Study Design Systematic review. Background Little is known about the effectiveness of acupuncture
therapies for musculoskeletal disorders. Objective To assess the effectiveness and safety of acupuncture
therapies for musculoskeletal disorders of the extremities. Methods We searched MEDLINE, Embase, CINAHL, PsycINFO, and Cochrane Central Register of Controlled Trials from 1990 to 2015 for randomized controlled trials, cohort studies, and case-control studies. Eligible studies were appraised with Scottish Intercollegiate Guidelines Network criteria. A best-evidence synthesis was performed to synthesize results from included studies with a low risk of bias. A sensitivity analysis was conducted to determine the impact of excluding studies with a high risk of bias. Results The search revealed 5180 articles; 15 were included (10 with a low risk of bias, 5 with a high risk of bias). The studies with a low risk of bias suggested that (1) traditional needle acupuncture was superior to oral
steroids (1 RCT, n = 77) and may be superior to
vitamin B1/B6 supplements (1 RCT, n = 64) for
carpal tunnel syndrome (CTS), and was superior to exercise for Achilles
tendinopathy (1 RCT, n = 64). Traditional needle acupuncture did not provide important benefit over placebo for upper extremity
pain (1 RCT, n = 128), or no intervention for
patellofemoral pain (1 RCT, n = 75), and was inconclusive for
shoulder pain (2 RCTs, n = 849), suggesting no important benefit; (2)
electroacupuncture may be superior to placebo for
shoulder injuries (1 RCT, n = 130) and may not be superior to night splinting for persistent CTS (1 RCT, n = 78); and (3)
dry needling may be superior to placebo for
plantar fasciitis (1 RCT, n = 84). Sensitivity analysis suggests that including studies with a high risk of bias might have impacted the evidence synthesis in support of managing
shoulder pain with traditional needle acupuncture, and that would suggest traditional needle acupuncture may be effective for
lateral epicondylitis and
piriformis syndrome. Conclusion Evidence for the effectiveness of acupuncture for musculoskeletal disorders of the extremities was inconsistent. Traditional needle acupuncture may be beneficial for CTS and Achilles
tendinopathy, but not for nonspecific upper extremity
pain and
patellofemoral syndrome.
Electroacupuncture may be effective for
shoulder injuries and may show similar effectiveness to that of night wrist splinting for CTS. The effectiveness of
dry needling for
plantar fasciitis is equivocal. Level of Evidence
Therapy, 1a-. J Orthop Sports Phys Ther 2016;46(6):409-429. Epub 26 Apr 2016. doi:10.2519/jospt.2016.6270.