{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,22]],"date-time":"2026-04-22T08:04:09Z","timestamp":1776845049504,"version":"3.51.2"},"reference-count":25,"publisher":"Walter de Gruyter GmbH","issue":"8","license":[{"start":{"date-parts":[[2025,2,13]],"date-time":"2025-02-13T00:00:00Z","timestamp":1739404800000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"DOI":"10.13039\/100011362","name":"The American Association of Colleges of Osteopathic Medicine","doi-asserted-by":"crossref","award":["Research_Grant_M.Loomis 2023-2024"],"award-info":[{"award-number":["Research_Grant_M.Loomis 2023-2024"]}],"id":[{"id":"10.13039\/100011362","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2025,7,21]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec id=\"j_jom-2024-0167_abs_001\">\n                  <jats:title>Context<\/jats:title>\n                  <jats:p>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.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec id=\"j_jom-2024-0167_abs_002\">\n                  <jats:title>Objectives<\/jats:title>\n                  <jats:p>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.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec id=\"j_jom-2024-0167_abs_003\">\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>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.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec id=\"j_jom-2024-0167_abs_004\">\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>Comparison of the OMT and control groups revealed a mean increase in carpal tunnel depth from 0.45\u202fmm\u00a0\u00b1\u00a00.13\u202fmm pre-OMT to 0.48\u202fmm\u00a0\u00b1\u00a00.13\u202fmm post-OMT (p=0.0146, Cohen\u2019s <jats:italic>d<\/jats:italic>=0.214, 95\u202f% CI 0.0068 to 0.0517). There was also a mean increase in cross-sectional area from 1.83\u202fmm<jats:sup>2<\/jats:sup>\u00a0\u00b1\u00a00.56\u202fmm<jats:sup>2<\/jats:sup> pre-OMT to 1.98\u202fmm<jats:sup>2<\/jats:sup>\u00a0\u00b1\u00a00.59\u202fmm<jats:sup>2<\/jats:sup> post-OMT (p=0.0058, Cohen\u2019s <jats:italic>d<\/jats:italic>=0.260, 95\u202f% 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.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec id=\"j_jom-2024-0167_abs_005\">\n                  <jats:title>Conclusions<\/jats:title>\n                  <jats:p>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.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1515\/jom-2024-0167","type":"journal-article","created":{"date-parts":[[2025,2,12]],"date-time":"2025-02-12T18:36:41Z","timestamp":1739385401000},"page":"417-423","source":"Crossref","is-referenced-by-count":2,"title":["Carpal tunnel dimensions following osteopathic manipulation utilizing dorsal carpal arch muscle energy: a pilot study"],"prefix":"10.1515","volume":"125","author":[{"ORCID":"https:\/\/orcid.org\/0009-0006-2447-0287","authenticated-orcid":false,"given":"Lilian","family":"Zhan","sequence":"first","affiliation":[{"name":"Sam Houston State University College of Osteopathic Medicine , Conroe , TX , USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0001-4461-4819","authenticated-orcid":false,"given":"Juanita","family":"Brown","sequence":"additional","affiliation":[{"name":"Sam Houston State University College of Osteopathic Medicine , Conroe , TX , USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4311-9381","authenticated-orcid":false,"given":"Sharon","family":"Gustowski","sequence":"additional","affiliation":[{"name":"Kansas City University College of Osteopathic Medicine , Kansas City , MO , USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4873-4922","authenticated-orcid":false,"given":"Patrick","family":"Davis","sequence":"additional","affiliation":[{"name":"Sam Houston State University College of Osteopathic Medicine , Conroe , TX , USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7286-579X","authenticated-orcid":false,"given":"Mario","family":"Loomis","sequence":"additional","affiliation":[{"name":"Department of Clinical Anatomy , Sam Houston State University College of Osteopathic Medicine , Conroe , TX , USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"374","published-online":{"date-parts":[[2025,2,13]]},"reference":[{"key":"2025073108325966317_j_jom-2024-0167_ref_001","doi-asserted-by":"crossref","unstructured":"Padua, L, Cuccagna, C, Giovannini, S, Coraci, D, Pelosi, L, Loreti, C, et al.. Carpal tunnel syndrome: updated evidence and new questions. Lancet Neurol 2023;22:255\u201367. https:\/\/doi.org\/10.1016\/S1474-4422(22)00432-X.","DOI":"10.1016\/S1474-4422(22)00432-X"},{"key":"2025073108325966317_j_jom-2024-0167_ref_002","doi-asserted-by":"crossref","unstructured":"Sheereen, F, Sarkar, B, Sahay, P, Shaphe, M, Alghadir, A, Iqbal, A, et al.. 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 2022:1975803. https:\/\/doi.org\/10.1155\/2022\/1975803.","DOI":"10.1155\/2022\/1975803"},{"key":"2025073108325966317_j_jom-2024-0167_ref_003","doi-asserted-by":"crossref","unstructured":"Qattan, M. The anatomical site of constriction of the median nerve in patients with severe idiopathic carpal tunnel syndrome. J Hand Surg Br 2006;31:608\u201310. https:\/\/doi.org\/10.1016\/j.jhsb.2006.07.013.","DOI":"10.1016\/J.JHSB.2006.07.013"},{"key":"2025073108325966317_j_jom-2024-0167_ref_004","doi-asserted-by":"crossref","unstructured":"Al\u00e9man, L, Bern\u00e1, J, Reus, M, Martinez, F, Dom\u00e9nech-Ratto, G, Campos, M. Reproducibility of sonographic measurements of the median nerve. J Ultrasound Med 2008;27:193\u20137. https:\/\/doi.org\/10.7863\/jum.2008.27.2.193.","DOI":"10.7863\/jum.2008.27.2.193"},{"key":"2025073108325966317_j_jom-2024-0167_ref_005","doi-asserted-by":"crossref","unstructured":"Bueno-Gracia, E, Malo-Urri\u00e9s, M, Ruiz-de-Escudero-Zapico, A, Rodr\u00edguez-Marco, S, Jim\u00e9nez-Del-Barrio, S, Shacklock, M, et al.. Reliability of measurement of the carpal tunnel and median nerve in asymptomatic subjects with ultrasound. Musculoskelet Sci Pract 2017;32:17\u201322. https:\/\/doi.org\/10.1016\/j.msksp.2017.08.001.","DOI":"10.1016\/j.msksp.2017.08.001"},{"key":"2025073108325966317_j_jom-2024-0167_ref_006","doi-asserted-by":"crossref","unstructured":"Schreiber, AL, Sucher, BM, Nazarian, LN. Two novel nonsurgical treatments of carpal tunnel syndrome. Phys Med Rehabil Clin N Am 2014;25:249\u201364. https:\/\/doi.org\/10.1016\/j.pmr.2014.01.008.","DOI":"10.1016\/j.pmr.2014.01.008"},{"key":"2025073108325966317_j_jom-2024-0167_ref_007","doi-asserted-by":"crossref","unstructured":"Burnham, T, Higgins, D, Burnham, R, Heath, D. Effectiveness of osteopathic manipulative treatment for carpal tunnel syndrome: a pilot project. J AM Osteopath Assoc 2015;115:138\u201348. https:\/\/doi.org\/10.7556\/jaoa.2015.027.","DOI":"10.7556\/jaoa.2015.027"},{"key":"2025073108325966317_j_jom-2024-0167_ref_008","doi-asserted-by":"crossref","unstructured":"Wolny, T, Linek, P. Is manual therapy based on neurodynamic techniques effective in the treatment of carpal tunnel syndrome? A randomized controlled trial. Rehabil 2019;33:408\u201317. https:\/\/doi.org\/10.1177\/0269215518805213.","DOI":"10.1177\/0269215518805213"},{"key":"2025073108325966317_j_jom-2024-0167_ref_009","doi-asserted-by":"crossref","unstructured":"Jim\u00e9nez-Del-Barrio, S, Cadellans-Arr\u00f3niz, A, Ceballos-Laita, L, Est\u00e9banez-de-Miguel, E, L\u00f3pez-de-Celis, C, Bueno-Gracia, E, et al.. The effectiveness of manual therapy on pain, physical function, and nerve conduction studies in carpal tunnel syndrome patients: a systematic review and meta-analysis. Orthop 2022;46:301\u201312. https:\/\/doi.org\/10.1007\/s00264-021-05272-2.","DOI":"10.1007\/s00264-021-05272-2"},{"key":"2025073108325966317_j_jom-2024-0167_ref_010","doi-asserted-by":"crossref","unstructured":"Zaheer, S, Ahmed, Z. Neurodynamic techniques in the treatment of mild-to-moderate carpal tunnel syndrome: a systematic review and meta-analysis. J Clin Med 2023;12:4888. https:\/\/doi.org\/10.3390\/jcm12154888.","DOI":"10.3390\/jcm12154888"},{"key":"2025073108325966317_j_jom-2024-0167_ref_011","doi-asserted-by":"crossref","unstructured":"Wielemborek, PT, Kapica-Topczewska, K, Pogorzelski, R, Bartoszuk, A, Kochanowicz, J, Ku\u0142akowska, A. Carpal tunnel syndrome conservative treatment: a literature review. Postep Psychiatr Neurol 2022;31:85\u201394. https:\/\/doi.org\/10.5114\/ppn.2022.116880.","DOI":"10.5114\/ppn.2022.116880"},{"key":"2025073108325966317_j_jom-2024-0167_ref_012","doi-asserted-by":"crossref","unstructured":"Fern\u00e1ndez-De-Las-Pe\u00f1as, C, Cleland, J, Palacios-Ce\u00f1a, M, Fuensalida-Novo, S, Pareja, JA, Alonso-Blanco, C. The effectiveness of manual therapy versus surgery on self-reported function, cervical range of motion, and pinch grip force in carpal tunnel syndrome: a randomized clinical trial. J Orthop Sports Phys Ther 2017;47:151\u201361. https:\/\/doi.org\/10.2519\/jospt.2017.7090.","DOI":"10.2519\/jospt.2017.7090"},{"key":"2025073108325966317_j_jom-2024-0167_ref_013","doi-asserted-by":"crossref","unstructured":"Sucher, B. Myofascial release of carpal tunnel syndrome. J Am Osteopath Assoc 1993;93:1273\u20138. https:\/\/doi.org\/10.7556\/jaoa.1993.93.1.92.","DOI":"10.7556\/jaoa.1993.93.12.1273"},{"key":"2025073108325966317_j_jom-2024-0167_ref_014","doi-asserted-by":"crossref","unstructured":"Sucher, B. Palpatory diagnosis and manipulative management of carpal tunnel syndrome. J Am Osteopath Assoc 1994;94:647\u201363. https:\/\/doi.org\/10.7556\/jaoa.1994.94.8.647.","DOI":"10.7556\/jaoa.1994.94.8.647"},{"key":"2025073108325966317_j_jom-2024-0167_ref_015","unstructured":"Sucher, B, Hinrichs, R, Welcher, R, Quiroz, L, St Laurent, B, Morrison, B. Manipulative treatment of carpal tunnel syndrome: biomechanical and osteopathic intervention to increase the length of the transverse carpal ligament: part 2. Effect of sex differences and manipulative \u201cpriming\u2019\u2019. J Am Osteopath Assoc 2005;105:135\u201343."},{"key":"2025073108325966317_j_jom-2024-0167_ref_016","doi-asserted-by":"crossref","unstructured":"Sucher, B. Myofascial manipulative release of carpal tunnel syndrome: documentation with magnetic resonance imaging. J Am Osteopath Assoc 1993;93:1273\u20138. https:\/\/doi.org\/10.7556\/jaoa.1993.93.12.1273.","DOI":"10.7556\/jaoa.1993.93.12.1273"},{"key":"2025073108325966317_j_jom-2024-0167_ref_017","doi-asserted-by":"crossref","unstructured":"Sucher, B, Hinrichs, R. Manipulative treatment of carpal tunnel syndrome: biomechanical and osteopathic intervention to increase the length of the transverse carpal ligament. J Am Osteopath Assoc 1998;98:679\u201386. https:\/\/doi.org\/10.1515\/jom-1998-0118.","DOI":"10.1515\/jom-1998-0118"},{"key":"2025073108325966317_j_jom-2024-0167_ref_018","doi-asserted-by":"crossref","unstructured":"Fuss, F, Wagner, T. Biomechanical alterations in the carpal arch and hand muscles after carpal tunnel release: a further approach toward understanding the function of the flexor retinaculum and the cause of postoperative grip weakness. Clin Anat 1996;9:100\u20138. https:\/\/doi.org\/10.1002\/(SICI)1098-2353(1996)9:2<100::AID-CA2>3.0.CO;2-L.","DOI":"10.1002\/(SICI)1098-2353(1996)9:2<100::AID-CA2>3.0.CO;2-L"},{"key":"2025073108325966317_j_jom-2024-0167_ref_019","doi-asserted-by":"crossref","unstructured":"Bueno-Gracia, E, Ruiz-de-Escudero-Zapico, A, Malo-Urri\u00e9s, M, Shacklock, M, Est\u00e9banez-de-Miguel, E, Fanlo-Mazas, P, et al.. Dimensional changes of the carpal tunnel and the median nerve during manual mobilization of the carpal bones. Musculoskelet Sci Pract 2018;36:12\u201316. https:\/\/doi.org\/10.1016\/j.msksp.2018.04.002.","DOI":"10.1016\/j.msksp.2018.04.002"},{"key":"2025073108325966317_j_jom-2024-0167_ref_020","doi-asserted-by":"crossref","unstructured":"Li, Z, Masters, T, Mondello, T. Area and shape changes of the carpal tunnel in response to tunnel pressure. J Orthop Res 2011;29:1951\u20136. https:\/\/doi.org\/10.1002\/jor.21468.","DOI":"10.1002\/jor.21468"},{"key":"2025073108325966317_j_jom-2024-0167_ref_021","doi-asserted-by":"crossref","unstructured":"Mehner, T, Lewis, D. Osteopathic approach to treatment of carpal dysfunction: the carpal mobilization technique. J Am Osteopath Assoc 2020;120:783\u20134. https:\/\/doi.org\/10.7556\/jaoa.2020.120.","DOI":"10.7556\/jaoa.2020.120"},{"key":"2025073108325966317_j_jom-2024-0167_ref_022","unstructured":"Snyder, M, Hawks, M, Moss, D, Crawford, P. Integrative medicine: manual therapy. FP Essent 2021;505:11\u201317."},{"key":"2025073108325966317_j_jom-2024-0167_ref_023","doi-asserted-by":"crossref","unstructured":"Rani, M, Yadav, N, Srivastava, M, Jain, A, Srivastava, N, Yadav, A, et al.. An evaluation of the variations in the carpal tunnel dimensions of adult subjects in a hospital-based population: an ultrasonographic cross-sectional study. Cureus 2024;16:e56001. https:\/\/doi.org\/10.7759\/cureus.56001.","DOI":"10.7759\/cureus.56001"},{"key":"2025073108325966317_j_jom-2024-0167_ref_024","doi-asserted-by":"crossref","unstructured":"Pistorio, AL, Chung, KC, Miller, LE, Adams, JE, Hammert, WC. Protocol of a multicenter prospective trial of office-based carpal tunnel release with ultrasound guidance (ROBUST). Cureus 2023;15:e37479. https:\/\/doi.org\/10.7759\/cureus.37479.","DOI":"10.7759\/cureus.37479"},{"key":"2025073108325966317_j_jom-2024-0167_ref_025","doi-asserted-by":"crossref","unstructured":"Eberlin, KR, Amis, BP, Berkbigler, TP, Dy, CJ, Fischer, MD, Gluck, JL, et al.. Multicenter randomized trial of carpal tunnel release with ultrasound guidance versus mini-open technique. Expert Rev Med Devices 2023;7:597\u2013605. https:\/\/doi.org\/10.1080\/17434440.2023.2218548.","DOI":"10.1080\/17434440.2023.2218548"}],"container-title":["Journal of Osteopathic Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.degruyterbrill.com\/document\/doi\/10.1515\/jom-2024-0167\/xml","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/www.degruyterbrill.com\/document\/doi\/10.1515\/jom-2024-0167\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,7,31]],"date-time":"2025-07-31T08:33:36Z","timestamp":1753950816000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.degruyterbrill.com\/document\/doi\/10.1515\/jom-2024-0167\/html"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,2,13]]},"references-count":25,"journal-issue":{"issue":"8","published-online":{"date-parts":[[2025,7,21]]},"published-print":{"date-parts":[[2025,7,21]]}},"alternative-id":["10.1515\/jom-2024-0167"],"URL":"https:\/\/doi.org\/10.1515\/jom-2024-0167","relation":{},"ISSN":["2702-3648"],"issn-type":[{"value":"2702-3648","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,2,13]]}}}