This post will discuss hand and finger pain, especially along the Large Intestine channel distribution. This will be relevant to pain
associated with osteoarthritis and/or pain associated with myofascial
trigger points referrals. We will also look at how certain muscle
referral patterns can overlap and combine to increase the amount of
pain in a particular region. In this case, we will examine pain in
the LI-4 – LI-1 region, which can be associated with the first
interosseous muscle, the extensor carpi radialis longus, the
brachioradialis, the anterior scalenes, and often a combination of
these muscles.
The dorsal
interossei originate from the two adjacent metacarpal bones and
insert at the proximal phalanx into the tendinous expansion, which is
a fibrous branching of the extensor digitorum tendon.1,2
These intrinsic hand muscles flex the MCP joint, extend the
interphalangeal joint, and abduct the phalanges. Heberden's nodules
at the distal interphalangeal joint, often identified with
osteoarthritis, may be associated with trigger points in the interossei muscles.3 The nodules are sometimes caused by
contracture and enlargement of the soft tissue associated with the
tendinous expansion on the posterior aspect of the phalanges.2 There are some indications that trigger point activity in the muscles
attaching to this tendinous expansion, especially the dorsal
interossei, contribute to the progression and pain associated with
Heberden's nodules.3
 |
| Diagram of the finger tendons and ligaments extracted from Alexander2 |
Regardless of
whether Heberden's nodules are present, each dorsal interosseous
muscle refers pain primarily to that side of the finger to which the
interosseous muscle attaches.3 In particular, the first
interosseous muscle can be a significant generator of pain, primarily
to the radial side of the second phalanx, but also deeply into the
dorsum and palm of the hand. This muscle is best accessed from its
motor point location, which is located at the extrapoint M-UE-50
(Shangbaxie) approximately in
the region of LI-3. All of the dorsal interossei motor points
are located at the Shangbaxie.4
Needle technique for
the first interosseous muscle involves locating the head of the second
metacarpal and palpating along the bone in a proximal direction until
a node is felt (this is fairly close to the head of the metatarsal).
This node is the muscle
belly of the first interosseous. The guide tube can be placed
immediately distal to this node
and the needle can be advanced in a proximal and medial direction
into the belly of the first dorsal interosseus muscle. A strong da qi
sensation will be felt, and often a muscle fasciculation will be
illicited once the needle makes contact with the point. This is seen at the end of the video below as the finger suddenly abducts.
 |
| Fig. 3 |
* Jingbi should
only be needled by those with appropriate clinical training
and experience, due to its proximity to the pleural
dome and the risk of a pneumothorax.
References:
1.
Chaitow, L., DeLany, J., & Chaitow, L. (2008). Shoulder, arm, and
hand. In Clinical
application of neuromuscular techniques: Volume 1
(2nd ed., pp. 529-530). Philadelphia, PA: Churchill Livingstone
Elsevier.
2.
Alexander, C. J.
(1999). Heberden's and Bouchard's nodes. Annals
of the Rheumatic Diseases,
58(11),
675-678.
3.
Simons,
D. G., Travell, J. G., Simons, L. S., & Travell, J. G. (1999).
Interosseous muscles of the hand, lumbricals, and abductor digiti
minimi. In Travell
& Simons' myofascial pain and dysfunction: The trigger point
manual (2nd
ed., pp. 786-793). Baltimore: Williams & Wilkins.
4.
Callison,
M. (2007). Wrist and fingers. In Motor
point index: An acupuncturist's guide to locating and treating motor
points
(p. 90). San Diego, CA: AcuSport Seminar Series LLC.
 |
 |
 |
 |
 |