Dynamic Ultrasound to Enhance Understanding of Carpal Tunnel Syndrome

腕管综合征(CTS)，是最常见的周围神经病变，但目前 目前还没有生物标志物来帮助指导治疗或预测患者的特定结果。 我们假设超声波可以检测到神经、肌腱和 CTS患者滑膜下结缔组织(SSCT)的活动度可能是有用的 临床上作为功能性生物标记物，与 治疗反应的预测因子。为了验证这一假设，我们提出了一个临床实验。 对来接受CTS治疗的患者进行超声监测的研究 并通过手术和非手术治疗前后的临床评估。我们会 将临床结果与我们已有的初始超声运动模式相关联 发现在CTS患者中最具变异性。我们还将检验这一假设 成功的治疗使受影响的患者恢复正常 超声变量。 有4个具体目标。目标1是评估功能的能力 我们已经确定的生物标志物(SSCT与肌腱运动的比率，背神经运动， 和神经形状随运动的变化)来预测类固醇注射后的结果 CTS患者。目标2是评估我们拥有的功能生物标记物的能力 确定可预测CTS患者手术后的结果。目标3是测试我们的 二次假说：注射和手术后的治疗反应相关 随着受影响的超声变量向正常方向变化。目标4是使用 AIMS 1-3的结果，确定了可能与治疗相关的其他生物标志物 结果，并确定任何可能的综合临床和生物标志物措施 提高CTS治疗后预测结果的能力。 如果这些目标得以实现，功能性生物标记物将首次成为 可为特定的CTS患者量身定做治疗。这个新的美国工具可以 迅速转化为临床使用，因为设备普遍可用，而且 新的算法可能会迅速传播。

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 to 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.