A Randomized Clinical Trial of Acupuncture Versus Oral Steroids for Carpal Tunnel Syndrome: A Long-Term Follow-Up

This randomized controlled trial investigated the long-term effects of acupuncture compared with oral corticosteroids for the treatment of mild to moderate carpal tunnel syndrome (CTS). Carpal tunnel syndrome is the most common peripheral compression neuropathy, causing pain, numbness, and weakness in the median nerve distribution. Although several conservative treatment options exist, there is limited evidence on their long-term effects. The study followed 77 patients for 13 months after an initial 4-week treatment.

Participants were randomized into two groups: 38 received acupuncture (8 sessions of 30 minutes at points PC-7 and PC-6) and 39 received oral corticosteroids (prednisolone 20 mg for two weeks followed by 10 mg for two more weeks). All patients had electrophysiologically confirmed mild to moderate idiopathic CTS and were treatment-naive. The primary outcome was measured by the Global Symptom Score (GSS), a 0-to-50-point scale assessing pain, numbness, tingling, weakness, and nocturnal awakening. Nerve conduction studies were performed as a secondary outcome.

The results demonstrated clear and sustained superiority of acupuncture. At 7 months, 86.8% of patients in the acupuncture group showed good improvement (>50% reduction in GSS) compared with 59% in the steroid group. At 13 months, this difference widened: 81.6% versus 48.7%, respectively. The treatment failure rate at 13 months was significantly lower in the acupuncture group (15.8% versus 51.3%).

Recurrence rates also favored acupuncture: 10.5% versus 41% at 13 months. The electrophysiological studies confirmed the clinical findings, showing significant improvement in distal motor and sensory latencies in the acupuncture group, while the steroid group showed deterioration in some parameters. There was a significant correlation between symptom improvement and electrophysiological parameters, suggesting that acupuncture promotes real structural improvement of the nerve, not just symptomatic relief. The steroid group showed progressive loss of benefit after the first month, whereas the acupuncture group maintained therapeutic gains.

Possible mechanisms of acupuncture include anti-inflammatory action, improved local circulation in the vasa nervorum, and modulation of central pain processing. This is the first rigorous long-term study comparing acupuncture with standard treatment for CTS. The clinical implications are important: acupuncture can be considered an effective alternative to conventional conservative treatments, especially for patients who do not wish to undergo early surgery. The study suggests that acupuncture may be a disease-modifying rather than merely palliative therapy, offering lasting benefits with a low risk of adverse effects.