Zhan Lilian, Brown Juanita, Gustowski Sharon, Davis Patrick, Loomis Mario
Sam Houston State University College of Osteopathic Medicine, Conroe, TX, USA.
Kansas City University College of Osteopathic Medicine, Kansas City, MO, USA.
J Osteopath Med. 2025 Feb 13;125(8):417-423. doi: 10.1515/jom-2024-0167. eCollection 2025 Aug 1.
Carpal tunnel syndrome (CTS) is the most common entrapment neuropathy. When mild to moderate in severity, nonoperative treatments including osteopathic manipulative treatment (OMT) have been found to be effective. Studies have been carried out to quantify the mechanism of such treatments with cadaver studies, magnetic resonance imaging (MRI), and ultrasound.
This pilot project investigated the mechanism of a previously undescribed technique of nonoperative carpal tunnel treatment, dorsal carpal arch muscle energy (DCA-ME), which focuses on the dorsal arch (trapezium, trapezoid, capitate, and hamate bones) manipulating the bones to redome the arch, round the tunnel, and increase its volume. Although the actual effectiveness of such manipulation in the treatment of CTS can only be assessed and quantified in patients with the disorder, this initial study was carried out to see if it was feasible for physical changes following DCA-ME to be quantified with ultrasound.
A pilot study of 25 healthy volunteers with no prior history of CTS or related disorders was undertaken to quantify anatomical changes in carpal tunnel dimensions following OMT of the nondominant wrist, utilizing DCA-ME. The subjects were randomly assigned to either the OMT group (n=14) or the control group (n=11). The control group underwent a sham manipulation. Pre- and postultrasound measurements of carpal tunnel dimensions were made. The study employed a two-group, pre-/postmanipulation design to evaluate the anatomical changes resulting from the OMT manipulation compared to those following the control sham manipulation.
Comparison of the OMT and control groups revealed a mean increase in carpal tunnel depth from 0.45 mm ± 0.13 mm pre-OMT to 0.48 mm ± 0.13 mm post-OMT (p=0.0146, Cohen's =0.214, 95 % CI 0.0068 to 0.0517). There was also a mean increase in cross-sectional area from 1.83 mm ± 0.56 mm pre-OMT to 1.98 mm ± 0.59 mm post-OMT (p=0.0058, Cohen's =0.260, 95 % CI 0.0517 to 0.2490). There was no significant difference in canal width (p=0.5973) or transverse carpal ligament length (p=0.2673) following OMT intervention. The control group, which received the sham procedure, demonstrated no significant differences in the transverse carpal ligament length, carpal tunnel width, depth, or cross-sectional area before and after the sham intervention.
Ultrasound measurements at the narrowest section of the carpal tunnel before and after DCA-ME OMT of healthy asymptomatic wrists demonstrated a significant increase in cross-sectional area as well as depth, with no significant change in the length of the transverse carpal ligament, suggesting that the cause of the increased volume is an alteration of dorsal arch shape. A limitation of the study is the small sample size, inclusion of only healthy wrists, the short period of time between manipulation and measurements, and the difficulty of assuring the same level and angle of ultrasound measurements.
腕管综合征（CTS）是最常见的卡压性神经病。当病情为轻度至中度时，包括整骨手法治疗（OMT）在内的非手术治疗已被证明是有效的。已经通过尸体研究、磁共振成像（MRI）和超声对这些治疗的机制进行了量化研究。
本试点项目研究了一种先前未描述的非手术腕管治疗技术，即腕背弓肌肉能量技术（DCA-ME），该技术专注于腕背弓（大多角骨、小多角骨、头状骨和钩骨），通过操纵这些骨头来重塑腕背弓，使腕管变圆并增加其容积。虽然这种手法在治疗腕管综合征中的实际效果只能在患有该疾病的患者中进行评估和量化，但这项初步研究旨在确定通过超声对DCA-ME后的物理变化进行量化是否可行。
对25名无腕管综合征或相关疾病既往史的健康志愿者进行了一项试点研究，以量化在非优势手腕进行DCA-ME手法治疗后腕管尺寸的解剖学变化。受试者被随机分为手法治疗组（n = 14）和对照组（n = 11）。对照组接受假手法治疗。对手法治疗前后的腕管尺寸进行超声测量。该研究采用两组、手法治疗前/后的设计，以评估与假手法治疗相比，手法治疗引起的解剖学变化。
手法治疗组与对照组比较，腕管深度平均从手法治疗前的0.45 mm±0.13 mm增加到手法治疗后的0.48 mm±0.13 mm（p = 0.0146，科恩系数=0.214，95%置信区间0.0068至0.0517）。横截面积也平均从手法治疗前的1.83 mm±0.56 mm增加到手法治疗后的1.98 mm±0.59 mm（p = 0.0058，科恩系数=0.260，95%置信区间0.0517至0.2490）。手法治疗干预后，腕管宽度（p = 0.5973）或腕横韧带长度（p = 0.2673）无显著差异。接受假手术的对照组在假干预前后的腕横韧带长度、腕管宽度、深度或横截面积无显著差异。
对健康无症状手腕进行DCA-MEDCA-ME手法治疗前后，在腕管最窄处进行超声测量显示，横截面积和深度均显著增加，腕横韧带长度无显著变化，这表明容积增加的原因是腕背弓形状的改变。本研究的局限性在于样本量小、仅纳入健康手腕、手法治疗与测量之间的时间短以及难以确保超声测量的水平和角度相同。
