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J Acupunct Res > Volume 30(5); 2013 > Article
Kim, Noh, Kim, Yang, Lee, and Kim: Clinical Study on the Case of Patient with Iatrogenic Brachial Plexus Injury after Cervical Lymph Node Biopsy: A Case Report※
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Abstract

Objectives:

The purpose of this study is to report the effect of Korean medicine treatment on a patient with brachial plexus injury.

Methods:

The patient with symptoms of pain and dysesthesia on right forearm and hand was treated with acupuncture treatment, herbal medicine, moxibustion and physical treatment. Improvement of the patient`s symptoms was evaluated by Hepatic dullness sound, NRS, VAS, SF-36 bodily pain, grip strength.

Results:

After 42 days of treatment, NRS score significantly decreased. VAS score, SF-36 bodily pain and grip strength showed moderate improvement.

Conclusions:

This results suggest that Korean medicine treatment may be effective in reducing the symptoms of brachial plexus injury.

Fig. 1.
Changes of SF-36 bodily pain
acupunct-30-5-21-f1.gif
Fig. 2.
Changes of VAS
acupunct-30-5-21-f2.gif
Fig. 3.
Changes of NRS
acupunct-30-5-21-f3.gif
Table 1.
Comparison of CMAPs
Nerve and site Lt Rt
Latency(ms) Amplitude(mV) Latency(ms) Amplitude(mV)
Median Wrist 2.4 12.3 2.3 5.6
Elbow 5.9 12.3 5.9 5.3
Ulnar Wrist 2.4 10.0 2.2 7.8
Below elbow 5.5 7.6 5.3 7.5
Radial Forearm 1.4 4.4 1.4 4.2
Lateral brachium 3.4 3.5 3.2 3.8
Spiral groove 4.5 3.5 4.3 3.8
Musculocutaneous 3.9 5.4 4.3 0.9
Axillary Supraclavicular fossa 2.8 7.2 3.5 3.3
Table 2.
Comparison of SNAPs
Nerve and site Lt Rt
Latency(ms) Amplitude(mV) Latency(ms) Amplitude(mV)
Median Wrist 2.8 34 2.8 26
Ulnar Wrist 3.1 31 2.8 33
Radial Forearm 2.5 28 2.3 28
Lateral cutaneous Elbow 2.3 27 2.9 6
Table 3.
Revised STandards for Reporting Intervention in Clinical Trials of Acupuncture(STRICTA)
1. Acupuncture rationale
1a) Style of acupuncture Soyangin Taegeuk acupuncture (Korean)
1b) Reasoning for treatment provided Based on historical context and literature sources
1c) Extent to which treatment was varied Fixed formula
2. Details of needling
2a) Number of needle insertions per subject per session 6 / 14
2b-1) Names of points used HT3, SP9, KI3, LI4, LI11, ST36 / + LI11, LI10, LI4, TE5, Ex-UE9(Palsa)
2b-2) Uni/bilateral Unilateral
2c) Depth of insertion About 1.5 cm
2d) Response sought De-qi sensation
2e) Needle stimulation Manual stimulation ; rotation with deep breathing / +EA
2f) Needle retention time 20 minutes
2g) Needle type 0.25×40 mm, Dong-bang stainless steel disposable acupuncture needle
3. Treatment regimen
3a) Number of treatment sessions 50
3b) Frequency and duration of treatment sessions Twice daily for 25 days
4. Other components of treatment
4a) Details of other interventions administered to the acupuncture group Dry-cupping, ICT, indirect moxibustion, herbal decoction in accordance with the patient's condition
4b) Setting and context of treatment, including instructions to practitioners, and information and explanations to patients No specific setting or context
5. Practitioner background
5) Description of participating acupuncturists Specialist of acupuncture and moxibustion medicine with more than 30 years of experience
6. Control or comparator interventions No control intervention
Table 4.
Changes of Grip Strength
Grip strength (lbs) 1st Adm 2nd Adm
Admission Discharge Admission Discharge
Rt 8 11 14 16
Lt 31 35 34 30
Deficit Rt −74 % Rt −71 % Rt −58 % Rt −44 %

IV. References

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3. Korean Acupuncture & Moxibustion Society Textbook Compilation Committee. The Acupuncture and Moxibustion Medicine. Seoul: Jipmoondang. 2012:613.

4. Lee SW, Shin YW, Jung HR, Cha YY. A Case Report on the Brachial Plexus Injury patient caused by Traffic Accident. J of Oriental Rehabilitation Medicine. 2002;12(2):199–208.

5. Choi YJ, Shin HY, Kim SJ, et al. Clinical Study on the Case of Patient with Traumatic Brachial Plexus Injury. J of Korean Acupuncture & Moxibustion Medicine Society. 2012;29(2):99–106.

6. Chang DH, Kang YK, Cho SW, Lee YS. A Clinical case study on postural brachial plexus injury with whole body articulation-mechanics technique. J of Korea Chuna manual medicine for spine & nerves. 2010;5(2):49–55.

7. Lee HJ, Nam SS, Lee YH. The study of pain and functional disability scales for low back pain. J of Korean Acupuncture & Moxibustion Medicine Society. 2002;19(2):137–148.

8. Kim CK, Jin CW, Jung SW, Lee JH. Brachial Plexus Injury as a Complication of Arthroscopic Bankart Repair. J Korean Orthop Assoc. 2009;44(6):675–9.
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9. Kim SS, Chun CH, Kim DC, Chae SU. Electrical Stimulation for Early Axonal Regeneration after Nerve Surgery in Brachial Plexus Injury. J Korean Orthop Assoc. 1998;33(3):501–7.
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11. Yoo MC, Chung DW, Han JS, Lee KY. Surgical Treatment of Brachial Plexus Injury. J Korean Orthop Assoc. 1988;23(4):1165–73.
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12. Baek GH, Chung MS, Seo JB, Park JS, Park YB, Jun DS. Comparison of spontaneous recovery and nerve surgery in brachial plexus injury. J of Korean Microsurgery. 1996;5(1):137–46.

13. Kim JK, Chae H, Kim KH, Noh SH. Clinical Observation on Effectiveness of Taegeuk Acupuncture for Patients in Sub-health Status: a Case Series. J of Korean Acupuncture & Moxibustion Medicine Society. 2011;28(4):111–7.

14. Kim JK. Clinical opinion of Taegeuk Acupuncture treatment by Sasang constitutional medicine. J of Korean Acupuncture & Moxibustion Medicine Society. 2011;28(2):69–73.

15. Kim NS, Kim SJ, Ryu HJ, Nam SS, Kim YS. Effects of Taegeuk Acupuncture on the Autonomic Nervous System by Analyzing Heart Rate Variability in Soyangin. J of Korean Acupuncture & Moxibustion Medicine Society. 2011;29(3):81–8.



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