Acupuncture in treatment of carpal tunnel syndrome: A randomized controlled trial study
Khosrawi et al. · Journal of Research in Medical Sciences · 2012
Evidence Level
MODERATEOBJECTIVE
To evaluate the effects of acupuncture in the treatment of mild to moderate carpal tunnel syndrome
WHO
64 patients with mild to moderate carpal tunnel syndrome confirmed by electrophysiological studies
DURATION
4 weeks of treatment with 8 acupuncture sessions
POINTS
PC-7 (Daling) and PC-6 (Neiguan) - classical points of the pericardium meridian
🔬 Study Design
Acupuncture
n=32
True acupuncture + nighttime splint
Control
n=32
Sham acupuncture + nighttime splint + vitamins B1/B6
📊 Results in numbers
Reduction in global symptom score
Improvement in nerve conduction velocity
Baseline symptom score - acupuncture group
Final symptom score - acupuncture group
📊 Outcome Comparison
Global Symptom Score (after 4 weeks)
Nerve Conduction Velocity (m/s)
This study shows that acupuncture can be an effective option for relieving symptoms of carpal tunnel syndrome, such as pain, tingling, and numbness in the hands. Patients who received acupuncture had significant improvement in symptoms after 4 weeks of treatment, along with improvements in nerve conduction tests.
Article summary
Plain-language narrative summary
Carpal tunnel syndrome (CTS) is the most common form of peripheral neuropathy, characterized by numbness, tingling, hand pain, and muscle dysfunction. This randomized controlled trial investigated the efficacy of acupuncture in the treatment of mild to moderate CTS, a condition that affects millions of people worldwide and can cause significant disability if not adequately treated. The study was conducted in the physical medicine and rehabilitation clinics of Alzahra and Kashani Hospitals in Isfahan, Iran, between June 2010 and February 2011. Seventy-two patients were initially assessed, but 64 completed the 4-week study.
The diagnosis was based on clinical criteria confirmed by Tinel and Phalen tests, along with standardized electrophysiological criteria. Participants were randomized into two groups: the intervention group received true acupuncture at specific points (PC-7 Daling and PC-6 Neiguan) plus a nighttime splint, while the control group received sham acupuncture, a nighttime splint, and vitamins B1 and B6. The acupuncture treatment consisted of 8 sessions of 60 minutes each over 4 weeks, with 0.25 x 40 mm needles applied at the classical points of the pericardium meridian. The primary outcome was assessed using the Global Symptom Score (GSS), which rates clinical symptoms from 0 (no symptoms) to 10 (very severe symptoms) in five areas: pain, numbness, tingling, weakness/clumsiness, and nocturnal awakening, for a maximum score of 50 points.
Secondary outcomes included electrophysiological parameters such as distal motor latency, sensory nerve conduction velocity, and distal sensory latency. Results showed statistically significant differences between groups. The GSS in the acupuncture group decreased from 24.1 ± 8.1 at baseline to 14.6 ± 5.4 after 4 weeks (p < 0.001), while the control group remained virtually unchanged, going from 23.7 ± 8.9 to 22.5 ± 8.9. Among the electrophysiological parameters, nerve conduction velocity showed significant improvement in the acupuncture group (from 35.1 ± 5.3 to 37.6 ± 8.3 m/s, p = 0.02), while other parameters such as distal motor latency and distal sensory latency did not show significant differences.
The clinical implications of this study are important for the conservative management of CTS. Acupuncture proved effective both in improving subjective symptoms and in some objective parameters of nerve function. This suggests that acupuncture may be a valuable alternative or complement to traditional conservative treatments such as splints and medications. The mechanism of action of acupuncture in CTS is not yet fully elucidated, but functional magnetic resonance imaging studies suggest that acupuncture stimulation produces changes in brain processing and coordinated limbic response.
Other studies indicate anti-inflammatory and immunomodulatory effects. The study has several important limitations that should be considered when interpreting the results. The follow-up period was relatively short (4 weeks), preventing assessment of long-term effects. The sample size was small, precluding subgroup analyses to better characterize the effects of acupuncture in mild versus moderate cases.
In addition, there were more medical visits in the acupuncture group, which could influence outcomes through greater medical attention. No adverse effects were reported, although previous studies have documented some mild side effects such as swelling and pain. This study contributes to the body of evidence on acupuncture in CTS, which remains controversial in the medical literature. While some systematic reviews question the efficacy of acupuncture, others show promising results.
The variability in results may be due to differences in acupuncture protocols, patient selection criteria, and assessment methods. In conclusion, this randomized controlled trial provides evidence that acupuncture can significantly improve subjective symptoms of carpal tunnel syndrome and some objective parameters of nerve function, suggesting that it can be incorporated into comprehensive care programs for these patients.
Strengths
- 1Randomized controlled design with adequate control group using sham acupuncture
- 2Assessment of both subjective and objective outcomes through electrophysiological tests
- 3Well-defined acupuncture protocol with specific and standardized points
- 4Adequate blinding of patients and assessors during treatment
Limitations
- 1Short follow-up period (only 4 weeks) without assessment of long-term effects
- 2Small sample size precluding subgroup analyses
- 3Possible bias due to more medical visits in the acupuncture group
- 4Lack of systematic assessment of adverse effects
Expert Commentary
Dr. Marcus Yu Bin Pai
MD, PhD · Pain Medicine · Physical Medicine and Rehabilitation · Medical Acupuncture
▸ Clinical Relevance
Mild to moderate carpal tunnel syndrome represents a huge share of the demand at physiatry and musculoskeletal pain services, and the clinician's dilemma often comes down to how long to persist with conservative management before referring for surgery. This randomized controlled trial adds a relevant piece to that equation: acupuncture at points PC-7 and PC-6, combined with a nighttime splint, produced a statistically significant reduction in the global symptom score and improvement in sensory nerve conduction velocity in just four weeks. For the physician following patients with intensive manual occupations, pregnant patients, or those who refuse surgical intervention, having a resource with objective electrophysiological evidence of improvement concretely broadens the conservative arsenal. The protocol is standardized, feasible in a rehabilitation outpatient setting, and can be integrated with splint use and, when indicated, anti-inflammatories or local corticosteroid injection.
▸ Notable Findings
The most striking finding is not just the drop in the global symptom score from 24.1 to 14.6 in the acupuncture group — while the control group remained virtually static around 22.5 — but the documented improvement in sensory nerve conduction velocity, which advanced from 35.1 to 37.6 m/s with statistical significance. Electrophysiological outcomes are notoriously difficult to move with any short-term conservative intervention, which makes this finding particularly noteworthy. Functionally, this conduction gain corresponds to objective reduction in axonal dysfunction, not just symptomatic relief mediated by central pain modulation. The fact that distal motor latency did not reach significance suggests that acupuncture, in this protocol, acts preferentially on sensory fibers, which is consistent with the predominantly sensory clinical picture of mild to moderate CTS.
▸ From My Experience
In my practice in the pain and rehabilitation clinic, I usually see noticeable symptomatic response between the third and fifth session in patients with mild to moderate CTS, a pattern that aligns well with the 8-session, 4-week protocol described here. The profile that responds best, in my experience, is the patient with predominantly sensory symptoms, without established thenar atrophy and with electroneuromyography still in the moderate range — exactly the population in this study. I routinely combine acupuncture with wrist flexor stretching, ergonomic guidance, and a nighttime splint; I rarely use B vitamins alone as an active intervention, given their documented marginal effect. Patients with severe CTS or established muscle atrophy are not candidates for this conservative approach — I refer them directly for surgical evaluation. After the acute treatment phase, I have adopted biweekly maintenance sessions for two to three months, especially in those with a persistent occupational factor, which appears to sustain the initial functional gain.
Indexed scientific article
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Scientific Review
Marcus Yu Bin Pai, MD, PhD
CRM-SP: 158074 | RQE: 65523 · 65524 · 655241
PhD in Health Sciences, University of São Paulo. Board-certified in Pain Medicine, Physical Medicine and Rehabilitation, and Medical Acupuncture. Scientific review and curation of every entry in this library.
Learn more about the author →Medical disclaimer: This content is for educational purposes only and does not replace consultation, diagnosis, or treatment by a qualified professional. Some information may be assisted by artificial intelligence and is subject to inaccuracies. Always consult a physician.
Content reviewed by the medical team at CEIMEC — Integrated Centre for Chinese Medicine Studies, a reference in Medical Acupuncture for over 30 years.
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