Musculoskeletal Health of the Upper Extremity in Emerging Health Professionals

Study Overview
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Brief Summary
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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. 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. The primary aims of this study are to establish predictive validity of a novel method for early detection using sonographic imaging and to identify task components of intensive functional hand activity associated with morphologic changes.

Detailed Description
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This longitudinal study will follow dental hygiene students-a high-risk population with minimal retrospective and controlled prospective task exposure-for two years and compare them to a non-exposed cohort of occupational therapy students to investigate the primary 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. 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.

Official Title
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Sonographic Tissue Morphology in Early Stage Work-related Median Nerve Pathology

Conditions
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Carpal Tunnel Syndrome

Intervention / Treatment
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* Other: Academic Coursework
* Other: Work-Related Hand Activities


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Enrollment in one of the academic programs (i.e., register and pay for classes) Exclusion Criteria: <18 years of age Prior carpal tunnel release surgery Prior diagnosis of median nerve pathology or other poly-neuropathy that includes the median nerve

Ages Eligible for Study
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Minimum Age: 18 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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Accepts Healthy Volunteers

Study Plan
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How is the study designed?
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Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Dental Hygiene Students<br>Students enrolled in the 2-year dental hygiene academic coursework programs at the University of Southern California and Loma Linda University who are exposed to high-intensity work-related hand activities as part of their training program. | Other: Academic Coursework<br>* Didactic training provided by the university through coursework and laboratory training that meets requirements of the accreditation standards provided by the professional society associated with each professional degree granting program.<br>Other: Work-Related Hand Activities<br>* Exposure to intensive training in the use of dental scaling tools as part of laboratory courses, as well as fieldwork and residency training during the academic degree program.<br>|
| Occupational Therapy Students<br>Students enrolled in the 2-year occupational therapy academic coursework program at the University of Southern California. | Other: Academic Coursework<br>* Didactic training provided by the university through coursework and laboratory training that meets requirements of the accreditation standards provided by the professional society associated with each professional degree granting program.<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Change from Baseline in Symptom & Function Reports on the Boston Carpal Tunnel Questionnaire at 2 years |  | Baseline and 2 years | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Change from Baseline in Cross-Sectional Area of Median Nerve in the Carpal Tunnel Measured with Sonography at 1 year |  | Baseline and 1 year | 
| Change from Baseline in Cross-Sectional Area of Median Nerve in the Carpal Tunnel Measured with Sonography at 2 years |  | Baseline and 2 years | 
| Change from Baseline in Vascularity within the Median Nerve Measured with Doppler Sonography at 1 year |  | Baseline and 1 year | 
| Change from Baseline in Vascularity within the Median Nerve Measured with Doppler Sonography at 2 years |  | Baseline and 2 years | 
| Change from Baseline in Nerve Conduction Velocity of the Median Nerve at 1 year | Nerve conduction velocity testing of the median nerve includes physiological measurement of the ability of the nerve to conduct electrical signals using nerve conduction testing equipment (Sierra Wave) with a surface stimulator at the wrist and surface electrodes on the second and fifth digits. | Baseline and 1 year | 
| Change from Baseline in Nerve Conduction Velocity of the Median Nerve at 2 years | Nerve conduction velocity testing of the median nerve includes physiological measurement of the ability of the nerve to conduct electrical signals using nerve conduction testing equipment (Sierra Wave) with a surface stimulator at the wrist and surface electrodes on the second and fifth digits. | Baseline and 2 years | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Ultrasonography, Nerve Conduction Velocity, Ergonomics, Work Related Injury, Cumulative Trauma Disorders