Author(s): PETERCA, J., SNOJ, Ž., OMEJEC, G., Institution: UNIVERSITY MEDICAL CENTER LJUBLJANA, Country: SLOVENIA, Abstract-ID: 1493

INTRODUCTION:
Carpal Tunnel Syndrome (CTS) represents the most prevalent entrapment neuropathy of the upper limb and presents a significant challenge in sport and exercise medicine due to persistent sensorimotor impairment and activity limitations. Conservative management—including gliding and resistance exercise protocols are recommended to attenuate symptoms and enhance hand function. However, the biomechanical mechanisms underpinning these clinical benefits remain unresolved. Elevated shear-wave velocity (SWV) in the median nerve and associated flexor tendons has been linked to reduced tissue elasticity and increased intracarpal pressure, yet no randomized trials have examined whether exercise interventions alter intrinsic tissue elasticity in CTS.
METHODS:
In a prospective, assessor-blinded, three-arm randomized controlled trial, 102 adults (age 20–80) with electrodiagnostically confirmed mild to moderate CTS were randomized (1:1:1) to gliding exercise, resistance exercise, or control groups. Standardized interventions were performed daily over three weeks. SWE measurements were obtained at the carpal tunnel inlet using a Canon Aplio i800 system. Median nerve and third FDS tendon SWV were recorded with rigorously controlled probe placement and motion stability indices. Median nerve cross-sectional area (CSA) was also assessed. The primary outcome was post-intervention change in median nerve SWV adjusted for baseline. Secondary outcome included changes in tendon SWV and nerve CSA, and subjective symptom change evaluated on a Likert scale.
RESULTS:
Intention-to-treat analyses revealed no statistically significant differences in median nerve and 3rd FDS SWV between either intervention and control groups at 3 weeks. Similarly, changes in median nerve CSA did not differ between groups. In contrast, analysis of self-reported symptom change indicated a significant overall group effect (H = 9.01, p = 0.011, ε² = 0.071), with the gliding exercise group demonstrating greater symptom improvement relative to controls. No significant symptom differences were observed between exercise modalities.
CONCLUSION:
Short-term exercise protocols do not produce measurable alterations in intrinsic tissue elasticity as quantified by SWE in mild to moderate CTS, despite yielding meaningful symptomatic relief. These findings challenge the assumption that improvements in CTS symptoms are mediated by biomechanical remodeling of nerve or tendon material properties and suggest alternative mechanisms, such as enhanced neural excursion, modified vascular dynamics, or central pain modulation, may be responsible for early clinical adaptation. Future research should explore neuromuscular, vascular, and central adaptations using multimodal assessment frameworks to elucidate the mechanisms through which exercise promotes recovery in CTS. Furthermore, the effect of longer intervention duration on elasticity of soft tissue should be investigated.