Effect of Exercise on Ultrasound SWV in CTS Patients

NCT07281573 | Completed

• 1 other identifier: 0120-25/2023/3
• Study Type: interventional
• Target: 91
• Locations: 1 country
• Sites: 1

Brief Summary

Carpal tunnel syndrome (CTS) is the most common peripheral neuropathy, and studies suggest exercises can be used for symptom management. Purpose: The study evaluated the impact of exercise protocols on the ultrasound shear wave velocity (SWV) of the median nerve and 3rd flexor digitorum superficialis (3rd FDS) in participants with mild to moderate CTS. Methods: Ninety-one CTS participants (79 females) were divided into control group, nerve and tendon gliding exercise group, and strength exercise group. The participants followed a three-week daily exercise plan. The SWV measurements were conducted using Canon Aplio i800 ultrasound and linear probe (LX18i5). Regions of interest were positioned within the nerve epineurium and hyperechogenic borders of the 3rd FDS tendon. The pre- and post-intervention SWV values were recorded. Results: In preliminary results on a smaller sample, trends indicated reduced SWV in both the median nerve and 3rd FDS in the nerve and tendon gliding group and reduced SWV in the median nerve in the strengthening group. No measurable change was observed in the 3rd FDS in strength group and in the control group. Conclusion: Trends suggest specific exercises may decrease stiffness in the median nerve and 3rd FDS in CTS participants.

Conditions

Carpal Tunnel Syndrome; Peripheral Neuropathies

Keywords

CTS; Nerve gliding; strength; stiffness; Ultrasound; Shear wave velocity

Outcome Measures

Primary Outcomes (1)

• Ultrasound shear wave velocity

  SWV in m/s will be measured using ultrasound and linear probe i18Lx3. Three consequtive readings will be saved and the median value will be further procesed in statystical analysis

  SWV will be measured pre and post intervention in all three groups. There will be 3 weeks between pre and post intervention ultrasound SWV measurement

Study Arms (3)

Gliding group

EXPERIMENTAL

Participants randomized to Gliding received written description of exercises supported with images. Nerve and tendon gliding exercises targeted flexion and extension of the index and ring fingers, complemented by wrist flexion and extension movements. These exercises were taken from literature and designed to promote median nerve and tendon gliding through the carpal tunnel, thereby reducing entrapment of the median nerve and the third flexor digitorum superficialis (FDS) tendon (Abdolrazaghi et al., 2023; Savage \& Albano, 2020; Sheereen et al., 2022).

Other: Nerve and tendon gliding exercises and strength exercises

Strength group

EXPERIMENTAL

Patients randomized to Strength group received written description of exercises supported with images. Strengthening exercises involved movement patterns (finger and wrist flexion and extension) similar to the nerve and tendon gliding exercises; however, external resistance was introduced through the use of hand therapy resistance balls (Unver \& Akyolcu, 2018) or low-weight dumbbells ranging from 0.5 to 2.0 kg depending on the participant (Doyle, 2024; Hamzeh et al., 2021).

Other: Nerve and tendon gliding exercises and strength exercises

Control

NO INTERVENTION

The control group did not participate in any training program and was instructed to continue with their usual daily and work-related activities.

Interventions

Nerve and tendon gliding exercises and strength exercises OTHER

The intervention lasted for 3 weeks and was performed once daily. Each participant recieved a detailed exercise plan including sets and repetitions and exercise description in steps and images of body parts position at each step of the exercise. The first session was demonstrated and supervised by a kinesiologist with 8 years of experiences. Nerve and tendon gliding exercises included the movements of arms, hands palms and fingers that triggered the gliding of the median nerve and 3rd FDS tendon through the carpal tunnel. There were 5 exercises for nerve gliding and 5 exercises for tendon gliding in the exercise plan. Furthermore the strength group exercise plan also included 5 exercises that were focusing on fingers and palm flexion and extension with therapeutic ball and elastic bands and wrist flexion and extension using low weight dumbbells (\<2.0kg).

Gliding group; Strength group

Eligibility Criteria

• Age: 18 Years - 80 Years
• Sex: all
• Healthy Volunteers: No
• Age Groups: Adult (18-64), Older Adult (65+)

You may qualify if:

• age between 24 and 78 years
• tingling in at least two of the first four digits;
• symptoms worsening at night or in the morning;
• symptom relief with hand flicking (flick sign);
• electrodiagnostic (EDx) confirmation of mild to moderate median nerve entrapment neuropathy at the wrist.

You may not qualify if:

• previous wrist fracture or surgery;
• polyneuropathy,
• motor neuron disease,
• cervical radiculopathy,
• brachial plexopathy
• structural abnormalities within the carpal tunnel
• tenosynovitis

Sponsors & Collaborators

• University Medical Centre Ljubljana: lead

Study Sites (1)

University Medical center Ljubljana

Ljubljana, 1000, Slovenia

Location

Related Publications (9)

• Wang Y, Qiang B, Zhang X, Greenleaf JF, An KN, Amadio PC, Zhao C. A non-invasive technique for estimating carpal tunnel pressure by measuring shear wave speed in tendon: a feasibility study. J Biomech. 2012 Nov 15;45(16):2927-30. doi: 10.1016/j.jbiomech.2012.09.002. Epub 2012 Sep 29.

  PMID: 23031416 BACKGROUND

• Kubo K, Zhou B, Cheng YS, Yang TH, Qiang B, An KN, Moran SL, Amadio PC, Zhang X, Zhao C. Ultrasound elastography for carpal tunnel pressure measurement: A cadaveric validation study. J Orthop Res. 2018 Jan;36(1):477-483. doi: 10.1002/jor.23658. Epub 2017 Aug 14.

  PMID: 28731271 BACKGROUND

• Bortolotto C, Lungarotti L, Fiorina I, Zacchino M, Draghi F, Calliada F. Influence of subjects' characteristics and technical variables on muscle stiffness measured by shear wave elastosonography. J Ultrasound. 2017 Mar 1;20(2):139-146. doi: 10.1007/s40477-017-0242-9. eCollection 2017 Jun.

  PMID: 28593004 BACKGROUND

• Hobson-Webb LD, Massey JM, Juel VC, Sanders DB. The ultrasonographic wrist-to-forearm median nerve area ratio in carpal tunnel syndrome. Clin Neurophysiol. 2008 Jun;119(6):1353-7. doi: 10.1016/j.clinph.2008.01.101. Epub 2008 Apr 1.

  PMID: 18387336 BACKGROUND

• Hamzeh H, Madi M, Alghwiri AA, Hawamdeh Z. The long-term effect of neurodynamics vs exercise therapy on pain and function in people with carpal tunnel syndrome: A randomized parallel-group clinical trial. J Hand Ther. 2021 Oct-Dec;34(4):521-530. doi: 10.1016/j.jht.2020.07.005. Epub 2020 Jul 30.

  PMID: 32893098 BACKGROUND

• Unver S, Akyolcu N. The Effect of Hand Exercise on Reducing the Symptoms in Hemodialysis Patients with Carpal Tunnel Syndrome. Asian J Neurosurg. 2018 Jan-Mar;13(1):31-36. doi: 10.4103/ajns.AJNS_343_16.

  PMID: 29492117 BACKGROUND

• Sheereen FJ, Sarkar B, Sahay P, Shaphe MA, Alghadir AH, Iqbal A, Ali T, Ahmad F. Comparison of Two Manual Therapy Programs, including Tendon Gliding Exercises as a Common Adjunct, While Managing the Participants with Chronic Carpal Tunnel Syndrome. Pain Res Manag. 2022 Jun 8;2022:1975803. doi: 10.1155/2022/1975803. eCollection 2022.

  PMID: 35719196 BACKGROUND

• Savage NJ, Albano J. Marrying Tendon and Nerve Gliding Exercises with Hydrodissection Following Injection for Carpal Tunnel Syndrome - A New Treatment Approach? J Orthop Case Rep. 2020 Dec;10(9):38-46. doi: 10.13107/jocr.2020.v10.i09.1896.

  PMID: 34169015 BACKGROUND

• Abdolrazaghi HA, Khansari M, Mirshahi M, Ahmadi Pishkuhi M. Effectiveness of Tendon and Nerve Gliding Exercises in the Treatment of Patients With Mild Idiopathic Carpal Tunnel Syndrome: A Randomized Controlled Trial. Hand (N Y). 2023 Mar;18(2):222-229. doi: 10.1177/15589447211006857. Epub 2021 Apr 15.

  PMID: 33855879 BACKGROUND

MeSH Terms

Conditions

Carpal Tunnel Syndrome; Peripheral Nervous System Diseases

Condition Hierarchy (Ancestors)

Median Neuropathy; Mononeuropathies; Neuromuscular Diseases; Nervous System Diseases; Nerve Compression Syndromes; Cumulative Trauma Disorders; Sprains and Strains; Wounds and Injuries

Study Design

• Study Type: interventional
• Phase: not applicable
• Allocation: RANDOMIZED
• Masking: SINGLE
• Who Masked: INVESTIGATOR
• Masking Details: Ultrasound SWV measurements were performed by the primary investigator, who was blinded to participants' CTS diagnoses. A second investigator conducted the randomization process and scheduled participants' appointments; consequently, the primary investigator remained unaware of participant details prior to the SWV assessment.
• Purpose: PREVENTION
• Intervention Model: PARALLEL
• Sponsor Type: OTHER
• Responsible Party: PRINCIPAL INVESTIGATOR
• PI Title: asst. Jošt Peterca MSc, researcher

Model Details: The investigators conducted a prospective, randomized, three-arm, parallel-group trial with a 1:1:1 allocation ratio to Gliding, Strength, and Control groups. Outcome measures were assessed before and after the intervention. Randomization of participants into two intervention groups and one control group was performed using the Clinical Trial Randomization Tool developed by the National Cancer Institute. The same tool was applied in participants with bilateral CTS to randomly determine which hand was assessed and included in the study.

Study Record Dates

• First Submitted: November 20, 2025
• First Posted: December 15, 2025
• Study Start: April 7, 2025
• Primary Completion: July 14, 2025
• Study Completion: October 21, 2025
• Last Updated: December 22, 2025

Record last verified: 2025-12

Data Sharing

• IPD Sharing: Will share
• Shared Documents: STUDY PROTOCOL, SAP, ICF
• Time Frame: The IPD will be shared to the repository of the University of Ljubljana when the acquired IPD will be published in a scientific article
• Access Criteria: Sign in to the repository with research ccredentials and account

Locations

SL (1)