Exploration of Carpal Tunnel Mechanics for CTS Treatment

描述（由申请人提供）：腕管综合征（Carpal tunnel syndrome， CTS）是最常见的压迫性神经病变，对国民医疗保健、工人生产力和生活质量有着巨大的影响。尽管CTS发病率高，公共卫生成本高，但我们对CTS的认识有限，CTS的管理有待改进。目前，CTS的常规治疗方法是腕管释放手术，不幸的是，这种手术有许多并发症。这种外科手术的概念已经存在了近一个世纪，没有遇到根本性的挑战。我们曾尝试使用手动疗法保守治疗CTS，但由于缺乏科学和临床证据，其有效性尚不明确。在我们对CTS治疗的追求中，我们偶然发现了一种新的腕管操作机制，通过缩小腕弓宽度来扩大腕管。这一发现对于CTS保守治疗策略的发展具有令人兴奋的潜力。我们的腕管操作方法与现有的有争议的向外伸展腕弓的技术形成鲜明对比。因此，我们的最终目标是通过对腕管力学和病理力学的严格科学研究，开发一种生物力学治疗CTS的方法。我们的中心观点是CTS可以通过非手术治疗，通过缩小腕弓宽度对腕管进行生物力学操作。我们假设策略性地施加腕部压迫可以增加腕管截面积，减少腕管压力，从而减轻正中神经的机械损伤。我们将通过系统地研究横向压缩力、腕管压力、腕弓宽度和腕管截面积之间的生物力学关系来验证这一假设。该项目的实施将产生关于腕管力学和病理力学的新知识，从而为CTS提供基于证据的新型生物力学治疗策略。

DESCRIPTION (provided by applicant): Carpal tunnel syndrome (CTS) is the most common compression neuropathy and has an immense impact on national health care, worker productivity, and quality of life. Despite its high prevalence and public health cost, our understanding of CTS is limited, and the management of CTS awaits improvement. Currently, CTS is routinely treated by carpal tunnel release surgery, which unfortunately has a number of complications. The concept of this surgical procedure has existed for nearly a century without fundamental challenges. Attempts have been made to conservatively treat CTS using manual therapies, but their effectiveness is ambiguous due to the lack of scientific and clinical evidence In our pursuit of CTS management, we have serendipitously discovered a novel mechanism of carpal tunnel manipulation to obtain tunnel enlargement by narrowing the carpal arch width. This discovery has exciting potential for the development of conservative treatment strategies for CTS. Our approach to carpal tunnel manipulation is in sharp contrast to the existing controversial techniques that try to stretch the carpal arch outwards. Therefore, our ultimate goal is to develop a biomechanical treatment for CTS through rigorous scientific studies on the mechanics and pathomechanics of the carpal tunnel. Our central notion is that CTS can be treated by non-surgical, biomechanical manipulation of the carpal tunnel through the narrowing of the carpal arch width. We hypothesize that strategically applied compression on the wrist can increase carpal tunnel cross-sectional area and decrease carpal tunnel pressure, thus relieving the median nerve from mechanical insult. We will test this hypothesis by systematically investigating the biomechanical relationships among transverse compressive force, carpal tunnel pressure, carpal arch width, and carpal tunnel cross-sectional area using cadaveric specimens and human subjects. The implementation of this project will yield novel knowledge on carpal tunnel mechanics and pathomechanics, leading to an evidence-based, novel biomechanical treatment strategy for CTS.