Recurrent CTS refers to a case whe n treatment fails after the first CTR It's classified as pe rsistent, recurrent, or new . Persistent is a case there is no symptom improvement immediately after CTR because TCL is not released completely. ‘Recurrent’ is a case that the symptoms disappear temporarily after CTR, but reoccur by TLC fibrosis or reconstitution after about 6 months. New’ is a case that occur new symptoms the patient didn't have before, after CTR [10,11]. These patients require revision surgery, but 40% of patients are unfavorable and up to 95% have persistent symptoms . Because of the low success rate of revision. surgery, both patients and doctors feel the burden with revision There have been many efforts to release the fibrous tissue of the TCL with minimal invasion. Therefore, in medicine, incision of the carpal tunnel using scalpel blade or flap surgery are performed to prevent postoperative complica tions and recurrence [12, 13]. But there i s still no clear treatment for recurrent CTS.
In this case, Round Acupuncture was performed in a recurrent CTS patient who didn't improve after steroid injection and acupotomy. Round a cup oint was on the TCL, which is the most problematic site TCL is the ligament between the ulnar sided hamate and pisiform bones and the radial sid ed scaphoid and trapezium bones . CTR is most frequently performed at the distal fibers of TCL, especially at the point, regarded as safety zone, where the Kaplan's cardinal line meets the ulnar border of the ring finger. In addition, CTR can be also applied to the proximal fibers of TCL when symptom s are severe or confirmed there is a dhesion in the proximal region [6, 5, 16]. So, Round Acupuncture was performed by releasing the TCL toward the distal fibers of TCL in all directions (toward the hamate, pisiform, scaphoid and trapezium) at Round acupoint, which is the proximal region of TCL. Through this procedure, the adhered part of TCL was released to expand the narrow space. As a result, the patient's symptoms completely disappeared and the patient's satisfaction was also very high. Also, the patient lived well without recurrence until three months after treatment.
Recently, blunt cannula has been reported to be more effective than Nokor needle for acne scar treatment in terms of complications and satisfaction rates [In line with this, because Round Acupunct u re has blunt end, unlike the acupotomy, it can be expected to be more effective in the treatment. On the other hand, Bigeleisen et al.  reported that no nerve injury occurred in any of the 22 patients when 22 gauge needles were inserted directly into the axillary part of the patient under ultr asound guidance. And, they also revealed that when the needle touched the nerve, the nerve moved about 1 - 2 cm. In addition, since half of the nerve consists of connective and adipose tissue, and the other half consists of bundles of nerves, suggesting that needle contact with nerve does nt lead to immediate nerve damage. The most common complication of acupotomy is nerve damage. But, it's considered that there will be no nerve damage if the needle is inserted in a direction parallel to the nerve, and if the needle stimulated the nerve, retreat and reinject. If we use acupotomy to treat the CTS, we should be concerned about damage to the ulnar and median nerve. However, in the case of the Round Acupuncture, the end is blunt unlike acupotomy. So, it's thought to be safer from the risk of nerve damage. There have been many efforts to develop treatments with minimal invasion to reduce the burden on patients and to reduce side effects such as scars and adhesions after surgery. That is, it is thought that the Round Acupuncture may be an alternative in terms of safety and efficacy.
However, since there are no reports on the Round Acupuncture, it's considered that large scale follow up studies will be needed to prove the efficacy, safety and repeatability of the Round Acupuncture. In addition, there is no comparison with other treatments directly, and it is difficult to gener alize because of only one case. But, since only Round Acupuncture used to treat the CTS and obtained an effective result, it is expected to be a new treatment method with minimal invasion compared to the existing treatment.