Exploration of Carpal Tunnel Mechanics for CTS Treatment

描述(申请人提供)：腕管综合征(CTS)是最常见的压迫性神经病，对国家医疗保健、工人生产力和生活质量有巨大影响。尽管其发病率和公共卫生成本很高，但我们对CTS的了解有限，CTS的管理有待改进。目前，CTS的治疗是常规的腕管松解手术，不幸的是，这有一些并发症。这种外科手术的概念已经存在了近一个世纪，没有根本的挑战。人们曾尝试用手法保守治疗CTS，但由于缺乏科学和临床证据，在我们追求CTS治疗的过程中，我们偶然发现了一种新的腕管操纵机制，通过缩小腕弓宽度来获得隧道扩大。这一发现具有开发CTS保守治疗策略的令人兴奋的潜力。我们的腕管操作方法与现有的试图向外伸展腕弓的有争议的技术形成了鲜明对比。因此，我们的最终目标是通过对腕管的力学和病理力学的严格科学研究，开发一种治疗CTS的生物力学方法。我们的中心思想是，CTS可以通过缩小腕弓宽度对腕管进行非手术的生物力学操作来治疗。我们假设，策略性地对腕部施加压迫可以增加腕管横截面积，降低腕管压力，从而缓解正中神经的机械性损伤。我们将利用身体标本和人体标本，通过系统地研究横向压力、腕管压力、腕弓宽度和腕管横截面积之间的生物力学关系来验证这一假说。该项目的实施将在腕管力学和病理力学方面产生新的知识，从而为CTS提供一种基于证据的新的生物力学治疗策略。 公共卫生相关性：腕管综合征(CTS)是一种众所周知的手部疾病，对医疗保健、工人生产力和生活质量有巨大影响。每年，大约有50万美国人接受腕管手术，切断腕横韧带以缓解CTS的症状。毫无疑问，韧带的存在具有重要的解剖、生物力学和生理功能；因此，它应该被保存而不是被切断。对于CTS的非手术治疗，使用手法治疗的历史由来已久；然而，由于缺乏令人信服的科学和临床证据，这些干预措施的有效性仍然不明确。我们发现了一种通过生物力学操作来扩大腕管的新机制。这一发现对于开发CTS的保守治疗方法具有令人兴奋的潜力。因此，我们的项目最终将通过使用身体标本和人体标本对腕管的力学和病理力学进行严格的科学研究，开发一种非侵入性的生物力学治疗方法。

DESCRIPTION (provided by applicant): Carpal tunnel syndrome (CTS) is the most common compression neuropathy and has an immense impact on national health care, worker productivity, and quality of life. Despite its high prevalence and public health cost, our understanding of CTS is limited, and the management of CTS awaits improvement. Currently, CTS is routinely treated by carpal tunnel release surgery, which unfortunately has a number of complications. The concept of this surgical procedure has existed for nearly a century without fundamental challenges. Attempts have been made to conservatively treat CTS using manual therapies, but their effectiveness is ambiguous due to the lack of scientific and clinical evidence In our pursuit of CTS management, we have serendipitously discovered a novel mechanism of carpal tunnel manipulation to obtain tunnel enlargement by narrowing the carpal arch width. This discovery has exciting potential for the development of conservative treatment strategies for CTS. Our approach to carpal tunnel manipulation is in sharp contrast to the existing controversial techniques that try to stretch the carpal arch outwards. Therefore, our ultimate goal is to develop a biomechanical treatment for CTS through rigorous scientific studies on the mechanics and pathomechanics of the carpal tunnel. Our central notion is that CTS can be treated by non-surgical, biomechanical manipulation of the carpal tunnel through the narrowing of the carpal arch width. We hypothesize that strategically applied compression on the wrist can increase carpal tunnel cross-sectional area and decrease carpal tunnel pressure, thus relieving the median nerve from mechanical insult. We will test this hypothesis by systematically investigating the biomechanical relationships among transverse compressive force, carpal tunnel pressure, carpal arch width, and carpal tunnel cross-sectional area using cadaveric specimens and human subjects. The implementation of this project will yield novel knowledge on carpal tunnel mechanics and pathomechanics, leading to an evidence-based, novel biomechanical treatment strategy for CTS. PUBLIC HEALTH RELEVANCE: Carpal tunnel syndrome (CTS) is a well-known hand disorder and has an immense impact on health care, worker productivity, and quality of life. Annually, about half a million Americans undergo carpal tunnel surgery to cut the transverse carpal ligament to relieve the symptoms of CTS. Undoubtedly, the ligament exists to serve important anatomical, biomechanical and physiological functions; thus it should be preserved rather than cut. There is a long history of utilizing manual therapies for non-surgical treatment of CTS; however, the effectiveness of these interventions remains ambiguous due to the absence of convincing scientific and clinical evidence. We have discovered a novel mechanism to enlarge the carpal tunnel through biomechanical manipulation. This discovery has exciting potential for the development of a conservative treatment for CTS. Therefore, our project will ultimately develop a non-invasive biomechanical treatment of CTS through rigorous scientific investigation into the mechanics and pathomechanics of the carpal tunnel using cadaveric specimens and human subjects.