Carpal Tunnel Syndrome

Bruce N., Tarzana, California, 2010. Carpal Tunnel Syndrome.

Bruce is a 54 years old junior high school teacher, suffered from pain in his left wrist for about one year. He is a left hander and work as a teacher for about 25 years. As a teacher, he used his left hand frequently for writing on the board and on computer. He experienced moderatedly pain in his left wrist and aggravated by using. He also found to have numbness of the thumb and index finger with tingling in the tips of fingers. Nerve conduction test was performed and Carpal tunnel syndrome was diagnosed.   Since local injection of cortisone and wrist brace did not improved his condition, he was referred for acupuncture treatment. He did not have any condition in his neck or shoulder but mildly weakness in the wrist. On 4/5/2010 we provided him the first acupuncture with electric stimulation. The level of pain was 7/10 in the beginning and decreased to 5/10 after 4 treatments. Pain became lesser (3/10) after 9 treatments. The treatment was concluded with 12 treatments on 5/24/10. Pain in his wrist was subsided and occasionally numbness remained in a very mild degree. He was advised to use wrist brace when it is heavily use of his hand and during sleep. One year later, he came for knee pain treatment but he was maintained a pain-free condition in his wrist after the last treatment given.   

Carpal Tunnel Syndrome (CTS) is not a new developed condition which related to computer use as some might think. Although it is true that frequently tapping on keyboard might be a factor contributed to CTS, it is common and can be caused by many conditions. CTS occur particularly in women, and obesity, diabetes, rheumatoid arthritis, pregnancy and menopause have been associated with it. Forceful and repetitive usage of the hands and wrists have been linked to the syndrome and is one of the most common job-related injuries and is responsible for the highest number of days lost among all work related injuries. It is the reason for over two million visits to physicians’ offices and approximately 465,000 carpal tunnel release operations each year, making it the most frequent surgery of the hand and wrist.

The carpal tunnel is a narrow passageway bounded by the forearm bones on the palm side of the wrist. This tunnel protects the main nerve and tendons that functioning to bend the hand and fingers. When there is any reason that reduces the space of the tunnel, causing the nerve being compressed, then a development of numbness, pain and weakness of the hand characterize CTS. Bone spurs and swelling or thickening of the tendons are the most common causes of CTS.

For most people develop CTS, fortunately, proper treatment usually can relieve the pain and numbness and restore normal use of the wrist and hands. But with long –term compression to the nerve, muscle atrophy of the hand developed, the proper function of the hand might be lost.

Acupuncture is extremely effective at treating carpal tunnel syndrome; eliminating the need for surgery or the use of anti-inflammatory drugs or corticosteroids. In fact, one of the most common reasons that people get acupuncture is for repetitive stress injuries, including carpal tunnel syndrome.

Literature Review

Saeid Khosrawi, el al. Acupuncture in treatment of carpal tunnel syndrome: A randomized controlled trial study Journal of Research in Medical Sciences, Vol 17, No 1 (2012)

A randomized controlled trial study. Carpal tunnel syndrome (CTS) is the most prevalent form of peripheral neuropathy. The efficacy of acupuncture in management of mild to moderate CTS has been investigated in limited studies with controversial results. The aim of this study was to assess the short-term effects of acupuncture in treatment of mild to moderate carpal tunnel syndrome.

There were 72 subjects in this randomized controlled study. The acupuncture treatment group received 8 acupuncture treatments over a period of 4 weeks and night splinting was used as an additional component.  The control group received night splinting, sham acupuncture, vitamin B1 and vitamin B6. A follow up after the treatment regime measured a clinically significant nerve conduction velocity difference between the groups. The acupuncture group measured significantly better according to the nerve conduction study’s electrophysiological measurements. These findings indicated that the acupuncture can improve the overall subjective symptoms of carpal tunnel syndrome and could be adopted in comprehensive care programs of these patients.

Yang CP, et al. Acupuncture in patients with carpal tunnel syndrome: A randomized controlled trial. Clin J Pain. 2009 May;25(4):327-33.

A randomized, controlled study. This study was to investigate the efficacy of acupuncture compared with steroid treatment in patients with mild-to-moderate carpal tunnel syndrome (CTS) as measured by objective changes in nerve conduction studies (NCS) and subjective symptoms assessment.

A total of 77 patients who fulfilled the criteria for mild-to-moderate CTS were recruited in the study. There were 38 in the acupuncture group and 39 in the steroid group. The steroid group was to give 2 weeks of prednisolone 20 mg daily followed by 2 weeks of prednisolone 10 mg daily. The acupuncture group was to administer in 8 sessions over 4 weeks.  A validated standard questionnaire as a subjective measurement was used to rate the 5 major symptoms (pain, numbness, tingling, weakness and nocturnal awakening) on a scale from 0 (no symptoms) to 10 (very severe). The total score in each of the 5 categories was termed the global symptom score (GSS). Patients completed standard questionnaires at baseline and 2 and 4 weeks later. The changes in GSS were analyzed to evaluate the statistical significance. NCS were performed at baseline and repeated at the end of the study to assess improvement.

The result showed that there was a high percentage of improvement in both groups at weeks 2 and 4. Of the 5 main symptoms scores only nocturnal awakening showed a significant decrease in acupuncture compared with the steroid group at week 4. Patients with acupuncture treatment had a significant decrease in distal motor latency compared with the steroid group. The authors concluded that short-term acupuncture treatment is as effective as short-term low-dose prednisolone for mild-to-moderate CTS. For those who do have an intolerance or contraindication for oral steroid or for those who do not opt for early surgery, acupuncture treatment provides an alternative choice.

Yang CP, et al. A randomized clinical trial of acupuncture versus oral steroids for carpal tunnel syndrome: a long-term follow-up. J. Pain. 2011 Feb;12(2):272-9. Epub 2010 Nov 26.

This study was prospectively followed up patients with carpal tunnel syndrome (CTS) in ther previous study for 1 year. The acupuncture group had a significantly better improvement in GSS, distal motor latencies and distal sensory latencies when compared to the steroid group throughout the 1-year follow-up period. Furthermore, significant correlation was observed between changes of GSS and all parameters of the electrophysiological assessments except for compound muscle action potential amplitude. The result of this follow-up study demonstrated that short-term acupuncture treatment may result in long-term improvement in mild-to-moderate idiopathic CTS. Acupuncture treatment can be considered as an alternative therapy to other conservative treatments for those who do not opt for early surgical decompression