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

Abstract

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.

Acupuncture and related interventions for the treatment of symptoms associated with carpal tunnel syndrome

“…After screening the full text of the 32 remaining records, we excluded 16 records (see Characteristics of excluded studies), and identified two ongoing studies (see Characteristics of ongoing studies), and two studies awaiting classification (see Characteristics of studies awaiting classification). We included 13 publications from 12 studies (Aigner 1999; Feng 2011; Hadianfard 2015; Jin 2011; Kumnerddee 2010; Li 2011; Ramin 2013; Weinstein 2003; Yang 2009; Yao 2012; Zhang 2011; Chung 2016). Aflowdiagram summarising the study selection process is shown in Figure 1.…”

“…Of the included studies, five studies were carried out in mainland China (Feng 2011; Jin 2011; Li 2011; Ramin 2013; Zhang 2011), two in the USA (Weinstein 2003; Yao 2012), one in Germany (Aigner 1999),one in Hong Kong SAR(Chung 2016), one in Iran (Hadianfard 2015), one in Taiwan (Yang 2009), and one in Thailand (Kumnerddee 2010). One study included three comparison groups (Jin 2011), and the remainder compared two comparison groups.…”

“…steroid nerve blocks, oral steroid, night splints, medications, and physical therapy) (Feng 2011; Chung 2016; Hadianfard 2015; Jin 2011; Kumnerddee 2010; Ramin 2013; Yang 2009). The studies were conducted between the years 1999 in Aigner 1999 and 2014 in Chung 2016. For a detailed description of the included studies, see the Characteristics of included studies table.…”

“…Five studies reported that some participants had bilateral CTS (Chung 2016; Hadianfard 2015; Kumnerddee 2010; Ramin 2013; Yang 2009). Randomisation was carried out at the level of the individual in all of these studies, in which the more severely affected hand was chosen as the test hand.…”

“…Two studies reported that there was no baseline imbalance between the intervention groups (Aigner 1999; Chung 2016); however, there were no data regarding the baseline characteristics to check this statement. Three studies did not have sufficient information on baseline characteristics to establish whether there were imbalances (Feng 2011; Ramin 2013; Weinstein 2003).…”