Abstract

Background: Carpal tunnel syndrome (CTS) is the most common non-traumatic peripheral entrapment neuropathy. Nerve conduction studies (NCS), complemented with ultrasonography (US), are considered as the gold standard for diagnosing CTS. Treatments include oral medications, physiotherapy, wrist splinting, therapeutic exercise, local corticosteroid injections, and surgery. Therapeutic exercises can enhance the gliding of nerve and tendons within the tunnel, but, few studies have evaluated their efficacy with quantitative measures such as NCS and/or US.

Goals: This prospective, before-and-after trial study aimed to define the effects of nerve-tendon gliding exercises on CTS using US and structured questionnaires.

Methods: Twenty patients with CTS in rehabilitation center at a university hospital, diagnosed according to electrodiagnostic severity and classified as mild-to-moderate CTS, and 15 asymptomatic healthy control subjects were included. The diagnostic criteria for confirming the severity of CTS were as follows: mild CTS was defined by delayed sensory latencies of more than 3.5 ms, whereas moderate CTS was defined by delayed motor latencies of more than 4.4 ms. Eight weeks of nerve-tendon gliding exercises, instructed in the outpatient clinic and supplemented with an educational video-clip. Using a high-resolution US, the cross-sectional area (CSA) and flattening ratio (; transverse diameter/anteroposterior diameter) were measured at the proximal and distal levels of the carpal tunnel in a neutral position. The mobility (; the distance between the midpoint of the median nerve and that of the ulnar artery) of the median nerve was measured at the distal level (trapezium-hamate bone level) in the 70° extended position of involved wrist. US parameters and clinical features were assessed after 8 weeks of nerve-tendon gliding exercises intervention.

Results: Proximal and distal CSAs were significantly increased in the CTS group compared to control. Transverse sliding distance from the ulnar artery to the median nerve was decreased in the CTS group (Table 1). After 8 weeks of exercises, transverse sliding distance considerably increased in both CTS mild and moderate groups with symptom improvement.

Conclusions: Nerve-tendon gliding exercises in patients with CTS were able to increase the mobility of the median nerve within the tunnel with symptomatic improvement. We suggest that these exercises should be incorporated as a rehabilitation treatment option in those patients.