As the work week continues to push many of us past the point of our capacity to perform physical work whether it be typing or jackhammering, repetitive strain injuries (RSI) are becoming more prevalent in the developed world. RSI can refer to any injury to the muscles, tendons and soft tissues of a particular region of the body (1), however it most commonly occurs in the arm, wrist or hand, and as the name implies, it is usually caused or exacerbated by repetitive use of the area (2). Other factors such as poor posture, minimal rest from activity or excessive use of force may all contribute to the condition (3).
One of the most common RSI’s seen today is carpal tunnel syndrome (CTS). This occurs as a result of entrapment of the median nerve as it travels through the carpal tunnel at the wrist (4). The median nerve innervates (provides sensory and motor function to) the central palm, thenar eminence, and the palmar surfaces of the thumb, index, middle finger, and the lateral half of the ring finger, as well as the nail beds on the dorsal surface (5). Either by mechanical overuse or inappropriate posture (6), an increase in the volume of the tunnel contents or decrease in the size of the tunnel may occur which compresses the median nerve (7). This can cause a range of symptoms from local pain, paresthesias (pins and needles), hypoesthesia (reduced sensation), weakness and loss of grip strength, numbness and tingling in the areas innervated by the median nerve and nocturnal waking due to the pain (8).
Conservative treatments for CTS that displays mild to moderate symptoms include splinting, local steroid injection, ultrasound and oral steroids (9). While drugs such as non-steroidal anti-inflammatory drugs (NSAIDs), diuretics, and even anticonvulsants have been prescribed, they are considered to be no more effective than placebo (10). Failing the success of conservative treatment, and for those patients considered to have severe cases of CTS, surgical release of the transverse ligament is the preferred option (11). While this procedure has an initial success rate of 90%, this has been seen to drop to around 60% by around 5 years after surgery (12).
There have been a number of studies that provide strong evidence for the use of acupuncture and other Traditional Chinese medicine (TCM) therapies in the treatment of CTS. Both standard acupuncture and electroacupuncture have been shown to not only alleviate the symptoms of CTS and improve daily activity function, but also to promote nerve regeneration and improve nerve function (13).
Clinical trials have found that acupuncture produces significant improvements with results comparable to steroid treatment and night splinting, and significantly greater than placebo (14).
In a clinical trial by Ho et al. (2014), 26 patients with confirmed CTS were divided into 2 treatment groups that received either acupuncture (15 participants) or electroacupuncture (11 participants) (15). Participants received 24 treatments over 6 weeks (4 per week) with symptom severity recorded before the start and at the end of the treatment regime (16). The results indicate that electroacupuncture was effective for alleviating clinical symptoms, while standard acupuncture could improve grip strength, decrease signs of physical provocation, and improve motor and sensory nerve conduction function (17).
In a randomised control trial conducted by Khoswari et al. (2012), the results of 64 participants were compared following a 4 week treatment regime in either the intervention group (32 participants) or the control group (32 participants) (18). Treatment in the intervention group consisted of acupuncture (8 sessions over 4 weeks) and night splinting, while the control group received vitamins B1 and B6, sham (fake) acupuncture, and night splinting (19). Clinical symptoms were recorded at the start of the treatment plan and then 4 weeks after completion (20).
It was found that participants who received true acupuncture recorded a progressive loss of clinical effects of CTS, while those in the control group remained at about the same level even after 4 weeks (21). A marked difference of nerve conduction velocity between the two groups was also recorded with the acupuncture group showing significantly better improvement (22).
Naesar (1999) employed a range of TCM based therapies including red-beam laser acupuncture, transcutaneous electrical nerve stimulation (TENS) machine, infrared laser acupuncture, traditional needle acupuncture, Chinese herbal formulas and supplements to treat 31 participants suffering from CTS (23). 36 hands between 22 men and 9 women were included with a median pain duration of 24 months and each having had 1 – 2 failed surgical release procedures (24). Of the 31 cases, 28 participants treated with this program obtained successful pain relief in 4 – 5 weeks (25). 2 hands required follow treatments within the first year and were treated again successfully within a few weeks (26).
Moxibustion can also be a valuable addition to any acupuncture treatment of CTS as it has been found to heal affected areas of the median nerve and improve results of a range of muscle and nerve conduction tests for CTS (27). Significant improvements in the transverse carpal ligament and median nerve transection areas were also demonstrated under high-resolution ultrasound imaging following treatment by acupuncture and moxibustion (28).
As we can see from the available research, acupuncture offers a safe and effective form of treatment and pain relief for CTS. Like many strain injuries in the body, CTS takes time and attention with consistent treatment in order to obtain effective results. While RSI’s are considered to be self-limiting in that they will eventually heal on their own, there is no time frame applied to this and ‘self-limiting’ can mean anywhere from months to years. The time frame is also obviously delayed if the patient is not taking adequate rest from the very activity that caused the strain in the first place.
In my own experience with treating CTS and other RSI’s, 2 treatments a week for the first 4 weeks, followed by a month of weekly treatments provides noticeable results and a great deal of relief. After this, fortnightly or monthly maintenance treatments can then be done to prevent a relapse of the condition. Additional aids such as night splinting, stretches and low-resistance weight exercises only help to speed up the healing process. While optimum conditions call for complete rest from the aggravating conditions, repetitive strains are usually work-related so time off work or alternate duties are not always practical or possible. Despite this however, results show that regular acupuncture treatments still help to reduce the severity of CTS and restore function without drastic changes to a patient’s lifestyle, nor the need for invasive surgery.
- Knott, L 2014, ‘Repetitive Strain injury’, Patient Website, http://patient.info/health/repetitive-strain-injury-leaflet, viewed 28 Septmber
- Branco, K & Naeser, M 1999,’Carpal Tunnel Syndrome: Clinical Outcome After Low-Level Laser Acupuncture, Microamps Transcutaneous Electrical Nerve Stimulation, and Other Alternative Therapies – An Open Protocol Study’, The Journal of ALternative and Complementary Medicine, Vol. 5, No. 1, pp. 5 – 26, www.ebsco.com, viewed 28 September, p. 6
- Amirlak, B, Wolff, T, Ahmed, O, Upadhyaya, K, Tsai, T, Scheker, L & Tabbal, G 2016, ‘Median Nerve Entrapment – Anatomy’, Medscape Website, http://emedicine.medscape.com/article/1242387-overview#a12, viewed 28 September
- Ho, C, Lin, H, Lee, Y, Chou, L, Kuo, T, Chang, H, Chen, Y & Lo, S 2014, ‘Clinical Effectiveness of Acupuncture for Carpal Tunnel Syndrome’, The American Journal of Chinese Medicine, Vol. 42, No. 2, pp. 303 – 314, www.ebsco.com, viewed 22 September, p. 304
- Amirlak et al. 2016, loc.cit.
- Branco & Naeser 1999, loc.cit.
- Khosrawi, S, Moghtaderi, A & Haghighat, S 2012, ‘Acupuncture in treatment of carpal tunnel syndrome: A randomized controlled trial study’, Journal of Research in Medical Sciences, Vol. 17, No. 1 pp. 1 – 7, http://www.traditionalacupuncture.com.au/files/Acu%20CTS.pdf, viewed 28 September, p. 2
- Ashworth, N 2016, ‘Carpal Tunnel Syndrome Treatment & Management – Medical Treatment’, Medscape Website, http://emedicine.medscape.com/article/327330-treatment#d10, viewed 29 September
- Ashworth, N 2016, ‘Carpal Tunnel Syndrome Treatment & Management – Surgical Intervention’, Medscape Website, http://emedicine.medscape.com/article/327330-treatment#d11, viewed 29 September
- Ho et al. 2014, op.cit. p. 310
- Maeda, Y, Kettner, N, Lee, J, Kim, J, Cina, S, Malatesta, C, Gerber,J, McManus, C, Im, J, Libby, A, Mezzacappa, P, Morse, L, Park, K, Audette, J & Napadow, V 2013, ‘Acupuncture-Evoked Response in Somatosensory and Prefrontal Cortices Predicts Immediate Pain Reduction in Carpal Tunnel Syndrome’, Evidence-Based Complementary and Alternative Medicine, Vol. 2013, www.ebsco.com, viewed 22 September, p. 1
- Ho et al. 2014, op.cit. p. 303
- Ibid, pp. 310 – 11
- Khosrawi, S, Moghtaderi, A & Haghighat, S 2012, ‘Acupuncture in treatment of carpal tunnel syndrome: A randomized controlled trial study’, Journal of Research in Medical Sciences, Vol. 17, No. 1 pp. 1 – 7, http://www.traditionalacupuncture.com.au/files/Acu%20CTS.pdf, viewed 28 September, p. 9
- Ibid, p. 4
- Branco & Naeser 1999, op.cit. p. 5
- Ibid, p. 21
- Health CMi 2016, Acupuncture Reverses Carpal Tunnel Syndrome, Health CMi Website, http://www.healthcmi.com/Acupuncture-Continuing-Education-News/1611-acupuncture-reverses-carpal-tunnel-syndrome, viewed 28 September
Image 1 – http://www.hopkinsmedicine.org/healthlibrary/test_procedures/orthopaedic/carpal_tunnel_release_135,29/
Image 2 – http://www.hopkinsmedicine.org/healthlibrary/test_procedures/orthopaedic/carpal_tunnel_release_135,29/
Image 3 – http://hoysphysio.com.au/news/carpal-tunnel-syndrome/
Image 4 – http://www.healthcmi.com/Acupuncture-Continuing-Education-News/1611-acupuncture-reverses-carpal-tunnel-syndrome
Image 5 – http://www.dramyshiotani.com/moxibustion/