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Dear Doctor: Could acupuncture help my carpal tunnel syndrome?

Dear Reader: Carpal tunnel syndrome (CTS) is caused by compression of the median nerve within the wrist, specifically in an area called the carpal tunnel. The symptoms include pain or numbness that radiates to the first three fingers of the hand. The sensations can awaken patients at night or strike when they're doing certain activities. When the median nerve is significantly compressed, a person can develop weakness in the thumb and fingers and have difficulty even holding a cup. Wrist splints, physical therapy, NSAIDs and steroids can initially address the condition, while surgery is often recommended for severe cases. But only recently has acupuncture been studied for carpal tunnel syndrome.

Let's start with a 2011 review of multiple studies of acupuncture for carpal tunnel syndrome. Many studies were not randomized controlled trials, but the authors were able to evaluate six trials: four done in China, one from the United States and one from Germany. Five of the studies used needle acupuncture, and one of the studies used laser acupuncture, which targets acupuncture points with low-energy laser beams.

The U.S. study compared acupuncture in traditional acupuncture points with acupuncture in random points, called sham acupuncture. That study found no difference between the two types of acupuncture. Two studies that compared steroid injections to acupuncture found a greater benefit with the use of acupuncture. A study comparing massage to acupuncture with massage found greater benefit with the acupuncture version than with the massage alone. And a fifth study, comparing acupuncture to oral steroids, found only a mild benefit from acupuncture. As for the laser acupuncture trial, it found a greater benefit with laser upon traditional acupuncture points versus laser upon sham acupuncture points.

Overall, those authors concluded that the data supporting acupuncture for carpal tunnel syndrome are encouraging, but not convincing.

A 2012 study performed in Iran was slightly more positive. It compared the use of wrist splints at night along with two acupuncture treatments per week for four weeks versus the use of night splints along with B12 vitamins and sham acupuncture. Symptom scores stayed unchanged in the sham acupuncture group, but significantly improved with the use of traditional acupuncture points. In addition, nerve function slightly improved with the use of traditional acupuncture points, but not with sham acupuncture.

A 2017 U.S. study divided 79 carpal tunnel patients into three treatment groups: one group that received acupuncture with electrical stimulation against traditional points near the wrists; another group that used sham acupuncture; and a last group that used acupuncture with electrical stimulation against traditional points, but in an area far from the wrists. Each group had 16 treatments over eight weeks.

The authors found a greater improvement of symptoms with the use of traditional wrist acupuncture and electrical stimulation versus those who had sham acupuncture. They also found improvements in nerve conduction using the acupuncture with electrical stimulation against both local and distant points. What was most interesting about this study was that the authors showed how acupuncture in traditional, and not sham, acupuncture points caused brain changes on functional MRIs, which correlated with a decrease in symptoms of CTS.

If you have mild to moderate carpal tunnel syndrome, it certainly seems worth considering acupuncture in addition to wrist splints at night and physical therapy. However, more studies are needed to solidify this recommendation.

(Send your questions to askthedoctors@mednet.ucla.edu, or write: Ask the Doctors, c/o Media Relations, UCLA Health, 924 Westwood Blvd., Suite 350, Los Angeles, CA, 90095. Owing to the volume of mail, personal replies cannot be provided.)

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