ARFI and B-Mode Ultrasound Imaging for Transverse Carpal Ligament Pathomechanics

描述(申请人提供)：腕管综合征(CTS)是最常见的手部疾病，在美国每年有50万例腕管松解手术。它对国家医疗保健成本、工人生产力和日常生活活动产生了极大的负面影响。尽管它对公众健康有影响，但我们对CTS病因学的了解有限。然而，腕管的病理力学机制被认为是CTS发生的重要因素。值得注意的是，腕横韧带(TCL)在调节腕管力学中起着关键作用，是正中神经受压的潜在因素。本项目的目的是探索一种新的概念，即TCL的病理形态和病理力学特性作为CTS的病因。我们的中心假设是TCL的形态和力学性质的改变是CTS的发病机制。这一假说得到了腕管松解手术中的经验观察和文献中的初步数据的支持，但它仍有待科学的调查。本项目的具体目的是(1)用B型超声检查CTS相关的腕横韧带的病理形态；(2)用声辐射力脉冲(ARFI)超声成像研究CTS相关的腕横韧带的病理机制。我们将检验假设，与无症状对照相比，CTS患者的TCL更厚，杨氏模数更大。这项面向临床的研究创新性地将超声成像技术应用于CTS的病理形态和病理力学标志物的识别。这项研究的结果将有助于发现CTS的替代发病机制。无创B超和ARFI成像将为筛查CTS高危人群进行预防以及诊断和评估CTS的严重程度提供方便、经济高效的工具。此外，该项目产生的关键新知识将为具有深刻职业和临床应用的新研究方向提供基础。我们的假说的确认将鼓励未来的大规模临床和流行病学研究，强调腕管病理形态和病理力学作为CTS的新的病因。这一试点项目虽然是开发性和探索性的，但效益/成本比很高。

DESCRIPTION (provided by applicant): Carpal tunnel syndrome (CTS) is the most common hand disorder, accounting for half a million carpal tunnel release surgeries annually in the United States. It has an immensely negative impact on national health care costs, worker productivity, and activities of daily living. Despite its impact on public health, our understandin of CTS etiology is limited. However, carpal tunnel pathomechanics is known to be an important contributor to the development of CTS. Notably, the transverse carpal ligament (TCL) plays a critical role in regulating carpal tunnel mechanics and is a potential factor in median nerve compression. The goal of this project is to explore a novel concept of the pathomorphological and pathomechanical properties of the TCL as an etiological factor of CTS. Our central hypothesis is that changes in the morphological and the mechanical properties of the TCL are pathogenic mechanisms of CTS. This hypothesis is supported by empirical observations during carpal tunnel release surgeries and preliminary data in the literature, yet it remains to be scientifically investigated. The specific aims of this project are (1) to examine the pathomorphology of the transverse carpal ligament associated with CTS using B-mode ultrasound imaging, and (2) to investigate the pathomechanics of the transverse carpal ligament associated with CTS using acoustic radiation force impulse (ARFI) ultrasound imaging. We will test the hypotheses that, in comparison to asymptomatic controls, the TCLs in CTS individuals are thicker and have a greater Young's modulus. This clinically oriented research innovatively applies ultrasound imaging technology for the identification of pathomorphological and pathomechanical markers of CTS. The results of this study will aid in the discovery of alternative pathogeneses of CTS. The noninvasive B-mode and ARFI imaging will provide convenient, cost-effective tools to screen high-risk CTS populations for prevention and to diagnose and assess the severity of CTS. In addition, critical new knowledge generated from this project will provide a foundation for a new research direction with profound occupational and clinical applications. Confirmation of our hypotheses will encourage a future large-scale clinical and epidemiological study that emphasizes carpal tunnel pathomorphology and pathomechanics as novel etiological factors of CTS. This pilot project, though developmental and exploratory, has a high benefit/cost ratio.