Pago de premios

In many cases it is enough to needle the posterior or lateral neck muscles (splenius capitis, scalene muscles) for localized pain and also to obtain radiation effects. However, by needling a little deeper it is possible to reach the periosteum of the cervical articular column. This is a major ATA that is capable of influencing a wide range of symptoms in the upper half of the body as well as local neck problems (Russ et al., 1999).

Although this treatment is safe if done carefully, it requires a good knowledge of anatomy and should not be attempted in people with thick necks. In such cases, or if the acupuncturist is not confident about performing the treatment safely, ordinary needling of the musculature should be used instead. Note that the articular column is not the same as the transverse processes of the vertebrae; these are situated anterior to the column. It is essential to study the anatomy carefully before attempting this treatment and the acupuncturist should look at an articulated skeleton as well as at diagrams in books; as with most acupuncture treatments, practical instruction is essential before one undertakes it.

The treatment may be done with the patient sitting but it is easier to place them prone, with the head resting on the hands or on a pillow, as for needling GB20. The spine is then palpated at the C3 or C4 level. The tissues

Transverse process Superior articular process Inferior articular process Spinous process Posterior tubercle of transverse process Foramen transversarium Anterior tubercle of transverse process Body Pedicle Laminar

are compressed with the free hand and a fine needle is then inserted at about 45 degrees to the midline plane. The periosteum will be reached within a short distance (about 5 mm in a suitably thin patient) and it is pecked gently two or three times. If the periosteum has not been reached after the needle has penetrated to this depth, it indicates that the angle was incorrect and the needle has missed the articular column; no attempt to needle more deeply should be made. In obese patients or in men who are very heavily muscled, only the overlying tissues should be needled.

Mann, who first described this technique (Mann, 2000), uses it in a wide range of disorders and symptom complexes affecting the upper half of the body, and my experience of its efficacy agrees with his. I regard it as the best treatment to try for carpal tunnel syndrome, which often responds provided it is not too severe. It can also be used for autonomic disturbances of the hands, including Raynaud’s disease.

A woman in her 70s, a keen amateur bridge player, was unable to hold the cards because of pain in her hands, which she described as resembling hot swollen cushions. They were indeed red and swollen. She had consulted a neurologist and a rheumatologist without receiving any help. The main finding on examination, apart from the redness of her hands, was limitation of movement in her neck, presumably due to spondylosis. I therefore needled the cervical articular column bilaterally and also needled the interosseus muscles in her hands (this is described in Chapter 11). Within two or three treatments the pain in her hands had gone and their appearance had returned to normal. Although she continued to need treatment for her neck and lumbar spine in subsequent years (to which she always responded very well), she had no recurrence of the hand problem over a number of years.

The head and neck 97

Needling the cervical articular column can relieve the symptoms of mild vertigo or unsteadiness quite frequently seen in elderly patients. Such patients are often told they have vertebrobasilar artery insufficiency. This seems an unlikely explanation for their symptoms, since obstruction of the vertebral artery, which supplies the brain stem, would be more likely to cause unconsciousness than giddiness. There are several possible causes for this giddiness, but in many instances the probable explanation is disease of the facet joints in the neck. The innervation of these joints is closely connected with the vestibular apparatus in the brain stem and forms part of the proprioceptive balance mechanism. When this is disturbed, as it is by disease of the facet joints, this can give rise to abnormal information about body position when the patient turns his or her head. Needling the periosteum in this area, or failing that, needling the neck muscles, can give relief lasting for about 12 weeks each time it is done. However, it is unlikely to help in M´eni`ere’s disease or other kinds of vertigo, so it is important to take a detailed history; further investigations may be needed in some cases.

Tinnitus is normally unresponsive to acupuncture. However, I have seen occasional patients in whom the tinnitus came on after road traffic injuries in which the neck was violently stretched. In these cases there were trigger points in the neck muscles, and needling these eliminated the tinnitus. I have also seen one patient in whom needling the neck gave a temporary improvement in hearing. He was partially deaf as a result of blast exposure during the war. The acupuncture was being performed for neck symptoms, not deafness, but his wife noticed an improvement in his hearing, lasting for about four days after each treatment.