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Methodology in Case of Operative Surgery
In case of diagnostic acupressure (taking all the important aspects of the clinic and the surgery into account) and an anamnesis over a long period of time, the indication is surgical mobilization of the corresponding nerve-vessel bundles of definite acupuncture points. The operative procedure has already been described in detail (1, 2). It is again explained here in brief using the upper quadrant as an example (Fig. 1):An S-shaped cutaneous incision of 8 cm length is effected starting from the epicondylus lateralis towards distal in order to allow the exposure of the points relevant for the upper quadrant pain in such a way that the fascias respectively the aponeurosis perforations of LI 10 and LI 11 as well as Lu 5 and Lu 6 can be uncovered. The nerve-vessel bundles are followed in depth in order to lift and to indicate a restricting Frohse arcade or leaf of Henry.The muscular branches of the N. radialis, which perforate the fascia/aponeurosis on the reverse in a special acupuncture point (LI 7), are exposed subsequently. The nerve-vessel bundles are preserved carefully and the corresponding perforations are widened or incised.The incision edges of the fascia/aponeurosis are coapted by means of absorbable suture material.Skin and subcutis are closed up through continuous intradermal suture.

COMMENTS
This work demonstrates that in the fibromialgia symptomatology, the painful points of acupressure diagnostic play a vital role and the surgical intervention to free them could represent a new remedy to fight the painful fibromialgia symptomatology, in case conventional diagnostic research has not been successful. In operated patients, it was often noticed that - during the research or already at the beginning of the pathological manifestation - they had complained about some pain of the quadrant. The application of the acupressure diagnostic and the tender points principle as points of the acupuncture allow to identify that there are initial stages of fibromyalgia which are recognizable and can be diagnosed as a monolateral pain of the quadrant. In presence of a determined report, the most painful quadrant or the quadrant that was the first to suffer from pain must undergo an operation. This new procedure – which has already been put into practice - has the effect that operated patients are very likely to eliminate disturbs. The traditional treatment of fibromyalgia is limited to intervene on symptomatic processes followed by psychological, psychosomatic and psychotherapeutic measures in order to allow the patient to live with this pathology, which was up to now incurable.
Subsequent immobilization of the extremity in a cotton pad bandage for 24 hours. Active movement exercises as of Fig. 1. In case of absorbable sutures, they will dissolve after 14 days, the knots will fall off (in case of non-absorbable suture, removal of skin suture).As far as the lower legs are concerned, the points for operative surgery are Ki 3, 4, 5, 6 and 7, as well as SP 6, accordingly.Partial exercise is allowed as of the day of operation.To exaggerate, one might say that in case of pain in the shoulder and in the neck region the forearm must be operated on, and in case of pain in the back on the internal malleolus – to the surprise of both patient and pre-medicating specialist.

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