Carpal Tunnel Syndrome

Carpal Tunnel Syndrome (CTS)

Acupuncture plus night wrist splints was found to be superior to ibuprofen plus night wrist splints in improving both function and symptoms. Similarly, acupuncture (plus night splints) was found to be superior to ibuprofen (plus night splints) in affecting the electrodiagnostic findings, with the exception of distal motor latency.1

A systematic review in 2016 of acupuncture for musculoskeletal disorders of the extremities found that studies with a low risk of bias suggested that traditional needle acupuncture was superior to oral steroids and may be superior to vitamin B1/B6 supplements for carpal tunnel syndrome (CTS). Electroacupuncture may be as effective as, but not superior to, night splinting for CTS.2

Laser acupuncture produced a significantly greater reduction in Global Symptom Score than placebo laser acupuncture at Week 2 and Week 4, but there was no difference between groups in nerve conduction studies.3

A Cochrane Systematic Review on acupuncture for carpal tunnel syndrome published in 2018 noted that studies were generally of low quality and hence the certainty of any conclusions from the evidence is low or very low.4 The reviewers did concede that acupuncture for carpal tunnel syndrome was associated with no serious adverse events.4 The reviewers called for more high quality randomised controlled trials on acupuncture for carpal tunnel syndrome.4

A randomised controlled trial published in 2019 had more positive findings:
All clinical symptoms and the results of the electrodiagnostic tests improved significantly in the intervention group, and the improvements continued during the 3 months post-intervention. The therapeutic results of acupuncture were mostly similar to, and in certain cases better than, those of the conventional medical treatment. Therefore, acupuncture can be suggested as a safe and suitable therapeutic method in CTS.5

A systematic review in 2020 (which included 10 randomised controlled trials and 728 participants), while conceding that there were issues with the quality of some studies, reached the following conclusions: For both symptom relief and functional improvement, manual acupuncture is superior to ibuprofen and prednisolone. Electroacupuncture plus splinting outperforms splinting alone for improvement in functional status. Limited evidence showed electroacupuncture's potential role in pain reduction.6

In addition to improvement in symptoms and function, some studies have also shown that acupuncture for carpal tunnel syndrome can impact both peripheral nerves and the brain.

In a study comparing night splints alone with night splints plus acupuncture, it was found that while both groups improved in symptoms, a significant decrease in the cross-sectional area of the median nerve was observed only in the acupuncture plus night splints group.7

In a landmark fMRI study by Napadow et al in 2014 it was demonstrated that acupuncture could reverse adverse neuroplastic changes in the somatosensory cortex of the brain in a patient with carpal tunnel syndrome.8 Since adverse neuroplasticity can play an important role in complex pain syndromes, this was a very important finding about the potential of acupuncture in treating chronic pain.

References
1.            Hadianfard M, Bazrafshan E, Momeninejad H, Jahani N. Efficacies of Acupuncture and Anti-inflammatory Treatment for Carpal Tunnel Syndrome. Journal of acupuncture and meridian studies. 2015;8(5):229-35.2.
Cox J, Varatharajan S, Cote P, Optima C. Effectiveness of Acupuncture Therapies to Manage Musculoskeletal Disorders of the Extremities: A Systematic Review. J Orthop Sports Phys Ther. 2016;46(6):409-29.
3.            Juan CW, Chang MH, Lin TH, Hwang KL, Fu TC, Shih PH, et al. Laser Acupuncture for Carpal Tunnel Syndrome: A Single-Blinded Controlled Study. J Altern Complement Med. 2019;25(10):1035-43.
4.            Choi GH, Wieland LS, Lee H, Sim H, Lee MS, Shin BC. Acupuncture and related interventions for the treatment of symptoms associated with carpal tunnel syndrome. Cochrane Database Syst Rev. 2018;12:Cd011215.
5.            Bahrami-Taghanaki H, Azizi H, Hasanabadi H, Jokar MH, Iranmanesh A, Khorsand-Vakilzadeh A, et al. Acupuncture for Carpal Tunnel Syndrome: A Randomized Controlled Trial Studying Changes in Clinical Symptoms and Electrodiagnostic Tests. Altern Ther Health Med. 2019.
6.            Wu IX, Lam VC, Ho RS, Cheung WK, Sit RW, Chou LW, et al. Acupuncture and related interventions for carpal tunnel syndrome: systematic review. Clin Rehabil. 2020;34(1):34-44.
7.            Ural FG, Ozturk GT. The Acupuncture Effect on Median Nerve Morphology in Patients with Carpal Tunnel Syndrome: An Ultrasonographic Study. Evidence-based complementary and alternative medicine : eCAM. 2017;2017:7420648.
8.           Napadow V, Liu J, Li M, Kettner N, Ryan A, Kwong KK, et al. Somatosensory cortical plasticity in carpal tunnel syndrome treated by acupuncture. Hum Brain Mapp. 2007;28(3):159-71.

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