Acupuncture for Carpal Tunnel Syndrome: A Systematic Review of Randomized Controlled Trials

Sim, Hoseob; Shin, Byung‐Cheul; Lee, Myeong Soo; Jung, A-Ram; Lee, Hyangsook; Ernst, Edzard

doi:10.1016/j.jpain.2010.08.006

Cited by 51 publications

(46 citation statements)

References 23 publications

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“…muscle tissue) and non-TrP structures (i.e. neural and connective tissues) in combination, or non-TrP structures alone, is effective for the reduction of pain and disability in knee osteoarthritis,50–50–51,81–83,85–90,166–168 hip osteoarthritis,53,91–94 piriformis syndrome,60 carpal tunnel syndrome,36,37,40,41,44,45,47 migraine,95–101 tension type headache,97,98,102 temporomandibular disorder,59,67,103–107 shoulder pain,108–110 neck pain,23,24,29,35,61,63–65,80,111–114 low back pain,4,5,19,20,66,69,115–125 and plantar fasciitis 48,49,54,56,126,127…”

Section: Trp Needling Is Only One Kind Of Dry Needlingmentioning

confidence: 99%

Dry needling: a literature review with implications for clinical practice guidelines

Dunning¹,

Butts

Mourad³

et al. 2014

Physical Therapy Reviews

254

205

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Background:Wet needling uses hollow-bore needles to deliver corticosteroids, anesthetics, sclerosants, botulinum toxins, or other agents. In contrast, dry needling requires the insertion of thin monofilament needles, as used in the practice of acupuncture, without the use of injectate into muscles, ligaments, tendons, subcutaneous fascia, and scar tissue. Dry needles may also be inserted in the vicinity of peripheral nerves and/or neurovascular bundles in order to manage a variety of neuromusculoskeletal pain syndromes. Nevertheless, some position statements by several US State Boards of Physical Therapy have narrowly defined dry needling as an ‘intramuscular’ procedure involving the isolated treatment of ‘myofascial trigger points’ (MTrPs).Objectives:To operationalize an appropriate definition for dry needling based on the existing literature and to further investigate the optimal frequency, duration, and intensity of dry needling for both spinal and extremity neuromusculoskeletal conditions.Major findings:According to recent findings in the literature, the needle tip touches, taps, or pricks tiny nerve endings or neural tissue (i.e. ‘sensitive loci’ or ‘nociceptors’) when it is inserted into a MTrP. To date, there is a paucity of high-quality evidence to underpin the use of direct dry needling into MTrPs for the purpose of short and long-term pain and disability reduction in patients with musculoskeletal pain syndromes. Furthermore, there is a lack of robust evidence validating the clinical diagnostic criteria for trigger point identification or diagnosis. High-quality studies have also demonstrated that manual examination for the identification and localization of a trigger point is neither valid nor reliable between-examiners.Conclusions:Several studies have demonstrated immediate or short-term improvements in pain and/or disability by targeting trigger points (TrPs) using in-and-out techniques such as ‘pistoning’ or ‘sparrow pecking’; however, to date, no high-quality, long-term trials supporting in-and-out needling techniques at exclusively muscular TrPs exist, and the practice should therefore be questioned. The insertion of dry needles into asymptomatic body areas proximal and/or distal to the primary source of pain is supported by the myofascial pain syndrome literature. Physical therapists should not ignore the findings of the Western or biomedical ‘acupuncture’ literature that have used the very same ‘dry needles’ to treat patients with a variety of neuromusculoskeletal conditions in numerous, large scale randomized controlled trials. Although the optimal frequency, duration, and intensity of dry needling has yet to be determined for many neuromusculoskeletal conditions, the vast majority of dry needling randomized controlled trials have manually stimulated the needles and left them in situ for between 10 and 30 minute durations. Position statements and clinical practice guidelines for dry needling should be based on the best available literature, not a single paradigm or school of thought; therefore, ...

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Section: Trp Needling Is Only One Kind Of Dry Needlingmentioning

confidence: 99%

Dry needling: a literature review with implications for clinical practice guidelines

Dunning¹,

Butts

Mourad³

et al. 2014

Physical Therapy Reviews

254

205

View full text Add to dashboard Cite

show abstract

“…Importantly, while later Yao et al trials did not confirm CTS by nerve conduction studies and likely enrolled both CTS and idiopathic hand pain patients, the earlier Yang et al trials did enrol based on conduction latency (Yang et al, 2009), and evaluated long-term follow-up (Yang et al, 2011). A meta-analysis, performed prior to some of the recent trials, noted encouraging but not yet convincing evidence for acupuncture in the treatment of CTS (Sim et al, 2011), advocating for more randomized controlled trials.…”

Section: Introductionmentioning

confidence: 99%

Rewiring the primary somatosensory cortex in carpal tunnel syndrome with acupuncture

Maeda

Kim

Kettner

et al. 2017

Brain

134

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Ã These authors contributed equally to this work.Carpal tunnel syndrome is the most common entrapment neuropathy, affecting the median nerve at the wrist. Acupuncture is a minimally-invasive and conservative therapeutic option, and while rooted in a complex practice ritual, acupuncture overlaps significantly with many conventional peripherally-focused neuromodulatory therapies. However, the neurophysiological mechanisms by which acupuncture impacts accepted subjective/psychological and objective/physiological outcomes are not well understood. Eligible patients (n = 80, 65 female, age: 49.3 AE 8.6 years) were enrolled and randomized into three intervention arms: (i) verum electro-acupuncture 'local' to the more affected hand; (ii) verum electro-acupuncture at 'distal' body sites, near the ankle contralesional to the more affected hand; and (iii) local sham electro-acupuncture using non-penetrating placebo needles. Acupuncture therapy was provided for 16 sessions over 8 weeks. Boston Carpal Tunnel Syndrome Questionnaire assessed pain and paraesthesia symptoms at baseline, following therapy and at 3-month follow-up. Nerve conduction studies assessing median nerve sensory latency and brain imaging data were acquired at baseline and following therapy. Functional magnetic resonance imaging assessed somatotopy in the primary somatosensory cortex using vibrotactile stimulation over three digits (2, 3 and 5). While all three acupuncture interventions reduced symptom severity, verum (local and distal) acupuncture was superior to sham in producing improvements in neurophysiological outcomes, both local to the wrist (i.e. median sensory nerve conduction latency) and in the brain (i.e. digit 2/3 cortical separation distance). Moreover, greater improvement in second/third interdigit cortical separation distance following verum acupuncture predicted sustained improvements in symptom severity at 3-month follow-up. We further explored potential differential mechanisms of local versus distal acupuncture using diffusion tensor imaging of white matter microstructure adjacent to the primary somatosensory cortex. Compared to healthy adults (n = 34, 28 female, 49.7 AE 9.9 years old), patients with carpal tunnel syndrome demonstrated increased fractional anisotropy in several regions and, for these regions we found that improvement in median nerve latency was associated with reduction of fractional anisotropy near (i) contralesional hand area following verum, but not sham, acupuncture; (ii) ipsilesional hand area following local, but not distal or sham, acupuncture; and (iii) ipsilesional leg area following distal, but not local or sham, acupuncture. As these primary somatosensory cortex subregions are distinctly targeted by local versus distal acupuncture electrostimulation, acupuncture at local versus distal sites may improve median nerve function at the wrist by somatotopically distinct neuroplasticity in the primary somatosensory cortex following therapy. Our study further suggests that improvements in primary somatosensory cortex ...

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“…A systematic review published in 2011 included 2 trials that compared acupuncture and steroid injection; acupuncture was found to be slightly better in reducing symptoms of carpal tunnel syndrome. 15 A randomized trial (n = 77) published in 2009 reported that patients receiving acupuncture treatment showed more improvement than those taking low-dose prednisolone orally. 16 However, another trial that compared acupuncture with splinting reported no significant difference between them.…”

mentioning

confidence: 99%

Electroacupuncture and splinting versus splinting alone to treat carpal tunnel syndrome: a randomized controlled trial

Chung

Liu

et al. 2016

CMAJ

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Background:The effectiveness of acupuncture for managing carpal tunnel syndrome is uncertain, particularly in patients already receiving conventional treatments (e.g., splinting). We aimed to assess the effects of electroacupuncture combined with splinting. Methods:We conducted a randomized parallel-group assessor-blinded 2-arm trial on patients with clinically diagnosed primary carpal tunnel syndrome. The treatment group was offered 13 sessions of electroacupuncture over 17 weeks. The treatment and control groups both received continuous nocturnal wrist splinting. Results:Of 181 participants randomly assigned to electroacupuncture combined with splinting (n = 90) or splinting alone (n = 91), 174 (96.1%) completed all follow-up. The electroacupuncture group showed greater improvements at 17 weeks in symptoms (primary outcome of Symptom Severity Scale score mean difference [MD] -0.20, 95% confidence interval [CI] -0.36 to -0.03), disability (Disability of Arm, Shoulder and Hand Questionnaire score MD -6.72, 95% CI -10.9 to -2.57), function (Functional Status Scale score MD -0.22, 95% CI -0.38 to -0.05), dexterity (time to complete blinded pick-up test MD -6.13 seconds, 95% CI -10.6 to -1.63) and maximal tip pinch strength (MD 1.17 lb, 95% CI 0.48 to 1.86). Differences between groups were small and clinically unimportant for reduction in pain (numerical rating scale -0.70, 95% CI -1.34 to -0.06), and not significant for sensation (first finger monofilament test -0.08 mm, 95% CI -0.22 to 0.06).Interpretation: For patients with primary carpal tunnel syndrome, chronic mild to moderate symptoms and no indication for surgery, electroacupuncture produces small changes in symptoms, disability, function, dexterity and pinch strength when added to nocturnal splinting.

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Acupuncture for Carpal Tunnel Syndrome: A Systematic Review of Randomized Controlled Trials

Cited by 51 publications

References 23 publications

Dry needling: a literature review with implications for clinical practice guidelines

Dry needling: a literature review with implications for clinical practice guidelines

Rewiring the primary somatosensory cortex in carpal tunnel syndrome with acupuncture

Electroacupuncture and splinting versus splinting alone to treat carpal tunnel syndrome: a randomized controlled trial

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