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Peroneal Nerve Palsy Following Acupuncture Treatment A Case Report
Masaki Sato, MD; Hiromu Katsumoto, MD; Koui Kawamura, MD; Hiroshi Sugiyama, MD; Tsutomu Takahashi, MD
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Investigation performed at the Department of Orthopaedic Surgery, Asahi General Hospital, Asahi-City, Chiba, Japan

Masaki Sato, MD
Hiromu Katsumoto, MD
Koui Kawamura, MD
Hiroshi Sugiyama, MD
Tsutomu Takahashi, MD
Department of Orthopaedic Surgery, Asahi General Hospital, I-1326, Asahi-City, Chiba 289-2511, Japan

The authors did not receive grants or outside funding in support of their research or preparation of this manuscript. They did not receive payments or other benefits or a commitment or agreement to provide such benefits from a commercial entity. No commercial entity paid or directed, or agreed to pay or direct, any benefits to any research fund, foundation, educational institution, or other charitable or nonprofit organization with which the authors are affiliated or associated.

J Bone Joint Surg Am, 2003 May 01;85(5):916-918
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Acupuncture is an increasingly popular treatment method used to relieve pain. Adverse events related to acupuncture have been reported 1-3 rarely. The purpose of this report is to describe what we believe to be the first case of peroneal nerve palsy caused by penetration and breakage of an acupuncture needle. Our patient was informed that data concerning the case would be submitted for publication.
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    These activities have been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint sponsorship of the American Academy of Orthopaedic Surgeons and The Journal of Bone and Joint Surgery, Inc. The American Academy of Orthopaedic Surgeons is accredited by the ACCME to provide continuing medical education for physicians.
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    Farhan Alvi
    Posted on November 07, 2003
    Peroneal Nerve Palsy Following Acupuncture Treatment
    Manchester Royal Infirmary

    To the Editor:

    We read with interest the case report Sato, et.al.,¹ While interesting and informative we wonder why magnetic resonance imaging was performed in this patient. Did the MR imaging provide any further information regarding the location of the acupuncture needle?

    To our knowledge, subjecting a patient who has a metallic object in the soft tissues, to a magnetic field carries the danger of displacing the object. Currently used acupuncture needles may be made of stainless steel or silver. It was not clear whether the acupuncture needle in this case was made of a magnetic or non-magnetic material.

    In addition, there is a risk of creating a local heating effect when subjecting a foreign metallic object to a strong magnetic field, risking damage to the surrounding structures.² The needle tract might be contaminated with metallic microscopic debris, creating an artifact that could render the investigation unreliable.

    We suggest that a CT scan would be a preferable imaging modality to safely determine the exact position of the metallic foreign object, but we recognize that it would not show its position in relation to the common peroneal nerve.³

    The history of the patients symptoms suggest that an exploration may be ultimately required anyway.

    1. Masaki Sato, Hiromu Katsumoto, Koui Kawamura, Hiroshi Sugiyama, and Tsutomu Takahashi. Peroneal Nerve Palsy Following Acupuncture Treatment: A Case Report. J Bone Joint Surg Am 2003 85: 916-918. 2. Ho HS. Safety of metallic implants in magnetic resonance imaging. J Magn Reson Imaging 2001;14:472-77. 3. Gerard PS, Wilck E, Schiano T. Imaging implications in the evaluation of permanent needle acupuncture. Clin Imaging. 1993 Jan-Mar;17(1):36-40.

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