Gregor Omejec

Objective: To evaluate the effects of gliding and resistance exercises on median nerve and third flexor digitorum superficialis tendon shear wave velocity in patients with carpal tunnel syndrome. Design: Prospective, randomised, three-arm, parallel-group trial. Setting: At the Institute of Clinical Neurophysiology. Participants: A total of 102 patients with electrodiagnostically confirmed mild to moderate carpal tunnel syndrome aged 20–80 years (51.5 ± 12.9 years; 85.3% female). Intervention: Participants were randomised to the Gliding Exercise group, the Resistance Exercise group or the Control group. Participants in the exercise groups performed daily home-based gliding or low-load resistance exercises for 3 weeks, whereas controls received no intervention. At baseline and follow-up, shear wave velocity of the median nerve and the third flexor digitorum superficialis tendon was measured longitudinally at the carpal tunnel inlet, and the cross-sectional area of the median nerve was measured at the carpal tunnel inlet and 10 cm proximally to the distal wrist crease. Main measures: The primary outcome was the change in median nerve shear wave velocity at the carpal tunnel inlet. Secondary outcomes were changes in the third flexor digitorum superficialis tendon shear wave velocity and median nerve cross-sectional area at the same level. Results: Ninety-one participants completed the post-intervention assessment. No significant changes were observed in primary or secondary outcome measures despite improvements in self-reported symptoms in the gliding exercise group compared to controls. Conclusion: Short-term exercise-based interventions do not modify median nerve or tendon elasticity in mild to moderate carpal tunnel syndrome. Symptom improvement may occur through mechanisms other than changes in tissue stiffness.

Introduction/Aims: Ultrasound (US)‐guided perineural injection therapy (PIT) with corticosteroids (CS) or 5% dextrose in water (D5W) is commonly used to relieve symptoms in carpal tunnel syndrome (CTS). However, comparative data beyond short‐term follow‐up are limited. This study aimed to compare the efficacy of US‐guided PIT using D5W and CS over a 12‐month follow‐up period. Methods: Patients with bilateral mild to moderate CTS participated in a randomized, double‐blind, within‐subject trial. Each patient's right hand was randomly assigned to receive D5W or CS, while the contralateral hand received the alternate treatment. Primary outcomes included the Boston Carpal Tunnel Questionnaire symptom severity (BCTQs) and functional status (BCTQf) scales and the Visual Analogue Scale (VAS). A single US‐guided PIT was performed using 6 mL of injectate: 5% dextrose or triamcinolone acetonide diluted with saline. Clinical assessment, nerve conduction studies, and ultrasonography were performed at baseline and at 1, 3, 6, and 12 months. Results: Fifty‐seven patients (114 hands) were included in the analysis. Both D5W and CS produced similar improvements, with the greatest symptom relief observed within the first 3 months. Clinically meaningful improvement in BCTQs was observed in approximately 50% of hands in both groups at 1 and 3 months, and in 29% (D5W) and 25% (CS) at 12 months. Discussion: US‐guided PIT with D5W and CS provides comparable clinical benefit over 12 months in mild to moderate CTS, with maximal improvement occurring early after treatment. These results support D5W as a reasonable non‐steroidal alternative for perineural injection therapy in CTS.

Introduction/Aims: We aimed to determine differences in diaphragm thickness by including/excluding pleural and peritoneal membranes, the variability in diaphragm thickness over the apposition zone, and the predictors of diaphragm thickness and excursion measurements.Methods: At least 10 male and female subjects were recruited for each decade of life. Spirometry, respiratory muscle strength, and the diaphragm ultrasound (US) measurements were performed. Multivariate linear regression was applied to determine associations between diaphragm US parameters, subject characteristics, spirometry, and respiratory muscle strength.Results: In 156 subjects (mean 47.8 ± 17.7; 20–80 years of age), a significant difference in diaphragm thickness was found when comparing measurements that included and excluded the pleural and peritoneal membranes (mean 2.3 vs. 1.7 mm; average difference of 35% (95% CI [15.3–60]); p < 0.001), as well as the minimum and maximum diaphragm thicknesses at different locations over the apposition zone (mean 1.4 vs. 2.1 mm; p < 0.001). Adjusting for sex, age, height, sniff nasal inspiratory pressure, and forced vital capacity, a positive association was found between body mass index (BMI) and diaphragm thickness (β =0.024, p < 0.001, partial R ² = 0.31, 95% CI [0.018, 0.030]); a negative association was found with the thickening ratio (β = −0.013, p = 0.050, partial R ² = 0.04, 95% CI [−0.024, −0.002]).Discussion: Caliper placement and the location of measurement over the apposition zone greatly affect diaphragm thickness, which is also associated with BMI. Therefore, a standardized protocol for measuring diaphragmatic thickness and excursion is desirable, and BMI should be considered when interpreting the results.

Introduction: The aim of the study was to compare the utility of instrument‐based assessment of peripheral nerve function with the neurologic examination in ulnar neuropathy at the elbow (UNE). Methods: We prospectively recruited consecutive patients with suspected UNE, performed a neurologic examination, and performed instrument‐based measurements (muscle cross‐sectional area by ultrasonography, muscle strength by dynamometry, and sensation using monofilaments). Results: We found good correlations between clinical estimates and corresponding instrument‐based measurements, with similar ability to diagnose UNE and predict UNE pathophysiology. Discussion: Although instrument‐based methods provide quantitative evaluation of peripheral nerve function, we did not find them to be more sensitive or specific in the diagnosis of UNE than the standard neurologic examination. Likewise, instrument‐based methods were not better able to differentiate between groups of UNE patients with different pathophysiologies. Muscle Nerve 57: 951–957, 2018