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THE DOCTOR'S CORNER: Brachial plexus avulsion Robert Ferran DVM,CVA,AP This discussion involves Brachial plexus avulsion a Wei Syndrome and its differentiation from Chronic Bi Syndromes. Brachial Plexus avulsion involves traumatic injury to the nerve roots of the brachial plexus. It is usually not the plexus that bears avulsive injury but the nerves themselves due to their lack of a perineum. This large plexus is formed by the ventral branches of the sixth, seventh, and eighth cervical and the first and second thoracic spinal nerves. Clinical signs involve and depend on the distribution of the damage to the nerve roots and its branches. Conscious pain perception is usually impaired. Thus we can differentiate this from a Bi-Syndrome in which the prolonged motor impairment is due to pain. The Wei Syndrome is characterized by motor impairment with an absence of pain and a subsequent disuse atrophy and flaccidity. Contusion, in this case the avulsive injury sustained can cause severe injury to the meridians and interfere with the flow of qi and blood. This helps us understand the direct effect of poorly nourished tendons and muscles, which ultimately lead to atrophy and flaccidity. The Bi-Syndrome that presents with soreness, pain , heavy sensations in the affected area and numbness can also become a Wei-Syndrome if the nutrient and defensive qi becomes exhausted. Again this leads to malnourishment of muscles and tendons. The treatment principle this is one of Nourishing the muscles and tendons and Promoting the circulation of qi in the meridians. We also need to promote Blood circulation(Regulate Blood circulation) since Blood dominates nourishment and moisture. These pets present with varying levels of thoracic limb dysfunction. For this reason it is important to correlate your acupuncture to the nerve affected. LI 4(Hegu)Radial nerve branch SI 9(Jianzhen)Median and ulnar nerves and the axillary nerve located at the posterior medial deltoid muscle LI 11(Quchi)Radial nerve In this case we are talking about a trauma-induced problem so we can puncture the points on the affected side with even movement. We can also use electro acupuncture, stimulating the points in relation to the nerves of the paralyzed muscle. So what points can we use with brachial plexus injury? Jingbe is a miscellaneous or extra point located at the posterior margin of the sternocleidomastoid. This point also found below LI 18 approximately the same distance away as SJ 16 is to LI 18. Used in a combination with LI 11 and LI 5 for radial nerve paralysis for their effects in stimulating the radial nerve. SI 9(Jianzhen) Located posterior and inferior to the shoulder joint., 1 cun above the posterior axillary fold when the leg is adducted. LI 11(Quchi)A good point to regulate Nutritive Qi and Blood and also for its benefit on joints and sinews. PC 6(Neiguan)Treats blood stagnation and helps to move the blood. When used together with Bizhong good for median nerve paralysis, due to its activity on the median nerve. LI 4(Hegu)Releases the exterior(opens the wei qi). Tonifies Qi and helps remove obstruction from the channel. ST 36(Zusanli)Tonifies Qi and Blood, Strengthens the body, helps to regulate nutritive and defensive Qi. GB 34(Yanglingquan)Influential point of the tendon. Helps to relax the sinews and promote the smooth flow of Liver Qi. SI 8(Xiaohai)Helps to remove obstruction from the channel and when used with SI 17 together with Jingbe good for paralysis of the ulnar nerve. SI 7(Zhizheng)Removes obstruction from the channel. GV 20(Baihui)Helps clear the mind, tonify yang and lift the spirit. This point is the end point of the Liver meridian thus it helps regulate the Liver, calm the anxious pet and calm the spirit. LI 5(Yangxi)Helps resolve the Wei Syndrome in the path of the radial nerve. Bizhong a miscellaneous point at the midpoint between the transverse crease of the carpus and elbow. Located 1 cun above PC 4 between the radius and ulna. The above are points I have used in treating avulsive disorders of the brachial plexus. They all present at different stages of severity. Being able to locate the affected nerves and treating with the purpose of promoting the circulation of Blood and Qi in the meridians will help to nourish the tendons and bones thus give a better chance for a better and maybe complete recovery.
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