Dynamic Ultrasound Measurement of Median Nerve Kinematics in the Carpal Tunnel

描述(申请人提供)：腕管综合征(CTS)是最常见的压迫性周围神经病，与其诊断、治疗和间接费用相关的经济负担高达数十亿美元。临床检查和电诊断神经传导测试的典型诊断方案不适合保留正常神经功能的早期CTS患者。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，从而减少他们的长期残疾和治疗成本。不幸的是，MRI或超声等成像方法的使用并没有改善早期CTS的诊断。CTS是一种压迫性神经疾病，手部活动会加重这种疾病。在正常的、功能负荷的手运动中，正中神经被显示出戏剧性地通过指屈肌腱之间的腕管移动，从而使其处于被这些邻近结构压迫的巨大风险中。这些压迫性侮辱的积累可能有助于CTS症状的发展。超声是临床上唯一可用的方法，它允许在正中神经在整个手部运动过程中可能承受的所有潜在机械损伤期间进行动态成像。该项目的目标是使用超声波来识别与重复运动任务相关的正中神经运动学(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患者之间的神经运动学差异。第一个任务将是标准化超声图像外观，以便可以使用基于计算机的方法来测量神经运动学。然后，对进行重复活动的健康受试者进行正中神经运动学测量。最后，将确定健康受试者和CTS患者的正中神经运动学之间的差异。从长远来看，功能性组织运动学中可测量的异常可能提供CTS的客观诊断，并有助于理解导致CTS发生的潜在组织力学异常。

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.