**4. Acupuncture treatment for upper extremity dystonia**

Typical symptoms of upper extremity dystonia include writer's cramp and musician's cramp. Other cases may cause involuntary movements or abnormalities in muscle activity that impair the movements of those who perform the same movements repeatedly in their occupations.

In these cases, as with cervical dystonia, we identify the affected muscles and treat with consideration of the meridians and acupoints. When treating patients with upper limb symptoms, it is important to consider the relationship of the symptoms to the trunk muscles. For example, in a case of writer's cramp, when the patient's hand trembles and writing is difficult, the problem may be limited to the forearm or hand muscles. However, sufficient muscle activity of the serratus anterior and anterior deltoid fibers is necessary to coordinate upper extremity movements. It is also necessary to check for normal activity of the trunk and buttock muscles to maintain a sitting posture.

In the treatment of upper extremity dystonia, there is a distinctive treatment area. This is the "upper-limb area" proposed by Seikichi Wada. It is a 2 cm straight line drawn from the front one-third of the area that divides the temporal hairline into three equal parts toward the top of the head. In the treatment of this area, needles with a diameter of 0.2 mm are inserted at a depth of 2 cm [4].

We present the effects of acupuncture treatment on the upper limb on a case of occupational dystonia of the upper limb that we have experienced. The patient was a cook who frequently held his left hand, which was thought to have caused dystonia in the left upper limb (Case 4). At the time of initial acupuncture treatment, he had difficulty in opening his left hand. After 15 minutes of acupuncture treatment to the upper-limb area, the patient's left hand opening movement improved (**Figure 5**).

After acupuncture treatment in the upper-limb area, he can smoothly open his fingers.

**Figure 5.** *Hand opening and closing movements before and after initial acupuncture treatment.*
