{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,23]],"date-time":"2026-10-23T20:50:04Z","timestamp":1792788604176,"version":"4.5.0"},"reference-count":30,"publisher":"Walter de Gruyter GmbH","issue":"10","license":[{"start":{"date-parts":[[2026,4,16]],"date-time":"2026-04-16T00:00:00Z","timestamp":1776297600000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"name":"American Osteopathic Association","award":["23107880"],"award-info":[{"award-number":["23107880"]}],"id":[{"id":"https:\/\/ror.org\/045xtrm66","id-type":"ROR","asserted-by":"crossref"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,9,22]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec id=\"j_jom-2025-0177_abs_001\">\n                    <jats:title>Context<\/jats:title>\n                    <jats:p>Osteopathic manipulative treatment (OMT) has been recognized as a conservative management option for patients with carpal tunnel syndrome (CTS), although limited research exists to validate its ability to effect posttreatment changes in the median nerve or the surrounding soft tissues.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"j_jom-2025-0177_abs_002\">\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>The objectives of this study are to evaluate and quantify changes in the elasticity of the median nerve, transverse carpal ligament (TCL), and intracarpal tunnel soft tissues in patients treated for CTS with traditional conservative therapy (e.g., steroid injection and splinting), OMT, or OMT plus conservative therapy.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"j_jom-2025-0177_abs_003\">\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This single-blinded, randomized controlled pilot study included patients with a definitive diagnosis of mild to moderate-severe CTS. Participants were assigned to one of the three treatment groups utilizing a random number generator. Analysis of variance (ANOVA) was conducted to compare the following outcome measures from baseline through 6\u00a0weeks of treatment across the three groups of interest: the CTS-6 assessment tool and the shortened version of the Disabilities of the Arm, Shoulder, and Hand (Quick-DASH) questionnaire, electromyography (EMG) of the median nerve, grayscale ultrasound evaluation of the cross-sectional area (CSA) of the median nerve, and shear wave elastography (SWE) of the median nerve, TCL, and the intracarpal tunnel contents (ICTC). Associations between EMG severity scores, CTS-6 assessments, and Quick-DASH scores were also explored through correlation analyses.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"j_jom-2025-0177_abs_004\">\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Among the 15 wrists randomized to the study, 5 withdrew, primarily due to the inability to complete all follow-up visits. 10 wrists completed the study: 3 in the conservative group, 4 in the OMT group, and 3 in the OMT plus conservative group. Ultrasound and SWE were effective in measuring median-nerve CSA and stiffness, although changes through 6\u00a0weeks were generally limited. There was no significant difference in the CSA measurements of the median nerve throughout the study (p=0.22, 0.11, 0.18, and 0.71 at weekly visits 1, 3, 5, and 7, respectively). Only the conservative therapy group showed notable reductions in CSA and stiffness over time, which corresponded to statistically nonsignificant reductions in CTS-6 survey scores (ANOVA analysis at visit 6 producing p=0.35) and Quick-DASH scores (p=0.12). One ANOVA analysis of the TCL average shear velocity did produce significant results at visit 7 (OMT mean=4.1, combination mean=3.5, conservative mean=3.7, p=0.01). Changes in EMG parameters (amplitude, latency, and conduction velocity of the median nerve) from baseline through 6\u00a0weeks were variable, with no clear pattern of change in any group. Similarly, there was weak association between EMG severity scores and CTS-6 (R\n                      <jats:sup>2<\/jats:sup>\n                      =0.1463) and Quick-DASH scores (R\n                      <jats:sup>2<\/jats:sup>\n                      =0.4676).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"j_jom-2025-0177_abs_005\">\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>History and clinical examination are the primary means of establishing the diagnosis of CTS, with EMG and imaging playing supportive roles. The use of grayscale ultrasound and SWE as alternative, noninvasive diagnostic means in establishing a diagnosis of CTS continues to be explored. Given that SWE can serve as a reproducible, noninvasive, and objective means of evaluating the stiffness of soft tissues prior to and following various forms of treatment, further studies should be undertaken to investigate its utility and value in providing objective evidence of the efficacy of\u00a0OMT.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1515\/jom-2025-0177","type":"journal-article","created":{"date-parts":[[2026,4,21]],"date-time":"2026-04-21T18:59:25Z","timestamp":1776797965000},"page":"499-506","source":"Crossref","is-referenced-by-count":0,"title":["Evaluating median nerve stiffness in patients with mild to moderate-severe idiopathic carpal tunnel syndrome receiving OMT and conservative therapy: a pilot study"],"prefix":"10.1515","volume":"126","author":[{"given":"Roland","family":"Gazaille","sequence":"first","affiliation":[{"name":"Department of Diagnostic Radiology , Kettering Health Dayton , Dayton , OH , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cole","family":"Knox","sequence":"additional","affiliation":[{"name":"Department of Diagnostic Radiology , Kettering Health Dayton , Dayton , OH , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michelle","family":"Pershing","sequence":"additional","affiliation":[{"name":"Kettering Health Dayton , Dayton , OH , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"K. Doug","family":"Pugar","sequence":"additional","affiliation":[{"name":"Department of Neurology , Kettering Health Dayton , Dayton , OH , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"H. Brent","family":"Bamberger","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery , Kettering Health Dayton , Dayton , OH , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"James","family":"Schoen","sequence":"additional","affiliation":[{"name":"Department of Family Practice , Kettering Health Dayton , Dayton , OH , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nicklaus","family":"Hess","sequence":"additional","affiliation":[{"name":"Department of Family Practice , Kettering Health Dayton , Dayton , OH , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chelsea","family":"Nickolson","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine , Kettering Health Dayton , Dayton , OH , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Taylor","family":"Vickery","sequence":"additional","affiliation":[{"name":"Department of Diagnostic Radiology , Kettering Health Dayton , Dayton , OH , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Don","family":"Flowers","sequence":"additional","affiliation":[{"name":"Department of Diagnostic Radiology , Kettering Health Dayton , Dayton , OH , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Antipas","family":"Marati","sequence":"additional","affiliation":[{"name":"Department of Neurology , Kettering Health Dayton , Dayton , OH , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kortney","family":"LaCombe","sequence":"additional","affiliation":[{"name":"Department of Neurology , Kettering Health Dayton , Dayton , OH , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sharal","family":"Mall","sequence":"additional","affiliation":[{"name":"Department of Diagnostic Radiology , Kettering Health Dayton , Dayton , OH , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"374","published-online":{"date-parts":[[2026,4,16]]},"reference":[{"key":"2026092106580042877_j_jom-2025-0177_ref_001","doi-asserted-by":"crossref","unstructured":"Schwabl, C, Schmidle, G, Kaiser, P, Drakonaki, E, Taljanovic, MS, Klauser, AS. Nerve entrapment syndromes: detection by ultrasound. Ultrasonography 2023;42:376\u201387. https:\/\/doi.org\/10.14366\/usg.22186.","DOI":"10.14366\/usg.22186"},{"key":"2026092106580042877_j_jom-2025-0177_ref_002","unstructured":"Alvarez, CA, Brown, SR. Carpal tunnel syndrome. Am Fam Physician 2024;109:571\u201357."},{"key":"2026092106580042877_j_jom-2025-0177_ref_003","doi-asserted-by":"crossref","unstructured":"Haglin, JM, Hinckley, NB, Moore, ML, Deckey, DG, Lai, CH, Renfree, KJ. Long-term trends in open vs endoscopic carpal tunnel release among the medicare population in the United\u00a0States. Hand (NY) 2024;19:1069\u201374. https:\/\/doi.org\/10.1177\/15589447231168977.","DOI":"10.1177\/15589447231168977"},{"key":"2026092106580042877_j_jom-2025-0177_ref_004","doi-asserted-by":"crossref","unstructured":"Atroshi, I, Gummesson, C, Johnsson, R, Ornstein, E, Ranstam, J, Ros\u00e9n, I. Rosen L. prevalence of carpal tunnel syndrome in a general population. JAMA 1999;282:153\u20138. https:\/\/doi.org\/10.1001\/jama.282.2.153.","DOI":"10.1001\/jama.282.2.153"},{"key":"2026092106580042877_j_jom-2025-0177_ref_005","unstructured":"Evanoff, B, Dale, AM, Capellini, S, Song, M, Franzblau, A. Effects of varying case definition on carpal tunnel syndrome prevalence estimates in a pooled cohort. Am J Ind Med 2015;58:268\u201375."},{"key":"2026092106580042877_j_jom-2025-0177_ref_006","doi-asserted-by":"crossref","unstructured":"Lawrence, RC, Felson, DT, Helmick, CG, Arnold, LM, Choi, H, Deyo, RA, et al.. Estimates of the prevalence of arthritis and other rheumatic conditions in the United\u00a0States. Part II. Arthritis Rheum 2008;58:26\u201335. https:\/\/doi.org\/10.1002\/art.23176.","DOI":"10.1002\/art.23176"},{"key":"2026092106580042877_j_jom-2025-0177_ref_007","doi-asserted-by":"crossref","unstructured":"Shapiro, LM, Kamal, RN, Management of Carpal Tunnel Syndrome Work Group, American Academy of Orthopaedic Surgeons. American academy of orthopaedic surgeons. American academy of orthopaedic Surgeons\/ASSH clinical practice guideline summary management of carpal tunnel syndrome. J\u00a0Am Acad Orthop Surg 2025;33:e356\u201366. https:\/\/doi.org\/10.5435\/JAAOS-D-24-01179.","DOI":"10.5435\/JAAOS-D-24-01179"},{"key":"2026092106580042877_j_jom-2025-0177_ref_008","doi-asserted-by":"crossref","unstructured":"Fowler, JR, Gaughan, JP, Ilyas, AM. The sensitivity and specificity of ultrasound for the diagnosis of carpal tunnel syndrome: a meta-analysis. Clin Orthop Relat Res 2011;469:1089\u201394. https:\/\/doi.org\/10.1007\/s11999-010-1637-5.","DOI":"10.1007\/s11999-010-1637-5"},{"key":"2026092106580042877_j_jom-2025-0177_ref_009","doi-asserted-by":"crossref","unstructured":"Descatha, A, Huard, L, Aubert, F, Barbato, B, Gorand, O, Chastang, JF. Meta-analysis on the performance of sonography for the diagnosis of carpal tunnel syndrome. Semin Arthritis Rheum 2012;41:914\u201322. https:\/\/doi.org\/10.1016\/j.semarthrit.2011.11.006.","DOI":"10.1016\/j.semarthrit.2011.11.006"},{"key":"2026092106580042877_j_jom-2025-0177_ref_010","doi-asserted-by":"crossref","unstructured":"Torres-Costoso, A, Martinez-Vizcaino, V, Alvarez-Bueno, C, Ferri-Morales, A, Cavero-Redondo, I. Accuracy of ultrasonography for the diagnosis of carpal tunnel syndrome: a systematic review and meta-analysis. Arch Phys Med Rehabil 2018;99:758\u201365 e10. https:\/\/doi.org\/10.1016\/j.apmr.2017.08.489.","DOI":"10.1016\/j.apmr.2017.08.489"},{"key":"2026092106580042877_j_jom-2025-0177_ref_011","doi-asserted-by":"crossref","unstructured":"Roomizadeh, P, Eftekharsadat, B, Abedini, A, Ranjbar-kiyakalayeh, S, Yousefi, N, Ebadi, S, et al.. Ultrasonographic assessment of carpal tunnel syndrome severity: a systematic review and meta-analysis. Am J Phys Med Rehabil 2019;98:373\u201381. https:\/\/doi.org\/10.1097\/phm.0000000000001104.","DOI":"10.1097\/PHM.0000000000001104"},{"key":"2026092106580042877_j_jom-2025-0177_ref_012","doi-asserted-by":"crossref","unstructured":"Erickson, M, Lawrence, M, Lucado, A. The role of diagnostic ultrasound in the examination of carpal tunnel syndrome: an update and systematic review. J\u00a0Hand Ther 2022;35:215\u201325. https:\/\/doi.org\/10.1016\/j.jht.2021.04.014.","DOI":"10.1016\/j.jht.2021.04.014"},{"key":"2026092106580042877_j_jom-2025-0177_ref_013","doi-asserted-by":"crossref","unstructured":"Davis, LC, Bawner, TG, Bey, MJ, van Holsbeeck, M. Clinical utilization of shear wave elastography in the musculoskeletal system. Ultrasonography 2019:2\u201312. https:\/\/doi.org\/10.14366\/usg.18039.","DOI":"10.14366\/usg.18039"},{"key":"2026092106580042877_j_jom-2025-0177_ref_014","doi-asserted-by":"crossref","unstructured":"Miyamoto, H, Siedentopf, C, Kastlunger, M, Martinoli, C, Gabl, M, Jaschke, W, et al.. Intracarpal tunnel contents: evaluation of the effects of corticosteroid injection with sonoelastography. Radiology 2014;270:809\u201315. https:\/\/doi.org\/10.1148\/radiol.13131083.","DOI":"10.1148\/radiol.13131083"},{"key":"2026092106580042877_j_jom-2025-0177_ref_015","doi-asserted-by":"crossref","unstructured":"Cartwright, MS, White, DL, Demar, S, Wiesler, ER, Sarlikiotis, T, Chloros, GD, et al.. Median nerve changes following steroid injection for carpal tunnel syndrome. Muscle Nerve 2011;44:25\u20139. https:\/\/doi.org\/10.1002\/mus.22067.","DOI":"10.1002\/mus.22067"},{"key":"2026092106580042877_j_jom-2025-0177_ref_016","doi-asserted-by":"crossref","unstructured":"Gurun, E, Ozturk, M, Cakir, IM, Genc, AS, Bozduman, O, Sazak, HB, et al.. The efficacy of shear wave elastography in evaluating treatment response to US-guided steroid injection in patients with carpal tunnel syndrome. Acad Radiol 2025;32:2815\u201321. https:\/\/doi.org\/10.1016\/j.acra.2024.12.045.","DOI":"10.1016\/j.acra.2024.12.045"},{"key":"2026092106580042877_j_jom-2025-0177_ref_017","doi-asserted-by":"crossref","unstructured":"Hern\u00e1ndez-Secor\u00fan, M, Monta\u00f1a-Cort\u00e9s, R, Hidalgo-Garc\u00eda, C, Rodr\u00edguez-Sanz, J, Corral-de-Toro, J, Monti-Ballano, S, et al.. Effectiveness of conservative treatment according to severity and systemic disease in carpal tunnel syndrome: a systematic review. Int J Environ Res Publ Health 2021;18:2365. https:\/\/doi.org\/10.3390\/ijerph18052365.","DOI":"10.3390\/ijerph18052365"},{"key":"2026092106580042877_j_jom-2025-0177_ref_018","doi-asserted-by":"crossref","unstructured":"Karjalanen, T, Raatikainen, S, Jaatinen, K, Lusa, V. Update on efficacy of conservative treatments for carpal tunnel syndrome. J\u00a0Clin Med 2022;11:950. https:\/\/doi.org\/10.3390\/jcm11040950.","DOI":"10.3390\/jcm11040950"},{"key":"2026092106580042877_j_jom-2025-0177_ref_019","doi-asserted-by":"crossref","unstructured":"Burnham, T, Higgins, DC, Burham, RS, Heath, DM. Effectiveness of osteopathic manipulative treatment for carpal tunnel syndrome: a pilot project. J\u00a0Am Osteopath Assoc 2015;115:138\u201348. https:\/\/doi.org\/10.7556\/jaoa.2015.027.","DOI":"10.7556\/jaoa.2015.027"},{"key":"2026092106580042877_j_jom-2025-0177_ref_020","unstructured":"Siu, G, Jaffe, JD, Rafique, M, Weinik, MM. Osteopathic manipulative medicine for carpal tunnel syndrome. J\u00a0Am Osteopath Assoc 2012;112:127\u201339."},{"key":"2026092106580042877_j_jom-2025-0177_ref_021","doi-asserted-by":"crossref","unstructured":"Zhan, L, Brown, J, Gustowski, S, Davis, P, Loomis, M. Carpal tunnel dimensions following osteopathic manipulation utilizing dorsal carpal arch muscle energy: a pilot study. J\u00a0Osteopath Med 2025;125:417\u201323. https:\/\/doi.org\/10.1515\/jom-2024-0167.","DOI":"10.1515\/jom-2024-0167"},{"key":"2026092106580042877_j_jom-2025-0177_ref_022","doi-asserted-by":"crossref","unstructured":"Beaton, DE, Wright, JG, Katz, JN, The Upper Extremity Collaborative Group. Development of the QuickDASH: comparison of three item-reduction approaches. J\u00a0Bone Joint Surg Am 2005;87-A:1038\u201346. https:\/\/doi.org\/10.2106\/JBJS.D.02060.","DOI":"10.2106\/JBJS.D.02060"},{"key":"2026092106580042877_j_jom-2025-0177_ref_023","doi-asserted-by":"crossref","unstructured":"Atroshi, I, Lyr\u00e9n, PE, Gummesson, C. The 6-item CTS symptoms scale: a brief outcomes measure for carpal tunnel syndrome. Qual Life Res 2009;18:347\u201358. https:\/\/doi.org\/10.1007\/s11136-009-9449-3.","DOI":"10.1007\/s11136-009-9449-3"},{"key":"2026092106580042877_j_jom-2025-0177_ref_024","doi-asserted-by":"crossref","unstructured":"Gao, J, Caldwell, J, Wells, M, Park, D. Ultrasound shear wave elastography to assess tissue mechanical properties in somatic dysfunction: a feasibility study. J\u00a0Am Osteopath Assoc 2020;120:677\u201384. https:\/\/doi.org\/10.7556\/jaoa.2020.108.","DOI":"10.7556\/jaoa.2020.108"},{"key":"2026092106580042877_j_jom-2025-0177_ref_025","doi-asserted-by":"crossref","unstructured":"Sernik, RA, Pereira, RFB, Cerri, GG, Damasceno, RS, Bastos, BB, Le\u00e3o, RV. Shear wave elastography is a valuable tool for diagnosing and grading carpal tunnel syndrome. Skelet Radiol 2023;52:67\u201372. https:\/\/doi.org\/10.1007\/s00256-022-04143-0.","DOI":"10.1007\/s00256-022-04143-0"},{"key":"2026092106580042877_j_jom-2025-0177_ref_026","doi-asserted-by":"crossref","unstructured":"Baxter, SN, Millhuff, AC, Desai, GJ, Dowling, DJ. An osteopathic approach to carpal tunnel syndrome. Osteopath Fam Physician 2021:17\u201330. https:\/\/doi.org\/10.33181\/13054.","DOI":"10.33181\/13054"},{"key":"2026092106580042877_j_jom-2025-0177_ref_027","doi-asserted-by":"crossref","unstructured":"Sucher, BM. Effectiveness of osteopathic manipulative treatment for carpal tunnel syndrome [letter]. J\u00a0Am Osteopath Assoc 2015;115:356\u20137. https:\/\/doi.org\/10.7556\/jaoa.2015.073.","DOI":"10.7556\/jaoa.2015.073"},{"key":"2026092106580042877_j_jom-2025-0177_ref_028","doi-asserted-by":"crossref","unstructured":"Graham, B. The value added by electrodiagnostic testing in the diagnosis of carpal tunnel syndrome. J\u00a0Bone Joint Surg Am 2008;90:2587\u201393. https:\/\/doi.org\/10.2106\/JBJS.G.01362.","DOI":"10.2106\/JBJS.G.01362"},{"key":"2026092106580042877_j_jom-2025-0177_ref_029","doi-asserted-by":"crossref","unstructured":"Koyuncuoglu, HR, Kutluhan, S, Yesildag, A, Oyar, O, Guler, K, Ozden, A. The value of ultrasonographic measurement in carpal tunnel syndrome in patients with negative electrodiagnostic tests. Eur J Radiol 2005;56:365\u20139. https:\/\/doi.org\/10.1016\/j.ejrad.2005.05.013.","DOI":"10.1016\/j.ejrad.2005.05.013"},{"key":"2026092106580042877_j_jom-2025-0177_ref_030","doi-asserted-by":"crossref","unstructured":"Witt, JC, Hentz, JG, Stevens, JC. Carpal tunnel syndrome with normal nerve conduction studies. Muscle Nerve 2004;29:515\u201322. https:\/\/doi.org\/10.1002\/mus.20019.","DOI":"10.1002\/mus.20019"}],"container-title":["Journal of Osteopathic Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.degruyterbrill.com\/document\/doi\/10.1515\/jom-2025-0177\/xml","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/www.degruyterbrill.com\/document\/doi\/10.1515\/jom-2025-0177\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,9,21]],"date-time":"2026-09-21T06:59:25Z","timestamp":1789973965000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.degruyterbrill.com\/document\/doi\/10.1515\/jom-2025-0177\/html"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,4,16]]},"references-count":30,"journal-issue":{"issue":"10","published-online":{"date-parts":[[2026,4,16]]},"published-print":{"date-parts":[[2026,9,22]]}},"alternative-id":["10.1515\/jom-2025-0177"],"URL":"https:\/\/doi.org\/10.1515\/jom-2025-0177","relation":{},"ISSN":["2702-3648"],"issn-type":[{"value":"2702-3648","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,4,16]]}}}