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Yifeng Shen,1,2 Qiaoyin Zhou,1,3 Xiaojie Sun,4 Shiliang Li,1,3,4 Weiguang Zhang5 1College of Traditional Chinese Medicine, Fujian University of Traditional Chinese Medicine, Fuzhou, People’s Republic of China; 2Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, People’s Republic of China; 3Key Laboratory of Orthopedics & Traumatology of Traditional Chinese Medicine and Rehabilitation (Fujian University of TCM), Ministry of Education, Fuzhou, People’s Republic of China; 4Department of Acupuncture and Moxibustion, China-Japan Friendship Hospital, Beijing, People’s Republic of China; 5Health Science Center, Peking University, Beijing, People’s Republic of ChinaCorrespondence: Shiliang Li, Department of Acupuncture and Moxibustion, China-Japan Friendship Hospital, Beijing, People’s Republic of China, Email zrlishiliang1963@163.com Weiguang Zhang, Health Science Center, Peking University, Beijing, People’s Republic of China, Email zhangwg@bjmu.edu.cnBackground: De Quervain’s disease is a painful stenosing tenosynovitis of the first dorsal compartment of the hand affecting the tendons of the abductor pollicis longus and extensor pollicis brevis. This study aimed to evaluate the safety and efficacy of percutaneous first extensor compartment releases performed on embalmed cadaveric models by acupotomy operation with or without US guidance.Methods: Percutaneous release was performed with an acupotomy on 59 wrists of cadavers; 23 wrists were operated with US guidance, and 39 wrists were operated without US guidance. Each arm was dissected and assessed regarding the amount of release as well as the extent of neurovascular and tendon injury. Anatomical structures were also observed in this study.Results: Twenty cases (87%) were successfully released with ultrasound-assisted techniques, and 27 cases (75%) were successfully released with blind techniques. No neurovascular injury occurred in any arm, regardless of technique. No significant tendon injury was seen in any arm. Although minor surface scratches were visualized in 11 cases, they occurred in 3 cases (13.04%) with ultrasound assistance and in 8 cases (22.22%) with blind techniques. There was no statistically significant difference between the two groups in the measurement of the distance from the incision marks to the blood vessels and nerves. A fibrous septum and bony protrusions were found in the first dorsal compartment, which may be anatomical factors affecting the success of treatment.Conclusion: Both traditional and US-guided percutaneous release by acupotomy of the first extensor tendon compartment can be performed for all wrists. US-guided techniques can improve the success rate and reduce damage during acupotomy operations.Keywords: de Quervain’s disease, tendonitis, acupotomy, acupuncture, ultrasound guidance, anatomy

Case The patient was a 62-year-old woman presenting with low-back pain of 3 years’ duration and numbness in the right leg. Diagnosis She was diagnosed with lumbar spinal stenosis based on combined magnetic resonance imaging, physical examination, and symptoms. Interventions Treatment with computed tomography–guided percutaneous release of the ligamentum flavum was delivered. Outcomes Relief of symptoms immediately after treatment and complete resolution of symptoms after 1 month were achieved. At follow-up, there was no recurrence of symptoms after 2, 4, 6, and 12 months. Conclusion Lumbar ligamentum flavum hypertrophy is an important cause of degenerative lumbar spinal stenosis. The hypertrophic ligamentum flavum can directly compress the spinal canal, squeeze the cauda equina, and simultaneously lead to a reduction in the anteroposterior diameter of the intervertebral foramen, which compresses the nerve roots and causes numbness and other symptoms of lower extremities. In clinical practice, doctors should combine imaging findings with patient symptoms for diagnosis and an individualized treatment plan for each patient with lumbar spinal stenosis, and conduct gradual stepwise treatment using conservative minimally invasive surgery to prevent excessive surgery., Video Abstract Point your mobile at the code above. If you have a QR code-reader, the video abstract will appear. Or use: https://youtu.be/xUgzwLiZT5c

Background Tarsal tunnel syndrome (TTS) is a painful condition of the ankle that affects patients' quality of life and ability to work. Multiple clinical studies of nerve decompression by acupotomy have been published in China, and the results are encouraging. However, the efficacy and security of this treatment have not been evaluated scientifically and systematically. The purpose of this systematic review protocol is to evaluate the efficacy and security of acupotomy treatment in patients with TTS, which will be helpful to clinical acupotomy doctors. Methods Relevant randomized controlled trials will be identified by searching 9 databases (PubMed, Embase, Cochrane Library, Chinese literature databases, the Chinese Biomedical Literature Database, China National Knowledge Infrastructure, SinoMed, Technology Journal and the Wanfang Database. Randomized controlled trials examining the use of acupotomy for TTS patients will be identified independently by 2 reviewers by searching the databases from inception to March 2020. Clinical effects will be evaluated as the primary outcome. Visual analog scale scores will be assessed as a secondary outcome. Review Manager 5.3 will be used to perform a fixed effects meta-analysis, and the evidence level will be evaluated by using the Grading of Recommendations Assessment, Development, and Evaluation framework. Continuous outcomes will be presented as mean differences or standard mean differences, while dichotomous data will be expressed as relative risks. Results This study will evaluate the effectiveness and safety of acupotomy in the treatment of TTS in randomized controlled trials with high-quality visual analog scale and Roles and Maudsley score. Conclusion This systematic review will provide evidence to determine whether acupotomy is an effective intervention for patients with TTS. Registration number DOI 10.17605/OSF. IO/9PYC2 (https://osf.io/9pyc2/).

Background: De Quervain disease (dQD) is a painful condition of the wrist that affects patients’ quality of life and work ability. Acupotomy has been widely used in the treatment of dQD. It has been reported in many articles that acupotomy can improve the clinical symptoms of dQD. However, the efficacy has not been evaluated scientifically and systematically. The aim of this systematic review protocol is to evaluate the efficacy and safety of acupotomy treatment compared with local steroid injection in patients with de Quervain disease. Methods: Relevant randomized controlled trials will be identified by searching 9 databases (PubMed, EMBASE, Cochrane Library, Chinese literature databases, the Chinese Biomedical Literature Database [CBM], China National Knowledge Infrastructure [CNKI], SinoMed, Technology Journal [VIP], and the Wanfang Database). Randomized controlled trials (RCTs) of Acupotomy for dQD patients will be identified independently by 2 reviewers by searching the databases from inception to October 2018. Clinical effects will be evaluated as the primary outcome. The VAS (visual analog scale) score will be assessed as a secondary outcome. RevMan V.5.3 will be used to perform a fixed effect meta-analysis, and the evidence level will be evaluated by using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) methods. Continuous outcomes will be presented as the mean differences or standard mean differences, while dichotomous data will be expressed as relative risks. Results: This study will evaluate the effectiveness and safety of acupotomy in the treatment of de Quervain disease in RCTs with high-quality VAS and RM. Conclusion: This systematic review will provide evidence to judge whether acupotomy is an effective intervention for patients with de Quervain disease. PROSPERO registration number: CRD42018108786

Background: Acupotomy is a miniature surgery instrument. It can cut and detach the abnormal, cicatricial, and contractured tissues by causing only microtrauma. Acupotomy has been widely used clinically with a satisfactory efficacy. With the development of ultrasound technology, ultrasound-guided acupotomy has shown great value in clinical practice. But it is not yet clear that ultrasound-guided acupotomy is very effective and safe. Therefore, it is important to re-evaluate the available evidence to reach a relatively convincing conclusion that acupotomy by ultrasound-guided technique is a better choice than traditional acupotomy. The purpose of this systematic review is to provide a method for evaluating the effectiveness and safety of acupotomy by ultrasound-guided technique. Methods: This systematic review will be performed by searching relevant randomized controlled trials (RCTs) without any language or publication status restriction from inception to December 2019 by 2 researchers in nine databases (PubMed, Medline, Embase, Cochrane Library, Chinese literature databases, Chinese Biomedical Literature Database [CBM], China National Knowledge Infrastructure [CNKI], China Science and Journal Database [CSJD], and Wanfang Database). All RCTs evaluating acupotomy by the ultrasound-guided technique will be included in this study. Visual analog scale (VAS) and change of symptom will be assessed as the primary outcomes. The change in the ultrasound image, safety and adverse events, and acceptability will be assessed as secondary outcomes. The selection of study, data collection and analysis, and assessment of the study quality will be completed independently by 2 researchers. RevMan v.5.3 will be used for meta-analysis if no significant heterogeneity is detected. Continuous outcomes will be presented as the mean difference (MD) or standardized MD, while dichotomous data will be expressed as the relative risk. Results: This study will provide a high-quality synthesis of QL and AR to assess the effectiveness and safety of acupotomy by ultrasound-guided technique. Conclusion: This systematic review will provide evidence to judge whether acupotomy by ultrasound-guided technique is an effective the efficacy and safety intervention. PROSPERO registration number: CRD42018109070.

Background Trigger finger is thought to be caused by aseptic inflammation of the A1 pulley and subsequent thickening and narrowing of the fibrous sheath. Acupotomy has been an important treatment for trigger finger. But an updated systematic review about this issue has not yet been released. This systematic review protocol is aimed at providing a higher quality method used to evaluate the efficacy and safety of acupotomy treatment for trigger finger. Methods The following databases will be searched from the study inception to July 2019: the Cochrane Central Register of Controlled Trials (Cochrane Library), MEDLINE, EMBASE, PubMed, China National Knowledge Infrastructure, Wan-Fang Data, and Chinese Biomedical Literature Database. All English or Chinese randomized controlled trials related to acupotomy for trigger finger will be included. Two reviewers will independently perform the processes of study inclusion, data extraction, and quality assessment. The primary outcome will be assessed by improvement of the pain symptoms and finger activity. Secondary outcomes will be assessed through Safety assessment. Meta-analysis will be completed by RevMan V.5.3 software. Results This systematic review will provide an assessment of the current state of acupotomy for trigger finger, aiming to show the efficacy and safety of treatment. Conclusion This systematic review will re-evaluate a higher-quality systematic review to obtain a relatively convincing conclusion that finds acupotomy to be a better choice for trigger finger patients. Prospero registration number CRD42018118663.

Rationale Tendinitis of the longus colli muscle is an aseptic inflammatory process leading to acute posterior neck pain, neck stiffness, and dysphagia or odynophagia. We present a patient exhibiting an infrequent symptom, vertigo. This is the first description of the occurrence of vertigo symptoms caused by longus colli tendinitis. Patient concerns A 38-year-old man was diagnosed with vertigo, presenting with a 1-month history of dizziness, palpitations, and numbness in the hands. Diagnosis Longus colli tendinitis. The diagnosis was established using magnetic resonance imaging fat-suppression sequences. Interventions Treatment with corticosteroid injections and acupotomy. Outcomes The symptoms relieved immediately after the treatment and complete resolution of the symptoms was observed after 1 week. Lessons Longus colli tendinitis with vertigo is an under-reported condition in the literature and physicians should be aware of its existence. A lack of familiarity with the anatomy of the prevertebral space and its variable radiographic appearance makes the diagnosis of longus colli tendinitis clinically difficult. Misdiagnosis of this condition may lead to unnecessary interventions in vertigo.

Background Calcaneodynia customarily induces inferior heel pain, specialists believe that the pain is principally caused by acute or chronic injury due to the plantar fascia from accumulative overload pressure. Acupotomy has been widely used to treat calcaneodynia. But its efficiency has not been scientifically and methodically evaluated. The aim of this study is to evaluate the efficacy and safety of the acupotomy treatment in patients with calcaneodynia. Methods Relevant randomized controlled trials in 6 databases (PubMed, Embase, and Cochrane Library, Chinese literature databases, Chinese Biomedical Literature Database [CBM], China National Knowledge Infrastructure [CNKI], and Wanfang Database). The randomized controlled trials (RCTs) of the acupotomy for calcaneodynia patients will be searched in the databases from inception to December 2017 by 2 researchers. Visual analog scale (VAS) will be assessed as the primary outcomes. Roles and Maudsley Score (RM) will be assessed as the secondary outcome. The RevMan V.5.3 will be used for meta-analysis. Continuous outcomes will be presented as the mean difference or standard mean difference, while dichotomous data will be expressed as relative risk. Results This study will provide a high-quality synthesis of VAS and RM to assess the effectiveness and safety of acupotomy for calcaneodynia patients. Conclusion This systematic review will provide evidence to judge whether acupotomy is an effective intervention for patients with Calcaneodynia.