Department of Physical Therapy, Occupational Therapy, Rehabilitation and Physical Medicine, Universidad Rey Juan Carlos, Alcorcón Madrid, Spain.
J Orthop Sports Phys Ther. 2010 Nov;40(11):751-60. doi: 10.2519/jospt.2010.3331.
Case-control study with blinded examiner.
To investigate if pressure pain sensitivity is related to specific nerve trunks in the upper extremity of patients with either unilateral lateral epicondylalgia (LE) or carpal tunnel syndrome (CTS).
In the clinical setting, patients with LE tend to exhibit radial nerve trunk tenderness, whereas patients with CTS exhibit median nerve tenderness. No studies have investigated if specific nerve pressure pain hypersensitivity exists in patients with either LE or CTS.
Sixteen women with unilateral LE (mean±SD age, 43±7 years), 17 women with unilateral CTS (43±6 years), and 17 healthy women (43±6 years) were included in this study. Pressure pain thresholds (PPT) were bilaterally assessed over the median, ulnar, and radial nerve trunks, as well as over the C5-6 zygapophyseal joints, by an examiner blinded to the subjectsí condition. A mixed-model analysis of variance was used to evaluate differences in PPT among groups (LE, CTS, or controls) and between sides (affected/nonaffected or dominant/nondominant).
The individuals in both the LE and CTS groups demonstrated lower PPT bilaterally over the median (group, P<.001; side, P=.437), radial (group, P<.001; side, P=.556), and ulnar (group, P<.001; side, P=.938) nerve trunks as compared to controls. Additionally, radial (P<.001) and ulnar (P=.005) nerves were more sensitive bilaterally in patients with LE than in patients with CTS. The median nerve was more sensitive bilaterally in patients with CTS than patients with LE (P=.002). Lower PPT over the cervical spine (group, P<.001; side, P=.233) were found bilaterally in both the LE and CTS groups. Further, patients with CTS exhibited lower cervical PPT than patients with LE (P<.001). PPT was negatively correlated with both pain intensity and duration of symptoms in both the LE and CTS groups (P<.001).
Bilateral mechanical nerve pain hypersensitivity is related to specific and particular nerve trunks in women with either unilateral LE or CTS. Our results suggest the presence of central and peripheral sensitization mechanisms in individuals with either LE or CTS.
病例对照研究，盲法评估。
探讨单侧外侧肱骨上髁炎（LE）或腕管综合征（CTS）患者上肢特定神经干的压痛敏感性是否相关。
在临床实践中，LE 患者往往表现出桡神经干压痛，而 CTS 患者则表现出正中神经压痛。尚无研究调查 LE 或 CTS 患者是否存在特定神经压痛敏感性。
纳入 16 名单侧 LE（平均年龄±标准差，43±7 岁）、17 名单侧 CTS（43±6 岁）和 17 名健康女性（43±6 岁）进行研究。由一名对患者状况不知情的评估员对正中神经、尺神经和桡神经干以及 C5-6 椎间关节双侧进行压痛阈值（PPT）评估。采用混合模型方差分析评估组间（LE、CTS 或对照组）和侧间（患侧/非患侧或优势侧/非优势侧）PPT 的差异。
LE 和 CTS 组双侧正中神经（组间，P<.001；侧间，P=.437）、桡神经（组间，P<.001；侧间，P=.556）和尺神经（组间，P<.001；侧间，P=.938）的 PPT 均降低。此外，LE 患者双侧桡神经（P<.001）和尺神经（P=.005）的敏感性均高于 CTS 患者。CTS 患者双侧正中神经的敏感性高于 LE 患者（P=.002）。LE 和 CTS 组双侧颈椎（组间，P<.001；侧间，P=.233）的 PPT 均降低。此外，CTS 患者的颈椎 PPT 低于 LE 患者（P<.001）。LE 和 CTS 组的 PPT 与疼痛强度和症状持续时间均呈负相关（P<.001）。
女性单侧 LE 或 CTS 患者双侧机械性神经痛敏与特定神经干有关。我们的结果表明，LE 或 CTS 患者存在中枢和外周敏化机制。
