Pilot Study Evaluating the Elasticity and Shear Wave Modulus (Stiffness) of the Median Nerve in Patients With Mild to Moderate Idiopathic Carpal Tunnel Syndrome Receiving OMT and Conservative Therapy
Phase: NA
Conditions: Carpal Tunnel Syndrome
Sponsor: Kettering Health Network

PILOT RCT of OMT and Conservative Therapy in Carpal Tunnel Patients 
 
 
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PROTOCOL TITLE: 
Pilot Study Evaluating the Elasticity and Shear Wave Modulus (Stiffness) of 
the Median Nerve in Patients with Mild to Moderate Idiopathic Carpal 
Tunnel Syndrome Receiving OMT and Conservative Therapy 
 
 
PRINCIPAL INVESTIGATOR: 
Name:  Roland Gazaille, DO 
Department:  Diagnostic Radiology 
Telephone Number: (937) 564-3269 
Email Address: roland.gazaille@ketteringhealth.org 
 
VERSION NUMBER/DATE: 
Version 7.0  
Date: August 20, 2024 
 
 
REVISION HISTORY 
 
Revision 
# 
Version Date 
Summary of Changes 
Consent 
Change? 
1 
 
Updated CTS-6 form with corrections 
No 
2 
 
After obtaining elastography software and training, 
study team added sonoelastography as a scheduled 
study event for all subjects to evaluate the elasticity 
and stiffness of the median nerve, the transverse 
carpal ligament, and the carpal tunnel 
Yes 
3 
12/16/2023 
Revised: 
• 
number of total # of visits from 8 to 6 
• 
visit interval changed to every 3 weeks 
Yes 
4 
1/10/2024 
Revised: 
• 
Removed age cap for inclusion  
• 
Modified recruitment strategies  
• 
Allowance of remote consent and 
electronic documentation  
 
5 
2/20/2024 
Revised: 
Clarified exclusion criteria to include pregnancy 
and the criteria for uncontrolled hypothyroidism 
and diabetes mellitus; updated locations 
No 
6 
4/08/2024 
Revised Exclusion Criteria to exclude patients who 
have undergone OMT, Physical Therapy or 
Massage Therapy to the affected wrist(s) within the 
past 3 months. 
Yes 
7 
8/20/2024 
Revised Exclusion Criteria to expand time window 
for initial EMG from 3 months to 1 year. 
Yes 
 
 
 

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Table of Contents 
 
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26.0    References…………………………………………………………………...……13 
 
 
 
 
 

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1.0 
Study Summary 
Study Title 
Pilot Study Evaluating the Elasticity and Shear Wave 
Modulus of the Median Nerve in Patients with Mild to 
Moderate Idiopathic Carpal Tunnel Syndrome Receiving 
OMT and Conservative Therapy 
Study Design 
Randomized control trial with 3 arms of treatment 
Primary Objectives 
To evaluate and quantify changes in the elasticity and shear 
wave modulus (stiffness) of the median nerve in patients 
diagnosed with mild to moderate carpal tunnel syndrome 
following one of three pathways of treatment: 
• Patients receiving only OMT 
• Patients receiving only conservative therapy 
• Patients receiving both OMT & conservative therapy 
Outcome measures 
• Median nerve cross-sectional diameter (CSD) 
measurements taken by US and shear wave 
elastography (SWE) before and after the 
interventions for patients in the “OMT only” cohort 
& “OMT +conservative therapy” cohort (4x) 
• US & SWE (3x) in “Conservative therapy only” 
cohort   
• Quick DASH survey at each visit  
• CTS-6 tool completed by clinician at each visit 
• Full EMG done 1x at baseline & a limited EMG 1x at 
the end of study 
Research 
Intervention(s)/ 
Investigational 
Agent(s)  
Treatments: 
Three arms: 1. Patients in OMT cohort (3x) 
                    2. Patients in conservative therapy  
(standard of care) only (2x) 
                    3. Patients in OMT & conservative therapy (3x) 
IND/IDE #  
No IND/IDE will be utilized in this study.  
Study Population 
Patients with a diagnosis of unilateral or bilateral mild to 
moderate carpal tunnel syndrome based on clinical and 
recent EMG findings, ages 18 and above  
Sample Size 
36 
Study Duration for 
individual subjects 
Total of 6-7 visits over 8-10 weeks; 
Please see attached Schedule of Events 
Study Specific 
Abbreviations/ 
Definitions  
OMT- Osteopathic manipulative therapy 
US- ultrasound 
SWE- shear wave elastography 
CSD- cross-sectional diameter 
MN- median nerve 
DASH-Disabilities of the arm, shoulder, and hand survey 
CTS-6: Carpal Tunnel Syndrome  
EMG- electromyography 

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2.0 
Objectives 
To evaluate and quantify changes in the elasticity and shear wave modulus (stiffness) of 
the median nerve in patients diagnosed with mild to moderate carpal tunnel syndrome 
following one of three pathways of treatment: 
• 
Patients receiving only OMT 
• 
Patients receiving only conservative therapy 
• 
Patients receiving both OMT & conservative therapy 
 
3.0 
Background 
Carpal tunnel syndrome is the most common entrapment neuropathy in the human body 
and occurs at the level of the wrist.1-6 The diagnosis is typically made based on clinical 
signs and symptoms which may include nocturnal pain and numbness, weakness and/or 
atrophy of the thenar muscles, numbness or tingling in the median nerve distribution, loss 
of two-point discrimination, and positive provocative tests (ie. Phalen’s and Tinel’s). 
Most studies have suggested that the estimated prevalence is between 2-4% afflicting 
between 4-10 million patients in the United States.1-6 Other studies have estimated the 
incidence of carpal tunnel to be between 400,000 to 500,000 cases annually in the United 
States with economic costs in excess of $2 billion per year.7 Treatment is generally 
conservative and may include a combination of non-steroidal anti-inflammatory 
medications (NSAIDs), orthoses, and activity modifications along with adjunctive 
nonoperative treatments such as therapeutic ultrasound, extracorporeal shockwave 
therapy, corticosteroid injections, and platelet-rich plasma injections.8 Previous work by 
Yamanaka et al has shown that the mechanism of action of the corticosteroids is 
apparently mediated by their antifibrotic more than their anti-inflammatory and 
antiedematous properties.9The most effective combination of therapy, including 
musculoskeletal manipulation, remains unknown.10 Carpal tunnel release is reserved for 
refractory cases or those patients presenting with axonal loss on electromyography 
(EMG) and nerve conduction velocity (NCV) studies. 
 
Osteopathic physicians have long relied on their palpatory skills as a qualitative 
diagnostic tool in detecting disease processes in their patients. Palpation is limited to the 
evaluation of superficial structures and lacks objectivity.11 Osteopathic physicians 
evaluate their patients by performing an osteopathic structural exam during which they 
detect clinical manifestations of somatic dysfunction. Somatic dysfunction is broadly 
defined as the impaired or altered function of the body which can involve myofascial, 
arthrodial, osseous, vascular, lymphatic, and neural structures. The clinical findings of 
somatic dysfunction are defined in the osteopathic literature by Tissue texture changes, 
Asymmetry, Restricted range of motion, and Tenderness –otherwise mneumonically 
referred to as TART. Tissue texture changes may manifest themselves as edema, fibrosis, 
atrophy, rigidity, or hypertonicity of the soft tissues upon clinical examination.12-13 
Osteopathic physicians make a diagnosis of somatic dysfunction based on palpation and 
intersegmental motion testing. Following a diagnosis of somatic dysfunction, an 
osteopathic physician may then choose to treat the area of concern with a wide variety of 
osteopathic manipulative techniques. Following an osteopathic manipulative treatment, 
the osteopathic structural exam is repeated to assess for and document post-treatment 
changes in the initial findings as well as to plan for further treatment and follow up. 
Osteopathic manipulative treatment (OMT) has been recognized as an additional 

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conservative management option for carpal tunnel syndrome (CTS), although limited 
research exists to objectively validate its ability to effect post-treatment changes in the 
median nerve or the surrounding soft tissues.14-15 
 
The past few decades have seen an explosion in the rapid development of novel imaging 
modalities. From the development and clinical use of intravenous contrast in diagnostic 
ultrasound to the development of high-frequency linear array transducers which allow the 
depiction of anatomy in exquisite detail, ultrasound has been no such stranger to 
innovation during this time span. Sonoelastography is a modality which allows for the 
assessment of the mechanical properties (ie. Elasticity or stiffness) of soft tissue both 
qualitatively and quantitatively through a non-invasive imaging technique.16-17 Prior 
studies have demonstrated sonoelastography’s ability to demonstrate higher shear wave 
velocities in the nerves of patients with a peripheral neuropathy as compared to a normal 
nerve.18-21 Specifically, sonoelastography has been shown to be effective in both 
diagnosing and distinguishing between mild and severe carpal tunnel disease.21 
 
We hypothesize that OMT effects biomechanical changes in the transverse carpal 
ligament and soft tissue contents of the carpal tunnel in patients with carpal tunnel 
syndrome thus resulting in improvement of their symptomatology. We further 
hypothesize that sonoelastography will be useful in objectively detecting these effects as 
a change in the elasticity or stiffness of the transverse carpal ligamernt and the contents 
of the carpal tunnel in patients undergoing OMT. This is an area where grayscale (aka. B-
scale) ultrasound and EMG have fallen short in the assessment of patients who have 
experienced subjective improvement in their symptoms post OMT.14 
 
There are two forms of real-time sonoelastography which can be used to measure tissue 
stiffness: Strain and shear wave elastography. Both are non-invasive methods of imaging 
tissue stiffness or elasticity based on Young’s Modulus.16 Strain elastography evaluates 
elasticity through compression, with the degree of displacement being larger in soft tissue 
than in hard tissue. Shear wave elastography evaluates the propagation of transverse-
oriented shear waves, with the wave speed being faster in hard tissues as compared to 
softer tissues. With shear wave elastography, an acoustic radiation force is applied via the 
ultrasound probe which creates an “acoustic wind.” This induces mechanical and shear 
waves in the affected tissue. This results in qualitative color coded elastograms and 
quantitative maps of elasticity (kPa) or shear wave velocity (cm/s). Shear wave 
elastography is relatively operator independent, reproducible, and quantitative.16 These 
portable ultrasound techniques result in “virtual palpation” which can be available at the 
point of care in both inpatient and outpatient settings. 
 
As noted previously in the studies by Taljanovic et al and Sernick et al, there was a 
quantifiable difference in the stiffness of the median nerve in patients with carpal tunnel 
syndrome as compared to those without carpal tunnel syndrome.18-21To our knowledge, 
there are no known studies that have examined quantifiable objective measures which 
speak to the elasticity or stiffness of soft tissues pre and post OMT. If successful, this 
project could lay the groundwork for further research into the utility of sonoelastography 
as well as MR elastography in the diagnosis and post-treatment assessment of patients 
with somatic dysfunction. 

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4.0 
Study Endpoints 
Primary study endpoints:  
Compare and contrast the following between three treatment modalities:  
• US and shear wave elastography (SWE) before and after 
treatments 
• Quick DASH survey at each visit  
• CTS-6 tool completed by clinician each visit 
• Full EMG done 1x at baseline & Limited EMG 1x at the end of 
the study 
Please see attached Schedule of Events/ Cohort visit flowchart for visit 
activity specifics.  
 
Secondary study endpoints: 
• Concomitant medications, medical comorbidities, concurrent use 
of splint 
• OMT techniques documented and categorized 
• Types, dosages, and frequency of medications injected into carpal 
tunnel 
• Types, dosages, and frequency of oral NSAIDS and opioids used 
to treat CTS symptoms 
• Conservative therapy including OMT will include resolution of 
night symptoms or complete resolution of all symptoms 
 
Demographic characteristics: 
• Age 
• Sex 
• Race 
• Ethnicity 
 
5.0 
Study Intervention/Investigational Agent 
• Cohort 1, OMT only and Cohort 2, OMT + conservative therapy: will be utilizing 
standard of care osteopathic manipulation techniques as treatment 
• Cohort 3 will be only utilizing standard of care conservative therapies 
(medications/splinting) 
 
6.0 
Procedures Involved 
1. Following a full review and approval from the IRB, patients will be identified 
who have a definitive diagnosis of mild to moderate carpal tunnel syndrome 
(CTS). 
 

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2. Each potential subject will undergo an EMG to exclude findings related to severe 
carpal tunnel syndrome (ie. axonal loss) prior to being deemed eligible to enroll in 
the study. 
  
3. Research personnel will then obtain informed consent from each eligible study 
participant. 
  
4. The patients will be randomized to one of three groups via a simple 
randomization tool such as https://ctrandomization.cancer.gov/.  
 
5. A total of 36 patients will be enrolled in this study consisting of three arms:  
• 12 patients will undergo OMT only 
• 12 patients will undergo conservative therapy 
• 12 patients will undergo a combination of conservative therapy and 
OMT 
 
6. The individuals performing the ultrasound scans, EMG's, and collecting the 
symptom data will be blinded to the group assignment and whether the subject is 
pre-or post-treatment to minimize bias.  
 
7. Three osteopathic primary care physicians will treat each of the patients in the 
experimental group. They will treat each patient with a minimum of three direct 
techniques focused on the carpal tunnel.  
 
8. OMT therapy will include: the interosseous membrane technique, the flexor 
retinaculum soft tissue technique, and the radiocarpal somatic dysfunction 
technique (See the uploaded document).  
 
9. The osteopathic physicians will also evaluate and treat the cervical spine, with 
particular attention to the C5-7 levels, all the way to the wrist and hand as they 
see fit based on the findings of their osteopathic structural exam.  
 
10. All findings of the osteopathic structural exams and the subsequent respective 
treatments will be specifically documented in the patient's electronic medical 
record.  
 
11. The greyscale US and shear wave elastography studies will be performed by two 
osteopathic fellowship trained musculoskeletal radiologists with a combined 25 
years of experience in performing musculoskeletal ultrasound. The US and shear-
wave elastography studies will be performed at baseline, 3 to 7 days after the 
initial intervention as well as the interventions at the 3-week and 6-week visits. 
 
12. All patients will be asked to fill out the Quick DASH survey at each clinical visit, 
prior to receiving treatment. 
 
13.  A clinician will fill out the CTS-6 Evaluation Tool at each clinical visit, prior to 
performing treatment. 

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14. A limited EMG of the wrist will be performed no more than 3-14 days following 
the 6-week treatment visit. The EMG’s will be performed by Kettering Health 
Dayton senior neurology residents with appropriate attending oversight. We 
expect the patients’ EMG results to be categorized as mild, moderate or severe 
CTS.  
 
15. For the purposes of this study, conservative therapy will be defined as including 
the use of splints, NSAIDs, opioids, and therapeutic injection of the carpal tunnel 
with steroids. Physical therapy will be excluded from the conservative therapy 
regimen so as not to act as a confounding therapy to the OMT outcomes. 
 
16. All results will be entered into a database along with basic demographic 
information including age (age above age 89 will be categorized as >89), race, 
medical comorbidities; concurrent use of splint or other conservative therapies.  
 
Please see attached Schedule of Events/ Cohort visit flowchart for visit 
specific activity.  
 
7.0 
Data and Specimen Banking 
Surveys: 
The instruments as above (CTS-6 and Quick DASH) are needed to provide 
objective data on the severity, type of dysfunction, and overall functional 
capacity. These are standard treatment evaluations used by physicians. All efforts 
will be made to use study numbers but original (source) questionnaires may 
contain patient names or identifiers. However, the scores will then be transferred 
to a de-identified database (by using a linking key) that can be statistically 
analyzed. 
 
All results will be entered into a database that will be accessed by study personnel 
only. A linking system will be utilized so only de-identified information will be 
sent to a statistician for analysis.  
 
All results will be entered into a database along with basic demographic 
information including age (age above age 89 will be categorized as >89), race, 
medical comorbidities; concurrent use of splint or other conservative therapies.  
 
Additional Variables to be collected: 
•Complete OMT therapy schedule (including number of visits, time post initial 
evaluation)  
•OMT techniques documented and categorized types, dosages, and frequency of 
medications injected into the carpal tunnel 
•Types, dosages, and frequency of oral NSAIDs and opioids prescribed to treat 
the symptoms of CTS 
 
 
 

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8.0 
Sharing of Results with Subjects 
Study results will not be shared with study participants. 
 
9.0 
Study Timelines 
Note – these are estimated time lines 
Study enrollment following IRB approval:  Study enrollment begins January 1, 
2024 and will continue through November 1, 2024 
 
Data Collection following IRB approval: Data collection will continue through 
December 31, 2024 
 
 
Data analysis/write-up: January 1, 2025-  March 31, 2025 
 
Subject visit specific timeline: Please see attached Schedule of Events/ 
Cohort visit flowchart. 
 
10.0 Inclusion and Exclusion Criteria* 
 
Screening for Eligibility:  
Patients from the Kettering Health facilities, Dayton Center for 
Neurological Disorders (DCND), OMT practices, Orthopedic Hand Clinic,  
as well as Orthopedics of Southwest Ohio offices may be screened for 
carpal tunnel syndrome and whether they meet study specific inclusion 
criteria. 
 
Inclusion Criteria 
• Men and women with a diagnosis of unilateral or bilateral mild to 
moderate carpal tunnel syndrome based on recent clinical finding and 
EMG within 1 year 
• ages 18 and older 
• any sex, race, and ethnic group 
 
Exclusion Criteria: 
• History of undergoing recent (prior 3 months/current) physical therapy, 
OMT or massage therapy for treatment of carpal tunnel syndrome 
• No steroid injections in wrist in the last 3 months prior to enrollment 
• History of wrist trauma or surgery 
• Hypothyroidism (uncontrolled - defined as TSH >4.5 mIU/L in the last 12 
months) 
• Severe CTS  
• Systemic disease or condition including but not limited to uncontrolled 
diabetes mellitus (defined as HgbA1c >6.5% in the last 12 months), 

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thyroid disorders, rheumatoid disorders, Paget's bone disease, gout, 
myxedema, multiple myeloma, acromegaly, hepatic disease, dialysis 
patients, or other diseases or conditions in which peripheral neuropathies 
are common 
• Secondary cause of CTS such as a ganglion cyst, mass, or an accessory 
muscle shown by US or MRI of the affected wrist 
• Bifid median nerve as shown by US or MRI of the affected wrist 
• Pregnancy (self-reported)  
 
 
11.0 Vulnerable Populations 
No vulnerable populations such as pregnant women, minors, or prisoners will be 
included. 
 
12.0 Local Number of Subjects 
Up to 36 records meeting the inclusion/exclusion criteria will be included 
in the data collection.    
 
13.0 Recruitment Methods 
The target patient population are patients who have been diagnosed with mild to 
moderate carpal tunnel syndrome and will receive either traditional conservative 
therapy only, traditional conservative therapy + OMT, or OMT only. Within the 
past year, approximately 600 patients were seen by Orthopedics of Southwest 
Ohio alone for carpal tunnel syndrome, with 200 of these patients meeting criteria 
for immediate surgery and 400 meeting criteria for conservative therapy.  
 
This orthopedic office is very active in research and actively recruits patients to 
open clinical trials. Additionally, referrals can also be made from primary care 
practices throughout the network (Internal Medicine and Family Practice) and 
neurology. As the sub investigators for this project span many disciplines, we 
have the capacity to reach a wide variety of patients in our community hospital 
network. 
 
Recruitment materials will be available at other outpatient offices as approved by 
the practice. This includes, but not limited to: OMT offices, Orthopedic Hand 
Clinic, DCND, OASWO, and KH Primary Care. This also includes website 
presence.  
 
Deep 6 AI screening tool will be utilized by the Kettering Health team to identify 
patients that have carpal tunnel and a recent EMG.  
 
Screening the EMG schedule at DCND and EMG & Rehabilitation Physicians 
may also be performed.  
 
Kettering Health Primary Care is also referring potential patients.  
 
14.0 Withdrawal of Subjects 

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Patients may voluntarily withdrawal at any time without loss of benefit. Treating 
physicians will also have the option of withdrawing patients who are not 
benefiting from the prescribed therapy and require additional treatment options, 
who are not following their prescribed treatments or do not show up for scheduled 
visits, or any other reason they deem to be necessary in their clinical opinion. 
However, information that has already been collected and input into the database 
will be used up until the point the patient decides to leave the study. 
 
15.0 Risks to Subjects 
The treatments described are all considered standard of care. There are no new 
additional risks beyond those normally associated with each treatment modality. 
Each participant will be evaluated by the treating physician who may remove the 
patient from the study if they deem the participant needs additional treatment not 
allowed or included in this study. 
 
As data is being collected, despite all efforts to safeguard the patients' personal 
information, there is always a possibility of a breach of patient confidentiality. 
 
16.0 Potential Benefits to Subjects 
Patients may not receive any direct benefits from the study. They are receiving 
standard of care treatment and therefore should receive the same benefit as 
receiving prescribed treatment for Carpal Tunnel Syndrome. 
 
 
17.0 Data Management and Confidentiality 
Data Analysis: 
• Data will be evaluated for assumptions (e.g., normality, 
homogeneity of variances, etc.), checked for outliers, and assessed 
for systematic bias to ensure valid analysis. Transformations will 
be applied, as necessary. Significance will be evaluated at α<0.05. 
Analyses will be conducted using SAS® v9.4. 
• Descriptive statistics will be performed to describe and summarize 
the data. Median nerve mechanical properties (elasticity/stiffness) 
will be measured with shear wave elastography. The association 
between type of treatment and median nerve mechanical properties 
will be compared using analysis of variance (ANOVA), followed 
by multiple Bonferroni comparisons to compare difference in these 
parameters based on severity of properties.  
 
Data security: 
• All results will be entered into a database that will be accessed by study 
personnel only. A subject key will be utilized so only de-identified 
information will be sent to a statistician for analysis. 
 
• All study personnel will be trained in HIPAA guidelines and the ethical 
conduct of research.  

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• Upon completion of data collection and analysis, all electronic data will be 
permanently deleted and saved as a blank document. 
 
 
18.0 Provisions to Monitor the Data to Ensure the Safety of Subjects 
All patients will be monitored by the treating physician. The treating physician 
may, for any reason , remove the patient from the study and receive additional 
treatment. Additionally, the research personnel will enter data and will inform the 
treating personnel if trends or concerning findings within specific groups  
are noticed. 
 
19.0 Provisions to Protect the Privacy Interests of Subjects 
Due to the possible risk of breaching confidentiality, the provisions discussed in 
section 17.0 will be followed. 
 
20.0 Compensation to Subjects 
If a patient agrees to take part in this research study, Kettering Health will mail 
them a check after completing visits, following this payment schedule: 
· Initial Baseline/Screening Visit (includes EMG and Imaging) - $50 
· Treatment visits - $20 per visit 
· Ultrasound imaging visits - $20 per visit 
· Final EMG - $80 
 
21.0 Economic Burden to Subjects 
Because these are standard of care procedures and should be covered by 
insurance, there will not be any economic burden to a subject. 
 
22.0   Consent Process 
Only study personnel will obtain informed consent. Participants who met 
inclusion criteria will meet with a member of the study team to discuss the study. 
Patients will be given adequate time to review the consent and ask any questions. 
Patients who are interested in the study after being informed by their treating 
physician may be enrolled over the phone and will sign consent prior to beginning 
therapy.  
 
The informed consent discussion may be performed remotely via telephone, with 
the participant receiving an electronic copy of the informed consent prior to the 
discussion.  
 
Patients will need to be enrolled into the study prior to discharge from the index 
surgery so they can be entered into conservative therapy and given proper 
instructions, baseline questionnaires completed, and all pain medication usage 
captured. 

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23.0 Process to Document Consent in Writing 
• Patients who are seen in the or clinic who met inclusion criteria will meet with 
a member of the study team to discuss the study. Patients will be given 
adequate time to review the consent and ask any questions.  
 
• Patients who are interested in the study after being informed by their treating 
physician will sign consent or they may be enrolled over the phone and will 
sign consent prior to beginning therapy.  
 
• Patients will need to be enrolled into the study prior to discharge from the 
index surgery so they can be entered into the type of conservative therapy and 
the proper instructions can be given, baseline questionnaires can be completed 
and all pain medication usage will be captured 
 
• Signatures for the informed consent may be obtained electronically via 
DocuSign.  
 
 
22.0 Setting 
Orthopedic Associates of Southwest Ohio clinics, Yankee Office Building (where 
OMT treatment visits will take place), DCND where limited EMG’s will be 
performed, and Kettering Health Washington Township Radiology Department. 
 
23.0 Resources Available 
• Kettering Health is committed to innovation and research as evidenced by 
their Research Institute that is available to support experienced researchers 
and guide novice learners through the entire life cycle of a research project.  
 
• All residents, faculty, and staff members have access to medical library 
services through the Office of Research Integrity, the Institutional Review 
Board (IRB) for Kettering Health ensure oversight of research projects.  
 
• The Academic Research Specialist provides additional support and instruction 
ensuring projects are reasonable, feasible, and impactful. The 
other integral aspect of the Research Institute is a fully staffed and centralized 
clinical trial management capacity.  
 
• Office of Orthopedics of Southwest Ohio research study coordinator 
 
24.0 References 
 
I. Miller TT and Reinus WR. Nerve Entrapment Syndromes of the Elbow, Forearm, and 
Wrist AIR 2010; 195:585-594. 
 

PI L O T R C T of O M T a n d C o nser vati ve T hera p y i n Car pal T u n nel Patie nts 
 
 
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0. 3J 9 0 1jc m 1 1 0 4 0 9 5 0  
 
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