TCM Acupuncture and Massage

Chapter 63 Bone and Joint Diseases (1)
Cervical spondylosis

An overview of the disease

([-]) Relevant knowledge

Cervical spondylosis is a syndrome, also known as cervical syndrome, which is a group of syndromes caused by the gradual degeneration of the cervical intervertebral disc, hyperosteogeny of the cervical spine, or changes in the normal physiological curve of the cervical spine.It is a commonly encountered disease and frequently-occurring disease, and it is prone to occur in adults between the ages of 40 and 60, with more men than women.The lesion primarily involves the cervical intervertebral disc and surrounding fibrous structures, with marked degeneration of the cervical nerve roots and spinal cord.Such patients often feel numbness in the head, neck, shoulders and arms in mild cases, and in severe cases, limb weakness, and even incontinence and paralysis.

([-]) Etiology and pathogenesis

The cervical spine is located between the less active thoracic spine and the heavy head. It has a large range of motion and must support the head to keep it in balance. Therefore, the cervical spine is prone to strain, especially the lower cervical spine, that is, necks 5-6.Due to long-term strain of the neck, the intervertebral disc tissue, bones and joints gradually degenerate, affecting nearby nerves, spinal cord, and vertebral arteries, and various clinical symptoms appear.Its pathogenesis is related to the following factors.

1. Degeneration The degeneration of the cervical intervertebral disc with age and the resulting degeneration of the entire cervical spine and other parts of the cervical spine are the main causes of cervical spondylosis.

2. Chronic strain refers to the maximum activity beyond the range of normal physiological activities.Including the following aspects.

(1) Bad sleep position: Because of its long duration, it will cause paravertebral muscles, ligaments and joints to be out of balance, which will affect the tissues in the spinal canal and accelerate the transformation process.

(2) Improper working posture: In a sitting position, especially those who work with their heads down, although the workload is not heavy and the intensity is not high, the incidence of cervical spondylosis is extremely high.Such as secretaries, computer technicians, accountants, civil servants, employees in the electronics industry, teachers, college students, etc.Playing mahjong and watching TV for a long time in life can also cause it.

(3) Inappropriate physical exercise: Activities or sports that exceed the tolerance of the neck can increase the load on the cervical spine, especially in the absence of correct guidance. Once a mishandling causes trauma, the consequences will be more serious.

3. Head and neck trauma: half of the patients with cervical spondylosis are directly related to the trauma.Including the following aspects.

(1) Traffic accidents: In addition to causing fractures and dislocations, cervical spine injuries caused by sudden braking.

(2) Sports injuries: Athletes do not make sufficient preparations before competition.

(3) Accidents in work and life: sudden excessive flexion, extension and lateral bending of the neck.

(4) Other accidents: illegal massage, traction, etc. 4. Throat inflammation When there is acute or chronic infection in the pharynx and neck, it is easy to induce symptoms of cervical spondylosis or aggravate the original condition. 5. Developmental spinal stenosis The inner diameter of the cervical spinal canal is directly related to the occurrence of cervical spondylosis. Those with small spinal canal are prone to develop the disease when they are traumatized or even slightly injured.The initial pathological change of cervical spondylosis is the degeneration of the cervical intervertebral disc. Due to its degeneration, the annulus fibrosus and nucleus pulposus can protrude below the ligament, causing the ligament and periosteum to separate from the vertebrae, forming a ligament-intervertebral disc space. Microvascular tearing and blood formation gap hematoma, along with the hematoma organization and calcium salt deposition, finally formed protruding to the spinal canal or the anterior edge of the vertebral body spurs.Due to the degeneration of the intervertebral disc, it can also lead to a decrease in its ability to withstand pressure and traction force, resulting in a corresponding narrowing of the intervertebral space, dislocation or overlapping of facet joints, smaller intervertebral foramina up and down, and reduced stability between adjacent vertebral bodies , followed by facet joints, uncinate joint hyperosteogeny, ligament ossification, etc.In addition, long-term chronic strain, trauma, inflammation and deformity can induce and aggravate stimulation and compression of nerve roots and vertebral arteries.All of these pathological changes will be aggravated by developmental spinal stenosis.

([-]) Clinical manifestations and classification
The main clinical symptoms of this disease are pain in head, neck, arm, hand and chest, etc., and there may be progressive limb sensory and movement disorders. Corresponding clinical manifestations such as dizziness, palpitation, and heartbeat may occur in arteries and sympathetic nerves.The clinical manifestations of cervical spondylosis vary according to the location of the lesion, the compressed tissue and the degree of compression.Some of its symptoms can be alleviated or alleviated by itself, and they can also recur; individual cases have stubborn symptoms that affect life and work.According to the specific clinical symptoms, it can be divided into five types: nerve root type, spinal cord type, vertebral artery type, sympathetic type and mixed type.details as follows.

1. Nerve root type cervical spondylosis This type of cervical spondylosis is more common in people over 40 years old, with slow onset and no history of trauma.However, the disease can be induced when the head is traumatized by various causes.The main symptoms are as follows:
(1) Neck, shoulder and back pain: Pain has certain characteristics.Dull pain and soreness are not severe, and the neck is stiff and uncomfortable. A small number of patients feel knife-like pain.The pain affects sleep, especially when lying on the side, so the upper limbs feel sore and numb when lying on the side.The symptoms are especially obvious when you just wake up, and the symptoms intensify after fatigue.The pain is mostly on one side, and bilateral is rare.

(2) Radiating pain: the pain can radiate to the head, eyes, behind the ear, behind the head, chest and arm, and upper limb on the affected side.

(3) Numbness of fingers, electric touch or cold hands, especially at night and aggravated after exercise.

(4) Restricted neck movement.

(5) The upper limbs of the patient are heavy and weak, and sometimes the objects they hold drop. 2. Cervical spondylotic myelopathy can be divided into simple spinal cord type and spinal nerve root mixed type according to whether the oppressor is located in the center of the spinal cord or to one side.Its clinical symptoms are:
(1) Upper extremity symptoms: pure motor disturbance, pure sensory disturbance, or simultaneous sensory and movement disturbance in one or both upper limbs.

(2) Lower extremity symptoms: neurological dysfunction in one or both lower extremities.

(3) Hemisymptoms: sensorimotor disturbances in the upper and lower extremities on the same side.

(4) Cross symptoms: sensory or motor disturbances in one upper limb and the opposite lower limb.

(5) Extremity symptoms: neurological dysfunction in the extremities.

(6) Head symptoms: mainly manifested as headache, dizziness or scalp pain.

(7) Symptoms of the sacral nerve: manifested as urination or defecation disorders.

3. Vertebral artery cervical spondylosis is mainly caused by compression of the vertebral artery and brain tissue ischemia and hypoxia, which cause corresponding symptoms.

(1) Typical symptoms of vertebral artery insufficiency: episodic vertigo, diplopia with nystagmus, sometimes nausea, vomiting, and even tinnitus and deafness.

(2) Cataplexy.

(3) Brainstem symptoms: numbness of limbs, paresthesia, falling to the ground while holding objects.

(4) Occipital throbbing pain.

(5) Episodic coma.

4. Sympathetic cervical spondylosis mainly produces symptoms due to compression of the sympathetic nerves in the neck.Depending on the specific oppression situation, the following two situations can occur.

(1) Symptoms of sympathetic nervous excitement:
① Headache or migraine, heavy head, dizziness, occipital pain or neck pain.

② Enlarged eye fissures, blurred vision, dilated pupils, eye socket swelling and pain, dry eyes, and Venus in the field of vision, etc.

③Rapid heartbeat, cardiac rhythm disorder, precordial pain and elevated blood pressure.

④ The limbs are afraid of cold and cold, the local temperature is low, or the limbs feel itchy when they are cold, followed by redness and swelling or aggravated pain.

⑤ sweating disorder.

(2) Symptoms of sympathetic inhibition: dizziness, drooping eyelids, tearing, nasal congestion, bradycardia, low blood pressure, increased gastrointestinal motility or belching.

5. Mixed cervical spondylosis In several types of cervical spondylosis, two or more types appear together.

([-]) Diagnosis

There are two diagnostic criteria for cervical spondylosis:
1. If the clinical manifestations and X-ray findings are consistent with cervical spondylosis, the diagnosis can be made.

2. Those with typical clinical manifestations of cervical spondylosis but no abnormality on X-ray films should be diagnosed as cervical spondylosis on the premise of excluding other diseases.However, those who have no clinical complaints and signs but have abnormalities on X-ray films should not be diagnosed as cervical spondylosis.Positive findings on radiographs can be described.

The specific type of cervical spondylosis can be judged according to the specific clinical manifestations.

([-]) Treatment

At present, there are many methods for treating cervical spondylosis at home and abroad, which can be divided into two categories: non-surgical therapy and surgery.In my country, a variety of methods combining traditional Chinese and Western medicine are used to treat cervical spondylosis. Most patients can obtain better curative effect through non-surgical therapy, which is very popular because it costs less and causes less pain.Only in a very small number of cases, the symptoms of nerve, blood vessel, and spinal cord compression are progressively aggravated, or recurrent, seriously affecting work and life, and surgical treatment is required.Non-surgical treatments include manual therapy, traditional Chinese and Western medicine, neck collar, neck pillow, cervical traction, partial closure, physical therapy, acupuncture and functional exercises, etc.; surgical treatments include posterior laminectomy and decompression, and anterior discectomy Surgery, intervertebral bone grafting, bone spur resection, vertebral artery decompression, etc.During treatment, an appropriate method should be selected according to the patient's condition.

([-]) Prevention

There is no radical cure for cervical spondylosis, and the only way to relieve symptoms is through treatment.Therefore, its prevention is extremely important, as follows:
1. Read books about cervical spondylosis and master the use of scientific means to prevent and treat diseases.

2. Maintain an optimistic spirit, establish the idea of ​​struggling with the disease, cooperate with the doctor to treat, and reduce the recurrence.

3. Strengthen the exercise of the muscles of the neck and shoulders. During work or spare time, do forward flexion, extension and rotation of the head and both upper limbs, which can not only relieve fatigue, but also make the muscles develop and strengthen the toughness, which is beneficial to the neck. It improves the stability of the spine and enhances the ability of the neck and shoulders to adapt to sudden changes in the neck.

4. Avoid the bad habit of sleeping with a high pillow. A high pillow can make the head bend forward, increase the stress of the lower cervical spine, and may accelerate the transformation of the cervical spine.

5. Pay attention to keep the neck and shoulders warm, avoid heavy objects on the head and neck, avoid excessive fatigue, and do not doze off when riding in the car.

6. Early and thorough treatment of neck, shoulder and back soft tissue strain to prevent it from developing into cervical spondylosis.

7. Avoid flashes and contusions when working or walking.

8. Long-term desk workers should change the head position regularly and do neck and shoulder muscle exercises on time.

9. Pay attention to the posture of the head, neck, shoulders and back. Do not tilt your head and shrug your shoulders. When talking or reading, you should look straight ahead.Keep the spine straight.

10. Traditional Chinese medicine believes that walnuts, cornus, rehmannia, black sesame, etc. have the function of nourishing the kidney and marrow. Taking a small amount reasonably can strengthen the muscles and bones and delay the deterioration of the kidneys and joints.

[-]. Point massage

([-]) Acupuncture therapy

1. Select acupoints Baihui, Fengchi, Tianzhu, Jianjing, Jianwaiyu.

2. Locate Baihui—at the intersection of the midline of the top of the head and the line connecting the two ear tips.Wind Pool—between the subtrochanteric depression of the occipital bone and the mastoid, between the trapezius muscle and the sternocleidomastoid muscle.Tianzhu—about 1.3 inches beside Yamen point.

Jianjing—the midpoint of the line connecting Dazhui Point and the acromion, at the height of the shoulder.

Jianwaiyu—3 cun below the spinous process of the first thoracic vertebra.

([-]) Self-massage
1. Use two fingers to pinch, rub, and rub the nuchal ligament and trapezius muscle respectively, for about 2 to 3 minutes, until local fever occurs.

2. Use the four fingertips of the right hand to apply gravity grasping and pulling on both sides of the spinous process of the cervical spine, and do it repeatedly for about 2 to 3 minutes.

3. Pinch the Fengchi points on both sides for about 1 minute.

4. Pinch the Hegu points on both sides (the back of the hand, the midpoint of the second metacarpal bone, the radial edge) for about half a minute.

5. The nails of the thumb and second index finger of both hands pinch the Shixuan point on the tip of the ten fingers of both hands for about 3 minutes each.

6.做头颈部前屈、后伸、左右旋转动作5～7遍，速度不宜太快，各约1～2分钟。

7. Hitting Baxie method: Stretch the five fingers of both hands naturally, with a distance of about 5 inch between the fingers, cross the two fingers, and collide with the roots of the fingers. 1-50 times.

Do the above methods 1 to 3 times a day, and you can also do the method of fighting the eight evils at any time when you are free. This method is more effective in eliminating the symptoms of hand numbness.

Periarthritis of the shoulder

An overview of the disease

([-]) Relevant knowledge

Frozen shoulder is the abbreviation of periarthritis of the shoulder. It is a disease based on the aseptic inflammation of the soft tissue around the shoulder joint and manifested as shoulder pain and shoulder joint dysfunction syndrome.If carefully analyzed, frozen shoulder can be divided into narrow and broad frozen shoulder.

1. Frozen shoulder in the narrow sense is the so-called "frozen shoulder".Frozen shoulder is named for the significant limitation of active and passive movement in all directions of the scapulohumeral joint, accompanied by shoulder pain.Most of them occur after middle age, and the peak incidence is between fifty and sixty years old. There is a saying of "fifty shoulders" in Chinese medicine.Roughly coincides with menopause in time.Approximately one out of every 60 people suffers from the disease every year, and the incidence rate of women is slightly higher than that of men. About 50% of patients with frozen shoulder on one side will also develop frozen shoulder on the opposite side within 12 to 40 years.Therefore, frozen shoulder is a disease that seriously affects the quality of life of middle-aged and elderly people.However, about 5% of patients have no obvious inducement before the onset of the disease, and the cause of pain and joint movement limitation cannot be found. We call this frozen shoulder primary frozen shoulder.There is a clear incentive called secondary frozen shoulder.

2. Generalized frozen shoulder also includes subacromial bursitis, supraspinatus tendonitis, rotator cuff disease, long head biceps tendinitis and tenosynovitis, coracoid process or coracohumeral ligamentitis, acromioclavicular arthritis, acromion Lower impingement syndrome and narrow frozen shoulder and other diseases.

([-]) Etiology and pathogenesis

1. Reduced activity of the braking shoulder joint is the main predisposing factor for frozen shoulder.Immobilization generally occurs after trauma or surgery.Such as shoulder or upper arm fracture, even forearm, wrist fracture after fixation reduces the activity of the shoulder joint can also cause scapulohumeral periarthritis.In addition, periarthritis of the ipsilateral shoulder joint can also be caused by cardiac surgery, thoracic surgery, female breast cancer surgery, and sometimes even hepatobiliary surgery.

2. Intrinsic lesions of the shoulder joint Degenerative diseases of the shoulder joint itself, especially local soft tissue degenerative changes, can cause frozen shoulder due to pain that limits the movement of the shoulder joint.The most common soft tissue degenerative diseases leading to frozen shoulder are tendonitis and tenosynovitis, followed by impingement syndrome and subacromial damage.These diseases can cause the occurrence of frozen shoulder due to the further formation of pathological changes such as tendon, rotator cuff, synovial bursa, joint capsule damage, adhesion, contracture.In addition, injuries to the shoulder, sometimes even minor injuries, are also very likely to be the cause of frozen shoulder.

3. Diseases in adjacent parts. The possibility of frozen shoulder is greatly increased in patients with cervical disease, and patients with frozen shoulder are often accompanied by a significant decline in lateral flexion and rotation of the ipsilateral cervical spine.Cervical spondylosis-induced frozen shoulder may be caused by shoulder pain or muscle spasm after spinal nerve root stimulation to reduce shoulder activity, or nervous system dysfunction in cervical spondylosis, especially autonomic nerve involvement.Therefore, it is necessary to be cautious when clinically diagnosing or determining whether frozen shoulder is caused by cervical spondylosis.Other nearby diseases include heart disease, pulmonary tuberculosis, and subdiaphragmatic diseases.

4. Endocrine system diseases Diabetes, hyperthyroidism or hypothyroidism and other endocrine system diseases are also closely related to frozen shoulder.The incidence of diabetic patients with frozen shoulder can reach 10-20%. The change of hypothalamus-pituitary-adrenal gland and gonadal axis during menopause may also be one of the inducing factors of frozen shoulder.

5. Nervous system diseases Patients suffering from neurological diseases such as hemiplegia and nerve paralysis have a higher incidence of frozen shoulder.This may be related to decreased muscle strength and reduced exercise, such as the incidence of frozen shoulder in Parkinson's disease patients as high as 12.7%.

6. Changes in immune function The occurrence of frozen shoulder is related to the autoimmune response induced by degenerative changes of tendon tissues such as supraspinatus tendon. After the age of 50, the supraspinatus tendon and other parts become significantly thinner, and focal necrosis occurs in the vascular supply-poor area at the insertion point of the tendon, which is very vulnerable to damage and inflammation.Local nonbacterial inflammation can produce foreign body cellular immune response, which gradually spreads to other parts of the rotator cuff and joint capsule, causing diffuse capsulitis.In some patients with frozen shoulder, the positive rate of human leukocyte-associated antigen HLA_B27, IgA, C-reactive protein and immune complex levels and other immune indicators are also relatively high, which may be related to the autoimmune response caused by fibrosis after soft tissue injury around the shoulder joint .

(End of this chapter)