Exploration of Carpal Tunnel Mechanics for CTS Treatment

CTS治疗的腕管力学探索

• 批准号: 8285010
• 负责人: Zong-Ming Li
• 金额: $ 20.78万
• 依托单位: CLEVELAND CLINIC LERNER COM-CWRU
• 依托单位国家: 美国
• 财政年份: 2012
• 资助国家: 美国
• 起止时间: 2012-04-05 至 2014-03-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8285010
• 关键词: Achievement; Address; American; Area; Biomechanics; Carpal Tunnel Syndrome; Clinical; Complement; Development; Devices; Disease; Effectiveness; Effectiveness of Interventions; Foundations; Goals; Hand; Health Care Costs; Health Personnel; High Prevalence; Individual; Investigation; Knowledge; Ligaments; Manuals; Mechanics; Methods; Morphology; National Institute of Arthritis and Musculoskeletal and Skin Diseases; Neuropathy; Operative Surgical Procedures; Physiological; Population; Positioning Attribute; Principal Investigator; Process; Productivity; Property; Public Health; Quality of life; Recording of previous events; Recruitment Activity; Research; Solutions; Specimen; Staging; Stretching; Symptoms; Techniques; Technology; Testing; Therapeutic Intervention; Treatment Efficacy; United States National Institutes of Health; Width; Wrist; clinical practice; evidence base; human subject; improved; in vivo; innovation; median nerve; novel; pressure; programs; risk benefit ratio; sound; treatment strategy

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.

描述（由申请人提供）：腕管综合征（CTS）是最常见的压迫性神经病，对国民保健、工人生产力和生活质量有巨大影响。尽管CTS的患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通常通过腕管松解手术治疗，不幸的是，该手术有许多并发症。这种外科手术的概念已经存在了近世纪，没有根本的挑战。已经尝试使用手动疗法保守治疗CTS，但由于缺乏科学和临床证据，其有效性尚不明确。在我们对CTS管理的追求中，我们偶然发现了一种新的腕管操作机制，通过缩小腕弓宽度来扩大腕管。这一发现对于CTS保守治疗策略的发展具有令人兴奋的潜力。我们的方法腕管手术是在鲜明的对比，现有的争议技术，试图伸展腕弓向外。因此，我们的最终目标是通过对腕管力学和病理力学的严格科学研究，开发CTS的生物力学治疗方法。我们的中心概念是，CTS可以通过非手术治疗，通过腕弓宽度缩小腕管的生物力学操作。我们假设，手腕上的战略应用压缩可以增加腕管横截面积和减少腕管压力，从而减轻正中神经的机械损伤。我们将使用尸体标本和人类受试者，通过系统地研究横向压缩力、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设。该项目的实施将产生新的知识腕管力学和病理力学，导致一个循证的，新的生物力学治疗策略的CTS。 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着巨大的影响。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，韧带的存在是为了发挥重要的解剖学、生物力学和生理学功能;因此，应该保留而不是切断。使用手法治疗CTS的非手术治疗有很长的历史;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。我们已经发现了一种新的机制，扩大腕管通过生物力学操作。这一发现对于CTS保守治疗的发展具有令人兴奋的潜力。因此，我们的项目将最终开发一种非侵入性的CTS生物力学治疗，通过严格的科学调查的力学和病理力学的腕管使用尸体标本和人类受试者。