Wrist pain

Wrist pain covers several conditions with separate trial literatures: de Quervain’s tenosynovitis, a painful swelling of the sheath around two thumb tendons where they cross the thumb side of the wrist; pain and stiffness while recovering from a fracture of the distal radius, the forearm bone just above the wrist, or from wrist surgery; and arthritic or unexplained wrist pain. Compression of the median nerve at the wrist has its own page, carpal tunnel syndrome. For the conditions here the published evidence is a handful of small trials, most of them in de Quervain’s tenosynovitis, and reviews of treatments in general in which acupuncture is one option among many.

The Cochrane reviews

No Cochrane review covers acupuncture, electroacupuncture, acupressure or laser acupuncture for any of these conditions. The nearest is the 2015 Cochrane review of rehabilitation for distal radial fractures by Handoll and Elliott at Teesside University, which searched to January 2015 and included 26 trials with 1,269 people, mostly older women. GRADE, the system that rates confidence in a result from high to very low, put the evidence for every one of its 23 comparisons at low or very low, and the authors found it insufficient to establish which rehabilitation methods work best. The interventions its abstract lists, among them exercise programmes, ice, ultrasound and pulsed electromagnetic fields, include no acupuncture.

Reviews of de Quervain’s tenosynovitis

Three of the four are network meta-analyses, which rank many treatments against each other by combining direct comparisons with indirect ones made through shared comparators. In the 2023 network meta-analysis in JAMA Network Open, Challoumas and colleagues at the University of Glasgow ranked a steroid injection followed by 3 to 4 weeks in a thumb splint most likely to be the best treatment for function in the first 12 weeks, and acupuncture second. The one acupuncture trial in its reference list is the Iranian trial below.

The 2024 review by Qin and colleagues at Chengdu University of Traditional Chinese Medicine, the only one limited to acupuncture, searched Chinese and English databases and found 14 randomised trials with 851 people. Against topical painkillers, acupuncture had a higher response rate (risk ratio 1.24, 95% confidence interval 1.11 to 1.39) and visual analogue pain scores 1.06 points lower, with no significant difference in the Cooney wrist function score. Pain scores were also lower than with a waiting list. Against steroid injections, the trials found no significant difference in pain, response rate or wrist score. The authors said the number and quality of the trials limit what they show.

In the 2024 network meta-analysis by Chong and colleagues at University Hospitals of Leicester, acupuncture, like steroid injection alone, platelet-rich plasma injection and a splint alone, did not differ significantly from placebo in pain within six weeks; shockwave therapy ranked highest. The 2026 network meta-analysis by Cuenca-Zaldívar and colleagues in Madrid, of 21 studies of which 12 entered the network, ranked a full-time splint with a steroid injection first for pain and function, a steroid injection alone second and acupuncture third. Every active treatment did better than a waiting list. Most studies were at high risk of bias, the pain results varied far more between trials than chance explains, and the certainty was low to very low.

Trials in de Quervain’s tenosynovitis

• Against a steroid injection, 2014. At Shiraz University of Medical Sciences, Hadianfard and colleagues randomised 30 people to five 30-minute acupuncture sessions at LI05 (Yangxi), LU07 (Lieque), LU09 (Taiyuan) and tender points, or to one injection of methylprednisolone, a corticosteroid, into the tendon compartment. Six weeks after treatment began, the Q-DASH, a disability score for the arm, shoulder and hand, had fallen from a baseline mean of 62.8 to 9.8 with acupuncture and 6.2 with the injection, and pain from 6.9 to 2 and 1.2. The success rate was higher with the injection, and the authors proposed acupuncture as an alternative for people who decline one.
• Against a waiting list, 2022. At the University of Hong Kong, Leung and colleagues randomised 68 people to five sessions over 2 weeks or to a waiting list. The trial registration describes the method, sinew acupuncture, as 4 to 6 needles inserted almost parallel to the skin in the wrist and forearm with the tips pointing towards the painful spot. At 2 weeks pain had fallen by 19.5 points with acupuncture and 3.4 with the waiting list, a difference of −16.2 points (95% CI −26.7 to −5.6). Grip and pinch strength and the Q-DASH also favoured acupuncture; quality of life did not differ. At the end of 10 weeks of follow-up, pain in the acupuncture group remained 30.6 points below its baseline. The waiting list does not control for the expectation of treatment.

Sham acupuncture sets out what a sham procedure controls for that a waiting list does not.

After a fracture or wrist surgery

In a 2017 trial of laser acupuncture, Acosta-Olivo and colleagues treated people whose distal radius fracture had been fixed with pins and a short cast for six weeks. Alongside physiotherapy exercises, one group had an infrared laser applied for 30 seconds to each of a set of points, among them SI05 (Yanggu), TB04 (Yangchi), LI05, PC07 (Daling) and LI04 (Hegu) on the injured side, and the other had the same procedure with the laser switched off. Over 10 sessions, three a week, the laser group reported 44% less pain and 33% better wrist function than the control group. The abstract does not give the number of people randomised.

At China Medical University in Taichung, Chang and colleagues randomised 42 people after arthroscopic repair of a tear in the triangular fibrocartilage complex, on the little-finger side of the wrist, to 4 weeks of rehabilitation exercises with or without electroacupuncture, which passes a small current through the needles. The 12 sessions used four points on the opposite leg: BL60 (Kunlun), GB34 (Yanglingquan), SP06 (Sanyinjiao) and KD03 (Taixi). At the end of treatment and 4 weeks later, the electroacupuncture group had better DASH scores, wrist movement and key pinch strength. The assessor was blinded, and the authors note that the trial had no sham group.

A trial protocol published in 2022 by Fu and colleagues at Southern Medical University in Guangzhou plans to randomise 222 people after distal radius fracture surgery to routine treatment with or without electroacupuncture at LI05, TB04, SI05, LI04 and LU09; Europe PMC listed no results paper in October 2026. Laser acupuncture and electroacupuncture describe the two methods.

Arthritis and other wrist pain

A 2022 review of hand and wrist pain by Trinh and colleagues at McMaster University excluded trials against active treatments and found 10 trials with 622 people, 6 at low risk of bias. One rheumatoid arthritis trial reported less pain and better function at the end of treatment and in the short term, one tenosynovitis trial reported the same in the short term, and for osteoarthritis of the joint at the base of the thumb the review noted no significant improvement. The authors concluded that acupuncture may be effective and safe for short-term pain reduction and function in hand and wrist conditions, and asked for caution because of small samples and differences between trials.

At Gansu Provincial Hospital of Traditional Chinese Medicine, Zhang and colleagues randomised 80 people with active rheumatoid arthritis of the wrist to methotrexate alone or methotrexate with acupuncture at points including LI04, SI03 (Houxi) and TB05 (Waiguan), five times a week for 8 weeks; 74 finished. They reported that the combination improved symptoms and wrist function and lowered markers of inflammation more than methotrexate alone; the trial had no sham control. Rheumatoid arthritis covers the wider trial literature.

Safety

The Hong Kong trial reported no serious adverse event, and in the 2022 hand and wrist review the adverse effects reported came from two carpal tunnel trials. A 2015 case report from Ewha Womans University in Seoul describes an 80-year-old man in whom a mass appeared at the wrist after acupuncture for a wrist sprain. He continued acupuncture for 3 years as the mass grew into the palm and little finger, with recurring open wounds. Surgeons removed encapsulated masses filled with small “rice bodies” around the flexor tendon sheath, and a culture from the wound grew the bacterium Enterococcus faecalis and no tuberculosis. Infection and clean needles covers infection after needling.

What guidelines say

The American Academy of Orthopaedic Surgeons’ guideline on distal radius fractures, published in December 2020 and adopted by the American Society for Surgery of the Hand in May 2021, recommends by consensus opioid-sparing and multimodal pain management and lists ice, elevation, compression and cognitive therapies as non-drug options. It does not mention acupuncture. It states that it will be updated, reissued or withdrawn within five years, and in October 2026 the academy’s OrthoGuidelines site still listed the 2020 edition. For de Quervain’s tenosynovitis, the 2023 JAMA Network Open review found no definitive management guidelines. Clinical guidelines compares how guideline bodies treat acupuncture across conditions.

What the reviews could not settle

For de Quervain’s tenosynovitis the reviews could not say whether acupuncture does more than a sham procedure. The trials they describe compare it with topical painkillers, waiting lists and steroid injections, and the one network that set it against placebo found no significant difference in short-term pain. The two trials described here enrolled 30 and 68 people, the reviews rated most trials at high risk of bias or limited in quality, and both networks that ranked acupuncture put it below a steroid injection combined with a splint. After a fracture or wrist surgery, one sham-controlled laser trial and one electroacupuncture trial without a sham have reported results, and the largest planned trial has not. A search of Europe PMC in October 2026 found no randomised trial of acupuncture for wrist sprain or for osteoarthritis of the wrist joint itself.

AcuiQ’s symptom page for wrist pain lists the protocols individual studies prescribed, each with its citation.