Median Nerve Small- and Large-Fiber Damage in Carpal Tunnel Syndrome: A Quantitative Sensory Testing Study

Tamburin, Stefano; Cacciatori, Carlo; Praitano, Maria Luigia; Cazzarolli, Clizia; Foscato, Cristina; Fiaschi, Antonio; Zanette, Giampietro

doi:10.1016/j.jpain.2010.06.010

« Previous Next »The Journal of Pain
Volume 12, Issue 2 , Pages 205-212, February 2011

Median Nerve Small- and Large-Fiber Damage in Carpal Tunnel Syndrome: A Quantitative Sensory Testing Study

Stefano Tamburin
- Department of Neurological, Neuropsychological, Morphological and Movement Sciences, University of Verona, Verona, Italy
- Section of Neurology, Pederzoli Hospital, Peschiera del Garda, Verona, Italy
- Address reprint requests to Stefano Tamburin, MD, PhD, Department of Neurological, Neuropsychological, Morphological and Movement Sciences, G.B. Rossi Hospital, Piazzale Scuro 10, 37134, Verona, Italy.
Carlo Cacciatori
- Department of Neurological, Neuropsychological, Morphological and Movement Sciences, University of Verona, Verona, Italy
- Section of Neurology, Pederzoli Hospital, Peschiera del Garda, Verona, Italy
Maria Luigia Praitano
- Department of Neurological, Neuropsychological, Morphological and Movement Sciences, University of Verona, Verona, Italy
- Section of Neurology, Pederzoli Hospital, Peschiera del Garda, Verona, Italy
Clizia Cazzarolli
- Department of Neurological, Neuropsychological, Morphological and Movement Sciences, University of Verona, Verona, Italy
Cristina Foscato
- Section of Neurology, Pederzoli Hospital, Peschiera del Garda, Verona, Italy
Antonio Fiaschi
- Department of Neurological, Neuropsychological, Morphological and Movement Sciences, University of Verona, Verona, Italy
Giampietro Zanette
- Department of Neurological, Neuropsychological, Morphological and Movement Sciences, University of Verona, Verona, Italy
- Section of Neurology, Pederzoli Hospital, Peschiera del Garda, Verona, Italy

Received 6 April 2010; received in revised form 31 May 2010; accepted 25 June 2010. published online 27 August 2010.

Abstract

We explored the contribution of median nerve small (Aδ, C)-and large (Aβ)-fiber damage to the severity and topographic distribution of sensory symptoms in carpal tunnel syndrome (CTS) and the timing of fiber damage across CTS stages. We recruited 106 CTS patients. After selection, 49 patients were included. They underwent electrodiagnostic and quantitative sensory testing (QST) study and were asked on the severity of Boston Carpal Tunnel Questionnaire (BCTQ) Symptoms Severity Scale, daytime pain (DP), night pain and paresthesia, on the distribution of hand symptoms, and the presence of proximal symptoms. BCTQ Symptoms Severity Scale and DP severity was significantly correlated with Aδ-fiber damage. Small-fiber QST measures were impaired in electrodiagnostic-negative CTS patients and did not change across CTS neurographic stages. QST findings were not correlated to the topographical distribution of symptoms. Aδ-fiber damage contributes to CTS symptoms and in particular to DP. Night pain and paresthesia might be ascribed to ectopic fiber discharges secondary to median nerve enhanced mechanosensitivity. Small-fiber damage takes place earlier than large fiber. Median nerve fiber involvement does not directly contribute to extraterritorial symptoms spread. Our data may help understanding CTS pathophysiology and explain the well-known discrepancy between CTS symptoms and electrodiagnostic findings.

Perspective

We explored the involvement of median nerve small and large fibers in carpal tunnel syndrome (CTS). We found a significant correlation between Aδ-fiber function and CTS symptoms. Small-fiber involvement took place in milder disease stages. These findings could help reconcile the discrepancy between CTS symptoms and electrodiagnostic data.

Key words: Carpal tunnel syndrome, extraterritorial spread, median nerve, nerve fiber, neuropathic pain, pathophysiology, quantitative sensory testing (QST)