Dynamic Ultrasound to Enhance Understanding of Carpal Tunnel Syndrome

描述（由申请人提供）：腕管综合征（Carpal tunnel syndrome， CTS）是最常见的周围神经病变，但目前还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CTS患者的神经、肌腱和滑膜下结缔组织（SSCT）活动度的变化可能作为与CTS相关的功能性生物标志物在临床上有用，从而作为治疗反应的预测因子。为了验证这一假设，我们提出了一项临床研究，在该研究中，就诊的CTS患者将在手术和非手术治疗前后通过超声和临床评估进行监测。我们将临床结果与最初的超声运动模式联系起来，我们发现在CTS患者中最可变。我们还将检验成功治疗导致受影响的超声变量向正常方向变化的假设。有4个具体目标。目的一是评估

DESCRIPTION (provided by applicant): 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 t 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.