Longitudinal Gliding of the Median Nerve in the Carpal Tunnel: Ultrasound Cadaveric Evaluation of Conventional and Novel Concepts of Nerve Mobilization

• Published in: Archives of physical medicine and rehabilitation Vol. 96; no. 12; pp. 2207 - 2213
• Main Authors: Meng, Stefan, MD, Reissig, Lukas F., MD, Beikircher, Reinhard, MAS, Tzou, Chieh-Han John, MD, Grisold, Wolfgang, MD, Weninger, Wolfgang J., MD
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.12.2015
• Subjects: Cadaver; Carpal tunnel syndrome; Carpal Tunnel Syndrome - diagnostic imaging; Carpal Tunnel Syndrome - rehabilitation; Exercise Therapy - methods; Forearm - innervation; Humans; Median nerve; Median Nerve - diagnostic imaging; Median neuropathy; Movement - physiology; Physical Medicine and Rehabilitation; Physical Therapy Modalities; Range of Motion, Articular; Rehabilitation; Ultrasonography; Wrist - diagnostic imaging; Wrist - innervation; Carpal tunnel syndrome; CTS; subsynovial connective tissue; Median nerve; Ultrasonography; SSCT; Rehabilitation; Median neuropathy; US; ultrasound
• ISSN: 0003-9993; 1532-821X
• DOI: 10.1016/j.apmr.2015.08.415

Abstract Objective To evaluate median nerve excursion during conventional nerve gliding exercises and newly developed exercises, primarily comprising abduction and adduction of the fingers. Design Descriptive study. Setting Anatomical dissection facility. Cadavers Random sample of upper extremities of fresh whole-body human cadavers (N=18). Cadavers with neuromuscular diseases in the medical record or anatomic variations were excluded. Intervention Conventional and new nerve gliding exercises. Main Outcome Measures Distances between markers applied into the nerve and markers in the periosteum were visualized with ultrasound and measured. Comparisons of nerve excursions between different exercises were performed. Results Conventional exercises led to substantial nerve gliding proximal to the carpal tunnel and between the head of the pronator teres (12 and 13.8mm, respectively), but it led to far less in the carpal tunnel (6.6mm). With our novel exercises, we achieved nerve gliding in the carpal tunnel of 13.8mm. No substantial marker movement could be detected during lateral flexion of the cervical spine. Conclusions Although conventional nerve gliding exercises only lead to minimal nerve excursions in the carpal tunnel, our novel exercises with the abduction and adduction of the fingers result in substantial longitudinal gliding throughout the arm. Clinical trials will have to deliver the clinical evidence.