Treatment of Traumatic Brachial Plexus Injury with Traditional Korean Medicine Focusing on Warm Needling and Bee Venom Injection: A Case Report

Dae Hyun Jo; Min Soo Kwon; Jung Hwan Kim; Ji Eun Choi; Ji Sun Han; Dong Woo Nam; Do Young Choi; Jae Dong Lee

doi:10.13045/acupunct.2015033

J Acupunct Res > Volume 32(2); 2015 > Article

Jo, Kwon, Kim, Choi, Han, Nam, Choi, and Lee: Treatment of Traumatic Brachial Plexus Injury with Traditional Korean Medicine Focusing on Warm Needling and Bee Venom Injection: A Case Report

Case Report

Acupuncture 2015; 32(2): 229-240.

DOI: https://doi.org/10.13045/acupunct.2015033

Treatment of Traumatic Brachial Plexus Injury with Traditional Korean Medicine Focusing on Warm Needling and Bee Venom Injection: A Case Report

Dae Hyun Jo, Min Soo Kwon, Jung Hwan Kim, Ji Eun Choi, Ji Sun Han, Dong Woo Nam, Do Young Choi, Jae Dong Lee^*

Department of Acupuncture & Moxibustion Medicine, Kyung Hee University Korean Medicine Hospital

^*Corresponding author: Department of Acupuncture & Moxibustion Medicine, Kyung Hee University Korean Medicine Hospital, 23, Kyungheedae-ro, Dongdaemun-gu, Seoul, 130-872, Republic of Korea,
Tel: +82-2-958-9202, E-mail: ljdacu@khmc.or.kr

Received May 15, 2015 Revised May 26, 2015 Accepted May 29, 2015

Abstract

Objectives:

The purpose of this report is to show the effect of complex traditional Korean medical care focused on warm needling(WN) and bee venom(BV) injection for a patient suffering from traumatic brachial plexus injury(BPI).

Methods:

A 51-year-old female patient with BPI was suffering from paresis and hypoesthesia with upper-extremity impairment. The patient had been treated once a day from 4 Feb to 11 Apr of 2015 mainly with WN and BV injection on the acupoints near the distribution of the brachial plexus. Improvement of the symptoms was measured by range of motion(ROM), manual muscle test(MMT) grip strength, and with the numeric rating scale(NRS) of tactile and pain sensitivity.

Results:

After 67 days of treatment, all obtained results showed remarkable improvement. The patient’s satisfaction declaration was recorded through an interview at the end of the treatment.

Conclusions:

The results suggest that anatomically concerned WN and BV treatment can be a valuable option in reducing or normalizing pains from traumatic BPI.

Key Words: BPI; Warm needling; Bee venom; ROM; MMT; NRS.

Fig. 1.

MRI images of brachial plexus

With the evidence of preserved neural continuity and mildly stretched nerve roots in this image, patient can be diagnosed as subacute stage of traumatic brachial plexopathy, left

Fig. 2.

Changes in range of motion of shoulder and elbow joints

Bar-graph indicates the counted numbers of the patient’s flexing and extending her own elbow, which was first executed on February 23th.

The ranges of movement of shoulder medial rotation, lateral rotation, elbow extension, wrist extension, wrist flexion were full almost from the start, Feb 7th, thus those results were emitted from this graph.

Fig. 3.

Changes in grasping strength of patient

Proportions of the power between intact right hand and impaired left hand was measured. The fact that the one’s strengths are fluctuating everyday makes these measurements reflect patient’s condition better

Fig. 4.

Changes in numeric rating scale score of tactile sensation

Fig. 5.

Changes in numeric rating scale score of pain sensitivity

Table 1.

Manual Muscle Test

Gr	Definition
5	Normal strength
4	Muscle holds the joint against a combination of gravity and moderate resistance
3	Muscle can‘t hold the joint against resistance, but moves the joint fully against gravity
2	Muscle moves the joint when gravity is eliminated
1	A flicker of movements is seen or felt in the muscle
0	No movement

Table 2.

Records of Muscle Manual Test before and During Treatment Period

Motion	Date	* 1. 16	* 1. 26	2. 4	2. 10	2. 17	2. 23	3. 2	3. 8	4. 10
Shoulder	Flexion	n.r	1	2	3	3	3+	3+	3+	3
	Extension	n.r	1	2	2	3	3+	3+	3+	3+
	Medial Rotation	n.r	n.r	2	3	3	3+	4	4	4
	Lateral Rotation	n.r	n.r	2	3	3	3+	5	5	5
	Abduction	1	1	2	2	2	2	3	3	3
Elbow	Flexion	1	2	2	2	3	3	3+	4	4+
Elbow	Extension	1	2	1	4	4	4	4+	4+	4+
Wrist	Flexion	3	3	4	3	4	5	5	5	5
Wrist	Extension	3	3+	4	4	4	5	5	5	5

^* tests in these days are executed and recorded in another place, Asan Medical Center in Seoul. n.r: not recorded.

V.

References

1. Samantha A, Kriya G, Morad A. Brachial plexus injury: treatment options and outcomes. J Craniofac Surg. 2014;25(4):1200–6.

2. Smania N, Berto G, La Marchina E, et al. Rehabilitation of brachial plexus injuries in adult and children. Eur J Phys Rehabil Med. 2012;48(3):483–506.

3. Jung DH. Brachial plexus injury. Collection of Dissertations of Korean Shoulder and Elbow Society. 2008;11:179–93.

4. Jeniffer JL, Kakar S, Bishop AT, Spinner RJ, Shin AY. Current concepts of the treatment of adult brachial plexus injuries. J Hand Surg Am. 2010;35(4):678–88.

5. The Korean Academy of Oriental Rehabilitation Medicine. Oriental rehabilitation medicine. 3rd ed. Seoul: Koonja. 2011:138–61.

6. Korean Acupuncture and Moxibustion Society Textbook Compilation Committee. The Acupuncture and Moxibustion Medicine. Seoul: Jipmoondang. 2012:143–249.

7. Kim YR, Noh SH, Kin KH, Yang GY, Lee BR, Kim JK. Clinical study on the case of patient with latrogeric brachial plexus injury after cervical lymph node biopsy: a case report. The Acupuncture. 2013;30(5):219–26.

8. Choi YJ, Shin HY, Kim SJ, et al. Clinical study on the case of patient with traumatic brachial plexus injury. The Acupuncture. 2012;29(2):99–106.

9. Jang DH, Kang YK, Cho SW, Lee YS. A clinical case study on postural brachial plexus injury with whole body articulation mechanics technique. The Journal of Korea Chuna Manual Medicine for Spine and Nerves. 2010;5(2):49–55.

10. Lee SW, Shin YW, Jung HR, Cha YY. A case report on the brachial plexus injury patient caused by traffic accident. Journal of Oriental Rehabilitation Medicine. 2002;12(2):199–208.

11. Jung AR, Kim KB, Cheon JH. A case report of neonatal brachial plexus injury. The Journal of Pediatrics of Korean Medicine. 2014;28(1):14–23.

12. Yu SA. A case report of child with brachial plexus palsy due to birth injury. The Journal of Pediatrics of Korean Medicine. 2014;28(1):24–31.

13. Songcharoen P, Wongtrakul S, Spinner RJ. Brachial plexus injuries in the adult. nerve transfers: the Siriraj Hospital experience. Hand Clin. 2005;21(1):83–89.

14. Merrell GA, Barrie KA, Katz DL, Wolfe SW. Results of nerve transfer techniques for restoration of shoulder and elbow function in the context of a meta-analysis of the English literature. J Hand Surg Am. 2001;26(2):303–14.

15. Bishop AT. Functioning free-muscle transfer for brachial plexus injury. Hand Clin. 2005;21(1):91–102.

16. Back GH, Chung MS, Seo JB, Park JS, Park YB, Jun DS. Comparison of spontaneous recovery and nerve surgery in brachial plexus injury. J Korean Soc Microsurg. 1996;5(1):137–46.

17. Lee JD. Bee venom therapy - method of clinical approach. J Korean Oriental Med. 2000;21(3):3–8.

18. Yoon SW. A study of thermal effect in ultrasound enhanced transdermal drug dilivery. Seoul: Sungkyunkwan Univ. 1998:Korean.

Appendices

Appendix 1.

Time-table of Present History

Appendix 2.

Record of the Interview