Background

Carpal tunnel syndrome patients demonstrate diminished motion of the median nerve and fibrotic changes in the subsynovial connective tissue within the carpal tunnel. Currently, there are few prognostic factors to help predict the outcome of commonly performed treatments including surgical carpal tunnel release and corticosteroid injections. This study aimed to non-invasively assess the changes in the dynamic response of the subsynovial tissue relative to tendon motion after the intervention and to correlate this with disease severity.

Methods

A total of 145 patients with carpal tunnel syndrome were recruited into this study. Clinical and demographic data, electrophysiological severity and dynamic ultrasound images were collected before and after treatment, either by injection or surgery. The relative motion of the subsynovial tissue with the underlying middle finger flexor digitorum superficialis tendon was measured using a speckle tracking algorithm and was expressed as a shear index (SI). Baseline and follow-up data, the association between change in SI and severity, and the role of treatment modality were analyzed and statistically compared.

Findings

Overall, there was a significant increase (more relative motion) after treatment in the mean shear index from 79.9% (±15.4% SD) to 82.9% (±14.8% SD) (p = 0.03). Secondary analyses showed that this change was mostly present in those with mild disease severity undergoing surgery (p = 0.01).

Interpretation

This study shows that the relative subsynovial tissue movement increases in patients after intervention. The present study lays a foundation for future studies to non-invasively assess the role of carpal tunnel dynamics in response to treatment.

中文翻译：

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腕管综合征的治疗以及随后肌腱和结缔组织动力学的改变

 背景

腕管综合征患者表现出正中神经运动减弱和腕管内滑膜下结缔组织纤维化变化。目前，很少有预后因素可以帮助预测常用治疗的结果，包括外科腕管松解术和皮质类固醇注射。本研究旨在非侵入性评估干预后滑膜下组织相对于肌腱运动的动态反应的变化，并将其与疾病严重程度相关联。

 方法

本研究共招募了 145 名腕管综合征患者。通过注射或手术治疗前后收集临床和人口统计数据、电生理严重程度和动态超声图像。使用散斑跟踪算法测量滑膜下组织与下面的中指指浅屈肌腱的相对运动，并表示为剪切指数（SI）。对基线和随访数据、SI 变化与严重程度之间的关联以及治疗方式的作用进行了分析和统计比较。

 发现

总体而言，治疗后平均剪切指数显着增加（更多相对运动），从 79.9% (±15.4% SD) 增加到 82.9% (±14.8% SD) ( p = 0.03)。二次分析表明，这种变化主要出现在接受手术的轻度疾病严重程度的患者中（ p = 0.01）。

 解释

这项研究表明，干预后患者的相对滑膜下组织运动增加。本研究为未来的研究奠定了基础，以非侵入性评估腕管动力学在治疗反应中的作用。