Case of Thumb Tendon Injury

Patient Information
Mr. He, male, 43 years old, married, working in an office position.

Medical History
Denies any history of drug or food allergies. No history of chronic illness. Underwent cardiac stent placement surgery earlier this year.

Presenting Complaint
Pain in the right thumb metacarpophalangeal joint on the palm side for six months, with recurring symptoms.
States that at the beginning of 2021, without any collision or twisting, there was noticeable tenderness on the palm side of the right thumb metacarpophalangeal joint. No imaging examinations were performed. From January to February, received approximately four sessions of traditional Chinese bone injury treatment, with some relief but occasional recurrence. Due to the need for cardiac stent placement surgery during this period, the patient sought treatment again for the thumb tendon injury after completing postoperative care. The patient works in an office job (video editing), requiring prolonged use of a mouse, which may be related to his pain.

Initial Consultation on July 14, 2021
The pain point is fixed, skin color is normal, no swelling or heat, and the thenar muscles are thick. Additionally, there is pain upon inward movement of the thumb. Compared to the healthy side, there is slight limitation in outward movement of the thumb, and the thumb inward movement resistance test is positive (++). A nodular swelling is palpated at the distal end of the first metacarpal bone on the palm side, believed to be the attachment point of the adductor pollicis transverse head muscle or inflamed. The patient appears slightly fatigued, with dark eye circles, dull complexion, and speaks at a normal pace with a clear voice. He has a solid build with dark skin. He often stays up late and feels extremely tired, but sleeps well, has a good appetite, and no gastrointestinal symptoms. No chest or rib discomfort, normal bowel movements once daily, well-formed stools, normal urination with nocturia once a night, sweats easily, no back or leg weakness, no tinnitus/hearing loss. Tongue is slightly red with a slightly greasy white coating. Pulse is slippery, slow, and strong.

Diagnosis: Bi Syndrome - Thumb Tendon Injury (long-term overuse, blood stasis in meridians, pain due to obstruction); Treatment aims to use bone injury treatment to regulate tendons, promote blood circulation, and alleviate pain.

Treatment: The patient lies down, and the practitioner sits on the affected side. First, apply Zheng Hong Hua Oil, then use techniques such as traction shaking (mainly for the thumb and index finger), rubbing, and kneading to loosen the tendons and muscles of the affected area and identify tender points for treatment preparation.

Since the tender point is located on the palm side below the thenar eminence and in a relatively hidden position, the treatment area is small. Therefore, thumb side peaks or fingertip pressure is mainly applied to the attachment point of the adductor pollicis transverse head muscle, producing rhythmic stimulation. The pressure should be tolerable, occasionally adding medicated oil, and alternating with the previously mentioned relief techniques. During the process, the patient is instructed to actively flex and extend the thumb to straighten the tendons.

Gentle tendon treatment techniques such as traction shaking, rubbing, and thenar/thenar eminence kneading are used to relieve muscle tension caused by aggressive treatment.

Finally, apply a prefabricated anti-swelling, dispersing stasis, and pain-relieving ointment. (The entire treatment process takes about 20 minutes.)

During treatment, the patient mentioned the possible causes of pain. Since there was no history of collision or twisting trauma or other diseases, it is likely due to long-term overuse, possibly related to his prolonged use of a mouse. Therefore, the physician suggested switching to a standing mouse, which may help alleviate his condition. The patient was advised to visit a store in the same mall that sells such mice. The patient was also advised to rest the affected area more to allow for recovery after treatment.

Second Consultation on July 19, 2021
The patient reported that after the first consultation, the pain had reduced by about sixty to seventy percent, with the sharp tenderness greatly diminished and replaced by soreness. He also reported that the nodular swelling previously palpable had disappeared. Therefore, he continued to seek treatment. The physician confirmed that the swelling had indeed disappeared, and the tenderness had significantly reduced. Tongue and pulse were consistent with the previous examination. Treatment continued using the previous method.

During the conversation, the patient mentioned visiting the store to check the aforementioned mouse, but was shocked by its price—nearly eight hundred yuan. The physician jokingly responded, "With the number of consultations you've had, you could have bought it already. If it really helps, you wouldn't have to suffer anymore!" They both laughed, and the physician continued, "If we can reduce your pain by seventy to eighty percent, it's already a very good treatment outcome. The remaining twenty to thirty percent needs to be relieved by changing lifestyle habits or work methods. Relying solely on treatment will only lead to recurrence and prolonged suffering."

Pathological Summary
Pain disorders (belonging to the ancient category of Bi Syndrome) can be caused by various factors such as invasion of wind, cold, and dampness, long-term overuse, degenerative changes, trauma, secondary to other diseases (such as cancer pain), or psychological factors. In terms of duration, pain disorders can be classified as acute or chronic. Chronic pain disorders generally refer to pain lasting or intermittently appearing for more than three months, including cases where pain cannot be managed solely by medication or where rest alone does not improve pain, hindering treatment progress. Therefore, if compared to the above standards and symptom manifestations, if there are no clear inducements or recognizable signs, this case of pain disorder can be classified as a tendon injury caused by long-term overuse. The pathogenesis is due to long-term repetitive movements/positions (such as the patient's long-term use of a mouse or mobile phone), leading to prolonged tension or excessive activity of the muscle group in the same area, resulting in blood and Qi stagnation or inadequate nourishment (as referred to in traditional Chinese medicine as "if not circulating, then painful" or "if not flourishing, then painful"), thus causing local strain and triggering pain—this can also be referred to as "static strain injury".

Reflections and Insights
In this case, there is nothing particularly unique about the diagnosis and treatment; everything is straightforward. The cause of chronic pain disorders is often due to excessive or inappropriate use of our bodies in daily life. Therefore, based on my experience in treating chronic pain disorders, my insight is: if the pain arises from life, to completely heal, in addition to standard treatment, it is necessary to return to life to relieve it—appropriate exercise and changing poor lifestyle or work habits should be the key. Traditional Chinese medicine is not just about medical treatment; it also involves principles of health maintenance related to daily life. Just as the "Yellow Emperor's Inner Canon" states: "In ancient times, those who knew were in harmony with Yin and Yang, followed the principles of arts and numbers, regulated their diet and behavior, did not overexert themselves, and could maintain both form and spirit, living to a hundred years before departing. However, people nowadays are different; they use alcohol as their staple, indulge recklessly, enter their chambers drunk, exhaust their vital essence with desires, dissipate their true essence, do not know how to preserve and replenish, do not know how to regulate their spirits in a timely manner, pursue only pleasure, go against the natural course of life, lack regularity in their daily activities, and thus age prematurely at fifty." This clearly points out the impact of attitudes and habits in life on a person's physical and mental well-being, showing how significant the difference can be!

Therefore, Mr. He hopes to completely relieve his pain, not by purchasing an eight hundred yuan mouse, but by planning to change his lifestyle and work habits and mindset outside of treatment, supplemented by appropriate exercise.