Download PDF
CC BY-NC-ND 4.0 · Revista Fisioterapia Invasiva / Journal of Invasive Techniques in Physical Therapy 2020; 03(01): 013-025
DOI: 10.1055/s-0040-1701432
Review Article
Thieme Revinter Publicações Ltda Rio de Janeiro, Brazil

Acupuncture and electroacupuncture in the treatment of carpal tunnel syndrome: Systematic review

Article in several languages: English | español
Marc Badia
1   Unit of Histology and Neurobiology, Department of Basic Medical Sciences, Faculty of Medicine and Health Sciences, Universitat Rovira i Virgili, Reus, Spain
,
Manel M. Santafé
1   Unit of Histology and Neurobiology, Department of Basic Medical Sciences, Faculty of Medicine and Health Sciences, Universitat Rovira i Virgili, Reus, Spain
› Author Affiliations
Further Information

Publication History

01 November 2019

22 November 2019

Publication Date:
26 May 2020 (online)

   Permissions and Reprints

Abstract

Introduction Carpal tunnel syndrome (CTS) is the most diagnosed compression neuropathy of the upper limb. In mild and moderate cases, the treatment is extensive and controversial, whereas severe cases receive surgical intervention.

Objective To analyze the scientific evidence on the effectiveness of treatment of CTS using acupuncture and electroacupuncture.

Methods The PRISMA declaration was followed. A literature search was performed using the following databases: Clinical Evidence BMJ, NICE, Cochrane Library, PubMed, PEDro, Science Direct, SciELO, Google Scholar. The search strategy used the terms “acupuncture”, “electroacupuncture” “carpal tunnel syndrome”. The inclusion criteria limited studies to English publications. The risk of bias was assessed for each study using the Cochrane scale. The level of evidence and the level of recommendation was determined using the SIGN scale.

Results The search retrieved 698 articles in total. After applying the inclusion and exclusion criteria, 21 articles were included. The level of evidence of all the articles was medium-high. The level of recommendation was medium, and the risk of bias was neutral, with a tendency towards low bias. The articles included revealed symptomatic and neurophysiological improvements, both peripheral as well as central, due to the cerebral response that occurs associated with the function of the median nerve.

Conclusion Acupuncture and electroacupuncture are a therapeutic option for mild to moderate CTS with a medium level of scientific evidence, tending towards a high level, and with a medium level of recommendation.

Keywords

magnetic resonance - median nerve - neurography - neuronal plasticity - pain
 

  • References

  • 1 Alfonso C, Jann S, Massa R, Torreggiani A. Diagnosis, treatment and follow-up of the carpal tunnel syndrome: a review. Neurol Sci 2010; 31 (03) 243-252
    CrossrefPubMedGoogle Scholar
  • 2 Stevens JC. ; American Association of Electrodiagnostic Medicine. AAEM minimonograph #26: the electrodiagnosis of carpal tunnel syndrome. Muscle Nerve 1997; 20 (12) 1477-1486
    CrossrefPubMedGoogle Scholar
  • 3 Aroori S, Spence RA. Carpal tunnel syndrome. Ulster Med J 2008; 77 (01) 6-17
    PubMedGoogle Scholar
  • 4 Jablecki CK, Andary MT, So YT, Wilkins DE, Williams FH. ; AAEM Quality Assurance Committee. Literature review of the usefulness of nerve conduction studies and electromyography for the evaluation of patients with carpal tunnel syndrome. Muscle Nerve 1993; 16 (12) 1392-1414
    CrossrefPubMedGoogle Scholar
  • 5 MacDermid JC, Doherty T. Clinical and electrodiagnostic testing of carpal tunnel syndrome: a narrative review. J Orthop Sports Phys Ther 2004; 34 (10) 565-588
    CrossrefPubMedGoogle Scholar
  • 6 Dorwart BB. Carpal tunnel syndrome: a review. Semin Arthritis Rheum 1984; 14 (02) 134-140
    CrossrefPubMedGoogle Scholar
  • 7 Viikari-Juntura E, Silverstein B. Role of physical load factors in carpal tunnel syndrome. Scand J Work Environ Health 1999; 25 (03) 163-185
    CrossrefPubMedGoogle Scholar
  • 8 Chammas M. Carpal tunnel syndrome. Chir Main 2014; 33 (02) 75-94
    CrossrefPubMedGoogle Scholar
  • 9 Millesi H, Zöch G, Rath T. The gliding apparatus of peripheral nerve and its clinical significance. Ann Chir Main Memb Super 1990; 9 (02) 87-97
    PubMedGoogle Scholar
  • 10 Lundborg G. Intraneural microcirculation. Orthop Clin North Am 1988; 19 (01) 1-12
    CrossrefPubMedGoogle Scholar
  • 11 Ettema AM, Amadio PC, Zhao C, Wold LE, An KN. A histological and immunohistochemical study of the subsynovial connective tissue in idiopathic carpal tunnel syndrome. J Bone Joint Surg Am 2004; 86 (07) 1458-1466
    CrossrefPubMedGoogle Scholar
  • 12 Lundborg G. Nerve entrapment. In: Lundborg G. , editor. Nerve injury and repair. Philadelphia (PA): Churchill Livingstone; 1988: 102-148
    Google Scholar
  • 13 Page MJ, Massy-Westropp N, O'Connor D, Pitt V. Splinting for carpal tunnel syndrome. Cochrane Database Syst Rev 2012; 7 (07) CD010003
    Google Scholar
  • 14 Marshall S, Tardif G, Ashworth N. Local corticosteroid injection for carpal tunnel syndrome. Cochrane Database Syst Rev 2007; 2 (02) CD001554
    Google Scholar
  • 15 Boyer MI. Corticosteroid injection for carpal tunnel syndrome. J Hand Surg Am 2008; 33 (08) 1414-1416
    CrossrefPubMedGoogle Scholar
  • 16 Gong HS, Baek GH, Oh JH, Lee YH, Jeon SH, Chung MS. Factors affecting willingness to undergo carpal tunnel release. J Bone Joint Surg Am 2009; 91 (09) 2130-2136
    CrossrefPubMedGoogle Scholar
  • 17 Leyva Glez M, Palomina Carmenate E, Barrios Hdez J, Cruz Font J, Romero Hdez L. Acupuntura del Microsistema Su Jok y quiropraxia en el Síndrome del Túnel Carpiano. Correo Científico Méd Holguín 2011 15(01):
    PubMedGoogle Scholar
  • 18 Lao L, Zhang G, Wei F, Berman BM, Ren K. Electro-acupuncture attenuates behavioral hyperalgesia and selectively reduces spinal Fos protein expression in rats with persistent inflammation. J Pain 2001; 2 (02) 111-117
    CrossrefPubMedGoogle Scholar
  • 19 Lao L, Zhang RX, Zhang G, Wang X, Berman BM, Ren K. A parametric study of electroacupuncture on persistent hyperalgesia and Fos protein expression in rats. Brain Res 2004; 1020 (1-2): 18-29
    CrossrefPubMedGoogle Scholar
  • 20 Li A, Zhang RX, Wang Y. , et al. Corticosterone mediates electroacupuncture-produced anti-edema in a rat model of inflammation. BMC Complement Altern Med 2007; 7: 27
    CrossrefPubMedGoogle Scholar
  • 21 Zhang RX, Lao L, Wang X. , et al. Electroacupuncture attenuates inflammation in a rat model. J Altern Complement Med 2005; 11 (01) 135-142
    CrossrefPubMedGoogle Scholar
  • 22 Zhang RX, Lao L, Wang L, Liu B, Wang X, Ren K, Berman BM. Involvement of opioid receptors in electroacupuncture-produced anti-hyperalgesia in rats with peripheral inflammation. Brain Res 2004; 1020 (1–2): 12-17
    CrossrefPubMedGoogle Scholar
  • 23 Schulman RA, Liem B, Moroz A. Treatment of carpal tunnel syndrome with medical acupuncture. Med Acupunct 2008; 20 (03) 163-167
    CrossrefGoogle Scholar
  • 24 Shokunbi GO. Acupuncture and Ergonomic interventions in the management of carpal tunnel syndrome among industrial workers-Case studies. Nigerian J Med Rehabil 2014 17(01):
    PubMedGoogle Scholar
  • 25 Napadow V, Liu J, Ryan A. , et al. Effect of Acupuncture on Carpal Tunnel Syndrome with fMRI Assessment of Cortical Somatotopy. Int Soc Magn Resonance Med 2004; 11 (01) 11-23
    Google Scholar
  • 26 Zailaa A. Magnetic Resonance Imaging Evaluation of Acupuncture Effects on Carpal Tunnel Syndrome. 2010
    PubMedGoogle Scholar
  • 27 Ding Q, Shen F. Effects of acupuncture and moxibustion of Yangchi point on carpal tunnel syndrome. Int J Traditional Chin Med 2013; 2: 117-119
    Google Scholar
  • 28 Wong CHL, Wu XY, Wong W. Is adding electroacupuncture on top of nocturnal splinting an alternative treatment option for carpal tunnel syndrome patients?. AIMED 2016; 3 (01) 31-32
    Google Scholar
  • 29 Dimitrova A, Murchison C, Oken B. Local effects of acupuncture on the median and ulnar nerves in patients with carpal tunnel syndrome: a pilot mechanistic study protocol. Trials 2019; 20 (01) 8
    CrossrefPubMedGoogle Scholar
  • 30 Chen L, Xue L, Li S, Kang T, Chen H, Hou C. [Clinical research on mild and moderate carpal tunnel syndrome treated with contralateral needling technique at distal acupoints and acupuncture at local acupoints]. Zhongguo Zhenjiu 2017; 37 (05) 479-482
    Google Scholar
  • 31 Ural FG, Öztürk GT. The Acupuncture Effect on Median Nerve Morphology in Patients with Carpal Tunnel Syndrome: An Ultrasonographic Study. Evid Based Complement Alternat Med 2017; 2017: 7420648
    PubMedGoogle Scholar
  • 32 Maeda Y, Kim H, Kettner N. , et al. Rewiring the primary somatosensory cortex in carpal tunnel syndrome with acupuncture. Brain 2017; 140 (04) 914-927
    CrossrefPubMedGoogle Scholar
  • 33 Hadianfard M, Bazrafshan E, Momeninejad H, Jahani N. Efficacies of Acupuncture and Anti-inflammatory Treatment for Carpal Tunnel Syndrome. J Acupunct Meridian Stud 2015; 8 (05) 229-235
    CrossrefPubMedGoogle Scholar
  • 34 Maeda Y, Kettner N, Lee J. , et al. Acupuncture Evoked Response in Contralateral Somatosensory Cortex Reflects Peripheral Nerve Pathology of Carpal Tunnel Syndrome. Med Acupunct 2013; a 25 (04) 275-284
    CrossrefPubMedGoogle Scholar
  • 35 Ho CY, Lin HC, Lee YC. , et al. Clinical effectiveness of acupuncture for carpal tunnel syndrome. Am J Chin Med 2014; 42 (02) 303-314
    CrossrefPubMedGoogle Scholar
  • 36 Maeda Y, Kettner N, Lee J. , et al. Acupuncture-evoked response in somatosensory and prefrontal cortices predicts immediate pain reduction in carpal tunnel syndrome. Evid Based Complement Alternat Med 2013; b 2013: 795906
    PubMedGoogle Scholar
  • 37 Khosrawi S, Moghtaderi A, Haghighat S. Acupuncture in treatment of carpal tunnel syndrome: A randomized controlled trial study. J Res Med Sci 2012; 17 (01) 1-7
    PubMedGoogle Scholar
  • 38 Kumnerddee W, Kaewtong A. Efficacy of acupuncture versus night splinting for carpal tunnel syndrome: a randomized clinical trial. J Med Assoc Thai 2010; 93 (12) 1463-1469
    PubMedGoogle Scholar
  • 39 Yang CP, Wang NH, Li TC. , et al. A randomized clinical trial of acupuncture versus oral steroids for carpal tunnel syndrome: a long-term follow-up. J Pain 2011; 12 (02) 272-279
    CrossrefPubMedGoogle Scholar
  • 40 Yang CP, Hsieh CL, Wang NH. , et al. Acupuncture in patients with carpal tunnel syndrome: A randomized controlled trial. Clin J Pain 2009; 25 (04) 327-333
    CrossrefPubMedGoogle Scholar
  • 41 Napadow V, Kettner N, Liu J. , et al. Hypothalamus and amygdala response to acupuncture stimuli in Carpal Tunnel Syndrome. Pain 2007; a 130 (03) 254-266
    CrossrefPubMedGoogle Scholar
  • 42 Napadow V, Liu J, Li M. , et al. Somatosensory cortical plasticity in carpal tunnel syndrome treated by acupuncture. Hum Brain Mapp 2007; b 28 (03) 159-171
    CrossrefPubMedGoogle Scholar
  • 43 Yao E, Gerritz PK, Henricson E. , et al. Randomized controlled trial comparing acupuncture with placebo acupuncture for the treatment of carpal tunnel syndrome. PM R 2012; 4 (05) 367-373
    CrossrefPubMedGoogle Scholar
  • 44 Beissner F, Meissner K, Bär KJ, Napadow V. The autonomic brain: an activation likelihood estimation meta-analysis for central processing of autonomic function. J Neurosci 2013; 33 (25) 10503-10511
    CrossrefPubMedGoogle Scholar
  • 45 Kim J, Loggia ML, Cahalan CM. , et al. The somatosensory link in fibromyalgia: functional connectivity of the primary somatosensory cortex is altered by sustained pain and is associated with clinical/autonomic dysfunction. Arthritis Rheumatol 2015; 67 (05) 1395-1405
    Google Scholar
  • 46 Padua L, Coraci D, Erra C, Pazzaglia C, Paolasso I, Loreti C, Caliandro P, Hobson-Webb LD. Carpal tunnel syndrome: clinical features, diagnosis, and management. Lancet Neurol 2016; 15: 1273-1284
    CrossrefPubMedGoogle Scholar
  • 47 Sato A, Sato Y, Uchida S. Blood flow in the sciatic nerve is regulated by vasoconstrictive and vasodilative nerve fibers originating from the ventral and dorsal roots of the spinal nerves. Neurosci Res 1994; 21 (02) 125-133
    CrossrefPubMedGoogle Scholar
  • 48 Ooi CC, Wong SK, Tan AB. , et al. Diagnostic criteria of carpal tunnel syndrome using high-resolution ultrasonography: correlation with nerve conduction studies. Skeletal Radiol 2014; 43 (10) 1387-1394
    CrossrefPubMedGoogle Scholar
  • 49 Ghasemi-Esfe AR, Khalilzadeh O, Mazloumi M. , et al. Combination of high-resolution and color Doppler ultrasound in diagnosis of carpal tunnel syndrome. Acta Radiol 2011; 52 (02) 191-197
    CrossrefPubMedGoogle Scholar
  • 50 Napadow V, Dhond R, Kennedy D, Hui KK, Makris N. Automated brainstem co-registration (ABC) for MRI. Neuroimage 2006; 32 (03) 1113-1119
    CrossrefPubMedGoogle Scholar
  • 51 Tecchio F, Padua L, Aprile I, Rossini PM. Carpal tunnel syndrome modifies sensory hand cortical somatotopy: a MEG study. Hum Brain Mapp 2002; 17 (01) 28-36
    CrossrefPubMedGoogle Scholar
  • 52 Coghill RC, Sang CN, Maisog JM, Iadarola MJ. Pain intensity processing within the human brain: a bilateral, distributed mechanism. J Neurophysiol 1999; 82 (04) 1934-1943
    CrossrefPubMedGoogle Scholar
  • 53 Derbyshire SW, Jones AK, Gyulai F, Clark S, Townsend D, Firestone LL. Pain processing during three levels of noxious stimulation produces differential patterns of central activity. Pain 1997; 73 (03) 431-445
    CrossrefPubMedGoogle Scholar
  • 54 Sim H, Shin BC, Lee MS, Jung A, Lee H, Ernst E. Acupuncture for carpal tunnel syndrome: a systematic review of randomized controlled trials. J Pain 2011; 12 (03) 307-314
    CrossrefPubMedGoogle Scholar
  • 55 Lund I, Lundeberg T. Are minimal, superficial or sham acupuncture procedures acceptable as inert placebo controls?. Acupunct Med 2006; 24 (01) 13-15
    CrossrefPubMedGoogle Scholar
  • 56 Linde K, Niemann K, Schneider A, Meissner K. How large are the nonspecific effects of acupuncture? A meta-analysis of randomized controlled trials. BMC Med 2010; 8: 75
    CrossrefPubMedGoogle Scholar
  • 57 Kaptchuk TJ, Stason WB, Davis RB. , et al. Sham device v inert pill: randomised controlled trial of two placebo treatments. BMJ 2006; 332 (7538): 391-397
    CrossrefPubMedGoogle Scholar
  • 58 Harris RE, Zubieta JK, Scott DJ, Napadow V, Gracely RH, Clauw DJ. Traditional Chinese acupuncture and placebo (sham) acupuncture are differentiated by their effects on mu-opioid receptors (MORs). Neuroimage 2009; 47 (03) 1077-1085
    CrossrefPubMedGoogle Scholar
  • 59 Napadow V, Lee J, Kim J. , et al. Brain correlates of phasic autonomic response to acupuncture stimulation: an event-related fMRI study. Hum Brain Mapp 2013; 34 (10) 2592-2606
    CrossrefPubMedGoogle Scholar
  • 60 Claunch JD, Chan ST, Nixon EE. , et al. Commonality and specificity of acupuncture action at three acupoints as evidenced by FMRI. Am J Chin Med 2012; 40 (04) 695-712
    CrossrefPubMedGoogle Scholar
  • 61 Yan B, Li K, Xu J. , et al. Acupoint-specific fMRI patterns in human brain. Neurosci Lett 2005; 383 (03) 236-240
    CrossrefPubMedGoogle Scholar
  • 62 Zhang WT, Jin Z, Luo F, Zhang L, Zeng YW, Han JS. Evidence from brain imaging with fMRI supporting functional specificity of acupoints in humans. Neurosci Lett 2004; 354 (01) 50-53
    CrossrefPubMedGoogle Scholar
  • 63 Hui KK, Liu J, Makris N. , et al. Acupuncture modulates the limbic system and subcortical gray structures of the human brain: evidence from fMRI studies in normal subjects. Hum Brain Mapp 2000; 9 (01) 13-25
    CrossrefPubMedGoogle Scholar
  • 64 Huang W, Pach D, Napadow V. , et al. Characterizing acupuncture stimuli using brain imaging with FMRI--a systematic review and meta-analysis of the literature. PLoS One 2012; 7 (04) e32960
    CrossrefPubMedGoogle Scholar
  • 65 Peyron R, Laurent B, García-Larrea L. Functional imaging of brain responses to pain. A review and meta-analysis (2000). Neurophysiol Clin 2000; 30 (05) 263-288
    CrossrefPubMedGoogle Scholar
  • 66 Shinoura N, Suzuki Y, Yamada R, Kodama T, Takahashi M, Yagi K. Fibers connecting the primary motor and sensory areas play a role in grasp stability of the hand. Neuroimage 2005; 25 (03) 936-941
    CrossrefPubMedGoogle Scholar
  • 67 Asghar AU, Green G, Lythgoe MF, Lewith G, MacPherson H. Acupuncture needling sensation: the neural correlates of deqi using fMRI. Brain Res 2010; 1315: 111-118
    CrossrefPubMedGoogle Scholar