Biomechanical Treatment of Carpal Tunnel Syndrome

 描述(申请人提供)：腕管综合征(CTS)是一种常见的手部疾病，由腕部正中神经压迫引起。它对国家医疗保健、工人生产力和生活质量有着巨大的影响。CTS的治疗通常采用横断腕横韧带以减压正中神经的手术。这种外科手术的概念已经存在了近一个世纪，没有根本的挑战，尽管这种手术有许多并发症。已经尝试了不释放韧带的替代治疗方法，但由于缺乏科学和临床证据，其疗效仍然存在争议。我们对改进的CTS治疗策略的探索偶然发现了一种新的正中神经减压机制，即通过对腕部施加横向压迫来重塑和扩大隧道空间。我们通过缩短腕弓宽度来扩张腕管的方法与现有的试图向外拉伸腕管的方法形成了鲜明对比。我们的发现和概念验证具有根据生物力学原理进行非手术治疗CTS的巨大潜力。这个拟议项目的总体目标是设计和开发一种腕管操作策略，以达到治疗CTS的效果。我们的中心假设是，我们的生物力学操作方法增加了腕管面积，从而减压了正中神经，缓解了CTS症状。为了实现这一目标并确认假设，将实施三个具体目标：(1)确定腕管操作的最佳生物力学策略，使腕管横截面积以最小的压力量有效增大；(2)研究CTS患者在生物力学操作过程中腕管形态、正中神经形态和腕管压力的变化；以及(3)证实生物力学干预在改善CTS相关神经生理缺陷和症状方面的临床有效性。该项目结合基础科学和临床翻译，阐明生物力学干预的潜在形态和生理机制，以系统和严格地开发以证据为基础的CTS治疗策略。该项目的完成将加速我们实现一种新的策略，即无需手术即可实现生物力学管理CTS。

 DESCRIPTION (provided by applicant): Carpal tunnel syndrome (CTS) is a prevalent hand disorder caused by compression of the median nerve at the wrist. It has an immense impact on national health care, worker productivity, and quality of life. CTS is commonly treated by a surgery that transects the transverse carpal ligament to decompress the median nerve. This surgical concept has existed for nearly a century without fundamental challenges, even though this procedure has a number of complications. Alternative treatments that do not release the ligament have been attempted, but their efficacy remains controversial due to lack of scientific and clinical evidence. Our search for an improved CTS treatment strategy has resulted in the serendipitous finding of a novel mechanism of median nerve decompression by applying transverse compression to the wrist to reshape and enlarge the tunnel space. Our approach to carpal tunnel expansion by shortening the carpal arch width is in contrast to existing methods that try to stretch the carpal tunnel outwards. Our finding and proof-of-concept hold significant potential to non-surgically treat CTS according to biomechanical principles. The overall goal of this proposed project is to design and develop a strategy of carpal tunnel manipulation that achieves treatment efficacy for CTS. Our central hypothesis is that our approach of biomechanical manipulation increases carpal tunnel area, thereby decompressing the median nerve and alleviating CTS symptoms. Three specific aims will be implemented to achieve the objective and confirm the hypothesis: (1) to determine the optimal biomechanical strategy of carpal tunnel manipulation such that the carpal tunnel cross-sectional area is effectively enlarged with the least amount of compressive force; (2) to investigate changes of carpal tunnel morphology, median nerve shape, and carpal tunnel pressure in response to the biomechanical manipulation in individuals with CTS; and (3) to demonstrate the clinical effectiveness of the biomechanical intervention in improving the neurophysiological deficiencies and symptoms associated with CTS. This project combines basic science and clinical translation, elucidating the underlying morphological and physiological mechanisms of the biomechanical intervention for a systematic and rigorous development of an evidence-based strategy for CTS treatment. Completion of this project will accelerate our realization of a novel strategy to biomechanically manage CTS without surgery.