Comparison Of Acupuncture And Corticosteroid In Improvement Of Carpal Tunnel Syndrome And Its Mechanism

OBJECTIVE:to compare the efficacy of acupuncture and corticosteroid in improving of carpal tunnel syndrome and to evaluate the effectiveness on nerve conduction study and assessment of mechanism of acupuncture in treatment of carpal tunnel syndrome.PATIENTS AND METHODS:After diagnosis of CTS (Carpal Tunnel Syndrome) by clinical examination and neuroevaluation in77patients,52of them met the inclusion criteria and enrolled the study. The CTS patients were randomly divided into2treatment arms:(1)4weeks of prednisolone5mg daily (n=26), and (2) acupuncture administered in12sessions over4weeks (n=26). A validated standard questionnaire as a subjective measurement was used on a scale from1(no symptoms) to5(very severe). The total score was termed the global symptom score. Patients completed standard questionnaires at baseline and one week after end of treatment. The changes in questionnaire scores were analyzed to evaluate the statistical significance. NCS were performed at baseline and repeated one week after end of the study to assess improvement. All main analyses used intent-to-treat.RESULTS:A total of52patients who fulfilled the criteria for mild-to moderate CTS were recruited in the study. There were26in the acupuncture group and26in the steroid group. The evaluation of total scores of questionnaires showed that there was a high percentage of improvement in both groups, but improvement in acupuncture group was better than steroid group specially in nocturnal awaking. Patients had not significant changes in NCS except CMAP in steroid group. Acupuncture was well tolerated with minimal adverse effects.CONCLUSION:Short-term acupuncture treatment is as effective as short-term low-dose prednisolone for mild-to-moderate CTS. The mechanism of efficacy of acupuncture in treatment of CTS is not just through changing in large nerves conduction. 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.