The year of 2017 was relatively miserable for me. I received 5 different diagnoses from 5 different doctors for the same set of symptoms. All of the medical professionals that I saw had done their best to accurately diagnose and treat the insidious bilateral hand pain that unexpectedly emerged in late February 2017. My initial diagnosis was arthritis (internal medicine doctor), followed by: carpal tunnel syndrome (rheumatologist), myofascial pain syndrome (orthopedic hand surgeon), non-specific peripheral neuropathy (neurologist), and small-fiber neuropathy (second internal medicine doctor).
None of the doctors ever pinpointed exactly what was occurring in my hands, however, based on results from multiple EMG tests – median nerve function was abnormal, indicative of carpal tunnel syndrome. That said, because my symptoms included more pain than numbness, and also involved my radial nerves, it was unclear as to whether I really had carpal tunnel syndrome. Nevertheless, I utilized a myriad of medically-recommended interventions in effort treat my bilateral neuropathic pain (and carpal tunnel-like symptoms).
As of today, I’m doing much better than approximately 11 months ago when my painful symptoms first emerged. Although doctors were never able to make a definitive diagnosis nor agree upon a “most-likely diagnosis,” a combination of ergonomic changes, lifestyle changes, and letting time pass have yielded partial recovery from the pain (I can at least type and wash dishes without stabbing sensations throughout my hands). Nevertheless, there was a time when I became so desperate to make the pain stop that I considered interventions that would make most skeptics cringe – one of which was acupuncture.
What is carpal tunnel syndrome (CTS)?
Carpal tunnel syndrome is a medical condition characterized by compression of the median nerve as it passes through the carpal tunnel of the wrist. Common symptoms of carpal tunnel syndrome include (but are not limited to): numbness, tingling, and pain – within the thumb, index finger, middle finger, and innermost half of the ring finger. Symptoms may begin gradually and are frequently suggested to be worse at nighttime for certain patients.
If left untreated, carpal tunnel syndrome may impair occupational performance, compromise psychological well-being, and possibly lead to atrophy of muscle tissue near the base of the thumb. For this reason, it is imperative for anyone who exhibits symptoms of carpal tunnel syndrome to seek immediate medical attention. Early diagnosis and treatment of carpal tunnel syndrome may facilitate complete recovery in a subset of patients without the need for carpal tunnel release surgery.
What is acupuncture?
Acupuncture is a form of complementary alternative medicine in which thin needles are inserted into specific sites of the body in effort to treat medical conditions and/or enhance one’s well-being. Though there are many different acupuncture techniques and philosophies, the most popular acupuncture format in the United States is the format that’s rooted in traditional Chinese medicine (TCM). While many acupuncture proponents and anecdotes suggest that acupuncture is effective as a treatment for a host of medical conditions – the scientific data suggest otherwise.
Evidence from numerous systematic reviews indicates that acupuncture is no more effective than a placebo in treating most medical conditions. Furthermore, most evidence from well-designed trials devoid of significant biases suggests that, even if acupuncture is effective, its therapeutic effect is generally short-lived. That said, acupuncture is usually regarded as safe when performed by an adequately trained and licensed practitioner who utilizes: clean needle technique and single-use needles.
How might acupuncture treat carpal tunnel syndrome?
Acupuncture is sometimes recommended [by medical professionals] and/or pursued [by patients] as an intervention (adjunct or standalone) for carpal tunnel syndrome (CTS). Because acupuncture is typically safe, inexpensive, and harmless – there’s generally little risk associated with “giving it a try” for carpal tunnel syndrome. At this time, the exact mechanisms by which acupuncture attenuates symptoms of carpal tunnel syndrome aren’t fully elucidated.
Anyone with a modicum of commonsense understands that acupuncture doesn’t treat carpal tunnel syndrome (or any medical condition) via modulation of Qi (energy), meridians, or other mystical (i.e. “woo”) pseudoscientific nonsense. However, several viable mechanisms have been documented as the potential means by which acupuncture reduces symptoms of CTS. Legitimate mechanisms by which acupuncture might reduce CTS are listed below.
- Anatomical changes: Some evidence indicates that acupuncture treatment may induce a cascade effect whereby downstream anatomical changes occur within the wrists, hands, and fingers of persons with CTS. A case report written by a medical doctor documented marked sonographic changes in measures of anterior-posterior diameters and cross-sectional areas of the median nerves in a patient with CTS after acupuncture. These post-acupuncture anatomical changes may attributable to anti-inflammatory or anti-edema effects induced downstream of acupuncture-mediated neurologic stimulation.
- Anti-inflammatory effect: Another means by which acupuncture may alleviate symptoms of carpal tunnel syndrome is via eliciting an anti-inflammatory effect. It’s unknown as to whether acupuncture specifically reduces inflammation within joints and/or tiny muscles near the carpal tunnels and wrists, or whether acupuncture may reduce inflammation throughout the entire body. Nevertheless, any reduction of inflammation that’s causally implicated in presentation or exacerbation of CTS may prove therapeutic. Anti-inflammatory effects facilitated by acupuncture may be a byproduct neuropeptides released during nerve stimulation and/or psychological relaxation (from the procedure).
- Brain activity modulation: The most plausible mechanism by which acupuncture treats symptoms of CTS is via neuromodulation. Researchers have compared the brain activations (via fMRI) of persons with CTS to that of healthy individuals (without CTS) and been able to pinpoint specific differences. After consecutive treatments with acupuncture, brain activations of persons with CTS often change significantly such that their activations shift closer to those exhibited by healthy individuals (devoid of CTS). In other words, acupuncture may help normalize brain activity in certain regions via needle stimulation-induced neuroplastic changes. Regions that have been noted to exhibit antinational changes among patients with CTS after acupuncture include: the primary somatosensory cortex (and its surrounding microstructures) and limbic system. If a patient responds to acupuncture for CTS, brain activity changes within the following areas: Contralesional hand area, Ipsilesional hand area, and Ipsilesional leg area.
- Electrophysiological changes: Electrophysiology refers to the flow of ions (currents) throughout biological tissues. Persons with carpal tunnel generally exhibit abnormal electrophysiological activity on tests like nerve conduction studies. Evidence indicates that acupuncture may induce considerable electrophysiological changes among patients with carpal tunnel syndrome. These electrophysiological changes after acupuncture among patients with CTS are evidenced by changes in amplitudes and latencies at the median nerve.
- Immune modulation: Some researchers have suggested that acupuncture may modulate immune activation, and that this modulation may play contribute to its therapeutic effect among patients with CTS. I’m highly skeptical of this hypothesized mechanism of action in the treatment of CTS, however, it’s possible that immune function indirectly improves as a result of relaxation (assuming anxiolytic effects are derived from acupuncture).
- Nerve fiber stimulation: Another likely mechanism by which acupuncture may benefit patients with carpal tunnel syndrome is via stimulating alpha-delta nerve fibers. Alpha-delta fibers are afferent fibers known to carry sensations of cold, pressure, and pain. When alpha-delta fibers are strategically stimulated with acupuncture needles, the stimulation may alter nerve fiber signaling to the brain and/or neuropeptide release whereby CTS symptoms of pain, tingling, and/or numbness are reduced.
- Tissue edema reduction: It has been suggested that acupuncture may reduce tissue edema within the median nerve area. This reduction of tissue edema may occur as a result of nerve stimulation-mediated neuropeptide release and/or an anti-inflammatory effect. Assuming tissue edema is reduced, this may decrease interstitial pressure around the median nerves (within the carpal tunnel) such that symptoms lessen or resolve.
Note: Unless higher-quality research is conducted, it’ll remain unknown as to which of the aforementioned mechanisms of acupuncture’s action are most relevant in the treatment of CTS. If I were to guess, I’d suggest that a combination of: brain modulation (somatosensory cortex plasticity); nerve fiber stimulation (alpha-delta fibers); and a downstream anti-inflammatory effect – explains symptomatic reductions among persons with CTS after acupuncture.
Acupuncture for Carpal Tunnel Syndrome (Research)
When discussing my condition with laypeople, many recommended that I seek treatment from: chiropractors, physiotherapists, and acupuncturists. I’m related to a chiropractor, and this past summer, I discussed my symptoms with him but refrained from allowing him to make any significant pseudoscientific “adjustments” (per recommendation from my orthopedic surgeon – as well as my own common sense). Later, I consulted physiotherapists and incorporated recommended stretches and nerve glides into my daily routine.
The stretches and nerve glides exacerbated my symptoms and my neurologist instructed me to discontinue (something I had already done because the pain was worse). Chiropractor, check. Physiotherapists, check. What’s next for my nerve pain? Acupuncture?! Although I have actually heard some orthopedic hand surgeons endorse it as a therapy for CTS, I couldn’t think of any plausible mechanism by which it would help my symptoms.
Eventually, I got around to reviewing studies in which acupuncture was evaluated as a treatment for CTS, and was relatively surprised with the findings. Despite the fact that I’m highly skeptical of claims suggesting that acupuncture effectively treats an array of medical conditions, there seems to be several conceivable mechanisms by which it might attenuate CTS symptoms. Included below are summaries of all studies that I dug up in which the effectiveness of acupuncture underwent evaluation among persons with CTS. (Let’s just say there were way more studies than I expected).
2017: Rewiring the primary somatosensory cortex in carpal tunnel syndrome with acupuncture.
Maeda, Kim, Kettner, et al. organized a study to determine the effect of electroacupuncture (locally and distally) in patients with CTS compared to a sham-electroacupuncture intervention. Not only did researchers assess symptomatic severity among patients before and after treatment, but they evaluated changes in activity within the somatosensory cortex region of patients’ brains.
- Participants: 80 patients with CTS
- Design: Randomized, controlled
- 3 groups: Electroacupuncture locally (on the affected hands); electroacupuncture distally (sites away from the affected hands); and sham electroacupuncture locally (on affected hands) with non-penetrating needles.
- Duration: 8 weeks (16 total sessions)
- Measures: Boston Carpal Tunnel Syndrome Questionnaire (at baseline and 3-month follow-up); nerve conduction studies; neuroimaging data (fMRI) with digit stimulation
- Results: All 3 acupuncture treatments (local, distal, and sham) significantly reduced symptomatic severity. However, recipients of legitimate electroacupuncture (locally and distally) exhibited significantly greater improvements in neurophysiological measures (median nerve conduction latency) and brain activity (separation between digits 2 and 3 in the somatosensory cortex) – compared to sham electroacupuncture recipients. What’s more, the recipients of legitimate electroacupuncture exhibited sustained therapeutic benefit at 3-month follow-up evaluations.
Based on the findings of this study, it appears as though acupuncture may be a therapeutically valuable non-surgical intervention for the treatment of carpal tunnel syndrome. This study was well-designed (with adequate controlling, randomization, duration) and incorporated a reasonable sample size. Furthermore, it’s impossible to dismiss the neuroplastic changes associated with digits 2 and 3 that occurred in the somatosensory cortices of acupuncture recipients. Authors believe that degree of somatosensory cortex changes among patients with carpal tunnel syndrome may predict their long-term outcomes.
2017: The Acupuncture Effect on Median Nerve Morphology in Patients with Carpal Tunnel Syndrome: An Ultrasonographic Study.
Ural and Öztürk conducted a small-scale study to examine the effect of acupuncture on the cross-sectional area (CSA) of the median nerve at the wrist among patients diagnosed with carpal tunnel syndrome. Though all patients were instructed to wear wrist splints at night as an intervention for carpal tunnel syndrome, only a subset were assigned to receive additional acupuncture. Below is a brief overview of the study and discussion of the results.
- Participants: 27 female patients with CTS
- Design: Randomized, controlled
- Groups: Acupuncture vs. Control
- Duration: 4 weeks
- Measures: Visual analog scale (VAS), Duruöz Hand Index (DHI), Quick Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire scores, electrophysiologic measurements, and median nerve cross-sectional areas (CSAs) – before and after the 4-week trial.
- Results: A total of 45 limbs were assessed among the 27 participants – before and after the 4-week trial. Researchers reported significant improvements among both the acupuncture and control group (compared to baseline) in the following measures: VAS, DHI, DASH scores, and electrophysiological activity. That said, improvements in VAS, DHI, DASH, and S-NCV were significantly greater among acupuncture recipients. Moreover, only the acupuncture recipients exhibited significant reductions in the cross-sectional areas of their median nerves.
It was concluded that acupuncture therapy may facilitate clinical and morphological improvement among patients with carpal tunnel syndrome. However, it is important to underscore the fact that this study is riddled with limitations including: small sample size (27); zero male participants; short duration; and confounding as a result of nightly wrist splinting – a notoriously therapeutic intervention for carpal tunnel syndrome. Nevertheless, the results of this study indicate that acupuncture plus nightly wrist splinting may be therapeutically superior to standalone nightly wrist splinting for the treatment of carpal tunnel syndrome.
2015: Efficacies of Acupuncture and Anti-inflammatory Treatment for Carpal Tunnel Syndrome.
Hadianfard, Bazrafshan, Momeninejad, et al. sought to compare the efficacy of “acupuncture plus nightly wrist splinting” to that of “anti-inflammatories plus nightly wrist splinting” for the treatment of mild-to-moderate carpal tunnel syndrome (CTS).
- Participants: 50 patients with CTS (mild-to-moderate)
- Design: Randomized, controlled
- Groups: Acupuncture/splinting vs. Ibuprofen/splinting – All participants were assigned to utilize night wrist splints for the entire 1-month trial. Half of the participants received 8 sessions of acupuncture (2 sessions per week), whereas the remaining half of participants received ibuprofen (400 mg) three times per day for a total of 10 days.
- Duration: 1 month
- Measures: Visual analog scale (VAS), Boston Carpal Tunnel Questionnaire (BCTQ), and electrodiagnostic data – at baseline and after 1 month of treatment
- Results: Both groups exhibited significant improvements in symptomatic severity after 1 month compared to pre-treatment baseline. That said, recipients of acupuncture exhibited significantly greater attenuation of CTS than recipients of ibuprofen as evidenced by: decreased numbness/tingling at night, fewer nighttime awakenings due to symptoms, and electrodiagnostic data. Additionally, improvements in the ability to perform daily tasks such as using a phone and doing housework were slightly greater among acupuncture recipients than those who received ibuprofen.
In conclusion, the results of this study support the efficacy of acupuncture for the treatment of mild-to-moderate CTS. There are a few limitations associated with this study that were not mentioned by authors including: short-term ibuprofen treatment (10 days rather than the entire month), short-duration of study (just 1 month), and the relatively modest sample size. Nevertheless, authors concluded that short-term acupuncture appears safe, effective, and of greater therapeutic value than ibuprofen for mild-to-moderate CTS.
2014: Clinical effectiveness of acupuncture for carpal tunnel syndrome.
Ho, Lin, Lee, et al. compared the efficacy of acupuncture and electroacupuncture on upper limbs (at acupoints PC-6 and PC-7) for the treatment of carpal tunnel syndrome. All patients that participated in this study received 24 sessions (15 minutes each) of either acupuncture or electroacupuncture over the span of 6 weeks.
- Participants: 26 patients with CTS
- Design: Non-controlled, non-randomized
- Groups: Acupuncture (15) vs. Electroacupuncture (11)
- Duration: 6 weeks
- Measures: Short clinical questionnaire (symptom severity) and electrophysiological measurements – at baseline and post-treatment.
- Results: Electroacupuncture significantly reduced the severity of CTS symptoms among recipients. Acupuncture treatment significantly increased grip strength among recipients. Electrophysiological recordings revealed marked increases in distal median motor amplitude on the palm-wrist segment. Moreover, Tinel’s sign was substantially reduced after treatment.
Researchers concluded that electroacupuncture may improve overall symptoms of CTS and acupuncture might also improve CTS symptoms, enhance grip strength, and normalize electrophysiological activity within hands/wrists. However, it should be noted that this study was neither randomized nor controlled (e.g. with a sham). Moreover, although the duration was sufficient, the number of participants was extremely low, and the scale utilized to gauge improvement may have been questionable. For the aforementioned reasons, results of this study should be interpreted with caution.
2012: Randomized controlled trial comparing acupuncture with placebo acupuncture for the treatment of carpal tunnel syndrome.
Yao, Gerritz, Henricson, et al. organized a robustly-designed trial to evaluate the effectiveness of acupuncture for the treatment of CTS.
- Participants: 34 acupuncture-naïve adults with CTS (mild-to-moderate)
- Design: Randomized, placebo-controlled, double-blinded
- Groups: Acupuncture vs. placebo acupuncture – both groups were given wrist braces to be worn at night
- Duration: 6 weeks
- Measures: CTSAQ (Carpal Tunnel Self-Assessment Questionnaire) – baseline vs. post-treatment
- Secondary measures: Tip/key pinch strength; combined sensory index – baseline vs. post-treatment
- Results: Acupuncture recipients exhibited significant symptomatic improvement on the CTSAQ (0.58) compared to baseline. Placebo acupuncture recipients also exhibited significant symptomatic improvement on the CTSAQ (0.81) compared to baseline. In fact, the placebo acupuncture response was superior to that of the legitimate acupuncture response. Neither group differed from the other with regard to CTS symptoms, function, tip/key pinch, and combined sensory index scores.
Authors of the study noted was the very first randomized, placebo-controlled, and double-blinded trial in which traditional acupuncture was evaluated in patients with CTS. Though both treatment groups exhibited significant symptomatic improvement after treatment, acupuncture was no more effective than a placebo [when combined with nighttime splinting] – among patients with CTS. Despite the favorable study design and duration, there were some limitations that warrant mentioning, including: the small sample size (34) and the placebo acupuncture procedure (which may have elicited therapeutic effects via stimulation – regardless of the needle type)
2012: Acupuncture in treatment of carpal tunnel syndrome: A randomized controlled trial study.
Khosrawi, Moghtaderi, and Haghighat conducted a study to determine the short-term effect of acupuncture among patients with CTS.
- Participants: 64 patients with CTS (mild-to-moderate)
- Design: Randomized, controlled
- Groups: Acupuncture (acupuncture/night splinting) vs. Control (night splinting/vitamins (B1/B6)/sham acupuncture)
- Duration: 4 weeks
- Measures: Global symptom score (GSS) and electrophysiological measures – at baseline and after the 4-week study
- Results: Recipients of acupuncture (8 sessions) over the span of 4 weeks exhibited significant improvements in both global symptom scores and nerve conduction velocity (an electrophysiological measure) – compared to baseline and recipients of the sham acupuncture.
It was concluded that acupuncture improves subjective symptoms of CTS and nerve conduction velocities. That said, this study may be limited by its short-term duration, small sample size, and confounded by a greater number of physician visits among those who received acupuncture. Nevertheless, results from this study suggest that acupuncture may serve as a therapeutic intervention for CTS.
Further research is recommended to determine long-term outcome and comparison of acupuncture to other conservative managements of CTS.
2011: Acupuncture for carpal tunnel syndrome: a systematic review of randomized controlled trials.
Sim, Shin, Lee et al. conducted a systematic review of randomized controlled trials in which acupuncture was evaluated as a treatment for CTS. Because this is a systematic review, it provides the highest quality of evidence in determining whether acupuncture is effective among patients with CTS.
- Methods: 11 electronic databases were searched for RCTs in which acupuncture was tested as a treatment for CTS. Researchers utilized the Cochrane risk of bias to determine methodological quality of each trial.
- Inclusion: 6 RCTs met inclusion criteria of the researchers to be included in the systematic review. That said, the methodological quality of these RCTs was, for the most part, “low.”
- Results: The systematic review and meta-analysis conducted by researchers indicated that acupuncture may be useful as a treatment for CTS. However, due to “low” methodological quality of the RCTs included in the review, the clinical efficacy of acupuncture among patients with CTS remains unclear.
In summary, authors of this review suggested that acupuncture exhibits preliminary therapeutic potential as a treatment for CTS, however, evidence is insufficient as to garner clinical support.
2009: Acupuncture in patients with carpal tunnel syndrome: A randomized controlled trial.
Yang, Hsieh, Wang, et al. conducted a trial to compare the effect of acupuncture to that of oral steroids for the treatment of carpal tunnel syndrome (CTS).
- Participants: 77 patients with CTS (mild-to-moderate)
- Design: Randomized, controlled
- Groups: Acupuncture (8 sessions) vs. Oral steroids (prednisolone)
- Duration: 4 weeks
- Measures: Nerve conduction studies (NCS); global symptom score (GSS) – taken at baseline, Week 2, and Week 4.
- Results: Global symptom scores revealed significant improvement in both groups at Week 2 and Week 4. Symptomatic improvements did not differ significantly between groups. That said, recipients of acupuncture exhibited significant reductions in distal motor latency (DML) compared to steroid recipients at Week 4.
The researchers involved in this study concluded that short-term acupuncture (8 sessions delivered twice per week for a duration of 4 weeks) is as efficacious as oral steroids (prednisolone 20 mg then 10 mg) for the treatment of mild-to-moderate CTS. On a side note, I’m not sure how frequently oral steroids are utilized in the treatment of CTS. I’m aware that steroid injections are often utilized as a last-resort prior to surgery, but have never encountered any medical professionals who endorse or regularly consider oral steroids among patients with CTS.
If the CTS is mediated by autoimmune conditions, then oral steroids may seem like a reasonable option. In any regard, both acupuncture and oral steroids effectively attenuated symptoms of CTS in this short-term, yet well-designed study. The findings provide additional support for the usage of acupuncture as a therapy among persons with mild-to-moderate CTS.
2007: Somatosensory cortical plasticity in carpal tunnel syndrome treated by acupuncture.
Napadow, Liu, Li et al. hypothesized that irregular afferent nerve innervations associated with CTS cause maladaptive neuroplastic changes within the brain such as to reinforce CTS-related pain and/or symptoms. The authors believed that the maladaptive neuroplastic changes could be ameliorated via targeted therapies – one of which happens to be acupuncture.
- Participants: Patients with CTS (received acupuncture) vs. healthy adults
- Design: Controlled
- Duration: 5 weeks
- Measures: Functional MRI (fMRI) with sensory stimulation on digits 2, 3, and 5 – at baseline and after 5 weeks of acupuncture.
- Results: Patients with CTS that received acupuncture exhibited significant changes in fMRI activation in contralateral Brodmann Areas 1 and 4 – after the 5 weeks of treatment (shifting their brain activation closer towards that exhibited by the healthy adults). Moreover, prior to treatment, separation of digits 2 and 3 was blurred among patients with CTS compared to healthy adults, there was a lateral shift in digit 2 representation within the somatosensory cortex (S1) of patients with CTS after 5 weeks of acupuncture – leading to greater separation between digits 2 and 3 in the somatosensory cortex.
Researchers concluded that acupuncture appears to induce neuroplastic changes in the brains of patients with CTS and that these changes may yield symptomatic improvement.
2002: Acupuncture for carpal tunnel syndrome.
Freedman authored a case report in which acupuncture was utilized to successfully treat severe CTS in a 51-year-old woman. The acupuncture was administered by the author of this case report.
- Case: 51-year-old woman – colloquially referred to as “lollipop lady” due to the fact that she worked as a school crossing patrol officer and regularly held up a sign in the shape of a lollipop.
- History: 5-year history of pain in the right wrist, forearm, shoulder/neck, and paresthesias in fingers of the right hand. She was diagnosed with carpal tunnel syndrome in 1996 based on symptoms in which the median nerve was implicated.
- Initial treatments: Physiotherapy, bendrofluazide, nighttime splinting – none of these interventions provided adequate benefit in 1996. In 1998 she received NSAIDs, a cortisone injection, and additional physiotherapy. As of 1999, the pain was more debilitating and impaired her ability to work.
- Work-related: An obvious link between the woman’s occupational duties and her symptoms was made. Whenever the woman held up her lollipop-shaped stop sign for lengthy durations, her symptoms substantially worsened. Whenever the woman took time off from work – her symptoms markedly improved.
- Acupuncture treatment: Weekly at first, then every 2-3 weeks based on severity of symptoms for a total of 8 sessions. Average needling time never exceeded 5 minutes.
- Results: The acupuncture sessions provided substantial CTS relief – enabling the woman to continue working without severe symptoms. That said, the woman eventually would eventually necessitate carpal tunnel decompression surgery – which completely cured her CTS.
The author of this case report noted that acupuncture may provide significant therapeutic benefit among patients with CTS whereby they have an easier time working and/or coping with symptoms while awaiting surgery. It was further suggested that while acupuncture may alleviate CTS over a short-term, it is unlikely to act as a long-term or permanent cure. Nevertheless, this is yet more evidence that acupuncture may help treat CTS (even if it doesn’t cure it).
2001: Case report: acupuncture for carpal tunnel syndrome. Ultrasound assessment of adjunct therapy.
Banner and Hudson authored a case report in which a woman with carpal tunnel syndrome derived significant therapeutic benefit from acupuncture. The acupuncture was administered by a medical doctor and author of the case report.
- Case: A 36-year-old woman with a history of Chron’s disease (requiring no treatment) presented with severe CTS. She was eventually referred to a medical doctor who utilized acupuncture as a treatment for her CTS.
- History: The patient reported experiencing unilateral numbness and pain in her right hand and wrist for a duration of 9 months. No symptoms were reported in her left hand/wrist.
- First-line treatment: Custom-made wrist splint worn at bedtime. This intervention provided modest, yet unsatisfactory symptom reduction.
- Diagnosis: Severe CTS was diagnosed based on medical examinations including: soft-tissue sonograms, positive Tinel’s and Phalen’s signs, and positive arterial blood pressure cuff occlusion tests with symptomatic reproduction in under 60 seconds. The patient exhibited: wasting of the right thenar muscle and first/second dorsal interossei muscles, as well as weakness of the opponens pollicis. Moreover, each of the patient’s median nerves were flattened with anterior-posterior diameters of 2 mm and the right median nerve was hypoechoic (on the ultrasound) when compared to the left. Average cross-sectional areas of median nerves were 5 mm2 (right) and 9 mm2 (left).
- Acupuncture treatment: The patient received acupuncture once-per-week for a total of 5 weeks. It was noted that, for unknown reasons, the patient discontinued nighttime splinting of her wrist at some point during the 5 consecutive weeks of acupuncture. Within 5 weeks of receiving once-per-week acupuncture, the patient was symptom free.
- Follow-up examination: Follow-up soft-tissue sonographic examination revealed symmetric echogenicity among the median nerves. Additionally, the nerves exhibited substantial changes in anterior-posterior diameters (1.4 mm) and average cross-sectional areas (3 mm2).
It was concluded by authors that acupuncture treatment induced significant and measurable anatomical changes which correlated with remission of CTS symptoms. Obviously, because this is merely a case report, it is unclear as to whether similar remission of CTS symptoms would occur in a majority of the populace. That said, the sonographic changes observed in this patient support the idea that acupuncture may effectively treat CTS via anatomical modulation.
1999: Carpal tunnel syndrome: clinical outcome after low-level laser acupuncture, microamps transcutaneous electrical nerve stimulation, and other alternative therapies–an open protocol study.
Branco and Naeser sought to determine the efficacy of low-level laser acupuncture plus transcutaneous electrical nerve stimulation for the treatment of refractory carpal tunnel syndrome.
- Participants: 31 patients with CTS who derived insufficient benefit from conventional medical treatments.
- Design: Non-controlled / non-randomized
- Primary procedure: Low-level laser acupuncture (670 nm, continuous wave) plus transcutaneous electrical nerve stimulation (with microamps) on the affected hands of patients with CTS.
- Secondary procedure: Infrared low-level laser (904 nm, pulsed) and/or needle acupuncture on the affected hands of patients with CTS.
- Third procedure: Chinese herbal medicine formulas and supplements were administered if necessary (3 times per week) for 4-5 weeks.
- Measures: Melzack pain scores, profession/employment status.
- Results: Melzack pain scores significantly decreased after treatment. A total of 33 hands (of the 36) were noted to have had pain reductions exceeding 50%. Patients were able to maintain employment as a result of treatment. At 1-to-2 years post-treatment, 2 of 23 hands experienced pain relapse, but was successfully re-treated over a span of several weeks.
Authors of the study concluded that the efficacy of the low-level laser acupuncture for the treatment of refractory CTS may be from its ability to increase adenosine triphosphate (ATP). Moreover, authors estimate that the average patient with refractory CTS spends approximately $12,000 on medical treatment, whereas the treatment utilized in this study only costs around $1,000 per patient. It was further noted that acupuncture procedures are considered safe and virtually pain free.
Despite the overwhelmingly favorable responses among CTS patients to low-level laser acupuncture interventions in this study, there are some serious limitations associated with this study that warrant mentioning, including: poor design (non-randomized, uncontrolled), small sample size (31 patients), and limited duration. Unless the limitations are addressed via a follow-up study, it’s impossible to gauge the accuracy of the findings.
Based on the research, is acupuncture effective for CTS?
Likely. Although many studies in which acupuncture was investigated as a treatment for CTS are of low methodological quality, short-duration, and/or small-scale, as of current, the available data are unanimous in suggesting that acupuncture significantly reduces symptoms of CTS or exhibits potential as a therapeutic intervention for CTS. As of current, no published studies have discovered acupuncture as being ineffective for the treatment of CTS.
Moreover, symptomatic improvements among patients with CTS after acupuncture are associated with a host of: neuroplastic changes in somatosensory cortex (as evidenced by fMRI scans); anatomical changes in the hand, wrist, and fingers (as evidenced by sonography); and electrophysiological changes (as evidenced by nerve conduction studies). It’s difficult to dismiss these changes that occur among patients with CTS as a result of acupuncture as mere coincidence – especially because they don’t occur among healthy adults devoid of CTS. In brief, acupuncture isn’t eliciting a therapeutic effect via pseudoscientific modulation of qi energy via meridians – it’s altering activity within the brain and peripheral nervous systems of patients with CTS to attenuate symptoms.
Will everyone with CTS benefit from acupuncture?
Probably not. Most treatments for medical conditions do not have a 100% success rate. Some individuals who receive acupuncture in hopes that it’ll treat their CTS may derive zero noticeable therapeutic relief from the procedure. That said, other individuals may derive significant therapeutic relief from the procedure. Effectiveness of acupuncture for the treatment of CTS may be contingent upon several factors, including:
- Acupuncturist: Not all acupuncturists are equal – some are likely amateurs who lack skill and/or proper technique, whereas others are probably highly skilled with great technique. If you hope to get relief from your symptoms of CTS, you’ll probably want to find an acupuncturist with a solid reputation – not a complete random.
- CTS severity: Acupuncture may be more likely to facilitate symptomatic reduction among patients with mild-to-moderate CTS – rather than severe CTS.
- Protocol: Just because someone is a licensed acupuncturist and claims to treat CTS does not mean that they’ve bothered reading the latest literature to dig up the most successful acupuncture protocols for the treatment of CTS. You may want to ask the acupuncturist that you’re working with if they’ve created a protocol for CTS based on studies – or if they’re just winging it.
- Treatments: The duration, frequency, and total number of treatments that you receive may influence the degree of benefit you get from acupuncture for CTS. Someone getting acupuncture twice per week for 20 sessions may report superior benefit than if the same person only got acupuncture once per week for 4 sessions.
Would I recommend trying acupuncture for carpal tunnel syndrome?
Yes. Before resorting to steroid injections, oral steroids, or carpal tunnel release surgery – I’d definitely give acupuncture a shot. That said, there are a host of interventions I’d test for the treatment of CTS before considering acupuncture – they are listed below. (Keep in mind that these are things that I’d personally consider – I’m not suggesting that you incorporate them).
- Wrist splints: Nightly. (Possibly during the day when resting).
- Supplements: B-vitamins, curcumin, alpha lipoic acid, lion’s mane mushroom.
- LLLT: Low-level laser therapy on the hands, wrists, forearms.
- Cardio: High-intensity cardio to upregulate NGF.
- Rest: Rest the hands as much as possible (esp. if CTS was triggered by RSI).
- Extensor strengthening: Strengthening the extensor muscles of the hand/forearm may provide benefit.
- Ergonomics: Optimize ergonomics when using cell phones and computers (posture, keyboard, mouse, monitor, desk, etc.)
- Nerve glides: Very gentle nerve gliding exercises performed 1-2 times per day might prove beneficial.
- Hot vs. cold therapy: Heat packs (to increase blood flow) may help. Fully immersing hands/wrists in a bucket of ice water for 5-10 minutes may help (reduce inflammation).
- Self-massage: Lightly massaging the fingers, hands, and wrists may prove therapeutic.
- Reduce stress: Meditation, deep breathing, etc. Stress reduction can decrease blood pressure and muscle tension – each of which might improve CTS.
- Correct micronutrient deficiencies: Eat a balanced diet, consider a daily multivitamin. Micronutrient deficiencies may play a role in certain cases of CTS.
- Weight loss: If you’re overweight, losing weight may improve CTS.
- Sleep position: Sleeping in the supine position (on your back) may alleviate CTS.
Should you try acupuncture for CTS?
It’s your decision. I’m not here to give advice as to how you should treat your CTS. If I was diagnosed with CTS, I’d be willing to giving acupuncture a try. The literature suggests that acupuncture can be effective in reducing CTS symptoms, and for a subset of recipients, potentially curative. Patients who employ conventional CTS interventions such as: nighttime wrist splints, anti-inflammatories, daily exercise, weight management, resting the hands, and ergonomic changes – might derive adjunct benefit from acupuncture.
Individuals with mild-to-moderate CTS may find that acupuncture effectively reduces symptoms such that they no longer need to consider carpal tunnel release surgery. Persons with severe CTS may find that acupuncture treatments make it easier to cope with symptoms in months, weeks, or days leading up to their scheduled carpal tunnel release surgery.
Reasons you may want to consider acupuncture for CTS…
- Cost (?): Acupuncture may not be cheap, but it may be cheaper than regularly seeing your doctor for CTS treatments or carpal tunnel release surgery (estimated as falling between $4000 and $12000). Most acupuncture treatments will cost between $50 and $150 – depending on where you live, whether you pay upfront, the specific practitioner, and duration of the session.
- Evidence-based for CTS: Though the evidence isn’t necessarily “high quality,” acupuncture is an evidence-based intervention for CTS. All studies suggest that acupuncture is likely to benefit patients with CTS.
- Plausible mechanisms of action: There seems to be legitimate mechanisms by which acupuncture treats CTS (involving neither qi energy nor meridians). Acupuncture seems to remap the cortex and modulate electrophysiological activity.
- Pre-surgery relief: Some individuals may want to seek out acupuncture to reduce CTS symptoms while awaiting carpal tunnel release surgery.
- Safety: In most cases, it should be safe to receive acupuncture from licensed acupuncturists who follow protocol. The safety of acupuncture for CTS is likely superior to that of NSAIDs and steroids – each of which often induce unwanted side effects.
- Sustained effects: Some research suggests that certain CTS patients experience sustained long-term benefit from acupuncture. While likely a bit sanguine, other research indicates that certain patients are permanently cured of CTS after acupuncture.
How many sessions of acupuncture will you need to alleviate CTS symptoms?
Research suggests that receiving acupuncture 2 times per week over a span of 4 consecutive weeks (for a total of 8 sessions) should attenuate symptoms of CTS. For certain individuals, receiving acupuncture just 1 time per week is sufficient enough to substantially attenuate symptoms of CTS. Moreover, understand that most acupuncture sessions for CTS need not be lengthy for adequate relief – one medical doctor and acupuncturist reported significant therapeutic benefit can be attained with less than 5 minutes dedicated to each hand/wrist.
If you want to give acupuncture a thorough test for your CTS, you may want to try 2 sessions per week for a total of 8 weeks – this should be more-than-enough time to gauge its efficacy. That said, most people should know whether acupuncture is helping their CTS within 4 weeks (at 2 sessions per week). If you don’t benefit from acupuncture within 4 weeks: you don’t respond to acupuncture for CTS (most likely) or your acupuncturist is an amateur that doesn’t know how to treat CTS (less likely).
Recommendations for persons pursuing acupuncture for CTS
Before getting acupuncture in effort to treat CTS, you should first talk with a medical doctor. Make sure you were properly diagnosed (actually have CTS) and have tried all practical and less expensive interventions. Assuming you’ve calculated the costs associated with acupuncture and want to test it as a treatment for your CTS, below are some recommendations to consider.
- Medical doctor acupuncturist: Some medical doctors are also licensed acupuncturists. While a medical doctor who’s also an acupuncturist may be rare and/or more expensive than standard acupuncturists, these individuals are likely aware of evidence-based acupuncture protocols that are most effective in the treatment of CTS. If you can find a medical doctor who incorporates acupuncture into his/her practice – this should be your top choice.
- Skilled, licensed acupuncturist: If you’re unable to find an MD that also offers acupuncture, you’ll still want to find a skilled licensed acupuncturist with a solid reputation. You don’t want an amateur who lacks knowledge of acupuncture protocols for CTS – as his/her poor technique or protocol may yield no therapeutic effect.
- CTS protocol: Any acupuncturist should know of effective protocols specifically for the treatment of CTS. If an acupuncturist is merely “winging it” and isn’t following any particular protocol engineered for CTS – you’ll probably want to avoid this acupuncturist and find someone who’s bothered reading studies and analyzing some CTS protocols.
- Minimum commitment: Assuming you’ve found a qualified and knowledgeable acupuncture practitioner, you may want to commit yourself to receiving a minimal number of sessions before deciding whether its helping your CTS. In the literature, 8 sessions of acupuncture (2 per week) administered over a 1-month span alleviated symptoms of CTS. I’d personally try at least 2 sessions before dismissing it as completely useless.
- Track symptoms: To know whether you’re benefitting from acupuncture, document your symptoms before and after treatment. Keep a daily log of symptomatic severities. Write down all of your symptoms before acupuncture and rate each on a numeric scale (1 to 10 works fine). Then rate symptoms each day after acupuncture in between sessions. If symptoms don’t seem to improve for the better – you’ll know that acupuncture isn’t helping.
Would my peripheral neuropathy (CTS-like symptoms) benefit from acupuncture?
Because medical professionals are unsure as to whether I have carpal tunnel syndrome plus another condition OR carpal tunnel syndrome-like symptoms as a byproduct of a more serious health issue, I’m unsure as to whether my symptoms would respond well to acupuncture. My symptoms are usually as follows: hand pain (most severe, 24/7), tingling (intermittent), numbness (relatively rare). Both my median nerve and radial nerves have been confirmed by a neurologist as causing my symptoms (evidenced by multiple nerve conduction studies).
In any regard, because acupuncture may improve electrophysiological activity, modulate wrist anatomy, as well as induce neuroplastic changes within the somatosensory cortex – it may be worth a shot for my mysterious nerve condition – even if I don’t specifically have CTS. That said, because my symptoms have lessened significantly over the past month, and because I’ve already spent thousands on medical bills (specialists, blood work, nerve studies, imaging, etc.) – I’m not particularly motivated to dole out additional funds for acupuncture. Nonetheless, if my symptoms worsen again (i.e. flare up), I’ll seriously consider giving acupuncture a try.
Have you tried acupuncture for carpal tunnel syndrome?
If you’ve tried acupuncture for carpal tunnel syndrome, I’d like to grill you with a lineup of questions to be answered in the comments section. Understand that you don’t need to answer any questions (or all of the questions) to leave a comment. By answering the questions you’ll help myself (and other readers) get a better understanding of your CTS and experience with acupuncture.
- Were you formally diagnosed with CTS? (If so, was a nerve conduction study performed to aid in diagnosis?)
- When diagnosed with CTS, were your symptoms mild, moderate, or severe?
- How long had you lived with CTS before trying acupuncture?
- After acupuncture, did your CTS symptoms change? (If so, were they better or worse – and to what extent?)
- How many sessions of acupuncture did you receive for your CTS?
- What was the cumulative cost of your acupuncture treatments?
- How long was each acupuncture session?
- Before trying acupuncture – or between sessions – did you utilize any other therapies for CTS? (e.g. nighttime braces, resting the hands, anti-inflammatories, steroids)
- Based on your experience, would you recommend that others try acupuncture for CTS?