Dynamic Ultrasound to Enhance Understanding of Carpal Tunnel Syndrome

腕管综合征（CTS）是最常见的周围神经病变，但目前 没有生物标志物来帮助指导治疗或预测患者的具体结果。 我们假设，超声检测到的神经，肌腱和 在CTS患者中，滑膜下结缔组织（SSCT）活动度可能是有用的 在临床上作为功能性生物标志物，其与 治疗反应的预测因子。为了验证这一假设，我们提出了一个临床 通过超声监测接受CTS治疗的患者的研究 并通过手术和非手术治疗前后的临床评估。我们将 将临床结果与我们拥有的初始超声运动模式相关联， 发现CTS患者的变化最大。我们还将检验以下假设： 成功的治疗会使受影响的人变得正常 超声变量 有四个具体目标。目的1是评估功能性 我们已经确定的生物标志物（SSCT与肌腱运动，背神经运动， 以及运动时神经形状的变化）来预测类固醇注射后的结果。 CTS患者目的2是评估我们所拥有的功能性生物标志物的能力 预测CTS患者手术后的结果。目标3是测试我们的 注射和手术后的治疗反应相关的次要假设 受影响的超声变量向正常变化。目标4是，使用 目的1-3的结果，鉴定可能与治疗相关的其他生物标志物 结果，并确定任何复合临床和生物标志物措施， 提高预测CTS治疗后结果的能力。 如果这些目标得以实现，功能性生物标志物将首次被 为CTS患者量身定制治疗方案。美国的这一新工具可以在 迅速转化为临床使用，因为设备是普遍可用的， 新的算法可以迅速传播。

Carpal tunnel syndrome (CTS), is the most common peripheral neuropathy, but currently there are no biomarkers to help guide treatment or to predict patient specific outcomes. We hypothesize that ultrasound detectable variations in nerve, tendon and subsynovial connective tissue (SSCT) mobility in patients with CTS may be useful clinically as functional biomarkers that correlate with, and thereby serve as predictors for, treatment response. To test this hypothesis, we propose a clinical study in which patients presenting for treatment of CTS will be monitored by ultrasound and by clinical assessment before and after surgical and non-surgical treatment. We will correlate the clinical outcomes with the initial ultrasound motion patterns that we have found to be most variable in CTS patients. We will also test the hypothesis that successful treatment results in a change towards normal in the affected ultrasound variables. There are 4 Specific Aims. Aim 1 is to assess the ability of the functional biomarkers we have identified (the ratio of SSCT to tendon motion, dorsal nerve motion, and changes in nerve shape with motion) to predict outcome after steroid injection in patients with CTS. Aim 2 is to assess the ability of the functional biomarkers we have identified to predict outcome after surgery in patients with CTS. Aim 3 is to test our secondary hypothesis that treatment response after both injection and surgery correlates with a change towards normal in the affected ultrasound variables. Aim 4 is to, using the results from Aims 1-3, identify additional biomarkers that may correlate with treatment outcome, and to identify any composite clinical and biomarker measures that may improve the ability to predict outcome after treatment for CTS. If these aims are achieved, functional biomarkers will, for the first time, be available to tailor treatment for specific patients with CTS. This new US tool can be rapidly translated into clinical use, since the equipment is commonly available and the new algorithms could be rapidly disseminated.