Ankle Arthrosis
Leech therapy has also proven successful in practice in the treatment of arthroses of the ankle. Three to 6 leeches can be applied medially and
laterally.
In clinical practice, leeches are used to treat degenerative joint disease in many
locations. According to a survey of leech therapists, the main joints treated for this condition are the shoulder, the thumb, and the ankle. The application of leeches to the hip joint for treatment of coxarthrosis is also possible but less promising because the hip is poorly accessible to leeches. Furthermore, painful insertion tendinopathies and myopathies play a less important role in the pathogenesis of pain in coxarthro-sis than in gonarthrosis. The application of leeches to finger and toe joints is generally not recommended because of the increased risk of delayed wound healing. However, when the subcutaneous tissue layer is thick enough and the potential risks and benefits of leeching have been thoroughly considered, treatment with leeches is possible. An unpublished observation study conducted by researchers at the University of Moscow, which was presented at
the European Congress of Rheumatologists in 2002, prospectively analyzed the effect of leech therapy on periarticular pain/trigger points, arthralgia, joint mobility, and morning stiffness in 51 patients with degenerative joint disease in various locations and in 51 patients with rheumatoid arthritis. Leech therapy achieved a significant improvement of function, arthralgia, and morning stiffness in nearly all patients in both diagnosis groups. Further specific studies on the efficacy of leeching in other forms of degenerative joint disease are currently lacking. In light of the promising results achieved in gonarthrosis studies, clinical investigators should concentrate on testing the efficacy of leeching in degenerative diseases in other commonly treated joints.
The situation is much the same for myofascial pain syndrome. Lower back pain and iliosacral joint pain syndrome are two conditions that are commonly and successfully (subjectively) treated with leeches, but the corresponding data from clinical trials are lacking. Humerolateral epicondylitis is another frequent indication for leeching. No clinical/scientific assessment of the efficacy of leeching in these diseases is possible at present.
In the classical literature, leeching is often recommended for contusions and sprains. Reduction of swelling and pain in response to leech therapy has been observed in case studies and in practical experience. The use of leeches in sports medicine (e.g., in professional soccer) is now on the increase. Based on these observations, it would probably be safe to conclude that leeching must be effective, but controlled clinical trials should be carried out to obtain scientific proof of efficacy.
Due to the complex structure of the shoulder joint, arthrosis of the shoulder has manifold causes that are inadequately described by the commonly used term "humeroscapular periarthritis." In leech therapy, a pragmatic regional pain management approach can be recommended. A total of four to eight leeches are generally applied to sites around the shoulder joints while targeting the points of maximum pain and trigger points. Pain points frequently reflect pain from the anterior and posterior joint capsules and the proximal course of the anterior biceps muscle. The leeches should be distributed in the front and back shoulder regions. When administering the treatment on an out-patient basis, a proper dressing technique is indispensable yet also difficult due to the complexities of the shoulder joint.
Hip Arthrosis
Unlike the knee and shoulder joints, the hip joint is poorly accessible to leech secretions because it is deeply embedded in muscle tissues. Therefore, leech therapy of the hip is generally successful only in slim patients or when there is major involvement of superficial muscles and tendons in the overall pain syndrome. Especially in obese patients, leech secretions generally cannot penetrate the thick layer of subcutaneous tissue to get near enough to the joint. Considering the size of the hip joint (and initial blood test results), eight to ten leeches are applied to the skin directly over the hip joint and greater trochanter. Due to the intensity of treatment, only two initial treatment attempts should be made when testing for a treatment response.
Index