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Understanding and Treating Carpal Tunnel Syndrome with Acupuncture

Carpal Tunnel Syndrome (CTS) is a painful condition characterized by inflammatory swelling of the tendons within the narrow carpal tunnel, a common repetitive strain injury. Its primary symptoms, such as numbness and tingling in the base of the thumb and the middle three fingers, result from the compression of the median nerve within the carpal tunnel. Acupuncture has been found to be quite effective in treating CTS.

To enhance the effectiveness of acupuncture for CTS, understanding the anatomy of the wrist and the causes of CTS is crucial. The back of the carpal tunnel is formed by bones (the carpal bones), and the front is covered by a thin layer of soft tissue. The main contents of the tunnel are nine tendons that control hand functions and the median nerve, all secured by a ligament. Overuse of these tendons leading to tendonitis is a primary cause of CTS. The median nerve is the most pressure-sensitive structure in the wrist. When local tendonitis or diseases of the carpal bones (such as osteoarthritis) increase pressure within the tunnel, numbness and tingling occur in the nerve's distribution area (thumb, index, middle, and half of the ring finger), along with weakness in hand movements, particularly the thumb. Some patients may experience pain spreading to the lower forearm, and late-stage cases can exhibit forearm muscle atrophy and weakness.

Therefore, the primary local reflex points for CTS typically appear and are most accessible within the carpal tunnel, particularly on the palmar side of the wrist. This explains why the acupoint 'Da Ling' is a primary point for treatment, as the first occurrence in CTS is tendonitis of the flexor muscles. The best method to treat tendonitis with acupuncture is direct stimulation. However, as each patient may overuse different wrist tendons, pinpointing the affected tendons during acupuncture is essential. The sign of accurate targeting is obtaining a needle sensation in the area of spontaneous numbness or tingling. When multiple tendons are affected, simultaneous stimulation of each tendon is possible, which is why 'multi-needle' techniques at Da Ling and adjacent auxiliary acupoints are used. 'Nei Guan' is also an optimal point for directly stimulating the median nerve.

While the dorsal side of the wrist and forearm predominantly comprises extensor muscles and their tendons, reflex points or acupoints related to CTS often appear in these areas. These may be due to pain spread from the wrist or associated with the weakness of hand movements. The loss of sensation and strength in the fingers often leads patients to use their forearm and thumb muscles more forcefully, which can contribute to the involvement of these forearm muscles. Stimulating these acupoints, such as 'Yang Chi,' 'Yang Xi,' 'Yang Gu,' 'Wai Guan,' 'He Gu,' and 'Shou San Li,' can help control wrist pain and hand weakness. Additionally, since these muscles are antagonists to the palmar flexors, stimulating these acupoints also follows the acupuncture principle of treating the back for front ailments.

Since CTS is primarily caused by overuse of the hands, limiting the use of the affected tendons or changing hand usage habits is essential during treatment. Wearing wrist supports can also provide protection. However, flexion exercises to strengthen the hands, wrists, and forearm muscles can still be beneficial in the early stages of the condition. Wrist stretching exercises are also helpful in improving local blood circulation.


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