Case Report

Split Viewer

Journal of Acupuncture Research 2023; 40(4): 382-388

Published online November 30, 2023

https://doi.org/10.13045/jar.2023.00157

© Korean Acupuncture & Moxibustion Medicine Society

Efficacy of Integrated Korean Medicines in the Treatment of Partial Triangular Fibrocartilage Complex Tears: A Case Report

Jae-Joon Ha , Myeong-Yeol Yang , Ji-Sun Kim , Hong-Wook Choi , Gyu-Bin Lee , Dong-Ju Yoon , Dong-Jin Kim , Do-Young Kim

Department of Acupuncture and Moxibustion, Jaseng Hospital of Korean Medicine, Seoul, Korea

Correspondence to : Jae-Joon Ha
Department of Acupuncture and Moxibustion, Jaseng Hospital of Korean Medicine, 536 Gangnam-daero, Gangnam-gu, Seoul 06110, Korea
E-mail: waterjoon@naver.com

Received: July 20, 2023; Revised: August 22, 2023; Accepted: September 8, 2023

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

The triangular fibrocartilage complex (TFCC) is crucial for stabilizing the ulnar side of the wrist but can be partially torn due to degenerative changes, falling, or sudden injuries. However, only a few studies have focused on the use of Korean medicine treatments for TFCC-related wrist pain. This case report presents the successful outcomes of integrated Korean medicine treatment in a patient with a partial TFCC tear. The diagnosis was confirmed via magnetic resonance imaging, which revealed the tear. Subsequently, the patient received integrated Korean medicine treatments. The assessment of the pain scale scores revealed a significant reduction in wrist pain and an improvement in daily life activities. Based on the findings of this study, integrated Korean medicine treatments have been proven to be an effective treatment option for patients with a partial TFCC tear. However, further research is needed to determine the potential benefits and mechanisms of these treatments in managing TFCC-related wrist pain.

Keywords Korean traditional medicine; Pharmacopuncture; Single-case study; Triangular fibrocartilage complex

Triangular fibrocartilage complex (TFCC) is a complex structure positioned between the distal ulna and the carpal bones [1], with components, such as the articular disk; a few ligaments; meniscus homologue; and extensor carpi ulnaris (ECU) tendon sheath [2,3]. Moreover, the complex anatomical structures and the complex load transmission kinetics in this area make it vulnerable to injuries [4].

TFCC injury is a common cause of ulnar lateral pain in the wrist with limited range of motion (ROM), swelling, and wrist instability. The TFCC serves as a stabilizing structure, bearing almost 20% of the axial load on the forearm, and plays a crucial role in the supination-pronation motion [5,6].

Damage to the TFCC can be categorized into two main causes: (1) traumatic and (2) degenerative. Traumatic causes include occupations that require the repetition of supination-pronation movements [7], and trauma, such as traffic accidents or falls. Degenerative changes can also lead to TFCC injuries.

TFCC injury management involves modifying daily activities and avoiding exercises that strain the wrist joints to prevent pain and further deterioration. Temporary splints or casts may also be used in conjunction with the use of nonsteroidal anti-inflammatory drugs [4].

Currently, no study has yet investigated the efficacy of integrated Korean medicine treatments for partial TFCC tears. This case report presents the outcomes of a patient who underwent integrated Korean medicine treatments at the Jaseng Hospital of Korean Medicine.

1. Medical history

This study included a 37-year-old woman who sought treatment for wrist and forearm pain in July 2022. She experienced intense pain in the right wrist, which occasionally extended to the elbow. She had not taken any medication, had no family history of wrist pain, did not have any underlying medical conditions, and had not undergone any previous treatments for wrist pain prior to visiting the Jaseng Hospital of Korean Medicine. Her initial visit to the hospital occurred on August 15, 2022, and she was then admitted on the same day. After receiving 14 days of integrated Korean medicine treatments, she was discharged on August 28, 2022.

2. Magnetic resonance imaging and radiography

The X-ray scans of the patient’s wrists and elbows were conducted on August 15, revealing no significant findings (Fig. 1). However, the magnetic resonance imaging of the right wrist on August 24 revealed a high signal in the proximal/distal laminae of the TFCC in both the coronal and axial views (Fig. 2). Based on these results and the absence of other joint diseases, the patient was diagnosed with pain attributed to partial TFCC tear.

Fig. 1. X-ray of the right wrist (August 15, 2022).
Fig. 2. Magnetic resonance imaging coronal view/axial view of the right wrist (August 24, 2022). High signal in the proximal/distal laminae of the triangular fibrocartilage complex (yellow arrows).

3. Treatment

1) Acupuncture/electroacupuncture therapy

For acupuncture therapy, disposable standardized (0.25 × 30 mm) and sterilized stainless-steel needles were utilized. The needles were inserted at five specific points on both wrists: LI5, TE4, SI5, TE5, and LI11, and additionally at the tender points of the ECU. These points were mainly used in patients with wrist pain, and in this case, the patient complained of pain on the ulnar side and the radial side, but also on the radial side, so the areas were treated together. Electroacupuncture therapy was also performed twice daily for 10 minutes, with a frequency of 2 Hz at the right wrist’s LI5 and SI5 points and the ECU’s tender points.

2) Pharmacopuncture therapy

The patient had Shinbaro 2 pharmacopuncture injections twice a day. A disposable needle (29 gage × 13 mm) and a 1-mL insulin syringe were used. Shinbaro 2 was administered at a depth of 0.5 cm using a dosage of 0.2 mL per point (Table 1).

Table 1 . Pharmacopuncture (Shinbaro 2)

Pharmacopuncture prescriptionHerbal medicine components (g/mL)AdministeredDaily dose
SJ3-SBO Shinbaro 2Paeonia lactiflora (0.0027)
Ostericum koreanum (Max) Kitagawa (0.0013)
Aralia continentalis (0.0013)
Eucommiae Cortex (0.0013)
Achyranthis Radix (0.0013)
Rhizoma Cibotii (0.0013)
Radix Ledebouriellae (0.0013)
Acanthopanacis Cortex (0.0013)
Scolopendra subspinipes mutilans (0.0013)
Day 1–141 vial (2 mL/vial)

3) Herbal medicine

The patient was administered with Shinbaro herbal medicine three times a day. The prescribed herbal medicines included Chungpajeon-H, Shinkyungbaro-hwan, and Gwanjeolgo, which have been known for their ability to suppress joint destruction, protect the cartilages, and promote regeneration effects (Table 2).

Table 2 . Herbal medicine prescriptions

Herbal prescriptionHerbal medicine components (g/pouch)AdministeredDaily dose
Chungpajeon-HAcanthopanacis Cortex (5.000)
Eucommiae Cortex (5.000)
Ledebouriellae Radix (5.000)
Achyranthis Radix (5.000)
Cibotii Rhizoma (5.000)
Atractylodis Rhizoma (2.500)
Amomi Semen (2.500)
Geranium thunbergii (2.500)
Zingiberis rhizoma (1.250)
Ledebouriellae Radix (0.250)
Glycyrrhiza uralensis (1.667)
Lasiosphaera seu Calvatia (7.500)
Day 1–143 times/d
Shinkyungbaro-hwanPoria cocos (Schw.) Wolf (1.320)
Ginseng Radix Alba (0.692)
Achyranthes bidentata Bl. (0.112)
Asini Gelatinum (0.029)
Rhizoma Cibotii (0.310)
Atractylodis Rhizoma Alba (0.310)
Aconiti Lateralis Radix Preparata (0.086)
Cinnamomi Cortex (0.054)
Zingiberis Rhizoma (0.032)
Piperis Longi Fructus (0.032)
Cinnamomi Ramulus (0.021)
Day 1–143 times/d
GwanjeolgoRehmannia glutinosa (3.268)
Wolfiporia extensa (1.634)
Apis cerana Fabricius (1.634)
Ginseng Radix Alba (0.817)
Achyranthes bidentata (0.204)
Collas corii asini (0.102)
Cervus nippon Temminck (0.340)
Day 1–143 times/d

4) Cupping therapy

The patient underwent cupping therapy twice daily for 5 minutes to increase blood circulation and relieve pain.

5) Chuna therapy

Chuna therapy was performed once daily specifically for the right wrist. This therapy aims to increase the space within the wrist joint, which involves shaking the wrist for approximately 2 minutes to restore ROM and relieve pain.

4. Assessments

1) Numeric rating scale

The numeric rating scale (NRS) was used as the primary tool to quantify the patient’s subjective pain. Although NRS is difficult to completely exclude subjectivity, it is widely used due to its simplicity. Once a day, the patient was requested to choose a single number between 0 and 10 that most accurately reflected their current level of pain, with 0 representing no pain and 10 representing the most severe imaginable pain [8].

2) Modified Mayo Wrist Score

The Modified Mayo Wrist Score (MMWS), which is a comprehensive assessment tool for the carpal joint, was used to determine the patient’s progress [1]. This evaluation system comprised four items: pain (25 points), satisfaction (25 points), ROM (25 points), and grip strength (25 points). The total score ranges from 0 to 100 points, wherein higher scores indicate better outcomes.

3) European quality of life 5-dimensions

The European quality of life 5-dimensions (EQ-5D) questionnaire is a widely used tool in healthcare to assess health-related quality of life [9]. The values on the scale range from -1 point, which indicates a worse health state than death, to 1 point, which indicates full health. The EQ-5D consists of five dimensions: usual activities, mobility, pain/discomfort, self-care, and anxiety/depression. The patient’s EQ-5D score was measured upon hospitalization, one week later, and on the day of discharge.

4) ROM and special provocative test

ROM was assessed to evaluate the joint’s mobility. Specifically, measurements were taken for wrist flexion, extension, and lateral bending movements. The ROM assessments were conducted upon hospitalization, 1 week later, and on the day of discharge. Moreover, an ulnocarpal stress test was performed to check for any potential underlying diseases [10].

5. Progress note

The patient’s NRS score indicated a gradual decrease during her hospital stay from 6 points upon admission to 5 points after 2 days, 4 points at 6 days, 3 points at 11 days, and 2 points at the time of discharge (Fig. 3). Moreover, the MMWS showed noticeable improvement, starting at 60 upon admission, increasing to 80 after one week, and reaching 95 at the time of discharge (Fig. 4). The patient’s EQ-5D score also showed improvement, with a score of 0.405 upon admission, 0.639 after one week, and 0.829 at the time of discharge (Fig. 5). The ROM test revealed gradual recovery over the course of the patient’s hospitalization (Table 3). Importantly, no adverse reactions were reported during the patient’s hospital stay.

Table 3 . Range of motion and special provocative tests

Range of motionSpecial test
Flexion (0–80)Extension (0–70)Ulnar deviation (0–30)Radial deviation (0–20)Ulnocarpal stress test
Rt.Lt.Rt.Lt.Rt.Lt.Rt.Lt.Rt.Lt.
22.08.154080407010301020(-)(-)
22.08.227080707015302020(-)(-)
22.08.288080707030302020(-)(-)

Rt., right; Lt., left.


Fig. 3. Changes in the numeric rating scale (NRS) pain scores of the right wrist.

Numerous case reports and systematic reviews have investigated partial TFCC tears. However, the application of traditional Korean medicine treatment strategies has not been further studied. In this case, a combination of Korean medicines improved pain, physical function, and the quality of life. Various types of musculoskeletal pain were successfully treated with acupuncture and electroacupuncture therapy, which are known for their efficacy and safety [11,12].

Pharmacopuncture therapy, which uses mechanical and chemical stimulation, involves the combination of traditional acupuncture and herbal medicine. Moreover, acute and chronic musculoskeletal pain and disorders are commonly treated with pharmacopuncture therapy [13]. Shinbaro, a purified extract obtained by mixing six herbal medicines, has been found to treat inflammation [14] and facilitate nerve and cartilage regeneration [15].

During the patient’s hospitalization, she was administered with Chungpajeon-H and Shinkyungbaro-hwan 3 times a day. These are unique herbal medicines for musculoskeletal inflammatory diseases that are used at the Jaseng Hospital of Korean Medicine and are widely known for their anti-inflammatory and neuroregenerative effects [15,16]. Notably, Chungpajeon-H has exhibited potent anti-inflammatory and neuropreservative effects in vivo and in vitro [17]. Furthermore, the patient was administered with Gwanjeolgo, which has been found to effectively suppress joint destruction and provide remarkable cartilage protection, regeneration, and pain relief [18].

The patient also underwent cupping therapy twice daily, which is a treatment method used to improve blood circulation, and speed up recovery [19,20]. Chuna therapy, which is performed once a day, is used to increase the space within the wrist joint and involves gentle shaking motions.

Despite the strengths of this study, several limitations were considered. First, this study only included one patient, which resulted in a relatively low level of evidence. Second, it was not determined whether the patient’s improvement was attributed to the treatments performed during hospitalization, as this study did not include a control treatment. Nevertheless, the findings of this case report are significant as this is the first study to confirm the positive outcomes of integrated Korean medicines for wrist pain caused by partial TFCC tears. The results suggest that integrated Korean medicine treatments may benefit patients with partial TFCC tears. However, further research is needed to confirm these findings.

In conclusion, this case report investigated the efficacy of integrated Korean medicine treatments in alleviating symptoms and enhancing functionality in individuals with partial TFCC tears. They have been shown to effectively reduce pain and improve overall function. Furthermore, these findings suggest that they could be a suitable therapeutic choice for patients diagnosed with partial TFCC tears.

Conceptualization: JJH, MYY. Formal analysis: JJH, DJK, DYK. Investigation: JJH, GBL, DJY. Methodology: JJH, JSK. Writing – original draft: JJH, HWC. Writing – review & editing: All authors.

The patient’s medical records and personal information were obtained from the Institutional Review Board (IRB) of the Jaseng Hospital of Korean Medicine (IRB file No. 2023-07-018).

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Article

Case Report

Journal of Acupuncture Research 2023; 40(4): 382-388

Published online November 30, 2023 https://doi.org/10.13045/jar.2023.00157

Copyright © Korean Acupuncture & Moxibustion Medicine Society.

Efficacy of Integrated Korean Medicines in the Treatment of Partial Triangular Fibrocartilage Complex Tears: A Case Report

Jae-Joon Ha , Myeong-Yeol Yang , Ji-Sun Kim , Hong-Wook Choi , Gyu-Bin Lee , Dong-Ju Yoon , Dong-Jin Kim , Do-Young Kim

Department of Acupuncture and Moxibustion, Jaseng Hospital of Korean Medicine, Seoul, Korea

Correspondence to:Jae-Joon Ha
Department of Acupuncture and Moxibustion, Jaseng Hospital of Korean Medicine, 536 Gangnam-daero, Gangnam-gu, Seoul 06110, Korea
E-mail: waterjoon@naver.com

Received: July 20, 2023; Revised: August 22, 2023; Accepted: September 8, 2023

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

The triangular fibrocartilage complex (TFCC) is crucial for stabilizing the ulnar side of the wrist but can be partially torn due to degenerative changes, falling, or sudden injuries. However, only a few studies have focused on the use of Korean medicine treatments for TFCC-related wrist pain. This case report presents the successful outcomes of integrated Korean medicine treatment in a patient with a partial TFCC tear. The diagnosis was confirmed via magnetic resonance imaging, which revealed the tear. Subsequently, the patient received integrated Korean medicine treatments. The assessment of the pain scale scores revealed a significant reduction in wrist pain and an improvement in daily life activities. Based on the findings of this study, integrated Korean medicine treatments have been proven to be an effective treatment option for patients with a partial TFCC tear. However, further research is needed to determine the potential benefits and mechanisms of these treatments in managing TFCC-related wrist pain.

Keywords: Korean traditional medicine, Pharmacopuncture, Single-case study, Triangular fibrocartilage complex

INTRODUCTION

Triangular fibrocartilage complex (TFCC) is a complex structure positioned between the distal ulna and the carpal bones [1], with components, such as the articular disk; a few ligaments; meniscus homologue; and extensor carpi ulnaris (ECU) tendon sheath [2,3]. Moreover, the complex anatomical structures and the complex load transmission kinetics in this area make it vulnerable to injuries [4].

TFCC injury is a common cause of ulnar lateral pain in the wrist with limited range of motion (ROM), swelling, and wrist instability. The TFCC serves as a stabilizing structure, bearing almost 20% of the axial load on the forearm, and plays a crucial role in the supination-pronation motion [5,6].

Damage to the TFCC can be categorized into two main causes: (1) traumatic and (2) degenerative. Traumatic causes include occupations that require the repetition of supination-pronation movements [7], and trauma, such as traffic accidents or falls. Degenerative changes can also lead to TFCC injuries.

TFCC injury management involves modifying daily activities and avoiding exercises that strain the wrist joints to prevent pain and further deterioration. Temporary splints or casts may also be used in conjunction with the use of nonsteroidal anti-inflammatory drugs [4].

Currently, no study has yet investigated the efficacy of integrated Korean medicine treatments for partial TFCC tears. This case report presents the outcomes of a patient who underwent integrated Korean medicine treatments at the Jaseng Hospital of Korean Medicine.

CASE REPORT

1. Medical history

This study included a 37-year-old woman who sought treatment for wrist and forearm pain in July 2022. She experienced intense pain in the right wrist, which occasionally extended to the elbow. She had not taken any medication, had no family history of wrist pain, did not have any underlying medical conditions, and had not undergone any previous treatments for wrist pain prior to visiting the Jaseng Hospital of Korean Medicine. Her initial visit to the hospital occurred on August 15, 2022, and she was then admitted on the same day. After receiving 14 days of integrated Korean medicine treatments, she was discharged on August 28, 2022.

2. Magnetic resonance imaging and radiography

The X-ray scans of the patient’s wrists and elbows were conducted on August 15, revealing no significant findings (Fig. 1). However, the magnetic resonance imaging of the right wrist on August 24 revealed a high signal in the proximal/distal laminae of the TFCC in both the coronal and axial views (Fig. 2). Based on these results and the absence of other joint diseases, the patient was diagnosed with pain attributed to partial TFCC tear.

Figure 1. X-ray of the right wrist (August 15, 2022).
Figure 2. Magnetic resonance imaging coronal view/axial view of the right wrist (August 24, 2022). High signal in the proximal/distal laminae of the triangular fibrocartilage complex (yellow arrows).

3. Treatment

1) Acupuncture/electroacupuncture therapy

For acupuncture therapy, disposable standardized (0.25 × 30 mm) and sterilized stainless-steel needles were utilized. The needles were inserted at five specific points on both wrists: LI5, TE4, SI5, TE5, and LI11, and additionally at the tender points of the ECU. These points were mainly used in patients with wrist pain, and in this case, the patient complained of pain on the ulnar side and the radial side, but also on the radial side, so the areas were treated together. Electroacupuncture therapy was also performed twice daily for 10 minutes, with a frequency of 2 Hz at the right wrist’s LI5 and SI5 points and the ECU’s tender points.

2) Pharmacopuncture therapy

The patient had Shinbaro 2 pharmacopuncture injections twice a day. A disposable needle (29 gage × 13 mm) and a 1-mL insulin syringe were used. Shinbaro 2 was administered at a depth of 0.5 cm using a dosage of 0.2 mL per point (Table 1).

Table 1 . Pharmacopuncture (Shinbaro 2).

Pharmacopuncture prescriptionHerbal medicine components (g/mL)AdministeredDaily dose
SJ3-SBO Shinbaro 2Paeonia lactiflora (0.0027)
Ostericum koreanum (Max) Kitagawa (0.0013)
Aralia continentalis (0.0013)
Eucommiae Cortex (0.0013)
Achyranthis Radix (0.0013)
Rhizoma Cibotii (0.0013)
Radix Ledebouriellae (0.0013)
Acanthopanacis Cortex (0.0013)
Scolopendra subspinipes mutilans (0.0013)
Day 1–141 vial (2 mL/vial)

3) Herbal medicine

The patient was administered with Shinbaro herbal medicine three times a day. The prescribed herbal medicines included Chungpajeon-H, Shinkyungbaro-hwan, and Gwanjeolgo, which have been known for their ability to suppress joint destruction, protect the cartilages, and promote regeneration effects (Table 2).

Table 2 . Herbal medicine prescriptions.

Herbal prescriptionHerbal medicine components (g/pouch)AdministeredDaily dose
Chungpajeon-HAcanthopanacis Cortex (5.000)
Eucommiae Cortex (5.000)
Ledebouriellae Radix (5.000)
Achyranthis Radix (5.000)
Cibotii Rhizoma (5.000)
Atractylodis Rhizoma (2.500)
Amomi Semen (2.500)
Geranium thunbergii (2.500)
Zingiberis rhizoma (1.250)
Ledebouriellae Radix (0.250)
Glycyrrhiza uralensis (1.667)
Lasiosphaera seu Calvatia (7.500)
Day 1–143 times/d
Shinkyungbaro-hwanPoria cocos (Schw.) Wolf (1.320)
Ginseng Radix Alba (0.692)
Achyranthes bidentata Bl. (0.112)
Asini Gelatinum (0.029)
Rhizoma Cibotii (0.310)
Atractylodis Rhizoma Alba (0.310)
Aconiti Lateralis Radix Preparata (0.086)
Cinnamomi Cortex (0.054)
Zingiberis Rhizoma (0.032)
Piperis Longi Fructus (0.032)
Cinnamomi Ramulus (0.021)
Day 1–143 times/d
GwanjeolgoRehmannia glutinosa (3.268)
Wolfiporia extensa (1.634)
Apis cerana Fabricius (1.634)
Ginseng Radix Alba (0.817)
Achyranthes bidentata (0.204)
Collas corii asini (0.102)
Cervus nippon Temminck (0.340)
Day 1–143 times/d

4) Cupping therapy

The patient underwent cupping therapy twice daily for 5 minutes to increase blood circulation and relieve pain.

5) Chuna therapy

Chuna therapy was performed once daily specifically for the right wrist. This therapy aims to increase the space within the wrist joint, which involves shaking the wrist for approximately 2 minutes to restore ROM and relieve pain.

4. Assessments

1) Numeric rating scale

The numeric rating scale (NRS) was used as the primary tool to quantify the patient’s subjective pain. Although NRS is difficult to completely exclude subjectivity, it is widely used due to its simplicity. Once a day, the patient was requested to choose a single number between 0 and 10 that most accurately reflected their current level of pain, with 0 representing no pain and 10 representing the most severe imaginable pain [8].

2) Modified Mayo Wrist Score

The Modified Mayo Wrist Score (MMWS), which is a comprehensive assessment tool for the carpal joint, was used to determine the patient’s progress [1]. This evaluation system comprised four items: pain (25 points), satisfaction (25 points), ROM (25 points), and grip strength (25 points). The total score ranges from 0 to 100 points, wherein higher scores indicate better outcomes.

3) European quality of life 5-dimensions

The European quality of life 5-dimensions (EQ-5D) questionnaire is a widely used tool in healthcare to assess health-related quality of life [9]. The values on the scale range from -1 point, which indicates a worse health state than death, to 1 point, which indicates full health. The EQ-5D consists of five dimensions: usual activities, mobility, pain/discomfort, self-care, and anxiety/depression. The patient’s EQ-5D score was measured upon hospitalization, one week later, and on the day of discharge.

4) ROM and special provocative test

ROM was assessed to evaluate the joint’s mobility. Specifically, measurements were taken for wrist flexion, extension, and lateral bending movements. The ROM assessments were conducted upon hospitalization, 1 week later, and on the day of discharge. Moreover, an ulnocarpal stress test was performed to check for any potential underlying diseases [10].

5. Progress note

The patient’s NRS score indicated a gradual decrease during her hospital stay from 6 points upon admission to 5 points after 2 days, 4 points at 6 days, 3 points at 11 days, and 2 points at the time of discharge (Fig. 3). Moreover, the MMWS showed noticeable improvement, starting at 60 upon admission, increasing to 80 after one week, and reaching 95 at the time of discharge (Fig. 4). The patient’s EQ-5D score also showed improvement, with a score of 0.405 upon admission, 0.639 after one week, and 0.829 at the time of discharge (Fig. 5). The ROM test revealed gradual recovery over the course of the patient’s hospitalization (Table 3). Importantly, no adverse reactions were reported during the patient’s hospital stay.

Table 3 . Range of motion and special provocative tests.

Range of motionSpecial test
Flexion (0–80)Extension (0–70)Ulnar deviation (0–30)Radial deviation (0–20)Ulnocarpal stress test
Rt.Lt.Rt.Lt.Rt.Lt.Rt.Lt.Rt.Lt.
22.08.154080407010301020(-)(-)
22.08.227080707015302020(-)(-)
22.08.288080707030302020(-)(-)

Rt., right; Lt., left..


Figure 3. Changes in the numeric rating scale (NRS) pain scores of the right wrist.
Figure 4. Changes in the Modified Mayo Wrist Score.
Figure 5. Changes in the European quality of life 5-dimensions (EQ-5D) scores.

DISCUSSION

Numerous case reports and systematic reviews have investigated partial TFCC tears. However, the application of traditional Korean medicine treatment strategies has not been further studied. In this case, a combination of Korean medicines improved pain, physical function, and the quality of life. Various types of musculoskeletal pain were successfully treated with acupuncture and electroacupuncture therapy, which are known for their efficacy and safety [11,12].

Pharmacopuncture therapy, which uses mechanical and chemical stimulation, involves the combination of traditional acupuncture and herbal medicine. Moreover, acute and chronic musculoskeletal pain and disorders are commonly treated with pharmacopuncture therapy [13]. Shinbaro, a purified extract obtained by mixing six herbal medicines, has been found to treat inflammation [14] and facilitate nerve and cartilage regeneration [15].

During the patient’s hospitalization, she was administered with Chungpajeon-H and Shinkyungbaro-hwan 3 times a day. These are unique herbal medicines for musculoskeletal inflammatory diseases that are used at the Jaseng Hospital of Korean Medicine and are widely known for their anti-inflammatory and neuroregenerative effects [15,16]. Notably, Chungpajeon-H has exhibited potent anti-inflammatory and neuropreservative effects in vivo and in vitro [17]. Furthermore, the patient was administered with Gwanjeolgo, which has been found to effectively suppress joint destruction and provide remarkable cartilage protection, regeneration, and pain relief [18].

The patient also underwent cupping therapy twice daily, which is a treatment method used to improve blood circulation, and speed up recovery [19,20]. Chuna therapy, which is performed once a day, is used to increase the space within the wrist joint and involves gentle shaking motions.

Despite the strengths of this study, several limitations were considered. First, this study only included one patient, which resulted in a relatively low level of evidence. Second, it was not determined whether the patient’s improvement was attributed to the treatments performed during hospitalization, as this study did not include a control treatment. Nevertheless, the findings of this case report are significant as this is the first study to confirm the positive outcomes of integrated Korean medicines for wrist pain caused by partial TFCC tears. The results suggest that integrated Korean medicine treatments may benefit patients with partial TFCC tears. However, further research is needed to confirm these findings.

In conclusion, this case report investigated the efficacy of integrated Korean medicine treatments in alleviating symptoms and enhancing functionality in individuals with partial TFCC tears. They have been shown to effectively reduce pain and improve overall function. Furthermore, these findings suggest that they could be a suitable therapeutic choice for patients diagnosed with partial TFCC tears.

AUTHOR CONTRIBUTIONS

Conceptualization: JJH, MYY. Formal analysis: JJH, DJK, DYK. Investigation: JJH, GBL, DJY. Methodology: JJH, JSK. Writing – original draft: JJH, HWC. Writing – review & editing: All authors.

CONFLICTS OF INTEREST

The authors have no conflicts of interest to declare.

FUNDING

None.

ETHICAL STATEMENT

The patient’s medical records and personal information were obtained from the Institutional Review Board (IRB) of the Jaseng Hospital of Korean Medicine (IRB file No. 2023-07-018).

Fig 1.

Figure 1.X-ray of the right wrist (August 15, 2022).
Journal of Acupuncture Research 2023; 40: 382-388https://doi.org/10.13045/jar.2023.00157

Fig 2.

Figure 2.Magnetic resonance imaging coronal view/axial view of the right wrist (August 24, 2022). High signal in the proximal/distal laminae of the triangular fibrocartilage complex (yellow arrows).
Journal of Acupuncture Research 2023; 40: 382-388https://doi.org/10.13045/jar.2023.00157

Fig 3.

Figure 3.Changes in the numeric rating scale (NRS) pain scores of the right wrist.
Journal of Acupuncture Research 2023; 40: 382-388https://doi.org/10.13045/jar.2023.00157

Fig 4.

Figure 4.Changes in the Modified Mayo Wrist Score.
Journal of Acupuncture Research 2023; 40: 382-388https://doi.org/10.13045/jar.2023.00157

Fig 5.

Figure 5.Changes in the European quality of life 5-dimensions (EQ-5D) scores.
Journal of Acupuncture Research 2023; 40: 382-388https://doi.org/10.13045/jar.2023.00157

Table 1 . Pharmacopuncture (Shinbaro 2).

Pharmacopuncture prescriptionHerbal medicine components (g/mL)AdministeredDaily dose
SJ3-SBO Shinbaro 2Paeonia lactiflora (0.0027)
Ostericum koreanum (Max) Kitagawa (0.0013)
Aralia continentalis (0.0013)
Eucommiae Cortex (0.0013)
Achyranthis Radix (0.0013)
Rhizoma Cibotii (0.0013)
Radix Ledebouriellae (0.0013)
Acanthopanacis Cortex (0.0013)
Scolopendra subspinipes mutilans (0.0013)
Day 1–141 vial (2 mL/vial)

Table 2 . Herbal medicine prescriptions.

Herbal prescriptionHerbal medicine components (g/pouch)AdministeredDaily dose
Chungpajeon-HAcanthopanacis Cortex (5.000)
Eucommiae Cortex (5.000)
Ledebouriellae Radix (5.000)
Achyranthis Radix (5.000)
Cibotii Rhizoma (5.000)
Atractylodis Rhizoma (2.500)
Amomi Semen (2.500)
Geranium thunbergii (2.500)
Zingiberis rhizoma (1.250)
Ledebouriellae Radix (0.250)
Glycyrrhiza uralensis (1.667)
Lasiosphaera seu Calvatia (7.500)
Day 1–143 times/d
Shinkyungbaro-hwanPoria cocos (Schw.) Wolf (1.320)
Ginseng Radix Alba (0.692)
Achyranthes bidentata Bl. (0.112)
Asini Gelatinum (0.029)
Rhizoma Cibotii (0.310)
Atractylodis Rhizoma Alba (0.310)
Aconiti Lateralis Radix Preparata (0.086)
Cinnamomi Cortex (0.054)
Zingiberis Rhizoma (0.032)
Piperis Longi Fructus (0.032)
Cinnamomi Ramulus (0.021)
Day 1–143 times/d
GwanjeolgoRehmannia glutinosa (3.268)
Wolfiporia extensa (1.634)
Apis cerana Fabricius (1.634)
Ginseng Radix Alba (0.817)
Achyranthes bidentata (0.204)
Collas corii asini (0.102)
Cervus nippon Temminck (0.340)
Day 1–143 times/d

Table 3 . Range of motion and special provocative tests.

Range of motionSpecial test
Flexion (0–80)Extension (0–70)Ulnar deviation (0–30)Radial deviation (0–20)Ulnocarpal stress test
Rt.Lt.Rt.Lt.Rt.Lt.Rt.Lt.Rt.Lt.
22.08.154080407010301020(-)(-)
22.08.227080707015302020(-)(-)
22.08.288080707030302020(-)(-)

Rt., right; Lt., left..


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Feb 29, 2024 Vol.41 No.1, pp. 1~73

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