Sonographic tissue morphology in early stage work-related median nerve pathology

早期工作相关正中神经病理学的超声组织形态

• 批准号: 9150539
• 负责人: Shawn C. Roll
• 金额: $ 60.28万
• 依托单位: UNIVERSITY OF SOUTHERN CALIFORNIA
• 依托单位国家: 美国
• 财政年份: 2015
• 资助国家: 美国
• 起止时间: 2015-09-30 至 2019-09-29
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9150539
• 关键词: Sonographic; tissue; morphology; early; stage

 DESCRIPTION (provided by applicant): Carpal tunnel syndrome is the most expensive upper extremity work-related musculoskeletal disorder, impacting 10 million people annually and costing employers up to $113,695 per incident. Although many etiologic mechanisms have been identified, one set of factors cannot accurately predict carpal tunnel syndrome development. As a result, carpal tunnel syndrome interventions are often provided reactively after initial symptom reports or inefficiently to employees perceived to be at risk. As the disorder progresses, it becomes increasingly expensive to treat and functional limitations become more challenging to remediate. There is currently no established method to detect this disorder prior to the onset of symptoms and nerve damage. Preliminary research suggests that sonography-a relatively inexpensive, widely available, increasingly portable technology-can provide a non-invasive and pain-free method of early detection that could reduce incidence, improve targeted interventions and ultimately reduce costs. Sonographic imaging has been used in an animal model to observe early progressive increases in median nerve size due to task exposure. By understanding this progression in humans, it would be possible to develop an early detection technique to stop, slow, or reverse this disorder before it becomes costly and debilitating. Thus, the long-term goal of this work is to develop a model of morphologic changes predictive of the onset and development of work-related carpal tunnel syndrome. As a first step, this study will establish predictive validity of a novel method for early detection using sonographic imaging and identify task components of intensive functional hand activity associated with morphologic changes. This longitudinal study will follow dental hygiene students-a high-risk population with minimal retrospective and controlled prospective task exposure-for two years to investigate these aims. This research is directed at the National Occupational Research Agenda's (NORA) Healthcare and Social Assistance sector with a focus on the National Institute of Occupational Safety and Health's (NIOSH) Exposure Assessment and Musculoskeletal Disorders cross-sectors. Intermediate outcomes of this research will establish sonographic imaging as an early detection tool for workplace-screening and inform methods for combining measures of nerve morphology, neurophysiology, and subjective symptoms for predicting the development of work-related carpal tunnel syndrome. This work will also inform the development of targeted preventive interventions for task components of intensive hand activities that are related to changes in tissue morphology. Finally, this work will provide access to a cohort of individuals who can be followed as they transition into the workforce to document the natural development of work-related musculoskeletal disorders. Identifying morphologic changes in early-stages of pathology and the specific task components linked to these changes are the first steps toward early detection and prevention of work-related carpal tunnel syndrome.

 描述（由申请人提供）：腕管综合症是最昂贵的上肢工作相关肌肉骨骼疾病，每年影响 1000 万人，每次事故给雇主造成的损失高达 113,695 美元。尽管已经确定了许多病因机制，但一组因素无法准确预测腕管综合征的发展。因此，腕管综合症干预措施通常是在最初的症状报告后被动提供的，或者对被认为处于危险之中的员工效率低下。随着疾病的进展，治疗费用越来越高，功能限制也变得越来越难以修复。目前还没有既定的方法可以在症状和神经损伤出现之前检测到这种疾病。初步研究表明，超声检查——一种相对便宜、广泛使用、日益便携的技术——可以提供一种非侵入性、无痛的早期检测方法，可以减少发病率、改善有针对性的干预措施并最终降低成本。超声成像已用于动物模型中，以观察由于任务暴露而导致的正中神经尺寸的早期渐进性增加。通过了解人类的这种进展，就有可能开发出一种早期检测技术，在这种疾病变得代价高昂和使人衰弱之前阻止、减缓或逆转这种疾病。因此，这项工作的长期目标是开发一种形态变化模型，预测与工作相关的腕管综合征的发生和发展。作为第一步，本研究将建立一种使用超声成像进行早期检测的新方法的预测有效性，并识别与形态变化相关的密集功能性手部活动的任务组成部分。这项纵向研究将跟踪口腔卫生专业的学生——一个高风险人群，以最少的回顾性和受控的前瞻性任务暴露——为期两年来调查这些目标。这项研究针对国家职业研究议程 (NORA) 的医疗保健和社会援助部门，重点关注国家职业安全与健康研究所 (NIOSH) 的暴露评估和肌肉骨骼疾病跨部门。这项研究的中期成果将建立超声成像作为工作场所筛查的早期检测工具，并为结合神经形态、神经生理学和主观症状的测量提供方法，以预测与工作相关的腕管综合症的发展。这项工作还将为针对与组织形态变化相关的密集手部活动的任务组成部分制定有针对性的预防干预措施提供信息。最后，这项工作将为一群人提供机会，在他们过渡到劳动力市场时对其进行跟踪，以记录与工作相关的肌肉骨骼疾病的自然发展。识别病理早期阶段的形态变化以及与这些变化相关的具体任务组成部分是早期发现和预防与工作相关的腕管综合症的第一步。