Research Projects

Dr. Amadio and our research team in the Tendon and Soft Tissue Biology Lab are engaged in numerous research projects, with a focus on carpal tunnel syndrome and tendon injury. Our studies include ultrasound shearwave elastography, novel antiaging treatments and bioengineered tendon lubricant.

As the nature of our work has changed through the years, attention is now focused on some new research areas. This includes a stronger focus on clinical care, such as product development and new imaging methods.

Funding for our work comes from a variety of sources, including Mayo Clinic and generous support from benefactors and grants from the Department of Defense and National Institutes of Health (NIH).

Tendon injury

Our lab studies the impact of tendon injury and degeneration on human hand function. Related projects over the years include:

  • Methods to improve repair and rehabilitation of tendon injuries in the fingers.
  • Tissue engineering to speed tendon healing and reduce scarring around tendons after injury and repair.
  • The role of fibrosis around tendons in the cause and progression of carpal tunnel syndrome.
  • Using ultrasound imaging of tendons and nerve motion, size and shape as imaging biomarkers to predict outcomes and guide treatment for carpal tunnel syndrome and other hand conditions.

Ultrasound imaging biomarkers

Dr. Amadio and his colleagues pioneered ultrasound biomarkers to assess carpal tunnel syndrome. This work included studies of 4D motion of the median nerve, tenosynovium and flexor tendons. It also included 3D imaging of median nerve shape and ultrasound shearwave elastography (SWE) to evaluate the function of the thenar muscles in carpal tunnel syndrome and other hand disorders. In addition to supplementing electromyography in evaluating carpal tunnel syndrome, ultrasound SWE could potentially serve as a biomarker to distinguish neuropathy and myopathy from disuse atrophy and as a prognostic tool to distinguish reversible from irreversible muscle atrophy.

Dr. Amadio and his colleagues with expertise in sonography and artificial intelligence are analyzing these biomarkers and nerve conduction waveforms. The long-term goal is to develop and commercialize AI-informed ultrasound biomarkers for carpal tunnel syndrome.

3D atlas of hand anatomy

In collaboration with the Department of Anatomy at Mayo Clinic and the University of Minnesota, Dr. Amadio is developing a comprehensive, multimodality 3D atlas of hand anatomy. This atlas would serve as an update to the National Library of Medicine Visible Human Project. It would feature new high-resolution (10.5T) magnetic resonance imaging, 2D and 3D ultrasound, and high-resolution CT imaging. It would complement updated thin section histology and dissections of the hand and wrist.

This project has already shown success. Dr. Amadio's team has identified an apparently common but previously unnoticed phenomenon — fatty infiltration of the opponens pollicis muscle in people with thumb carpometacarpal arthritis, a common hand condition. The impact of this fatty infiltration on thumb function is still unknown. Dr. Amadio plans to study it clinically. Dr. Amadio hopes to secure NIH funding and ultimately hopes that an enhanced publicly available database of hand anatomy can stimulate investigators around the world.

Senolytic medications

In collaborative research with the Robert and Arlene Kogod Center on Aging at Mayo Clinic, Dr. Amadio's team discovered that carpal tunnel syndrome is a condition with abnormal cellular aging (senescence). His team found that antiaging (senolytic) therapies can reverse fibrosis in lab models of carpal tunnel syndrome.

Dr. Amadio is pursuing a phase 2 clinical trial of fisetin in the hope that senolytic medication could someday replace surgery as the main treatment for carpal tunnel treatment. Fisetin is a bioactive flavonoid being developed at Mayo Clinic as a senolytic medication.

Bioengineered tendon lubricant

We're developing a bioengineered tendon lubricant for clinical use. This tendon lubricant is classified as a device by the U.S. Food and Drug Administration (FDA). This tendon lubricant could be used to prevent adhesion formation after tendon repair, reconstruction or tenolysis, among other uses. This work is being done in collaboration with the Center for Regenerative Biotherapeutics at Mayo Clinic, which will initially manufacture the clinical-grade product. Our lab has spent years developing this device, with funding by the Department of Defense and an NIH R01 grant.

We plan to apply for an investigational device exemption (IDE) from the FDA and then launch a clinical trial of our bioengineered tendon lubricant. Our goal is to launch clinical trials and ultimately commercialize the device through a start-up company or by acquisition from an existing manufacturer in the field.