Sonographic tissue morphology in early stage work-related median nerve pathology

 描述(申请人提供)：腕管综合征是最昂贵的上肢与工作有关的肌肉骨骼疾病，每年影响1000万人，每个事件给雇主造成的损失高达113,695美元。虽然许多病因机制已经确定，但一组因素不能准确地预测腕管综合征的发展。因此，腕管综合征的干预通常是在最初的症状报告后反应性地提供，或者向被认为处于危险中的员工提供效率低下的干预。随着疾病的发展，治疗变得越来越昂贵，功能限制变得更难补救。目前还没有一种既定的方法在症状和神经损伤出现之前检测到这种疾病。初步研究表明，超声检查--一种相对便宜、可广泛使用、越来越便携的技术--可以提供一种非侵入性、无痛的早期检测方法，可以减少发病率，改进有针对性的干预措施，并最终降低成本。超声成像已经在动物模型中用于观察由于任务暴露而导致的正中神经大小的早期进行性增加。通过了解人类的这种进展，有可能开发一种早期检测技术，在这种疾病变得昂贵和虚弱之前阻止、减缓或逆转它。因此，这项工作的长期目标是开发一个预测工作相关腕管综合征的发生和发展的形态学变化模型。作为第一步，这项研究将建立一种使用超声成像进行早期检测的新方法的预测有效性，并确定与形态变化相关的密集功能性手活动的任务组成部分。这项纵向研究将对口腔卫生专业的学生进行为期两年的跟踪调查，以调查这些目标。这项研究针对的是国家职业研究议程(NORA)的医疗保健和社会援助部门，重点是国家职业安全与健康研究所(NIOSH)的跨部门暴露评估和肌肉骨骼疾病。这项研究的中期成果将建立超声波成像作为工作场所筛查的早期检测工具，并提供结合神经形态、神经生理学和主观症状的方法来预测与工作相关的腕管综合征的发展。这项工作还将为与组织形态变化有关的密集手活动的任务部分制定有针对性的预防干预措施。最后，这项工作将提供接触到一群人，他们可以在过渡到劳动力市场时被跟踪，以记录与工作相关的肌肉骨骼疾病的自然发展。识别病理早期的形态变化和与这些变化相关的特定任务成分是早期发现和预防与工作相关的腕管综合征的第一步。

 DESCRIPTION (provided by applicant): Carpal tunnel syndrome is the most expensive upper extremity work-related musculoskeletal disorder, impacting 10 million people annually and costing employers up to $113,695 per incident. Although many etiologic mechanisms have been identified, one set of factors cannot accurately predict carpal tunnel syndrome development. As a result, carpal tunnel syndrome interventions are often provided reactively after initial symptom reports or inefficiently to employees perceived to be at risk. As the disorder progresses, it becomes increasingly expensive to treat and functional limitations become more challenging to remediate. There is currently no established method to detect this disorder prior to the onset of symptoms and nerve damage. Preliminary research suggests that sonography-a relatively inexpensive, widely available, increasingly portable technology-can provide a non-invasive and pain-free method of early detection that could reduce incidence, improve targeted interventions and ultimately reduce costs. Sonographic imaging has been used in an animal model to observe early progressive increases in median nerve size due to task exposure. By understanding this progression in humans, it would be possible to develop an early detection technique to stop, slow, or reverse this disorder before it becomes costly and debilitating. Thus, the long-term goal of this work is to develop a model of morphologic changes predictive of the onset and development of work-related carpal tunnel syndrome. As a first step, this study will establish predictive validity of a novel method for early detection using sonographic imaging and identify task components of intensive functional hand activity associated with morphologic changes. This longitudinal study will follow dental hygiene students-a high-risk population with minimal retrospective and controlled prospective task exposure-for two years to investigate these aims. This research is directed at the National Occupational Research Agenda's (NORA) Healthcare and Social Assistance sector with a focus on the National Institute of Occupational Safety and Health's (NIOSH) Exposure Assessment and Musculoskeletal Disorders cross-sectors. Intermediate outcomes of this research will establish sonographic imaging as an early detection tool for workplace-screening and inform methods for combining measures of nerve morphology, neurophysiology, and subjective symptoms for predicting the development of work-related carpal tunnel syndrome. This work will also inform the development of targeted preventive interventions for task components of intensive hand activities that are related to changes in tissue morphology. Finally, this work will provide access to a cohort of individuals who can be followed as they transition into the workforce to document the natural development of work-related musculoskeletal disorders. Identifying morphologic changes in early-stages of pathology and the specific task components linked to these changes are the first steps toward early detection and prevention of work-related carpal tunnel syndrome.