Median nerve small- and large-fiber damage in carpal tunnel syndrome: a quantitative sensory testing study.

We explored the contribution of median nerve small (Adelta, C)-and large (Abeta)-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 Adelta-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. Adelta-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 Adelta-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

Ulnar nerve impairment does not contribute to extramedian sensory symptoms in carpal tunnel syndrome

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EXTRATERRITORIAL SPREAD OF NEUROPATHIC PAIN SYMPTOMS IS FREQUENT IN PATIENTS WITH ULNAR NEUROPATHY AT THE ELBOW

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THE ASSOCIATION OF ULNAR NERVE CONDUCTION CHANGES WITH CARPAL TUNNEL SYNDROME. A MULTIVARIATE ANALYSIS STUDY

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INTERACTION BETWEEN NEGATIVE AND POSITIVE PSYCHOPHYSICAL VARIABLES IN CARPAL TUNNEL SYNDROME

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Active video game playing in children and adolescents with cystic fibrosis : exercise or just fun?

BACKGROUND: Xbox Kinect has been proposed as an exercise intervention in cystic fibrosis (CF), but its potential has not been compared with standard training modalities. METHODS: Using a crossover design, subjects were randomized to 2 intervention groups: Xbox Kinect and a traditional stationary cycle. Heart rate, SpO2, dyspnea, and fatigue were measured. Subject satisfaction was tested. RESULTS: Thirty subjects with CF (11 males, mean \ub1 SD age of 12 \ub1 2.5 y, mean \ub1 SD FEV1 of 73 \ub1 16% of predicted) were enrolled. Xbox Kinect provided a cardiovascular demand similar to a stationary cycle, although the modality was different (interval vs. continuous). Maximum heart rates were similar (P = .2). Heart rate target was achieved more frequently with a stationary cycle (P = .02). Xbox Kinect caused less dyspnea (P = .001) and fatigue (P < .001) and was more enjoyable than a stationary cycle (P < .001). CONCLUSIONS: Subjects preferred Xbox Kinect for its interactivity. Xbox Kinect has the potential to be employed as an exercise intervention in young subjects with CF, but investigation over longer periods is needed