title: Median nerve small- and large-fiber damage in carpal tunnel syndrome: a quantitative sensory testing study.
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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Neurological, Neuropsychological, Morphological and Movement Sciences, University of Verona, Verona, Italy. stefano.tamburin@univr.it
authors.forename: Stefano
authors.initials: S
authors.lastname: Tamburin
authors.forename: Carlo
authors.initials: C
authors.lastname: Cacciatori
authors.forename: Maria Luigia
authors.initials: ML
authors.lastname: Praitano
authors.forename: Clizia
authors.initials: C
authors.lastname: Cazzarolli
authors.forename: Cristina
authors.initials: C
authors.lastname: Foscato
authors.forename: Antonio
authors.initials: A
authors.lastname: Fiaschi
authors.forename: Giampietro
authors.initials: G
authors.lastname: Zanette
mesh_terms: D000328:Adult; D000368:Aged; D002349:Carpal Tunnel Syndrome / Q000175:diagnosis* / Q000473:pathology*; D005260:Female; D006801:Humans; D008297:Male; D008475:Median Nerve / Q000473:pathology*; D008875:Middle Aged; D009413:Nerve Fibers, Myelinated / Q000473:pathology*; D011237:Predictive Value of Tests; D012678:Sensation Disorders / Q000175:diagnosis* / Q000209:etiology*