Acupuncture relieves carpal tunnel syndrome pain and restores function. Two independent studies reveal the benefits of warm needle acupuncture for CTS (carpal tunnel syndrome). Participants in both studies experienced significant improvements in pain levels and wrist function following acupuncture treatment combined with either Huang Qi Gui Zhi Wu Wu Tang herbal formula or nighttime wrist splinting.

 

Acupuncture And Herbs
The first study, conducted at Qixia District Hospital (Nanjing) investigated the effects of warm needle acupuncture combined with herbs on 60 CTS patients with a TCM (Traditional Chinese Medicine) diagnosis of qi deficiency and blood stasis. [1] The study group was comprised og 23 male and 37 female patients, ages 30–67 years (mean age 45.64 years), with a disease duration of 18 days to 16 months (mean duration 7.56 months). Of these, 25 cases were classified as mild and 35 were classified as moderate. Thirty-seven patients’ symptoms were unilateral while 23 were bilateral.

Biomedical diagnostic criteria included: a history of occupational overuse, fracture, or dislocation of the wrist; numbness or pain in the hands, forearm, or upper arm; symptoms that worsen at night and during winter, and are relieved by movement; weakness when gripping objects or making a fist; thenar muscle atrophy; positive Phalen test or Tinel sign; EMG tests showing nerve conduction as normal. TCM diagnostic criteria included: numbness, tingling, or abnormal sensations; difficulty grasping, holding, rubbing, or rotating the wrist; pale-dull tongue with thin white coating; minute-rough and tight pulse.

For inclusion in the study, patients were required to have been diagnosed with mild to moderate CTS, have normal routine blood counts, and give informed consent to participate in the study. Exclusion criteria were: severe CTS with cervical radiculopathy or thoracic outlet syndrome; multiple peripheral neuropathies; acute or chronic wrist trauma; receiving any related surgery or treatment.

 

Treatment
Patients were treated in a seated position with their palms perpendicular to the horizontal plane. Following standard disinfection, 0.30 x 40 mm needles were inserted into the following primary acupoints on the affected side:

  • Neiguan (PC6)
  • Daling (PC7)

The following secondary acupoints were utilized:

  • Hegu (LI4)
  • Yangxi (LI5) 
  • Lieque (LU7)

The primary acupoints were stimulated with a lifting-thrusting, twisting-rotating technique to elicit a deqi sensation which radiated from Neiguan to the fingertips or upper arm. The secondary points were strongly stimulated to induce a sensation of distending numbness. A 1 cm piece of moxa roll was then attached to the needle handles and ignited. The moxa was allowed to burnout, and the procedure was repeated three times for each point before removing the needles. Each course of treatment was comprised of five consecutive days and two courses were administered, separated by a two-day break. In addition, patients were prescribed Huang Qi Gui Zhi Wu Wu Tang, comprised of the following herbs:

  • Huang Qi 15g
  • Chi Shao 12g
  • Gui Zhi 10g
  • Sheng Jiang 10g
  • Da Zao 10g
  • Sang Ji Sheng 15g
  • Shen Jin Cao 15g
  • Kuang Jin Teng 15g 

One dose of the formula was taken daily for a total of four weeks. The following additions were made according to each patient’s individual diagnosis:

  • For blood deficiency (pale complexion, dizziness, vertigo, limb numbness, pale tongue, fine-weak pulse), Dang Gui, Chuan Xiong, and Ji Xue Teng were added.
  • For blood stasis (dark complexion, rough-darkened skin, hyperpigmentation, bruising, dull lips, green-blue-purple tongue or tongue with petechiae, fine-rough pulse), Tao Ren and Hong Hua were added. 
  • For qi deficiency (bright white complexion, dizziness, vertigo, shortness of breath, lassitude, and in severe cases, fainting, plump and pale tongue, slow pulse), the dose of Huang Qi was increased and Dang Shen was added.

 

Results
Outcome measures for the study included the BCTQ (Boston Carpal Tunnel Syndrome Questionnaire) and a VAS (Visual Analog Scale) for pain determinations. Nerve conduction tests were performed before and after treatment, and the total effective rate was calculated. The BCTQ is comprised of 11 items relating to symptoms such as pain and abnormal sensations and eight questions relating to wrist function. Each item is rated on a scale of 1–5, with higher scores indicating increased disability.

Prior to treatment, mean BCTQ scores were 2.57 for symptomatology and 2.55 for function. Following treatment, scores fell to 1.87 and 1.65 respectively. The VAS rated pain on a scale of 0–10, with higher scores indicating increased pain. The mean pre-treatment VAS score was 5.58. This figure fell to 2.51 following treatment.

Nerve conduction test results included the middle finger-wrist and thumb-wrist SNAP (sensory nerve action potential), middle finger-wrist and thumb-wrist SNCV (sensory nerve conduction velocity), DML (distal motor latency), and thumb abductor muscle tests. Middle finger-wrist and thumb-wrist SNAP, middle finger-wrist and thumb-wrist SNCV, and thumb abductor muscle tests all showed significant improvements following treatment (p<0.05).

Each case was classified as either recovered, markedly effective, effective, or ineffective according to the degree of improvement in symptoms and test results. There were 30 recovered, 16 markedly effective, 11 effective, and 3 ineffective cases, yielding a total effective rate of 95%.

 

Acupuncture And Splinting
A study conducted at Zhejiang University of TCM investigated the effects of warm needle acupuncture combined with nighttime wrist splinting. [2] The study group was comprised of 8 male and 30 female patients, ages 23–56 years, with a disease duration of 0.5–6 months. Eighteen cases were classified as mild and 20 were classified as moderate. Biomedical diagnostic criteria were similar to the study detailed above. The study utilized 2 acupoints:

  • Daling (PC7)
  • Jianshi (PC5)

Following standard disinfection, 0.25 x 25 mm needles were inserted at Daling, with the needle angled toward the palm at approximately 30 degrees from the skin. Needles were inserted to a depth of 10 mm to elicit an electric shock sensation. At Jianshi, 0.25 x 40 mm needles were inserted perpendicularly to a depth of 10–15mm and stimulated using a twisting-rotating technique to elicit deqi. A 2 cm piece of moxa roll was then attached to the needle handle and ignited from below. A piece of thick paper was placed beneath the needle to protect the skin from falling ash. Two burnings of moxa were performed before the needles were removed. A total of 10 treatments were administered on alternate days.

In addition, a simple wrist splint was provided to be worn at night. The splint was comprised of a 10 cm wide piece of card stock that was wrapped around the wrist and secured with elastic bandages, ensuring that the splint was not too tight. The splint was worn at night to prevent involuntary flexion of the wrist and it was removed in the morning.

 

Results
Each case was classed as either recovered, markedly effective, effective, or ineffective depending on the degree of improvement in symptoms. There were initially 13 recovered (34.2%), 13 markedly effective (34.2%), 8 effective (21.1%), and 4 ineffective (10.5%) cases. Those that were not fully recovered were offered a second course of treatment.

Of the patients not fully recovered, 19 accepted a second course of treatment. Three cases initially classified as markedly effective and one initially classified as effective were upgraded to recovered, and three cases initially classified as effective were upgraded to markedly effective. The remaining patients did not experience further improvement.

The results of these two studies indicate that warm needle acupuncture is an effective treatment for mild to moderate CTS and may be combined with either herbal medicine or wrist splinting. Based on patient outcomes, acupuncture is definitively a safe and effective therapeutic method for the alleviation and elimination of carpal tunnel syndrome.

 

References:
1. Tao Gen, Ji Ai (2019) “Treatment of 60 Cases of Carpal Tunnel Syndrome with Huang Qi Gui Zhi Wu Wu Decoction and Warm Acupuncture” Chinese Journal of Traditional Chinese Medicine and Orthopedics Vol.27(3) pp.63-64.
2. Lang Xiang, Zhu Minjie, Shi Lanjun (2019) “Treatment of 38 cases of mild to moderate carpal tunnel syndrome with warm acupuncture combined with night wrist brake” Chinese Rural Medicine Vol.26 (1) pp.29.

 

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