Current Insights into Carpal Tunnel Syndrome: Clinical Strategies for Prevention and Treatment.

BACKGROUND: Carpal tunnel syndrome (CTS) is a condition that is caused by medial nerve compression, resulting in symptoms such as numbness, tightness, or weakness in the hand. OBJECTIVES: The aim of the study was to find out the genetic modulation, mechanism, available treatment, and recommendation for carpal tunnel syndrome at its specific stage. METHODS: Almost 200 papers were searched for this review article, and 145 articles were selected. The literature was collected from different sources like Google scholar, PubMed, a directory of open-access journals, and science.gov by using keywords, such as treatment, risk factors, recommendation, and clinical features of carpal tunnel syndrome. RESULTS: The most efficient non-surgical treatment is methylprednisolone acetate, which reduces inflammation by acting on the glucocorticoid receptor in conjunction with immunofilling. It has also been used successfully as a second-line drug for the treatment of patients with mild or moderate conditions in order to provide relief. New non-pharmacological options include laser therapy in acupuncture, transcutaneous electric nerve stimulation (TENS), and sham therapy. Modern treatments like TENS, laser therapy, splints, and injections of methylprednisolone acetate have been demonstrated to be helpful in sporadic situations. For patients with mild and moderate problems, more research should be conducted that includes the combination of these surgical and non-surgical treatments. CONCLUSION: We propose a multifunctional panel construct and define standard data items for future research into carpal tunnel syndrome. A discussion on idiopathic carpal tunnel syndrome, risk factors, combination of therapies, using guidelines-based recommendations and treatment should be initiated.

Additional contribution of phonophoresis and low-level laser therapy to exercise in the treatment of carpal tunnel syndrome: A clinical, electrophysiological, and ultrasonographic evaluation.

OBJECTIVES: Carpal Tunnel Syndrome (CTS) is the most common peripheral nerve compression syndrome. This study aims to evaluate the additive contribution of phonophoresis and low-level laser therapy (LLLT) to tendon and nerve gliding exercises electrophysiologically, ultrasonographically, and clinically in the treatment of moderate CTS. METHODS: The sample consisted of 45 patients with moderate CTS, randomized into three groups. Group 1 received phonophoresis and exercise, Group 2 received LLLT and exercise, and Group 3 received exercise alone. Participants were evaluated electrophysiologically, clinically, and ultrasonographically before treatment and at the 6th and 12th weeks after the treatment. RESULTS: An improvement was observed in clinical parameters (Boston Functional Status Scale, Boston Symptom Severity Scale, visual analog scale at rest, and visual analog scale during activity) for all groups at the 6th and 12th weeks after the treatment (p<0.05). An improvement was also noted in the ultrasonographic parameter (cross-sectional area) for all groups at the 12th week after the treatment (p=0.017). CONCLUSION: Phonophoresis and LLLT do not provide additional effects to exercise therapy. Exercise therapy alone may positively contribute to ultrasonographic and clinical outcomes in the treatment of moderate CTS.

Clinical efficacy of electroacupuncture-like magnetic therapy compared to conventional transcutaneous electrical nerve stimulation in individuals with carpal tunnel syndrome.

This study aimed to evaluate the clinical efficacy of an electroacupuncture-like magnetic therapy (ELMT) and conventional transcutaneous electrical nerve stimulation (TENS) in patients with carpal tunnel syndrome (CTS). A prospective randomized controlled trial in single-centre was conducted. Thirty-four CTS patients confirmed by electrodiagnostic study were randomized into TENS or ELMT group and completed a six-week treatment program. TENS or ELMT treatment was applied on acupuncture point PC-6 (Neiguan) and one selected hand acupoint. Therapeutic exercises were also included after the electrophysical modality. Their physical signs, motor and sensory performances, Boston Carpal Tunnel Questionnaire (BCTQ) scores, and results of electrodiagnostic study were evaluated. After treatments, both groups demonstrated significantly decreased BCTQ scores and positive rate of Tinel's sign in the major symptomatic side, which indicated improvements in the symptom severity and physical functions. Significant increases in distal sensory amplitude and nerve conduction velocity of the median nerve were only found in the ELMT group. Our study found either conventional TENS or ELMT plus therapeutic exercises could improve the symptomatology and physical provocation sign of CTS. The ELMT has additional improvement in the nerve conduction in patients with CTS.

Effectiveness of physiotherapy plus acupuncture compared with physiotherapy alone on pain, disability and grip strength in people with carpal tunnel syndrome: A randomized clinical trial.

BACKGROUND: Carpal tunnel syndrome (CTS) is the most common peripheral nerve entrapment syndrome in the upper extremities. Acupuncture is often used as a treatment method in CTS and numerous studies consider it effective. However, no study has yet compared the efficacy of physical therapy including bone and neural mobilization, exercise and electrotherapy with and without acupuncture in CTS patients. PURPOSE: comparing the effect of physiotherapy plus acupuncture with physiotherapy alone on pain, disability and grip strength in CTS patients. METHOD: Forty patients with mild to moderate CTS were randomly divided into two equal groups. Both groups received exercise and manual techniques for 10 sessions. Patients in the physiotherapy plus acupuncture group also received 30 min of acupuncture in every session. The visual analog scale (VAS) score, the score on the Boston carpal tunnel questionnaire for functional status and symptom severity, shortened disability of arm, shoulder, hand (Quick-DASH) score and grip strength were evaluated at pre-test and post-test. RESULTS: According to ANOVA results, there is a significant interaction between group and time for VAS, BCTQ and Quick-DASH parameters. At the post-test, while the parameters of VAS, BCTQ and Quick-DASH in the physiotherapy plus acupuncture group had a statistically significant difference compared to the physiotherapy group, no significant difference was observed between the two groups in the pre-test. Moreover, there is no significant difference between groups in grip strength improvement. CONCLUSION: This study shows preliminary evidence that physiotherapy plus acupuncture, was more effective than physiotherapy alone in pain relief and improving disability of patients suffering from CTS.

Comparison of 4 weeks of cupping and Kinesio-taping on clinical and ultrasound outcomes of carpal tunnel syndrome during pregnancy.

OBJECTIVE: To explore effect of cupping and Kinesio-taping techniques on clinical and ultrasound outcomes of carpal tunnel syndrome (CTS) during pregnancy. METHODS: Thirty pregnant women suffering from CTS were randomly assigned into Kinesio-taping (n = 15) and cupping (n = 15) groups. In Kinesio-taping group, individuals underwent Kinesio-taping for three days, one day with no treatment, and three days with Kinesio-taping, continuing this procedure for four weeks. In cupping group, cupping was moved for 5 min with pressure of 50 mm-Hg on the carpal tunnel area. This procedure continued longitudinally in forearm area for 2 min. The therapeutic intervention of cupping group continued with eight sessions, two days a week for 4 weeks. Ultrasound outcomes including median nerve cross-sectional area through ultrasonography, and clinical outcomes including pain through visual analog scale and severity of symptoms and functional status through Boston questionnaire were measured in both groups before and after therapeutic program. RESULTS: In both groups, a significant reduction was observed in all variables after treatment compared to pre-treatment (P < 0.001). In inter-group comparison, a significant improvement was found in outcomes of Boston questionnaire and ultrasound results about median nerve cross-sectional area at pisiform and hook of hamate in cupping group compared to Kinesio-taping at end of four weeks (P < 0.001). CONCLUSION: Both cupping and Kinesio-taping improved clinical and ultrasound outcomes of CTS. However, efficacy of cupping compared to Kinesio-taping was better in improvement of median nerve cross-sectional area at hamate hook and pisiform levels, symptoms severity scale, and functional status scale, which makes the results clinically more applicable.

Comparison of acupotomy release combined with glucocorticoid intrathecal injection versus isolated glucocorticoid intrathecal injection for carpal tunnel syndrome: A protocol for a meta-analysis of comparative studies.

BACKGROUND: Carpal tunnel syndrome (CTS) is more common in people who need to engage in repetitive wrist work. Once it has occurred, localized pain and numbness of the fingers will develop, in severe cases, muscle atrophy will even arise, and after rest and physical therapy, many patients will still be unable to relieve or recur. In this case, the patient can receive intrathecal glucocorticoid injections, but the hormone injections alone can only provide short-term relief, and because the mechanical factors of median nerve compression are not fundamentally removed. Therefore, combined acupotomy release can help to release the compression of the transverse carpal ligament on the nerve and increase the volume within the carpal tunnel to achieve more satisfactory long-term results. Hence, a meta-analysis is necessary to provide evidence whether there is a significant difference in the treatment of CTS with acupotomy release combined with glucocorticoid intrathecal injection (ARGI) compared with isolated glucocorticoid intrathecal injection (GI). METHODS: We will search, with no time restriction, without any restriction of language and status, the time from the establishment of the database to October 2022, on the following databases: PubMed, Cochrane central register of controlled trials, Web of Science, Chinese national knowledge infrastructure, Wanfang data, Chinese scientific journals database, Chinese databases SinoMed, and electronic databases. The electronic database search will be supplemented by a manual search of the reference lists of included articles. We will apply the risk-of-bias tool of the Cochrane collaboration for randomized controlled trials to assess the methodological quality. Risk-of-Bias Assessment Tool for nonrandomized studies was used to evaluate the quality of comparative studies. Statistical analysis will be conducted using RevMan 5.4 software. RESULTS: This systematic review will evaluate the difference in efficacy of ARGI versus isolated GI in the treatment of CTS. CONCLUSION: The conclusion of this study will provide evidence for judging whether ARGI is superior to GI for treatment of CTS.

[Expert consensus on the diagnosis and treatment of carpal tunnel syndrome with integrated Chinese and Western medicine].

Carpal tunnel syndrome (CTS) is the most common peripheral nerve compression disease. The early diagnosis and treatment are very necessary due to the high incidence rate, diverse hazard factors and the irreversible muscle atrophy caused by the late disease. Clinically, there are many treatments on CTS, both traditional Chinese medicine (TCM) and Western medicine treatment have their advantages and disadvantages. If we can combine them and complement each other, it will be more conducive to the diagnosis and treatment of CTS. Under the support of Professional Committee of Bone and Joint Diseases of the World Federation of Chinese Medicine Societies, in this consensus, we synthesized the opinions of experts in related fields of TCM and Western medicine and formed the recommendations for the diagnosis and treatment of TCM and western medicine of CTS. The consensus also makes a brief CTS diagnosis and treatment flow chart, hoping to provide reference for academic community.

Short-term effects of dry needling of thenar muscles in manual laborers with carpal tunnel syndrome: a pilot, randomized controlled study.

STUDY DESIGN: Pilot, randomized, single-blinded controlled clinical trial. BACKGROUND AND OBJECTIVE: Trigger point (s) (TrPs) in thenar muscles could be a cause of narrowing of carpal tunnel in manual laborers with carpal tunnel syndrome (CTS). Effects of dry needling (DN) on the treatment of muscle tension have been reported, but no research has been done on the effect of DN on thenar tight muscles on reducing CTS symptoms. The aim of this study was to assess the effect of DN of thenar muscles TrPs in the treatment of mild-to-moderate carpal tunnel syndrome. METHODS: Thirty manual laborers with mild-to-moderate CTS and the presence of TrP(s) in thenar muscles were randomized to DN group (n = 15) and control group (waiting list) (n = 15). The DN group received 2 sessions of DN of thenar muscles TrP(s), with a 48-h interval. The control group received no treatment. Boston Carpal Tunnel Syndrome Questionnaire (BCTQ) scores were the primary outcome, while secondary outcomes included electrophysiological domains, pinch and grip strength. Outcome measures were obtained at baseline, 48 hours, and 2 weeks after treatment (follow-up). Two-way analysis of variance (2 groups × 3 times) was used to compare within- and between-group differences. Bonferroni post hoc test was used to find any significant differences in the main effect for group, time, or interaction (group time). RESULTS: A baseline assessment revealed no intergroup differences in all evaluated parameters (P > .05). Compared to the control group, the DN group had a statistically significant improvement in pinch and grip strength, median SDL, and BCTQ score after 2 weeks (P < .05). There were no between-group differences in the assessment of motor electrophysiologic and SNCV findings (P > .05). CONCLUSION: Dry needling of thenar TrP(s) is effective in short-term improvement of function in manual laborers with mild-to-moderate CTS.

Effect of Acupotomy Combined with Electroacupuncture Therapy on Finger Mobility and Pain Relief in Patients with Carpal Tunnel Syndrome.

Objective: To explore the effect of acupotomy in combination with electroacupuncture therapy on the finger mobility and pain relief in patients who had carpal tunnel syndrome (CTS). Methods: The clinical data of 60 CTS patients in our hospital from November 2020 to November 2021 received retrospective analysis. With 30 cases in each group, they were randomly divided into the treatment group and the control group. The control group underwent hot compress, oral medication, and local injection during hospitalization, while the treatment group received acupotomy and electroacupuncture therapy on top of the above treatments, and the clinical effects, finger mobility, and pain relief were compared between both groups. Results: The clinical indexes in the treatment group after treatment were remarkably better than those in the control group (P < 0.05), with the remarkably higher number of cured cases in the treatment group (P < 0.05). After treatment, the treatment group had remarkably higher mean total active motion (TAM) and score of the 36-item short form (SF-36) health survey and a remarkably lower mean score of visual analog scale (VAS) than those in the control group (P < 0.001). Conclusion: The quality of life and finger mobility of CTS sufferers can be improved with acupotomy in conjunction with electroacupuncture therapy. In-depth research will help build better procedures for these patients because this approach lessens the discomfort and shortens the symptom duration in CTS sufferers.

Comparison of Two Manual Therapy Programs, including Tendon Gliding Exercises as a Common Adjunct, While Managing the Participants with Chronic Carpal Tunnel Syndrome.

Background: Carpal tunnel syndrome (CTS) is the symptomatic compression neuropathy of the median nerve at the wrist level that may become a reason for upper limb disability, in the women and men population. Objective: This study aimed to compare the efficacy of the neurodynamic technique (NT) and carpal bone mobilization technique (CBMT) incorporated with tendon gliding exercises (TGE) as an effect-enhancing adjunct while managing the participants with chronic CTS. Methods: The study followed a two-arm parallel-group randomized comparative design. Thirty participants (aged 30-59 years) with chronic CTS were recruited randomly to both the NT and CBMT groups. In addition to the TGE (a common adjunct), NT and CBMT were performed in the NT and CBMT groups, respectively, for three weeks. The primary outcome measures including pain intensity, functional status, grip strength, and motor nerve conduction study were assessed using a visual analogue scale (VAS), Boston Carpal Tunnel Questionnaire (BCTQ), hand-held dynamometer, and electromyograph, respectively, at baseline, 3 weeks postintervention, and follow-up at one week post end of the intervention. Paired and unpaired t-test were used to calculate the differences in intervention effects within and between the groups with keeping the level of significance α at 0.05. Results: The data analysis revealed a significant (95% CI, p < 0.05) difference for all outcomes within each group compared across different time intervals. Similarly, a significant difference was found for all outcomes except pain and grip strength compared between groups at 3 weeks postintervention and follow-up at one week post end of the intervention. Conclusions: The NT revealed more effectiveness than the CBMT when incorporated with TGE to improve nerve conduction velocity and functional status of the hand. However, both NT and CBMT were equally effective in improving pain and grip strength while managing the participants with chronic CTS. In addition, the TGE contributed as a beneficial, effect-enhancing adjunct to the NT and CBMT differently. Significance. The study will guide the physiotherapist in applying either of the combination techniques suitable for achieving treatment objectives while managing the participants with chronic CTS.

Laser Acupuncture as a Treatment Option for Carpal Tunnel Syndrome Management: a Case Series.

Carpal tunnel syndrome (CTS) is disease that gives burdens for many countries, with a few choices for the management such as drugs or surgery, each has side effects that decrease the quality of life. Acupuncture is proven to be an effective treatment for pain and can restore nerve functions, and laser acupuncture is one of the modalities. This study aims to assess the effectiveness of laser acupuncture with total sample of 3 patients (6 wrists) mostly with tingling sensations and the outcomes are Boston questionnaire (BCTQ), visual analogue scale (VAS), Tinel sign, Phalen sign, and parameters of nerve conduction study (NCS). Acupuncture points used here are PC6, PC7, EXUE9, and LI4. The results show a decrease in NCS grades for 3 wrists, all wrists have BCTQ score improvements, a decrease in VAS, but no significant improvement in Tinel and Phalen signs. It is concluded that laser acupuncture can be used as a treatment option for the management of carpal tunnel syndrome.

[Moderate bilateral carpal tunnel syndrome improved by median nerve neurodynamic mobilization: a case report]. / Syndrome du canal carpien bilatéral modéré amélioré par la mobilisation neurodynamique du nerf médian: à propos d'un cas.

Carpal tunnel syndrome is the most common neuropathy affecting the upper limb. Several therapeutic approaches are used to treat this syndrome, including conservative treatment, often used as the first line treatment. We here report the case of a 61-year-old female patient, presenting to the Department of Clinical Neurophysiology of the Specialty Hospital, Rabat, with moderate and bilateral carpal tunnel syndrome with sensory loss confirmed by electroneuromyography (ENMG). Manual therapy, including bilateral median nerve neurodynamic mobilization, was performed. Patient´s outcome was marked by disappearance of nocturnal numbness and follow up ENMG showed a marked improvement in nerve conduction parameters. Based on this positive result, neurodynamic mobilization of the median nerve may be considered as a possible approach for the conservative treatment of carpal tunnel syndrome.

The effectiveness of manual therapy on pain, physical function, and nerve conduction studies in carpal tunnel syndrome patients: a systematic review and meta-analysis.

AIM OF THE STUDY: Systematic review and meta-analysis to assess the effectiveness of manual therapy in improving carpal tunnel syndrome (CTS) symptoms, physical function, and nerve conduction studies. METHOD: MEDLINE, Web of Science, SCOPUS, Cochrane Library, TRIP database, and PEDro databases were searched from the inception to September 2021. PICO search strategy was used to identify randomized controlled trials applying manual therapy on patients with CTS. Eligible studies and data extraction were conducted independently by two reviewers. Methodology quality and risk of bias were assessed by PEDro scale. Outcomes assessed were pain intensity, physical function, and nerve conduction studies. RESULTS: Eighty-one potential studies were identified and six studies involving 401 patients were finally included. Pain intensity immediately after treatment showed a pooled standard mean difference (SMD) of - 2.13 with 95% confidence interval (CI) (- 2.39, - 1.86). Physical function with Boston Carpal Tunnel Syndrome Questionnaire (BCTS-Q) showed a pooled SMD of - 1.67 with 95% CI (- 1.92, - 1.43) on symptoms severity, and a SMD of - 0.89 with 95% CI (- 1.08, - 0.70) on functional status. Nerve conduction studies showed a SMD of - 0.19 with 95% CI (- 0.40, - 0.02) on motor conduction and a SMD of - 1.15 with 95% CI (- 1.36, - 0.93) on sensory conduction. CONCLUSIONS: This study highlights the effectiveness of manual therapy techniques based on soft tissue and neurodynamic mobilizations, in isolation, on pain, physical function, and nerve conduction studies in patients with CTS.

Utilization of Neurophysiological Classification Systems in Determining Interventions for Patients with Carpal Tunnel Syndrome.

BACKGROUND: Median mononeuropathy at or distal to the wrist, or carpal tunnel syndrome (CTS), is the most common peripheral nerve compression disorder in the upper extremity. Neurophysiological classification systems for patients with CTS have been developed and implemented to provide health care providers an enhanced system of electrophysiological evaluation with a grading scale, so that they may evaluate their patients with CTS within a system that confers relative severity. Electrophysiological data collected within these classification systems includes either nerve conduction studies (NCS), or both NCS and electromyography (EMG) test results. The purpose of this study was to assess the utilization of neurophysiological classification systems in determining interventions for patients with carpal tunnel syndrome (CTS). METHODS: To assess the utilization of neurophysiological classification systems in determining interventions for patients with CTS, an on-line survey of referring providers to NCS/EMG (electrophysiological testing) clinics was developed. These clinical sites were asked to submit three referring providers of their NCS/EMG services. The survey was emailed to the referring providers with a letter of introduction that included an overview and purpose of the study and specifically stated their responses were completely anonymous and analyzed data would be in an aggregate form. RESULTS: Of the 35 referring providers of NCS/EMG services for their patients with CTS contacted to participate in this study, 14 providers completed the on-line survey (40%). This included 12 physicians (MD), one osteopathic physician (DO), and one nurse practitioner (NP). Twelve of the referring providers (85.7%) were familiar with clinical electrophysiological classification systems for patients with CTS. Nine referring providers use a neurophysiological classification system (Greathouse Ernst Hall Shaffer (GEHS) and Bland-six; GEHS only-two; alternate system-one). Five respondents did not use a neurophysiological classification system, two of which were not familiar with these classification systems. The nine providers who use a neurophysiological classification system for their patients with CTS found these systems useful in assessing patient prognosis, treatment planning, and communicating back to referral services. The most preferable treatments for the very mild and mild (sensory only; sensory and motor) classifications were splinting followed by oral medication and injection. Splinting and surgery (open and endoscopic) were the interventions of choice for the moderate/severe and severe electrophysiological classifications. CONCLUSION: Referring providers of NCS/EMG services completed an on-line survey to assess the utilization of neurophysiological classification systems in determining interventions for patients with CTS. The most preferable treatments for the very mild and mild (sensory only; sensory and motor) classifications were splinting followed by oral medication and injection. Splinting and surgery (open and endoscopic) were the interventions of choice for the moderate/severe and severe electrophysiological classifications. A method for using a neurophysiological classification system for patients with CTS in a clinical report is provided. Additional research to assess the prognostic validity and utilization of carpal tunnel classification systems as longitudinal outcome measures is needed.

Acupuncture and related therapies for carpal tunnel syndrome: A protocol for systematic review and Bayesian network meta-analysis.

BACKGROUND: Carpal tunnel syndrome (CTS) is the most common peripheral nerve compression syndrome of the upper limb. Plenty of studies showed the effects of acupuncture therapy on relieving pain and improving functional status for CTS patients. Diverse types of acupuncture therapies have been used in the treatment for CTS, but their relative treatment effects are poorly understood. This study will evaluate the effects of different acupuncture and related therapies for CTS by conducting a systematic review and Bayesian network meta-analysis (NMA). METHODS: We will search randomized controlled trials (RCTs) of acupuncture and related therapies for CTS in MEDLINE (via PubMed), EMBASE, Web of Science, Cochrane Library, Chinese Biomedical Database, China National Knowledge Infrastructure, VIP Database, Wanfang Database, WHO International Clinical Trials Registry Platform, ClinicalTrials.gov, Chinese Clinical Trial Register, and OpenGrey from inception to November 2021. Then, we will select eligible studies, extract data, and conduct risk of bias assessment using the Cochrane tool. Pairwise meta-analysis and Bayesian NMA will be performed in Stata 15.1 software and Aggregate Data Drug Information System 1.16.8 software. We will assess the quality of the evidence using the Confidence in Network Meta-Analysis application. RESULTS: In this study, the treatment effects and safety of different acupuncture and related therapies for CTS will be evaluated. CONCLUSION: This study will provide evidence for choosing the optimal acupuncture and related therapies in the treatment for CTS.

Ring finger sensory latency difference in the diagnosis and treatment of carpal tunnel syndrome.

OBJECTIVE: To explore the sensitivity of median and ulnar nerve sensory latency differences in diagnosing carpal tunnel syndrome (CTS) at different severities. METHODS: CTS patients were divided into three groups based on disease severity (mild, moderate, and severe). Distal latency of sensory nerve action potential (SNAP) for the median and ulnar nerves was recorded. The sensitivity of SNAP distal latency to CTS and its correlation with CTS severity were analyzed. RESULTS: Significant differences were found in the median nerve sensory action potential distal latency (MSDL) and in the median and ulnar sensory latency difference to ring finger (MUD) but not in the ulnar nerve sensory action potential distal latency (USDL) between CTS and control. The sensitivity and specificity were 92.2 and 99.4% with an MSDL cutoff value of 2.40 ms, respectively, and were both 100% with a MUD cutoff value of 0.33 ms. There was no significant difference in USDL among the CTS and control groups. Significant differences were found in MSDL and MUD among the CTS severities and between mild and moderate CTS, but not between mild and severe CTS or between moderate and severe CTS. Correlations with CTS severity were observed for MSDL and MUD but not for USDL. CONCLUSION: The ulnar nerve of the CTS patients was not damaged. A smaller MSDL reflected median nerve damage, which can be used for the early diagnosis of CTS. MUD correlated with CTS severity with a higher sensitivity than MSDL, which can provide therapeutic insight without pain to patients.

The treatment effect of intramuscular stimulation on carpal tunnel syndrome: A blinded randomized trial on 75 patients.

BACKGROUND: Carpal tunnel syndrome (CTS) is a disorder with a prevalence of about 5.8% for females and 0.6% for males. This study aims to determine whether intramuscular stimulation (IMS) to the pronator teres muscle subsequently reduces the severity of clinical parameters and the diameter of the median nerve. METHODS: Seventy-five individuals with a cross-sectional diameter of the median nerve of more than 2 mm were included in this randomized clinical trial. Thirty-seven individuals received IMS to the pronator teres muscle with a depth of up to 45-50 mm. The 38 individuals in the control group received an acupuncture needle at Li11 with a depth of 4-5 mm. Both groups had 7 treatments within 7 weeks. The primary outcome was the cross-section of the median nerve in the carpal tunnel. Additionally, Phalen's test, Tinel's sign, VAS for pain intensity, and pincer grip strength were measured. RESULTS: Both IMS subjects and controls showed significant reductions in the cross-section of the median nerve from baseline to follow-up (p < 0.001 and p = 0.002 respectively). The IMS group had the largest change, but the difference in change between the groups was not significant (p = 0.39). On all clinical tests, IMS subjects showed significant improvement from baseline compared with the control group (largest p = 0.002). CONCLUSION: In this study we found that IMS to the pronator teres muscle significantly improved all clinical variables measured, compared with the group receiving acupuncture. Furthermore, the cross-section of the median nerve reduced over time for both groups. IMS may be a low-risk alternative while patients are waiting for surgery. TRIAL REGISTRATION: Clinicaltrials. gov Identifier: NCT01102868. Retrospectively registered: March 29th, 2010.