The LI4 Acupuncture Point: What It Is, What the Research Says, and Its Role in Wrist & Thumb Pain
If you've ever had acupuncture or clinical needling, there's a good chance a needle has been placed in the fleshy web between your thumb and index finger. That spot is known in Western acupuncture as Large Intestine 4, or LI4. It is one of the most widely used and extensively researched acupuncture points in clinical practice.
At MotionPlus Osteo in Hamilton, we use Osteopathic needling techniques also formally known as Western Medical Acupuncture as part of our approach to musculoskeletal care. This post explores what LI4 is, what the evidence says about how it may work, and why it's particularly relevant when discussing wrist and thumb conditions like De Quervain's tenosynovitis.
What Is the LI4 Point?
LI4 also known as Hegu, is an internationally standardised acupuncture point located in the dorsal first web space of the hand (World Health Organization, 2008). It is located in the dorsal first web space of the hand, at the midpoint of the second metacarpal bone on its radial border. In practical terms: it sits in the muscle belly of the first dorsal interosseous muscle, in the webbing between the thumb and index finger.
From a Western anatomical perspective, this is a clinically rich area. Cadaveric dissection studies have identified the tributaries of the dorsal venous plexus, branches of the superficial radial nerve, the first dorsal interosseous muscle, and arterial branches in the first interosseous space all converging in this region (Barker et al., 2017). Importantly, Umemoto et al. (2019) demonstrated that LI4 sits significantly closer to the vascular branches of the superficial radial nerve than other acupuncture points in the surrounding anatomical region a finding that may help explain why needling at this location consistently produces both local circulatory responses and pain modulating effects in the hand and wrist.
This anatomical proximity to both neural and vascular structures is one of the reasons LI4 produces the characteristic de qi sensation, a dull, aching, or radiating feeling when needled and why it may have broad effects that extend beyond the immediate area of needling.
How Does LI4 Work? The Western Science
In Western Medical Acupuncture, the effects of LI4 are understood through neurophysiology rather than traditional meridian theory. When a needle is inserted at LI4, it is proposed to activate A-delta and C nerve fibres in the local tissue, triggering a cascade of effects at both spinal and supraspinal levels (Fan et al., 2024).
Research using functional MRI has shown that needling at LI4 produces measurable changes in brain activity, including activation of the postcentral gyrus, associated with sensorimotor processing and deactivation of the anterior cingulate cortex, a region closely tied to the emotional experience of pain (Lee et al., 2025). This central modulation of pain processing is one of the key mechanisms proposed to explain acupuncture's analgesic effects.
At a local tissue level, needling at acupoints has been shown to influence connective tissue and fascia, collagen production, and fibroblast activity. All relevant considerations in tendon-related conditions (Ilfeld et al., 2022). Acupuncture has also demonstrated the capacity to reduce local inflammation, which in turn influences central pain processing (Niruthisard et al., 2024).
In the context of musculoskeletal practice, a large pooled meta-analysis of over 20,000 patients found that real acupuncture was consistently superior to both sham acupuncture and no acupuncture for musculoskeletal pain conditions and an evidence map of 111 systematic reviews published up to 2024 confirmed that acupuncture demonstrates positive short-term effects across the majority of musculoskeletal pain presentations assessed (Chen et al., 2025).
De Quervain's Tenosynovitis: What Is It?
De Quervain's tenosynovitis sometimes called De Quervain's disease is a condition involving the tendons that run through the first dorsal compartment of the wrist: the abductor pollicis longus (APL) and the extensor pollicis brevis (EPB). When the sheath surrounding these tendons becomes irritated or thickened, movement of the thumb and wrist becomes painful, particularly during gripping, pinching, or lifting.
The condition is most commonly associated with repetitive thumb and wrist use, and is frequently seen in new parents (particularly those repeatedly lifting infants), tradespeople, and athletes involved in racquet sports, weightlifting, or activities requiring sustained grip (Challoumas et al., 2023). The estimated prevalence is around 0.5% in men and 1.3% in women in the general population, though this rises significantly in occupationally at-risk groups (Leung et al., 2022).
Clinically, De Quervain's is characterised by tenderness at the radial styloid. The bony prominence on the thumb side of the wrist and is typically confirmed using Finkelstein's test, where the thumb is folded across the palm and the wrist is deviated toward the little finger, reproducing symptoms.
What Does the Research Say About Management?
The evidence base for De Quervain's management has strengthened considerably in recent years. A 2023 systematic review and network meta-analysis published in JAMA Network Open, analysing 30 studies involving over 1,600 patients. It found that corticosteroid injection combined with thumb spica immobilisation was associated with the most consistent short-term pain relief and functional improvement (Challoumas et al., 2023). A more recent 2024 network meta-analysis also identified extracorporeal shockwave therapy as a promising secondary option for those who do not respond to first-line approaches (Chong et al., 2024).
However, not everyone is comfortable with steroid injections, and conservative multimodal management remains a well-supported pathway. A 2025 systematic review and network meta-analysis specifically examining conservative options for De Quervain's confirmed that a combination of approaches, including manual therapy, splinting, and adjunctive needling techniques, which can produce meaningful improvements in both pain and function (Conservative Treatments NMA, 2025).
What About Acupuncture Specifically for De Quervain's?
The evidence for acupuncture in De Quervain's is emerging and generally encouraging, though the research base is smaller than the likes of neck pain or lower back pain.
A randomised controlled trial conducted at the University of Hong Kong recruited 68 participants with confirmed De Quervain's tenosynovitis and found that an acupuncture programme delivered over two weeks produced meaningful reductions in pain intensity at the end of treatment, with benefits maintained over a 10-week follow-up period (Leung et al., 2022). The treatment targeted sinew acupoints along the meridian pathways relevant to the affected tendons, a clinically grounded approach that aligns with Western anatomical thinking about the extensor compartment of the wrist.
A 2024 systematic review and meta-analysis specifically examining acupuncture for De Quervain's tenosynovitis concluded that, while higher-level evidence is still needed, the available data suggests acupuncture may offer meaningful symptomatic support for people with this condition, particularly in terms of pain and functional outcomes (Qin et al., 2024).
It's worth noting that LI4 itself sits directly over the dorsal aspect of the hand, in proximity to the first dorsal interosseous and the extensor compartment. Needling in this region, whether at LI4 or at adjacent anatomical points along the same neurovascular territory may produce both local tissue effects and broader neurophysiological responses relevant to wrist and thumb pain (Ilfeld et al., 2022; Fan et al., 2024).
How We Approach De Quervain's at MotionPlus Osteo
At our Hamilton clinic, a wrist or thumb assessment always begins with a thorough clinical picture. We want to understand not just the local anatomy, but how your hand is being used, whether that's caring for a newborn, working on a tools, training in the gym, or managing a desk-based workload.
Depending on the clinical findings, a management plan for De Quervain's or related wrist conditions may include:
Clinical needling — including points in and around the first dorsal compartment of the wrist, with LI4 considered as part of a broader point selection based on clinical assessment
Soft tissue therapy and joint mobilisation — addressing mobility of the wrist, thumb, and forearm
Load management and activity modification — particularly for tradespeople and new parents
Exercise rehabilitation — gentle progressive loading of the thumb extensors and abductors to support long-term tendon resilience
Splinting advice — where appropriate, guidance on thumb spica support to offload the affected tendons during recovery
As an ACC registered provider, no GP referral is needed. If your wrist or thumb pain followed an accident or sudden activity change, we may be able to lodge an ACC claim directly at the clinic.
References
Barker, A. R., Taghinia, A. H., & Bruneteau, R. J. (2017). An understanding of anatomy under the LI4 acupuncture point. Clinical Anatomy, 30(5), 602–609. https://doi.org/10.1002/ca.22889
Challoumas, D., Ramasubbu, R., Rooney, E., Seymour-Jackson, E., Putti, A., & Millar, N. L. (2023). Management of de Quervain tenosynovitis: A systematic review and network meta-analysis. JAMA Network Open, 6(10), e2337001. https://doi.org/10.1001/jamanetworkopen.2023.37001
Chen, Y., Wang, J., & Ang, L. (2025). Effects of acupuncture on musculoskeletal pain: An evidence map. Frontiers in Medicine, 12, 1575226. https://doi.org/10.3389/fmed.2025.1575226
Chong, H. H., Pradhan, A., Dhingra, M., Liong, W., Hau, M. Y. T., & Shah, R. (2024). Advancements in de Quervain tenosynovitis management: A comprehensive network meta-analysis. Journal of Hand Surgery, 49(6), 557–569. https://doi.org/10.1016/j.jhsa.2024.03.003
Conservative Treatments for De Quervain's Tenosynovitis Investigators. (2025). Conservative treatments for de Quervain's tenosynovitis: A systematic review and network meta-analysis. PubMed, CRD42023494486. https://doi.org/10.1016/j.ptsp.2025.11.001
Fan, Z., Dou, B., Wang, J., Wu, Y., Du, S., Li, J., Yao, K., Li, Y., Wang, S., Gong, Y., Guo, Y., & Xu, Z. (2024). Effects and mechanisms of acupuncture analgesia mediated by afferent nerves in acupoint microenvironments. Frontiers in Neuroscience, 17, 1239839. https://doi.org/10.3389/fnins.2023.1239839
Ilfeld, B. M., Gabriel, R. A., & Said, E. T. (2022). Acupuncture as an evidence-based nonpharmacologic strategy for comprehensive acute pain care: The Academic Consortium Pain Task Force White Paper update. Pain Medicine, 23(9), 1582–1601. https://doi.org/10.1093/pm/pnac056
Lee, I. S., Jung, W. M., Park, H., & Chae, Y. (2025). Understanding the multifaceted brain mechanisms of acupuncture based on neuroimaging studies: Findings and insights from meta-analyses. Frontiers in Neuroscience, 19, 1643302. https://doi.org/10.3389/fnins.2025.1643302
Leung, K., Ma, O. C., Qin, Z., Ting, H., Lau, A. H., Lun, K. K., Chan, H. Y., Wen, G. Y., Ng, J. T., & Liu, H. Y. (2022). Acupuncture for de Quervain's tenosynovitis: A randomized controlled trial. Phytomedicine, 104, 154254. https://doi.org/10.1016/j.phymed.2022.154254
Niruthisard, S., & Ma, Q. (2024). Recent advances in acupuncture for pain relief. PAIN Reports, 9(5), e1188. https://doi.org/10.1097/PR9.0000000000001188
Qin, Y., Luo, D., Qiu, H., Zhang, J., Yong, H., & Yu, S. (2024). A systematic review and meta-analysis of acupuncture for de Quervain's tenosynovitis treatment. Postgraduate Medical Journal, 100(1188), 709–720. https://doi.org/10.1093/postmj/qgae057
Umemoto, K., Naito, M., Tano, K., Terayama, H., Koike, T., Ohmichi, M., Ohmichi, Y., Sakabe, K., & Nakano, T. (2019). Acupuncture point "Hegu" (LI4) is close to the vascular branch from the superficial branch of the radial nerve. Evidence-Based Complementary and Alternative Medicine, 2019, 6173180. https://doi.org/10.1155/2019/6173180
World Health Organization. (2008). WHO standard acupuncture point locations in the Western Pacific Region. World Health Organization Regional Office for the Western Pacific. https://iris.who.int/handle/10665/206207