Sonographic Evaluation of Carpal Tunnel Syndrome Before and After Acupuncture Therapy

Abstract

Objective:

This quasi-experimental study investigated whether acupuncture would reduce median nerve cross-sectional area (CSA) in carpal tunnel syndrome (CTS) patients, assessed by ultrasonography, and compared findings with nerve conduction velocity (NCV) for diagnostic concordance.

Materials and Methods:

This cohort study was conducted in a teaching hospital in Iran, where 16 patients were evaluated for CTS and acupuncture treatment for CTS. The cohort provided 26 affected wrists (e.g., six unilateral and ten bilateral) and the patients were aged 24–63 years. This group was compared with a comparison group of 12 patients (e.g., 12 wrists) who did not receive acupuncture treatment. The diagnosis of CTS was confirmed by both clinical symptoms and NCV testing results. Sonography was used to evaluate the carpal tunnel (proximal, inlet, and outlet), pre- and post-treatment of ten acupuncture sessions. Patients were further grouped by NCV severity (e.g., mild: n = 10, moderate: n = 7, severe: n = 9). The Wilcoxon test was used to compare CSA changes, and McNemar’s tests assessed color Doppler shifts. Due to potential correlation within bilateral cases, a sensitivity analysis was performed on a subset of 16 independent wrists.

Results:

The series of acupuncture treatments significantly reduced CSA in the treatment group (p < .001) across all regions, unlike the comparison group (p > .05). Reduction in nerve swelling was noted for mild cases at the proximal/inlet site, the moderate cases across all regional sites, and severe cases at the inlet/outlet. A sensitivity analysis of 16 independent wrists confirmed the primary diagnostic findings (p < .01). Color Doppler indication of nerve inflammation decreased from 14/20 to 6/20 (p = .01). The NCV testing demonstrated a reduction in severity for the treatment group (p < .001). The treatment group’s responses to the Boston Carpal Tunnel Questionnaire improved from a mean of 3.2 ± SD 0.8 to 2.1 ± SE 0.6 (p = .01).

Conclusion:

In this cohort, acupuncture reduced median nerve CSA and improved CTS outcomes, particularly for those who had mild/moderate CTS. In this study, sonography aligned with NCV for monitoring CTS, however, long-term surveillance is recommended.