Department of Neurological, Neuropsychological, Morphological and Movement Sciences, University of Verona, Verona, Italy.
J Pain. 2011 Feb;12(2):205-12. doi: 10.1016/j.jpain.2010.06.010. Epub 2010 Aug 24.
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.
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.
我们探讨了正中神经小（Aδ、C）纤维和大（Aβ）纤维损伤对腕管综合征（CTS）中感觉症状的严重程度和分布以及纤维损伤在 CTS 各阶段的时间的贡献。我们招募了 106 名 CTS 患者。经过选择，有 49 名患者入选。他们接受了电诊断和定量感觉测试（QST）研究，并根据波士顿腕管问卷（BCTQ）症状严重程度量表、白天疼痛（DP）、夜间疼痛和感觉异常、手部症状的分布以及近端症状的存在对症状的严重程度进行了评估。BCTQ 症状严重程度量表和 DP 严重程度与 Aδ 纤维损伤显著相关。电诊断阴性 CTS 患者的小纤维 QST 测量值受损，且在 CTS 神经图各阶段均未改变。QST 结果与症状的分布无相关性。Aδ 纤维损伤与 CTS 症状相关，尤其是与 DP 相关。夜间疼痛和感觉异常可能归因于正中神经机械敏感性增强引起的异位纤维放电。小纤维损伤发生在大纤维之前。正中神经纤维的受累并不能直接导致越界症状的扩散。我们的数据可能有助于理解 CTS 的病理生理学，并解释 CTS 症状与电诊断结果之间众所周知的差异。
我们探讨了正中神经小和大纤维在腕管综合征（CTS）中的参与情况。我们发现 Aδ 纤维功能与 CTS 症状之间存在显著相关性。小纤维的受累发生在疾病较轻的阶段。这些发现有助于协调 CTS 症状与电诊断数据之间的差异。
