Acupuncture Benefits Patients With Carpal Tunnel Syndrome
A few months ago Ural et al, from Yildirim Beyazit University Medical School in Ankara, published an interesting paper looking into the effects of acupuncture on carpal tunnel syndrome (CTS). Their work was published in Evidence-Based Complementary and Alternative Medicine.
CTS affects more women than men and has a prevalence of 1-5%. Causes include overuse of the hand, diabetes, rheumatoid arthritis, hypothyroidism and pregnancy. Symptoms can include pain numbness and tingling of the first 3-4 fingers, as well as weakness and wasting of the hand muscles supplied by the median nerve. Some of the commonly used treatments are rest, non-steroidal anti-inflammatory drugs, splinting, steroid inject injections, vitamin B6 supplementation, physiotherapy and eventually surgery. The cross-sectional area (CSA) of the median nerve has been found to increase in association with the severity of CTS. In fact, this increase in CSA is so reliable that it can be used to diagnose CTS or predict the need for surgery.
Ural et al recruited 27 female patients with mild to moderate CTS. On average, their symptoms had lasted about 1.5 years. They were randomised into an acupuncture group and a control group. Both groups wore a night wrist splint for 4 weeks. In addition to the night splint, the acupuncture group received 10 sessions of acupuncture over 4 weeks. Nine acupuncture points were used and the needles were retained for 25 minutes. Evaluations of hand function (DHI and DASH) and pain (VAS), electrophysiological tests and ultrasound measurements of CSA were taken before and after treatment.
The results showed that symptom severity, hand function and electromyographic measurements improved in both groups but improvements were significantly greater in the acupuncture group. In the acupuncture group, pain decreased by just under 50% (from 9/10 to less than 5/10), and hand function measurements improved by 15-22%. These are impressive results when we consider that they took place over a month and that patients had been symptomatic for 1.5 years prior to that. CSA of the median nerve was unchanged in the control group but significantly reduced in the acupuncture group (8% reduction). The authors believe that this is the first time the effect of acupuncture on median nerve CSA in patients with CTS has been demonstrated.
Ural et al conclude that “acupuncture improves not only clinical and electrophysiological findings but also morphological features in patients with CTS”, however “the relationship between change of CSA and electrophysiological changes was not correlated. The small sample size of our study may cause this result”. They suggest confirming the results in future studies with larger sample and long-term monitoring.