title: Longitudinal Gliding of the Median Nerve in the Carpal Tunnel: Ultrasound Cadaveric Evaluation of Conventional and Novel Concepts of Nerve Mobilization.
abstract: OBJECTIVE
  To evaluate median nerve excursion during conventional nerve gliding exercises and newly developed exercises, primarily comprising abduction and adduction of the fingers.
  
  
  METHODS
  Descriptive study.
  
  
  METHODS
  Anatomical dissection facility.
  
  
  METHODS
  Random sample of upper extremities of fresh whole-body human cadavers (N=18). Cadavers with neuromuscular diseases in the medical record or anatomic variations were excluded.
  
  
  METHODS
  Conventional and new nerve gliding exercises.
  
  
  METHODS
  Distances between markers applied into the nerve and markers in the periosteum were visualized with ultrasound and measured. Comparisons of nerve excursions between different exercises were performed.
  
  
  RESULTS
  Conventional exercises led to substantial nerve gliding proximal to the carpal tunnel and between the head of the pronator teres (12 and 13.8mm, respectively), but it led to far less in the carpal tunnel (6.6mm). With our novel exercises, we achieved nerve gliding in the carpal tunnel of 13.8mm. No substantial marker movement could be detected during lateral flexion of the cervical spine.
  
  
  CONCLUSIONS
  Although conventional nerve gliding exercises only lead to minimal nerve excursions in the carpal tunnel, our novel exercises with the abduction and adduction of the fingers result in substantial longitudinal gliding throughout the arm. Clinical trials will have to deliver the clinical evidence.
authors: Department of Radiology, Kaiser-Franz-Josef Hospital, Vienna, Austria; Center for Anatomy and Cell Biology, Medical University of Vienna, Vienna, Austria. Electronic address: stefan.meng@meduniwien.ac.at.
authors: Stefan
authors: S
authors: Meng
authors: Center for Anatomy and Cell Biology, Medical University of Vienna, Vienna, Austria.
authors: Lukas F
authors: LF
authors: Reissig
authors: Physiotherapy, University of Applied Sciences, Krems, Austria.
authors: Reinhard
authors: R
authors: Beikircher
authors: Division of Plastic and Reconstructive Surgery, Department of Surgery, Medical University of Vienna, Vienna, Austria.
authors: Chieh-Han John
authors: CH
authors: Tzou
authors: Department of Neurology, Kaiser-Franz-Josef Hospital, Vienna, Austria.
authors: Wolfgang
authors: W
authors: Grisold
authors: Center for Anatomy and Cell Biology, Medical University of Vienna, Vienna, Austria.
authors: Wolfgang J
authors: WJ
authors: Weninger
mesh_terms: D002102:Cadaver; D002349:Carpal Tunnel Syndrome / Q000000981:diagnostic imaging* / Q000534:rehabilitation*; D005081:Exercise Therapy / Q000379:methods*; D005542:Forearm / Q000294:innervation; D006801:Humans; D008475:Median Nerve / Q000000981:diagnostic imaging*; D009068:Movement / Q000502:physiology; D026741:Physical Therapy Modalities; D016059:Range of Motion, Articular; D014463:Ultrasonography; D014953:Wrist / Q000000981:diagnostic imaging* / Q000294:innervation
keywords: Carpal tunnel syndrome; Median nerve; Median neuropathy; Rehabilitation; Ultrasonography