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 t 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.

Agency
National Institute of Health (NIH)
Institute
National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS)
Type
Research Project (R01)
Project #
5R01AR062613-02
Application #
8856502
Study Section
Musculoskeletal Rehabilitation Sciences Study Section (MRS)
Program Officer
Washabaugh, Charles H
Project Start
2014-09-01
Project End
2019-08-31
Budget Start
2015-09-01
Budget End
2016-08-31
Support Year
2
Fiscal Year
2015
Total Cost
Indirect Cost
Name
Mayo Clinic, Rochester
Department
Type
DUNS #
006471700
City
Rochester
State
MN
Country
United States
Zip Code
55905
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Evers, Stefanie; Bryan, Andrew J; Sanders, Thomas L et al. (2018) Influence of Injection Volume on Rate of Subsequent Intervention in Carpal Tunnel Syndrome Over 1-Year Follow-Up. J Hand Surg Am 43:537-544
Festen-Schrier, V J M M; Amadio, P C (2018) The biomechanics of subsynovial connective tissue in health and its role in carpal tunnel syndrome. J Electromyogr Kinesiol 38:232-239
Evers, Stefanie; Jansen, Miguel C; Slijper, Harm P et al. (2018) Hand Surgeons Performing More Open Carpal Tunnel Releases Do Not Show Better Patient Outcomes. Plast Reconstr Surg 141:1439-1446
Filius, Anika; Thoreson, Andrew R; Ozasa, Yasuhiro et al. (2017) Delineation of the mechanisms of tendon gliding resistance within the carpal tunnel. Clin Biomech (Bristol, Avon) 41:48-53
Evers, Stefanie; Bryan, Andrew J; Sanders, Thomas L et al. (2017) Effectiveness of Ultrasound-Guided Compared to Blind Steroid Injections in the Treatment of Carpal Tunnel Syndrome. Arthritis Care Res (Hoboken) 69:1060-1065
Evers, Stefanie; Bryan, Andrew J; Sanders, Thomas L et al. (2017) Corticosteroid Injections for Carpal Tunnel Syndrome: Long-Term Follow-Up in a Population-Based Cohort. Plast Reconstr Surg 140:338-347
Filius, Anika; Thoreson, Andrew R; Wang, Yuexiang et al. (2015) The effect of tendon excursion velocity on longitudinal median nerve displacement: differences between carpal tunnel syndrome patients and controls. J Orthop Res 33:483-7
Filius, Anika; Scheltens, Marjan; Bosch, Hans G et al. (2015) Multidimensional ultrasound imaging of the wrist: Changes of shape and displacement of the median nerve and tendons in carpal tunnel syndrome. J Orthop Res 33:1332-40