A Way to Avoid Muscular Fibrosis in the First Dorsal Interosseous Muscle after Acupuncture Injection Therapy

다국어 초록 (Multilingual Abstract)

Fibrosis of skeletal muscle following acupuncture is an iatrogenic disorder. The present case illustrates a patient with a unilateral fibrotic formation on a thumb muscle after acupuncture injection therapy with red sage. The patient in the present case was a counter-terrorism police officer with right-handedness; he noted a palpable nodule three months after injection therapy at his left first dorsal interosseous in which the acupuncture point LI4 (He Gu) is located. He also found a reduction in the strength of his left pinch grip that noticeably affected his left handgun marksmanship. However, being ambidextrous in single-hand pistol shooting is an essential requirement for counter-terrorism police officers. Based on the patient's medical history and claims, no underlying disease or trauma was found to be associated with his current complaint. During physical examination, a fibrotic formation in his left first dorsal interosseous muscle was visualized by using diagnostic ultrasound; also, as confirmed with dynamometry, the strength of his left pinch grip was significantly lower than that of the right counterpart. Because acupuncture injection therapy has three components, antiseptic practices, the mechanical action of syringe insertion, and the pharmacological effect of the sterile herb extract, any one of the components may have contributed to the present adverse event. The first dorsal interosseous muscle is small in dimension and rather vascular; thus, it is not an ideal site for intramuscular injection. When a clinician needs to treat a patient by performing acupuncture at the LI4 acupoint and injecting a herbal extract simultaneously, the clinician should only mechanically stimulate the LI4 acupoint while injecting the herbal medicine into the LI14 (Bi Noe) acupoint on the same meridian, the LI14 acupoint being located in the distal portion of the deltoid muscle and being fairly close to the universally agreed upon site on the upper arm for safe administration of an injection.

참고문헌 (Reference)

1 Adams D, "The safety of pediatric acupuncture: a systematic review" 128 (128): e1575-e1587, 2011

2 Copay AG, "The influence of grip strength on handgun marksmanship in basic law enforcement training" 24 (24): 32-39, 2001

3 Woo PC, "Relatively alcohol-resistant mycobacteria are emerging pathogens in patients receiving acupuncture treatment" 40 (40): 1219-1224, 2002

4 Ialongo C, "Phlebotomy, a bridge between laboratory and patient" 26 (26): 17-33, 2016

5 Soung DY, "Peroxynitrite scavenging activity of lithospermate B from Salvia miltiorrhiza" 55 (55): 1427-1432, 2003

6 Scully WF, "Injection-induced gluteus muscle contractures : diagnosis with the"reverse Ober test"and surgical management" 35 (35): 192-198, 2015

7 Incel NA, "Grip strength : effect of hand dominance" 43 (43): 234-237, 2002

8 Du W, "Drug safety surveillance in China and other countries: a review and comparison" 11 (11): 130-136, 2008

9 Chen HC, "Deltoid contracture : a case with multiple muscle contractures" 128 (128): 1239-1243, 2008

10 Ji Young Kim, "Antioxidant Potential of Dimethyl Lithospermate Isolated from Salvia miltiorrhiza (Red Sage) Against Peroxynitrite" 한국식품영양과학회 11 (11): 21-28, 2008

11 Zhang J, "Acupuncture-related adverse events: a systematic review of the Chinese literature" 88 (88): 915-21C, 2010