Non-invasive Electrical Stimulation to Augment Human Peripheral Nerve Regeneration in Carpal Tunnel Syndrome

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*What is this research about?*Our research is about improving nerve healing. Nerve injuries are very common, and typically caused by trauma or nerve compression. While nerves do regrow after injury, this process is not perfect and people are commonly left with pain, numbness, or weakness. In fact, the British Society for Surgery of the Hand recently identified improving nerve recovery as one of the top ten most important research topics in hand surgery.We are particularly interested in carpal tunnel syndrome (CTS), a nerve injury caused by compression of the median nerve at the wrist. CTS causes pain and tingling in the hand, and weakness of the thumb. Most people need surgery to decompress the nerve. CTS is very common - up to one in ten people will develop CTS in their lifetime, and carpal tunnel decompression is one of the commonest operations performed in UK. However, many people don't recover fully even after successful surgery. One of the most promising treatments to improve nerve regrowth and recovery in CTS is called electrical stimulation. This uses small amounts of electricity to stimulate the nerve.All previous research has used invasive electrical stimulation, implanting electrodes during surgery and using them to stimulate the nerve after the operation. This approach is not ideal as surgically implanting electrodes carries extra risks, and stimulating the nerve after the operation requires a simple operation like carpal tunnel decompression to be done under general anaesthetic. There is also evidence that stimulating the nerve before surgery promotes better nerve healing than post-operative stimulation. This study will be the first ever investigation into non-invasive stimulation applied before surgery, which would overcome these limitations. *What is the aim of this research?* We want to find out whether non-invasive electrical stimulation of the median nerve before carpal tunnel surgery helps people recover better function in their hands. Answering this question requires us to better understand what happens to the nerve during stimulation and eventually to run a large study comparing stimulation and no stimulation. *What will this research involve?*First, we plan to perfect techniques for stimulating the median nerve through the skin. We will make a computer model of the wrist from MRI scan images. We will use the computer model to design a non-invasive stimulation protocol which should produce the same healing effect as invasive stimulation. We will then run a small study in which people will receive either real or sham (placebo) non-invasive stimulation prior to their operation. We will follow these people for six months. The main aim of this small study is to determine if a larger study would be feasible. We are interested in:- How many people are willing to take part- If people stay on board for all six months- If people can tell whether they had the real or sham stimulationOf course, we also want to see if there are any differences in recovery after surgery between groups. We will collect information on symptoms and hand function before and after surgery, as well as detailed information on nerve function. We will also take small samples of skin from the finger before and after surgery, which will allow us look at how nerves regrow into the skin. We will look for differences in these outcomes between stimulation and sham groups, which will help us design a larger study afterwards.*Who will this research help?*This research will help people with CTS and other kinds of nerve injury, such as those caused by accidents, trauma during childbirth, or removal of cancers. Using computer models to understand nerve responses will allow other researchers to perfect stimulation for specific types of nerve injury, something we currently cannot do. Clinically, our results could help many people who treat nerve injuries, including surgeons, neurologists and physiotherapists.