Dynamic Ultrasound to Enhance Understanding of Carpal Tunnel Syndrome

描述（由申请人提供）：腕管综合征（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，超声可检测的变化，神经，肌腱和滑膜下结缔组织（SSCT）的流动性与CTS患者可能是有用的临床功能的生物标志物，相关的，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，将通过超声和手术和非手术治疗前后的临床评估来监测CTS治疗的患者。我们将把临床结果与我们发现的CTS患者最易变的初始超声运动模式相关联。我们还将测试的假设，即成功的治疗结果在一个正常的变化，在受影响的超声变量。有四个具体目标。目标1是评估 我们已经确定了功能性生物标志物（SSCT与肌腱运动、背神经运动和神经形状随运动的变化的比率），以预测CTS患者注射类固醇后的结果。目的2是评估我们已经确定的功能性生物标志物预测CTS患者手术后结果的能力。目的3是检验我们的次要假设，即注射和手术后的治疗反应与受影响的超声变量向正常变化相关。目标4是利用目标1-3的结果， 另外的生物标志物可能与治疗结果相关，并确定任何复合临床和生物标志物措施，可以提高预测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可用于针对特定CTS患者的治疗。这种新的超声工具可以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。

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.