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

      Affiliations

    • Department of Neurological, Neuropsychological, Morphological and Movement Sciences, University of Verona, Verona, Italy
    • Section of Neurology, Pederzoli Hospital, Peschiera del Garda, Verona, Italy
    • Corresponding Author InformationAddress 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

      Affiliations

    • 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

      Affiliations

    • 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

      Affiliations

    • Department of Neurological, Neuropsychological, Morphological and Movement Sciences, University of Verona, Verona, Italy
    • ,
  • Cristina Foscato

      Affiliations

    • Section of Neurology, Pederzoli Hospital, Peschiera del Garda, Verona, Italy
    • ,
  • Antonio Fiaschi

      Affiliations

    • Department of Neurological, Neuropsychological, Morphological and Movement Sciences, University of Verona, Verona, Italy
    • ,
  • Giampietro Zanette

      Affiliations

    • 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 ,Revised 31 May 2010 ,Accepted 25 June 2010.

References 

  1. AAEMAANAAPMR. Practice parameter for electrodiagnostic studies in carpal tunnel syndrome. Muscle Nerve. 1993;16:1390–1391
  2. AAEMAANAAPMR. Practice parameter: Electrodiagnostic studies in carpal tunnel syndrome. Neurology. 2002;58:1589–1592
  3. AANAAEMAAPMR. Practice parameter for carpal tunnel syndrome (summary statement). Neurology. 1993;43:2406–2409
  4. Arendt-Nielsen L, Gregersen H, Toft E, Bjerring P. Involvement of thin afferents in carpal tunnel syndrome: Evaluated quantitatively by argon laser stimulation. Muscle Nerve. 1991;14:508–514
  5. Arendt-Nielsen L, Yarnitsky . Experimental and clinical application of quantitative sensory threshold applied to skin, muscles and viscera. J Pain. 2009;10:556–572
  6. Atroshi I, Gummesson C, Johnson R, Ornstein E, Ranstam J, Rosén I. Prevalence of carpal tunnel syndrome in a general population. JAMA. 1999;282:153–158
  7. Baron R, Tolle TR. Assessment and diagnosis of neuropathic pain. Curr Opin Support Palliat Care. 2008;2:1–8
  8. Bostock H, Campero M, Serra J, Ochoa JL. Temperature-dependent double spikes in C-nociceptors of neuropathic pain patients. Brain. 2005;128:2154–2163
  9. Caliandro P, La Torre G, Aprile I, Pazzaglia C, Commodari I, Tonali P, et al. Distribution of paresthesias in carpal tunnel syndrome reflects the degree of nerve damage at the wrist. Clin Neurophysiol. 2006;117:228–231
  10. Campbell JN, Meyer RA. Mechanisms of Neuropathic Pain. Neuron. 2006;52:77–92
  11. Chan L, Turner JA, Comstock BA, Levenson LM, Hollingworth W, Heagerty PJ, et al. The relationship between electrodiagnostic findings and patient symptoms and function in carpal tunnel syndrome. Arch Phys Med Rehabil. 2007;88:19–24
  12. D'Arcy CA, McGee S. Does this patient have carpal tunnel syndrome?. JAMA. 2000;283:3110–3117
  13. de Campos CC, Manzano GM, Leopoldino JF, Nóbrega JA, Sañudo A, de Araujo Peres C, et al. The relationship between symptoms and electrophysiological detected compression of the median nerve at the wrist. Acta Neurol Scand. 2004;110:398–402
  14. de la Llave-Rincón AI, Fernández-de-las-Peñas C, Fernández-Carnero J, Padua L, Arendt-Nielsen L, Pareja JA. Bilateral hand/wrist heat and cold hyperalgesia, but not hypoesthesia, in unilateral carpal tunnel syndrome. Exp Brain Res. 2009;198:455–463
  15. de Tommaso M, Libro G, Difruscolo O, Sardaro M, Serpino C, Calabrese R, et al. Laser evoked potentials in carpal tunnel syndrome. Clin Neurophysiol. 2009;120:353–359
  16. Dilley A, Lynn B, Pang SJ. Pressure and stretch mechanosensitivity of peripheral nerve fibres following local inflammation of the nerve trunk. Pain. 2005;117:462–472
  17. Djouhri L, Koutsikou S, Fang X, McMullan S, Lawson SN. Spontaneous pain, both neuropathic and inflammatory, is related to frequency of spontaneous firing in intact C-fiber nociceptors. J Neurosci. 2006;26:1281–1292
  18. Fruhstorfer H, Lindblom U, Schmidt WG. Method for quantitative estimation of thermal thresholds in patients. J Neurol Neurosurg Psychiatry. 1976;39:1071–1075
  19. Giannini F, Cioni R, Mondelli M, Padua R, Gregori B, D'Amico P, et al. A new clinical scale of carpal tunnel syndrome: Validation of the measurement and clinical-neurophysiological assessment. Clin Neurophysiol. 2002;113:71–77
  20. Ginanneschi F, Mondelli M, Dominici F, Rossi A. Changes in motor axon recruitment in the median nerve in mild carpal tunnel syndrome. Clin Neurophysiol. 2006;117:2467–2472
  21. Jensen TS, Baron R. Translation of symptoms and signs into mechanisms in neuropathic pain. Pain. 2003;102:1–8
  22. Kimura J. Electrodiagnosis in Diseases of Nerve and Muscle. 3rd ed.. New York, NY: Oxford University Press; 2001;
  23. Kuwabara S, Tamura N, Yamanaka Y, Misawa S, Isose S, Bae JS, et al. Sympathetic sweat responses and skin vasomotor reflexes in carpal tunnel syndrome. Clin Neurol Neurosurg. 2008;110:691–695
  24. Lang E, Claus D, Neundorfer B, Handwerker HC. Parameters of thick and thin nerve-fiber functions as predictors of pain in carpal tunnel syndrome. Pain. 1995;60:295–302
  25. Levine DW, Simmons BP, Koris MJ, Daltroy LH, Hohl GG, Fossel AH, et al. A self-administered questionnaire for the assessment of severity of symptoms and functional status in carpal tunnel syndrome. J Bone Joint Surg Am. 1993;75:1585–1592
  26. Malan TP, Ossipov MH, Gardell LR, Ibrahim M, Bian D, Lai J, et al. Extraterritorial neuropathic pain correlates with multisegmental elevation of spinal dynorphin in nerve-injured rats. Pain. 2000;86:185–194
  27. McCabe SJ, Uebele AL, Pihur V, Rosales RS, Atroshi I. Epidemiologic associations of carpal tunnel syndrome and sleep position: Is there a case for causation?. Hand. 2007;2:127–134
  28. Mogil JS. Animal models of pain: Progress and challenges. Nature Rev Neurosci. 2009;10:283–294
  29. Mogyoros I, Bostock H, Burke D. Mechanisms of paresthesia arising from healthy axons. Muscle Nerve. 2000;23:310–320
  30. Ochoa J, Fowler TJ, Gilliat RW. Anatomical changes in peripheral nerves compressed by a pneumatic tourniquet. J Anat. 1972;113:433–455
  31. Padua L, LoMonaco M, Gregori B, Valente EM, Padua R, Tonali P. Neurophysiological classification and sensitivity in 500 carpal tunnel syndrome hands. Acta Neurol Scand. 1997;96:211–217
  32. Padua L, Padua R. Lo Monaco M, Aprile I, Tonali P: Multiperspective assessment of carpal tunnel syndrome: A multicenter study. Neurology. 1999;53:1654–1659
  33. Rempel D, Evanoff B, Amadio PC, de Krom M, Franklin G, Franzblau A, et al. Consensus criteria for classification of carpal tunnel syndrome in epidemiologic studies. Am J Pub Health. 1998;88:1447–1451
  34. Rolke R, Baron R, Maier C, Tölle TR, Treede RD, Beyer A, et al. Quantitative sensory testing in the German Research Network on Neuropathic Pain (DFNS): Standardized protocol and reference values. Pain. 2006;123:231–243
  35. Sesek RF, Khalighi M, Bloswick DS, Anderson M, Tuckett RP. Effects of prolonged wrist flexion on transmission of sensory information in carpal tunnel syndrome. J Pain. 2007;8:137–151
  36. Shy ME, Frohman EM, So YT, Arezzo JC, Cornblath DR, Giuliani MJ, et al. Therapeutics and Technology Assessment Subcommittee of the American Academy of Neurology: Quantitative sensory testing. Report of the Therapeutics and Technology Assessment Subcommittee of the American Academy of Neurology. Neurology. 2003;60:898–904
  37. Tamburin S, Cacciatori C, Praitano ML, Marani S, Zanette G. Ulnar nerve impairment at the wrist does not contribute to extramedian sensory symptoms in carpal tunnel syndrome. Clin Neurophysiol. 2009;120:1687–1692
  38. Tecchio F, Padua L, Aprile I, Rossini PM. Carpal tunnel syndrome modifies sensory hand cortical somatotopy: A MEG study. Hum Brain Mapp. 2002;17:28–36
  39. Thomas PK, Fullerton PM. Nerve fiber size in the carpal tunnel syndrome. J Neurol Neurosurg Psychiatry. 1963;26:520–527
  40. Tinazzi M, Zanette G, Volpato D, Testoni R, Bonato C, Manganotti P, et al. Neurophysiological evidence of neuroplasticity at multiple levels of the somatosensory system in patients with carpal tunnel syndrome. Brain. 1998;121:1785–1794
  41. Truini A, Padua L, Biasiotta A, Caliandro P, Pazzaglia C, Galeotti F, et al. Differential involvement of A-delta and A-beta fibres in neuropathic pain related to carpal tunnel syndrome. Pain. 2009;145:105–109
  42. Werner RA, Andary M. Carpal tunnel syndrome: Pathophysiology and clinical neurophysiology. Clin Neurophysiol. 2002;113:1373–1381
  43. Wilder-Smith EP, Fook-Chong S, Chew SE, Chow A, Guo Y. Vasomotor dysfunction in carpal tunnel syndrome. Muscle Nerve. 2003;28:582–586
  44. Wilder-Smith EP, Seet RC, Lim EC. Diagnosing carpal tunnel syndrome–clinical criteria and ancillary tests. Nat Clin Pract Neurol. 2006;2:366–374
  45. Wilder-Smith EP, Ng ES, Chan YH, Therimadasamy AK. Sensory distribution indicates severity of median nerve damage in carpal tunnel syndrome. Clin Neurophysiol. 2008;119:1619–1625
  46. Woolf CJ, Salter MW. Neuronal plasticity: Increasing the gain in pain. Science. 2000;288:1765–1769
  47. Yarnitsky D, Sprecher E, Zaslansky R, Hemli JA. Heat pain thresholds: Normative data and repeatability. Pain. 1995;60:329–332
  48. You H, Simmons Z, Freivalds A, Kothari MJ, Naidu SH. Relationships between clinical symptom severity scales and nerve conduction measures in carpal tunnel syndrome. Muscle Nerve. 1999;22:497–501
  49. Zanette G, Marani S, Tamburin S. Extra-median spread of sensory symptoms in carpal tunnel syndrome suggest the presence of pain-related mechanisms. Pain. 2006;122:264–270
  50. Zanette G, Marani S, Tamburin S. Proximal pain in patients with carpal tunnel syndrome: A clinical-neurophysiological study. J Peripher Nerv Syst. 2007;12:91–97
  51. Zanette G, Cacciatori C, Tamburin S. Central sensitization in carpal tunnel syndrome with extraterritorial spread of sensory symptoms. Pain. 2010;148:227–236

PII: S1526-5900(10)00584-5

doi: 10.1016/j.jpain.2010.06.010

The Journal of Pain
Volume 12, Issue 2 , Pages 205-212 , February 2011

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