhengqi internal deficiency and the external sense of wind, In the pathogenesis of the internal deficiency of vital energy and external wind, cold, dampness, heat, resulting in the meridian gas also blocked, the treatment can be a "through" word unification.

Modern medicine believes that the dermal nerves, especially the nerve trunks of the limbs, travel longer, when it passes through certain anatomical parts, such as bone holes, bony descents, fascia. Tendinous muscle margins and fibro-osseous ducts, easy to encounter repeated friction stimulation or pressure to produce pathological changes, this chronic pathological stimulation of the skin God end that is, for the cardiac nerve. This disease is clinically common, in the single nerve disease from an important position, but because it is often no obvious cause, the onset of disease is slow, easy to ignore and turn into a chronic disease, and even cause difficult to cure the results.

Diagnostic basis of cutaneous nerve compression syndrome

Diagnostic basis of cutaneous nerve compression syndrome: (1) long-term chronic local pain or sensory abnormality; (2) clear local pressure points; palpation can be found in the subcutaneous nodules or striated masses; (3) the local muscle tension, but does not affect the body movement; (4) except for other neurological diseases.

Therapeutic principles of cutaneous orthostatic compression syndrome

The key to the treatment of cutaneous neurologic compression syndrome is decompression. Dating back to ancient folk traditions of treating pain such as gua sha and cupping, physical decompression is also an important mechanism for its ability to relieve symptoms.

Because the etiology of cutaneous nerve entrapment is complex, and the local pathology is not homogeneous, the treatment of it is not a one-sided approach, so the basic principle of the treatment of cutaneous nerve entrapment syndrome is to examine the cause of the disease and to recognize the evidence and apply the treatment. In the choice of methods, we advocate the use of physical therapy without drug therapy, non-invasive therapy without invasive therapy, limited invasive therapy without surgical incision therapy.

Beryllium needle apparatus and its operation

"Ling Shu - nine needles" contains "the name of the nine needles, each with a different shape ......; three days hydrazinium is a needle, the length of three and a half inches; ... ... five days beryllium Zhao, four inches long, wide two and a half minutes; ...... hydrazinium is the needle, sharp as corn's sharp, the Lord press the pulse do not trap, so that the gas ...... beryllium needles, the end of the blade, such as the sword, in order to take the big pus", synthesize the stage The advantages and disadvantages of various therapies in the past, the junction of Chinese and Western medical therapies to take the non-access surgery, the choice of new titanium alloy material developed into a modern beryllium needle. The application of modern beryllium needles to treat cutaneous nerve entrapment syndrome has achieved good efficacy, small incision, small damage, and no pain.

1, beryllium needle specifications

Diameter 0.50 ~ 0.75 mm, the total length of 5 -8 cm, the head of the needle is 1 cm long, 0.50 ~ 0.75 mm. The needle handle has 2 kinds of structure, one is an ordinary needle handle wrapped with steel wire, about 3-5 cm long. The other is a beryllium needle mounted on a handle 10 cm long and 075 cm in diameter. The treatment is performed so that the plane markings of the cutter wire and the handle are in the same plane to identify the direction of the cutter wire in the body.

2, beryllium needle treatment of the common maneuvers there are four

疾刺法：Mainly used for needling the trunk, abdominal and dorsal, limbs of the dermatomal nerve card pressure points. The doctor's left thumb pressed in the diagnosis of clear skin nerve compression point next to the right hand with the wrist will be beryllium needle according to a predetermined scale straight t vertical stab into the compression point, do not twist, do not stay in the needle, rapid stabbing a method of quick extraction. The depth of the needle should depend on the patient's fat and thin and the lesion site, as well as light, medium and heavy different pressure points, depending on the person with the disease, flexible application, the general depth of the needle is about 3-5 centimeters.

Spot prick method: mainly used for card pressure at the head and the end of the limbs with thin muscle tissue. The doctor's left thumb pressed in the diagnosis of a clear cutaneous nerve compression point, the right hand holding a beryllium needle vertically in the compression point on the tip of the needle puncture, do not stay in the needle, pointing that is quickly out of the needle after a method. Generally, the needle is shallow, not more than 0.5 centimeters.

Prick and cut method: mainly applicable to the skin nerve compression syndrome with striae formation after the compression. The doctor holds the needle into the pre-selected site (the site must be selected accurately) to a certain depth, with the blade of the needle back and forth cut, usually about 1 cm in the range of scratching, in order to cut the stripes for the purpose of the action should be light and flexible, not rough.

Duplicate maneuver: mainly applicable to the card pressure after the formation of strips and card pressure parts of the deeper situation This method of needle entry is divided into 3 steps. ① The first step is to use the rapid stabbing away, the right hand quickly into the diagnosis of a clear card pressure site and once in place.

② The second step is to use in maneuver assistance, that is, with the left thumb in the pressure after the sprint, and then replace the pinch to take the release of the flick is equal to the method, so that the local tissue relaxation, in order to reduce the resistance, and initially let the beryllium needle and the pressure on the strip contact, to ensure that the accuracy of the beryllium needle into the package.

③3 The third step is based on the first 2 steps, using the method of stabbing and cutting, as above.

When loosening cutaneous nerve entrapment, the plated needle is used to do localized loosening or decompression at the point of compression to make the symptom significantly improved, and attention is paid to the protection of nerves and blood vessels of the nerve bundles when the beryllium needle is used to do the loosening, which can help the recovery of nerve function. Therefore, compared with other therapies, beryllium needle has the advantages of no anesthesia, small incision, no pain, less damage to the tissues around the nerves during the operation, small scar around the nerves after the operation, and obvious improvement of the symptoms, etc. The beryllium needle is used in the treatment of the nerve and the nerve bundle. And beryllium needles are made of peptide gold, compared with other metal materials, it has high hardness, good medium temperature performance, corrosion resistance and durability of four significant advantages, beryllium needles in the dermal nerve entrapment syndrome, synthesize the advantages of other therapies, especially the small needle therapy, take its strengths and shortcomings, which is not only suitable for promoting the application of domestic primary health care units, but also as a kind of acupuncture therapy, the application of which is also reduced a lot of unnecessary trouble in foreign countries. The application also reduces many unnecessary troubles.

Operating steps of beryllium needle therapy

The clinical application of beryllium needle therapy consists of the following procedures: localization, disinfection, needle insertion, loosening, and needle discharge.

Positioning: after palpation to find the pressure point on the body surface, use the end of the finger to make a cross indentation vertically downward, and pay attention to the intersection of the cross indentation to align with the center of the pressure point.

Disinfection: Disinfect the skin routinely with iodophor or alcohol-iodine-alcohol in a range slightly larger than the operating range of the treatment by two times.

Needle insertion: puncture method and bullet puncture method. ① Point puncture method: the operator pinches the handle of the needle with the thumb and index finger of one hand, and pinches the body of the needle with the thumb and index finger of the other hand with a sterile dry cotton ball or a block of sterile gauze, and the tip of the needle is aligned with the center of the skin's cross indentation, and both hands plummet downward, so that the beryllium needle passes quickly through the skin, when the beryllium needle passes through the subcutaneous, the tip of the needle is less resistance, and there is a feeling of void under the hand that feeds the needle, and when the tip of the needle punctures into the deep fascia, it meets with a greater resistance, and there is a feeling of resistance under the hand that holds the needle. According to different conditions, the loosening needle method is performed. ② Popping method: the operator pinches the body of the needle with a plastic casing needle in one hand, the tip of the needle is aligned with the midpoint of the cross indentation, and the casing is pressed down vertically, the end of the thumb and middle finger of the other hand are opposite to each other, and the nail of the middle finger is aligned with the end of the needle, and the end of the needle that is exposed outside the casing is bounced forcefully, so that it instantly passes through the skin, and then the casing is removed, and then the needle is inserted one after the other.

Release: Release is the key step in the treatment. The purpose of relaxation is to reduce the tension in the surrounding fascia through which the cutaneous nerve passes and the pressure in the interfascial compartment. Therefore, the depth of needling can be as deep as the beryllium needle can penetrate the fascia, and it is not necessary to reach the muscle layer, so as to avoid bleeding and reduce postoperative reactions. According to the therapeutic needs, the following methods can be used to release the fascial layer: ① One-point release: suitable for cases with limited pain points and accurate localization. The tip of the beryllium needle can be passed through the deep fascia, and the patient's localized pain often disappears. ②Multi-point release: for cases with limited pain points but ambiguous localization, when the tip of the beryllium needle passes through the deep fascia, gently lift the needle upward, withdraw the needle from the fascia to the subcutaneous area, slightly change the angle of entry, and then pass through the fascial layer of the country, which can be repeated for 3 to 5 times. (iii) Linear release: for cases with a large range of pain, long duration of disease, fascial hypertrophy and high muscle tension. The case of high muscle tension. Line release is actually a repeated continuous puncture along a direction, forming a 0.5 ~ 0.7 cm fascial cleft.

Out of the needle: after the completion of the relaxation, with the needle holding a cotton ball or gauze block pressed into the point of entry, quickly pull out the needle continued to press the point of entry for 1 to 2 minutes, and at the same time, ask the patient's local sensation, the patient's original general pain are reduced or disappeared. Aseptic dressings are applied to cover the point of entry, and the dressings are kept dry and clean for 24 hours.

Indications for beryllium needle therapy:

① Ineffective treatment by 1 to 2 courses of conservative therapy;

② Formation of adhesions after surgical treatment;

③ Dermatoglyphic nerve entrapment syndrome. The first diagnosis of clear cases.

Contraindications to beryllium needle therapy: Contraindications

① local soft tissue inflammatory reaction;

② bleeding tendency;

③ diabetic patients with a tendency to limb ischemia or soft tissue infections;

④ consciousness can not be cooperated with the patient or the patient does not accept this treatment plan.

Needle sensation of beryllium needle release

Because beryllium needle is a closed procedure, in order to be safe and be able to accurately carry out the procedure during the surgical operation, in addition to mastery of the procedure, mastery of the needle sensation of the procedure, is also extremely important for the procedure 's accuracy and safety.

Beryllium needles will be four-step protocol into the beryllium needle after the lesion in the superficial parts, the depth has been reached, if the lesion in the deeper parts, or muscle hypertrophy. After entering the needle, the depth is not yet reached, but also to continue to the deeper part of the piercing. At this time to feel into the needle, to needle feel to judge. The knife mouth touches the tissue, if in the tissue gap, the patient may complain that there is no feeling. If touching blood vessels, stabbing the normal muscle, the patient can report pain, touching the nerve patients complain of numbness, electric shock, should be timely and gently lifting the blade, slightly moving the blade l ~ 2mm, continue to enter the needle, until it reaches the required depth, that is, the site of the lesion. Various surgical methods of beryllium needle are now performed for treatment. When reaching the lesion site, the patient complained of a sensation of soreness and distension, without pain or numbness or electric shock. In the course of treatment, if there is pain or numbness or electric shock, the direction of the incision should be changed immediately. In other words, acidity and distension are the normal sensations of beryllium needles. Pain, numbness and electrocution are all abnormal sensations.

If there is an abnormal sensation, the needle cannot be inserted, and the procedure cannot be performed. No feeling indicates that the beryllium needle in the tissue gap, did not reach the lesion site, and generally do not carry out loosening, peeling, incision and other surgery. However, there are a number of lesions where the tissue is so severely degenerated that it has lost sensation, and there is no sensation when the needle is inserted or when surgery is performed. But this is generally less than ideal results.

The needle sense of beryllium needle is the patient's feeling after the beryllium needle into the patient's body, beryllium needle feel is beryllium needle into the human body after the doctor's own hands, this feeling is extremely important for us to carry out the correct judgment of the beryllium needle to reach the parts and tissues, such as stabbing in the muscle, is a soft feeling, if the beryllium needle stabbed in the fascia and nerves, there is a kind of pliable band feeling, if the beryllium needle stabbed in the lesion nodule, there is a kind of soft band feeling. If the beryllium needle is pricked on the lesion nodule, there is a hard and soft feeling, if the beryllium needle is pricked on the blood vessel, there is a feeling that first the resistance is large and then the resistance suddenly disappears, if the beryllium needle is pricked in the tissue gap, there is a feeling of no resistance and emptiness, and if the beryllium needle is pricked on the bone, there is a feeling of hardness. We rely on these different sensations to determine the different tissue structures in the area reached by the beryllium needle, and we rely on the hierarchical anatomy and the sensations in the area reached by the beryllium needle to determine whether the beryllium needle reaches the area we need to treat.

Beryllium needle in Chinese medicine: decompression of cutaneous nerves

In clinical practice, people who are diagnosed with "chronic soft tissue injury", "myofasciitis" or "rheumatic disease" are often diagnosed with "chronic soft tissue injury", "myofasciitis" or "rheumatic disease". A significant number of patients often diagnosed with "chronic soft tissue injuries", "myofasciitis" or "rheumatic diseases" have neurological deficits. These chronic diseases, some use a variety of methods of treatment for a long time, and the use of beryllium needle treatment once or twice to solve the problem.

Why is this? Chen Xiuhua, director of the Traditional Therapy Center of Guangdong Provincial Hospital of Traditional Chinese Medicine, said that beryllium needle as the State Administration of Traditional Chinese Medicine appropriate technology promotion project, has a targeted, easy to operate, safe, less traumatic, no side effects and clinical efficacy and so on. Her explanation tells the story.

Beryllium needle is a nerve external release

Chen Xiuhua introduced, the skin nerve in the process of walking, due to some reasons by the chronic compression of the nerve dysfunction caused by a series of nerve distribution area of varying degrees of sensory disorders, phytovagal dysfunction, dysfunction of nutrients and even motor dysfunction, collectively referred to as the skin nerve compression syndrome. The nerve compression syndrome.

This disease is one of the common clinical disorders, which manifests as localized pain, abnormal sensation, and examination reveals muscle tension, tenderness, painful nodules, striated masses, and radiating pain.

The information shows that beryllium needles originated from "Ling Shu - Nine Needles". The book records "the name of the nine needles, each different shape ...... five said beryllium needle, four inches long, wide two and a half minutes; ...... beryllium needle, the end of the blade, such as a sword, in order to take the big pus". It can be seen, beryllium needles are slightly thicker than acupuncture needles, the end of the flat with a blade of the apparatus. Beryllium needle treatment is only in the fascial layer, trauma is small, basically no bleeding, the general operation of a minute or two, can be effectively distributed in the skin and fascia in the distribution of a large number of small compressed dermal nerves, is equivalent to a less traumatic nerve external laxation.

The modern beryllium needle is made of titanium alloy material, which is designed according to the characteristics of the high tension state of the soft tissue caused by the dermal nerve compression. The general incision is beveled, and the incision line is 0.5 to 0.75 mm. the needle handle is an ordinary needle handle wrapped with steel wire and is about 3 to 5 cm long. the treatment should be performed so that the plane markings of the incision line and the handle are on the same plane in order to discern the direction of the incision line in the body.

She cited examples, such as for cervical spondylosis, through the beryllium targeting the patient's neck subcutaneous tissue, fascia cutting, to dredge the meridians and collaterals, regulate qi and blood, improve the local microcirculation, promote the local congestion and edema subside and aseptic inflammation of the absorption of the effective loosening of a large number of tiny compressed dermal nerves that are widely distributed in the skin and fascia.

Beryllium needle therapy has a strong clinical value and is mainly applied to all parts of the body with dermal nerve compression syndrome. This includes cases in which the first diagnosis of pudendal nerve compression syndrome is clear; cases in which the conservative treatment is ineffective after 1 to 2 courses of therapy; and cases in which adhesion compression is formed again after surgical treatment.

Five steps to complete the clinical operation

Yu old man suffering from saphenous nerve knee medial branch compression syndrome, the medial side of the knee and calf anterior medial persistent pain, walking knee tenderness, weight-bearing, strenuous activity pain aggravation. So he came to the Traditional Therapy Center of Guangdong Provincial Hospital of Traditional Chinese Medicine to seek medical treatment.

Chen Xiuhua first let the patient lie flat on the bed, the body position remains unchanged. She palpated to find the pressure and pain points on the surface of the body, and then found the positioning of the needle.

Next, with the needle point as the center and disinfection, the skin is routinely disinfected with iodophor, which is slightly more than twice the operating range of the treatment.

She held the needle in her right hand and a sterile cotton ball in her left hand to help the needle point into the subcutaneous, and then her hands suddenly downward, so that the beryllium needle quickly passes through the skin and reaches the fascia. When Chen Xiuhua talked about the experience of administering the needle, she mentioned that when the beryllium needle passes through the subcutaneous, the resistance of the needle tip is small, and there is a sense of emptiness under the hand that enters the needle, and when the tip of the needle stabs into the deep fascia, it will meet with greater resistance, and there is a sense of resistance under the hand that holds the needle.

Chen Xiuhua began to carry out the relaxation needle method, that is, to reduce the skin nerve through the surrounding fascial tension and inter-fascial chamber pressure. She said the depth of the needling is sufficient for the beryllium needle to penetrate the fascia, and does not have to go deeper than the muscle layer, which avoids bleeding and reduces postoperative reactions.

After completing the release, she presses down on the entry point with a needle-holding cotton ball or gauze block, quickly removes the needle, and continues to press down on the entry point for 1 to 2 minutes, ending with a sterile dressing-covered bandage.

In just a minute or two, Chen Xiuhua completed the beryllium needle treatment. The old man went down to walk on the ground and felt that the leg pain was obviously relieved a lot. Director Chen Xiuhua instructed him to treat him once a week, 3 times for a course of treatment, so that he can adhere to the treatment, can consolidate the effect of treatment. The old man happily agreed.

Chen Xiuhua explained, the knee is the body's main weight-bearing activity joints. The subcutaneous fat is thin, the buffering capacity is poor, is the hidden nerve most often occurs in the part of the card pressure. Degenerative changes in the knee joint and osteomalacia in the elderly are also an important cause of compression of the medial knee branch of the saphenous nerve. Beryllium needle therapy can relieve pain by loosening the soft tissue pressure that causes compression of the saphenous nerve and reducing the surface tension and pressure on the closed system.

The use of beryllium needles varies from person to person and from disease to disease

Beryllium needle therapy in the treatment of dermal nerve entrapment syndrome, although it has the advantages of a small incision, less pain, no anesthesia, accurate positioning, and more adequate relaxation, but not all people and diseases are appropriate to do this therapy, we must strictly grasp the indications and precautions, Chen Xiu-hua stressed.

She said that not all people and diseases are suitable for this treatment.

She said, according to the patient's situation before the needle can be in the needle point at the subcutaneous infiltration anesthesia. The depth of the needle is about 1 to 2cm, not deep stabbing, so as not to cause pneumothorax or neurovascular injury, the depth of the needle should be depending on the patient's fat and thin and the lesion site, different from person to person, flexible application.

For patients with aura of needle fainting, first remove the beryllium needle, comfort the patient and let the patient lie down. In mild cases, drink hot water or sugar water, and rest for a few moments to recover. In addition to the above treatment, the severe cases with finger pinch or needle acupuncture points such as the gutter. She explained that the common reason for the dizzy needles is the patient's mental tension, or physical weakness, hunger, fatigue, discomfort, and the doctor's manipulation is too heavy.

Clinical hematoma will also be encountered, which is caused by accidental injury to blood vessels, out of the needle without timely pressure. If it is a mild hematoma, generally do not have to deal with, can subside on their own. If the local hematoma is heavy, you can continue to press locally to prevent further bleeding, and then give internal and external medications to promote blood circulation and reduce swelling. Prevention is achieved by avoiding blood vessels and applying appropriate pressure after the needle is discharged.

She said, for postoperative patients, can be appropriate to carry out some manipulation and functional exercise, both to restore the body's dynamic balance, release muscle spasm, but also to further promote the body's metabolism.