The aim of this report was to show the effects of acupotomy in patients with carpal tunnel syndrome. Four patients were treated with acupotomy twice. Visual analogue scale (VAS), Tinel`s sign, Phalen`s test, Boston carpal tunnel syndrome questionnaire (BCTQ), muscular strength test, and a cross-sectional area of median nerve was measured using ultrasound before and after treatment. In all 4 cases, the VAS score, BCTQ score and cross-sectional area of median nerve, all decreased and muscular strength test score increased. Tinel`s sign and the Phalen`s test changed from a positive to a negative in most cases. This report shows that acupotomy is an effective treatment for carpal tunnel syndrome. Further larger are needed to fully evaluate the beneficial effects of this treatment.