Ultrasound verification of the effect of osteopathic correction on the structural and functional state of the median nerve in carpal tunnel syndrome (pilot study)

Introduction . Carpal tunnel syndrome occurs in 5–10 % of the total population, develops at working age between 35 and 65 years, women are affected 3–6 times more often than men, and the prevalence and severity of the disease increase with age. Ultrasound examination of peripheral nerves is quite widely used in medical practice but remains an underestimated diagnostic method in the practice of an osteopathic doctor. Despite the data on the use of osteopathy in the treatment of tunnel neuropathy of the median nerve, the available literature does not contain information on the objectifi cation of the results of osteopathic correction of the pathology of this nerve using ultrasound. The aim of the study : to study the direct (immediately after the session) effect of osteopathic correction on the condition of the median nerve in the carpal tunnel using ultrasound diagnostics. Materials and methods . Ultrasound and osteopathic correction sessions of patients with CTS were carried out at the Primorsky Institute of Vertebroneurology and Manual Medicine (Vladivostok). On the basis of voluntary informed consent, the study included 6 patients, women aged 38 to 64 years with a diagnosis of carpal tunnel syndrome. The ultrasound was performed using the SAMSUNG MEDISON HS50-RUS device with a LA3–14AD linear transducer with a frequency of 12 MHz. Transverse and longitudinal scanning was carried out sequentially. Measurements of the median nerve were carried out according to the generally accepted method. The patient underwent osteopathic diagnostics in order to identify the currently dominant somatic dysfunctions, in accordance with clinical guidelines. After that, he underwent a standard and dynamic ultrasound. Then the osteopathic doctor corrected the identifi ed somatic dysfunctions and again performed an ultrasound. Statistical processing was not carried out due to the lack of a representative sample. Results. Research conducted in accordance with the suggested methodological approach, focusing on the direct impact of an osteopathic session, has shown evident signs of the infl uence of osteopathic correction, resulting in signifi cant changes in structural parameters among almost all patients, including a reduction in compression zone length, decreased pathological nerve hypertrophy, and improved differentiation of intrastem nerve structures, thereby indicating a decrease in nerve edema and intracanal pressure, alongside a reduction in fl exor retainer thickness, which further contributes to enhanced nerve nutrition and mobility. After undergoing a session of osteopathic correction, along with the restoration of nerve morphology, its mobility improved, as revealed by longitudinal and transverse dynamic analysis, manifesting in the form of an increase in unilateral horizontal movement, the occurrence of translational and return movement, as well as the appearance of vertical dorsal displacement, horizontal or vertical movement (initially absent), an increase in the values of horizontal and vertical displacement, and a change in the type of movement of the median nerve in the canal. Conclusion . Ultrasound examinations provide objective (morpho-physiological) confi rmation of palpatory patterns in the diagnosis of median nerve somatic dysfunctions in carpal tunnel syndrome. The revealed effect of osteopathic correction on the structure and mobility of the median nerve in the carpal tunnel allows a more objective understanding of the mechanism of osteopathic correction and substantiates the possibility of its use in the treatment and rehabilitation of patients with compression-ischemic neuropathy.