Objectives: To investigate the efficacy of acupuncture compared with steroid treatment in patients with mild-to-moderate carpal tunnel syndrome (CTS) as measured by objective changes in nerve conduction studies (NCS) and subjective symptoms assessment in a randomized, controlled study.
Methods: A total of 77 consecutive and prospective CTS patients confirmed by NCS were enrolled in the study. Those who had fixed sensory complaint over the median nerve and thenar muscle atrophy were excluded. The CTS patients were randomly divided into 2 treatment arms: (1) 2 weeks of prednisolone 20 mg daily followed by 2 weeks of prednisolone 10 mg daily (n =39), and (2) acupuncture administered in 8 sessions over 4 weeks (n=38). A validated standard questionnaire as a subjective measurement was used to rate the 5 major symptoms (pain, numbness, paresthesia, weakness/clumsiness, and nocturnal awakening) on a scale from 0 (no symptoms) to 10 (very severe). The total score in each of the 5 categories was termed the global symptom score (GSS). Patients completed standard questionnaires at baseline and 2 and 4 weeks later. The changes in GSS were analyzed to evaluate the statistical significance. NCS were performed at baseline and repeated at the end of the study to assess improvement. All main analyses used intent-to-treat.
Results: A total of 77 patients who fulfilled the criteria for mild-to-moderate CTS were recruited in the study. There were 38 in the acupuncture group and 39 in the steroid group. The evaluation of GSS showed that there was a high percentage of improvement in both groups at weeks 2 and 4 (P<0.01), though statistical significance was not demonstrated between the 2 groups (P=0.15). Of the 5 main symptoms scores (pain, numbness, paresthesia, weakness/clumsiness, nocturnal awakening), only 1, nocturnal awakening, showed a significant decrease in acupuncture compared with the steroid group at week 4 (P=0.03). Patients with acupuncture treatment had a significant decrease in distal motor latency compared with the steroid group at week 4 (P=0.012). Acupuncture was well tolerated with minimal adverse effects.
Conclusions: Short-term acupuncture treatment is as effective as short-term low-dose prednisolone for mild-to-moderate CTS. For those who do have an intolerance or contraindication for oral steroid or for those who do not opt for early surgery, acupuncture treatment provides an alternative choice.
Departments of *Neurology
∥Orthopedics, Kuang Tien General Hospital
†Graduate Institute of Acupuncture Science
¶Graduate Institute of Chinese Medical Science, College of Chinese Medicine
♯Biostatistics Center, China Medical University
§Chinese Medicine, China Medical University Hospital
**Department of Public Health, Chung Shan Medical University
††Section of Neurology, Taichung Veterans General Hospital, Taichung
‡‡Department of Neurology, National Yang-Ming University, Taipei, Taiwan
Supported by KTGH grant.
Reprints: Ming-Hong Chang, MD, Section of Neurology, Veterans General Hospital, No 160, Chung-Kang Road, Section 3, Taichung, Taiwan, 40705 (e-mail: firstname.lastname@example.org).
Received for publication May 25, 2008; revised September 14, 2008; accepted September 20, 2008