Upper Limb Acupuncture Points

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Introduction

Musculoskeletal injuries of the extremities are highly prevalent and place a significant burden on the society as well as the healthcare system.[1] In particular, upper extremity musculoskeletal injuries are the leading cause of disabling work-related injuries in USA and Canada.[2] In 2013, upper extremity "sprain" and "strain" type injuries accounted for 22.3% of all lost time to the Ontario Workplace Safety and Insurance Board[1]. Acupuncture is commonly utilised to treat musculoskeletal injuries of the extremities. [1] Its scientific credibility is still scrutinised in orthodox medicine, consequently, translation of acupuncture into clinical practice is limited.[3] However, physiotherapists in particular continue to utilise acupuncture as an adjunct treatment and have been for the past 40 years.[4]

Location & Use

Pericardium Meridian

The pericardium channel consists of nine acupuncture points. The channel originates from the chest lateral to the nipple and travels upwards to the axillary fossa. It then descends down the anterio-medial aspect of the arm to the cubital fossa and continues between Palmaris Longus and Flexor Carpi Radialis. The channel terminates at the tip of the third digit.[5][6]

Used as an antiemetic point especially during pregnancy and post-operative pain.[5][6]

Heart Meridian

The Heart Meridian consists of nine acupuncture points. The channel originates from the centre of the axilla and descends through the anterio-medial aspect of the arm to the pisaform region, terminating at the tip of the little finger.[5][6]

Used for forearm/hand paresthesia and pain, tremors, elbow injuries and neck stiffness.[5][6]

Lung Meridian

The Lung Meridian consists of eleven acupuncture points. The channel originates on the lateral chest and descends through the anterio-medial region of the upper arm. It crosses over to the lateral aspect of the arm at the cubital fossa and continues to the radial side of the wrist, terminating at the tip of the thumb.[5][6]

Used for facial paralysis, jaw pain, elbow, shoulder and thoracic injuries and local soft tissue injuries of the wrist.[5]

Triple Energiser/Burner

The triple energiser/triple burner consists of 23 acupuncture points. The channel originates from tip of the ring finger and ascends through the posterior aspect of the arm until it reaches the shoulder. It terminates at the outer end of the eyebrow. [5][6]

Used for facial pain, cervical spine and shoulder restricted range of motion, shoulder arthritis and arm/elbow pain.[5]

Small Intestine

This channel consists of 19 acupuncture points. It originates at the tip of the 5th digit and ascends along the ulnar border to the scapula. Here it zig zags across the scapula and terminates at the anterior aspect of the ear.[5][6]

Used for motor function impairment of the arm, lumbar/cervical spine pain or stiffness, arm pain or weakness[5]

Large Intestine

This Meridian consists of 20 acupuncture points. It originates at the tip of the 2nd digit and ascends along the lateral aspect of the arm to the tip of the shoulder. It continues travelling upwards to terminate at the opposite side of the face.[5][6]

Used during difficult labour, arm pain, headaches and facial paralysis, motor function impairment of the upper limb.[5]

Common conditions treated

Frozen Shoulder

Although there is limited evidence on traditional acupuncture and frozen shoulder, The evidence available suggests that acupuncture or electro-acupuncture in combination with physiotherapy or alone may be effective in improving function and joint range of motion and reducing pain in patients with frozen shoulder/adhesive capsulitis when compared to physiotherapy alone.[3]

The average number of treatments consisted of 4-10 sessions over 4-7 weeks. Duration of treatments varied between 15-30 minutes.[3]

Lateral Epicondylalgia

Low to moderate quality of evidence suggests traditional acupuncture provides short term reductions in pain and improvements in function and strength, compared to sham/placebo and ultrasound.[3]

The average number of treatments consisted of 10 sessions over 2-6 weeks. Duration of treatments varied between 20-30 minutes.[3]

Carpal Tunnel Syndrome

In patients with mild to moderate Carpal Tunnel Syndrome, short term acupuncture treatment over four weeks was reported as effective as short-term low dose steroid. Therefore, it was concluded as an safe alternate choice of treatment for patients who are unable to tolerate oral steroid medications.[7]

Post-operative nausea and vomiting

Stimulation of wrist acupuncture, pericardium 6 (PC6) is likely to be beneficial for patients with a high base-line risk of post surgical nausea and vomiting. [8]

Shoulder Impingement Syndrome (SIS)

Exercise combined with exercise based therapies such as acupuncture is recommended as a safe treatment method in patients with early SIS.[9]

Meridians of the Upper Extremity

Anterior: Posterior:
Anterior arm 1.png
- Pericardium Channel (PC)

- Heart (HE)

- Lung (Lu)

Triple Energiser.png
- Triple Energizer/Burner (TE/TB)
Medial: Lateral:
Medial Arm.png
-Small Intestine (SI)
Large Intestine channel.png
-Large Intestine (LI)

Table 1. Meridian channels of the upper extremity [5]

References

  1. 1.0 1.1 1.2 Cox J, Varatharajan S, Côté P, Optima Collaboration. Effectiveness of Acupuncture Therapies to Manage Musculoskeletal Disorders of the Extremities: A Systematic Review. Journal of Orthopaedic & Sports Physical Therapy [Internet]. 2016 Apr [cited 2020 Sep 20];46(6):409-429. Available from https://www.jospt.org/doi:10.2519/jospt.2016.6270
  2. Van Eerd D, Munhall C, Irvin E, et al. Effectiveness of workplace interventions in the prevention of upper extremity musculoskeletal disorders and symptoms: an update of the evidence. Occupational and Environmental Medicine. 2016 Nov [cited 2020 Sep 20];73(1):62-70. https://pubmed.ncbi.nlm.nih.gov/doi:10.1136/oemed-2015-102992
  3. 3.0 3.1 3.2 3.3 3.4 The International Centre for Allied Health Evidence. Effectiveness and Safety of Acupuncture Interventions for the Treatment of Musculoskeletal Conditions. Adelaide: University of South Australia;2018 [cited 2019 Sep 19]. 501p. Available from https://www.acc.co.nz/assets/research/2b0c243f75/acupuncture-musculoskeletal-conditions-review.pdf
  4. Millet R. Getting to the Point. Frontline, 2011, March, 17:5
  5. 5.00 5.01 5.02 5.03 5.04 5.05 5.06 5.07 5.08 5.09 5.10 5.11 5.12 Macdonald A. Acupuncture Main Channels or Meridians: Visible Surfaces. Int J Complement Alt Med 2017;7:00233.
  6. 6.0 6.1 6.2 6.3 6.4 6.5 6.6 6.7 The Chiropractic Resource Organization. Atlas of Acupuncture Points [Internet]. Pottstown, PA: Acupuncture Products.com; 2007. Available from https://chiro.org/acupuncture/ABSTRACTS/FILES/Acupuncture_Points.pdf
  7. Yang C, Hsieh C, Wang N, Li T, Hwang K, Yu S, et al. Acupuncture in Patients With Carpal Tunnel Syndrome: A Randomized Controlled Trial, The Clinical Journal of Pain. 2009 May; 25 (4):327-333
  8. Lee A, Fan LT. Stimulation of the wrist acupuncture point P6 for preventing postoperative nausea and vomiting. Cochrane Database Systematic Reviews [Internet]. 2009 [cited 2020 Sep 20];(2). Available from https://pubmed.ncbi.nlm.nih.gov/doi:10.1002/14651858.CD003281.pub3
  9. Dong W, Goost H, Lin XB, et al. Treatments for shoulder impingement syndrome: a PRISMA systematic review and network meta-analysis. Medicine (Baltimore) [Journal on the Internet]. 2015 Mar [2016 Jan; 2020 Sep];94(10):e510.