Dynamic Ultrasound Measurement of Median Nerve Kinematics in the Carpal Tunnel

描述（由申请人提供）：腕管综合征（Carpal tunnel syndrome， CTS）是最常见的压缩性周围神经病变，其诊断、治疗和间接费用相关的经济负担高达数十亿美元。典型的临床检查和电诊断神经传导测试的诊断方案不适合早期CTS患者保留正常的神经功能。然而，早期CTS的明确诊断是非常可取的，因为这些患者可能更容易接受保守治疗，这将减少他们的长期残疾和治疗费用。不幸的是，使用MRI或超声等成像方法并不能改善早期CTS的诊断。CTS是一种压缩性神经障碍，可因手部活动而加重。在正常的、功能负荷的手部运动中，正中神经在指屈肌腱之间的腕管中剧烈移动，从而使其处于被这些邻近结构压迫的巨大风险中。这些压缩损伤的积累可能有助于CTS症状的发展。超声是唯一一种临床可用的方法，它允许在所有潜在的机械损伤中对正中神经进行动态成像，它可能在整个手部运动过程中承受。该项目的目的是利用超声识别重复性运动任务中正中神经运动学（运动路径、速度和运动连续性）的差异，并量化健康受试者和CTS患者之间神经运动学的差异。第一项任务将是标准化超声图像外观，以便使用基于计算机的方法进行神经运动学测量。然后，在进行重复性活动的健康受试者中测量正中神经运动学。最后，确定健康受试者与CTS患者正中神经运动学的差异。从长远来看，可测量的功能性组织运动学异常可能提供CTS的客观诊断，并有助于了解导致CTS发展的组织力学潜在异常。

DESCRIPTION (provided by applicant): Carpal tunnel syndrome (CTS) is the most commonly encountered compressive peripheral neuropathy, and the economic burden associated with its diagnosis, treatment, and indirect costs is in the billions of dollars. The typical diagnostic protocol of clinical examination and electro diagnostic nerve conduction testing is not suited to patients with early-stage CTS who retain normal nerve function. However, definitive diagnosis of early-stage CTS is highly desirable because these patients may be more receptive to conservative therapies that would decrease their long-term disability and treatment costs. Unfortunately, use of imaging methods such as MRI or ultrasound has not improved diagnosis of early-stage CTS. CTS is a compressive nerve disorder that is aggravated by hand activity. During normal, functionally-loaded hand movements, the median nerve has been shown to move dramatically through the carpal tunnel between the digital flexor tendons, thereby putting it at great risk for compression by these neighboring structures. Accumulation of these compressive insults may contribute to the development of CTS symptoms. Ultrasound is the only clinically available methodology which allows for dynamic imaging of the median nerve during all of the potential mechanical insults it may endure throughout the course of hand movement. The goal of this project is to use ultrasound to identify differences in median nerve kinematics (motion paths, speed, and movement continuity) associated with repetitive motion tasks, and to quantify differences in nerve kinematics between healthy subjects and CTS patients. The first task will be to standardize ultrasound image appearance so that measurements of nerve kinematics can be made using computer-based methods. Then, median nerve kinematics will be measured in healthy subjects performing repetitive activities. Finally, differences between median nerve kinematics in healthy subjects versus CTS patients will be identified. In the long term, measurable abnormalities in functional tissue kinematics may provide an objective diagnosis of CTS and contribute to the understanding of the underlying abnormalities in tissue mechanics that are responsible for the development of CTS.