Effects of gliding and resistance exercises on median nerve and tendon ultrasound elastography in carpal tunnel syndrome: Prospective, randomised, three-arm, parallel-group trial.

Abstract

ObjectiveTo evaluate the effects of gliding and resistance exercises on median nerve and third flexor digitorum superficialis tendon shear wave velocity in patients with carpal tunnel syndrome.DesignProspective, randomised, three-arm, parallel-group trial.SettingAt the Institute of Clinical Neurophysiology.ParticipantsA total of 102 patients with electrodiagnostically confirmed mild to moderate carpal tunnel syndrome aged 20-80 years (51.5 ± 12.9 years; 85.3% female).InterventionParticipants were randomised to the Gliding Exercise group, the Resistance Exercise group or the Control group. Participants in the exercise groups performed daily home-based gliding or low-load resistance exercises for 3 weeks, whereas controls received no intervention. At baseline and follow-up, shear wave velocity of the median nerve and the third flexor digitorum superficialis tendon was measured longitudinally at the carpal tunnel inlet, and the cross-sectional area of the median nerve was measured at the carpal tunnel inlet and 10 cm proximally to the distal wrist crease.Main measuresThe primary outcome was the change in median nerve shear wave velocity at the carpal tunnel inlet. Secondary outcomes were changes in the third flexor digitorum superficialis tendon shear wave velocity and median nerve cross-sectional area at the same level.ResultsNinety-one participants completed the post-intervention assessment. No significant changes were observed in primary or secondary outcome measures despite improvements in self-reported symptoms in the gliding exercise group compared to controls.ConclusionShort-term exercise-based interventions do not modify median nerve or tendon elasticity in mild to moderate carpal tunnel syndrome. Symptom improvement may occur through mechanisms other than changes in tissue stiffness.