Pressure pain sensitivity topographical maps reveal bilateral hyperalgesia of the hands in patients with unilateral carpal tunnel syndrome

2010 ◽  
Vol 62 (8) ◽  
pp. 1055-1064 ◽  
Author(s):  
César Fernández-de-las-Peñas ◽  
Pascal Madeleine ◽  
Almudena Martínez-Perez ◽  
Lars Arendt-Nielsen ◽  
Rodrigo Jiménez-García ◽  
...  
Keyword(s):  
Carpal Tunnel Syndrome ◽  
Carpal Tunnel ◽  
Pain Sensitivity ◽  
Pressure Pain ◽  
Tunnel Syndrome ◽  
Topographical Maps

scholarly journals Catechol-O-Methyltransferase Val158Met Polymorphism is Associated with Pain and Disability, but not Widespread Pressure Pain Sensitivity, in Women with Carpal Tunnel Syndrome

2013 ◽  
Vol 5;16 (5;9) ◽  
pp. E591-E600
Author(s):  
César Fernández-de-las-Peñas
Keyword(s):  
Carpal Tunnel Syndrome ◽  
Carpal Tunnel ◽  
Pain Sensitivity ◽  
Pain Thresholds ◽  
Pressure Pain ◽  
Val158met Polymorphism ◽  
Healthy Women ◽  
Study Results ◽  
Pressure Pain Thresholds ◽  
Tunnel Syndrome

Background: The genetic influence of Val158Met polymorphisms, one of the potential genetic determinants for nociceptive processing, has not been previously investigated in women with carpal tunnel syndrome (CTS). Objectives: To investigate the association between the Val158Met polymorphism with CTS and to assess the relationship between the Val158Met polymorphism and the clinical outcomes and widespread pressure pain hypersensitivity in women with CTS. Study Design: Case control study. Setting: Neurology department at an urban hospital. Method: One hundred nine (n = 109) women (mean age: 47 ± 9 years) with a clinical and electrodiagnostic diagnosis of CTS and 109 matched healthy women participated. After amplifying the Val158Met polymorphism by polymerase chain reactions, rs4680 genotype frequencies and allele distributions were calculated. We classified individuals according to their Val158Met polymorphism: Val/Val, Val/Met, Met/Met. The intensity of the pain was assessed with a numeric rating scale (0-10) and disability was determined with the Boston Carpal Tunnel Questionnaire. Pressure pain thresholds were bilaterally assessed over median, radial, and ulnar nerve trunks; C5-C6 facet joints; and carpal tunnel and tibialis anterior muscles. Institutional Review Board: The study project was approved by the local human research committee (HUFA-12/14). All participants signed an informed consent prior to their inclusion in the study. Results: The distribution of the 3 Val158Met genotypes (Val/Val, Val/Met, Met/Met) and alleles was not significantly different between women with CTS and healthy women (χ2 = 0.498; P = 0.780). Women with CTS carrying the Met/Met genotype showed higher levels of pain and disability than those with the Val/Met genotype (P < 0.01) and with the Val/Val genotype (P < 0.001). No differences in the years with pain (P = 0.954), age (P = 0.740), depression (P = 0.530), severity of CTS (P = 0.744) or presence of unilateral-bilateral symptoms (P = 0.279) existed depending on the rs4680 Val158Met genotype. No significant differences in widespread pressure pain sensitivity were observed in any of the points depending on the rs4680 Val158Met genotype (P > 0.315). Limitations: We only recruited women from a specialized department. Conclusion: Current results indicated that the Val158Met polymorphism seems not to be a risk factor for the development of CTS; however, it was associated with increased perception of pain and higher disability scores. Key words: Catechol-O-methyltransferase gene, carpal tunnel syndrome, polymorphism pressure pain thresholds, sensitivity.

scholarly journals Spectral Clustering Reveals Different Profiles of Central Sensitization in Women with Carpal Tunnel Syndrome

Symmetry ◽  
2021 ◽  
Vol 13 (6) ◽  
pp. 1042
Author(s):  
Oscar J. Pellicer-Valero ◽  
José D. Martín-Guerrero ◽  
César Fernández-de-las-Peñas ◽  
Ana I. De-la-Llave-Rincón ◽  
Jorge Rodríguez-Jiménez ◽  
...  
Keyword(s):  
Carpal Tunnel Syndrome ◽  
Clinical Features ◽  
Carpal Tunnel ◽  
Spectral Clustering ◽  
Grip Force ◽  
The Other ◽  
Pressure Pain ◽  
Thermal Pain ◽  
Pressure Pain Thresholds ◽  
Tunnel Syndrome

Identification of subgroups of patients with chronic pain provides meaningful insights into the characteristics of a specific population, helping to identify individuals at risk of chronification and to determine appropriate therapeutic strategies. This paper proposes the use of spectral clustering (SC) to distinguish subgroups (clusters) of individuals with carpal tunnel syndrome (CTS), making use of the obtained patient profiling to argue about potential management implications. SC is a powerful algorithm that builds a similarity graph among the data points (the patients), and tries to find the subsets of points that are strongly connected among themselves, but weakly connected to others. It was chosen due to its advantages with respect to other simpler clustering techniques, such as k-means, and the fact that it has been successfully applied to similar problems. Clinical (age, duration of symptoms, pain intensity, function, and symptom severity), psycho-physical (pressure pain thresholds—PPTs—over the three main nerve trunks of the upper extremity, cervical spine, carpal tunnel, and tibialis anterior), psychological (depressive levels), and motor (pinch tip grip force) variables were collected in 208 women with clinical/electromyographic diagnosis of CTS, whose symptoms usually started unilaterally but eventually evolved into bilateral symmetry. SC was used to identify clusters of patients without any previous assumptions, yielding three clusters. Patients in cluster 1 exhibited worse clinical features, higher widespread pressure pain hyperalgesia, higher depressive levels, and lower pinch tip grip force than the other two. Patients in cluster 2 showed higher generalized thermal pain hyperalgesia than the other two. Cluster 0 showed less hypersensitivity to pressure and thermal pain, less severe clinical features, and more normal motor output (tip grip force). The presence of subgroups of individuals with different altered nociceptive processing (one group being more sensitive to pressure pain and another group more sensitive to thermal pain) could lead to different therapeutic programs.

Increased Pain Sensitivity Is Not Associated With Electrodiagnostic Findings in Women With Carpal Tunnel Syndrome

2011 ◽  
Vol 27 (9) ◽  
pp. 747-754 ◽  
Author(s):  
Ana Isabel de la Llave-Rincón ◽  
César Fernández-de-las-Peñas ◽  
Sofia Laguarta-Val ◽  
Cristina Alonso-Blanco ◽  
Almudena Martínez-Perez ◽  
...  
Keyword(s):  
Carpal Tunnel Syndrome ◽  
Carpal Tunnel ◽  
Pain Sensitivity ◽  
Tunnel Syndrome

scholarly journals Bilateral widespread mechanical pain sensitivity in carpal tunnel syndrome: evidence of central processing in unilateral neuropathy

Brain ◽  
2009 ◽  
Vol 132 (6) ◽  
pp. 1472-1479 ◽  
Author(s):  
C. Fernandez-de-las-Penas ◽  
A. I. de la Llave-Rincon ◽  
J. Fernandez-Carnero ◽  
M. L. Cuadrado ◽  
L. Arendt-Nielsen ◽  
...  
Keyword(s):  
Carpal Tunnel Syndrome ◽  
Carpal Tunnel ◽  
Pain Sensitivity ◽  
Central Processing ◽  
Tunnel Syndrome

Clinical Update: Assessing Maximum Medical Improvement in Carpal Tunnel Syndrome

2003 ◽  
Vol 8 (4) ◽  
pp. 4-5
Author(s):  
Christopher R. Brigham ◽  
James B. Talmage
Keyword(s):  
Carpal Tunnel Syndrome ◽  
Carpal Tunnel ◽  
Proper Time ◽  
Carpal Tunnel Release ◽  
Hand Function ◽  
Factors Affecting ◽  
Early Results ◽  
Medical Evaluation ◽  
Nerve Recovery ◽  
Tunnel Syndrome

Abstract Permanent impairment cannot be assessed until the patient is at maximum medical improvement (MMI), but the proper time to test following carpal tunnel release often is not clear. The AMA Guides to the Evaluation of Permanent Impairment (AMA Guides) states: “Factors affecting nerve recovery in compression lesions include nerve fiber pathology, level of injury, duration of injury, and status of end organs,” but age is not prognostic. The AMA Guides clarifies: “High axonotmesis lesions may take 1 to 2 years for maximum recovery, whereas even lesions at the wrist may take 6 to 9 months for maximal recovery of nerve function.” The authors review 3 studies that followed patients’ long-term recovery of hand function after open carpal tunnel release surgery and found that estimates of MMI ranged from 25 weeks to 24 months (for “significant improvement”) to 18 to 24 months. The authors suggest that if the early results of surgery suggest a patient's improvement in the activities of daily living (ADL) and an examination shows few or no symptoms, the result can be assessed early. If major symptoms and ADL problems persist, the examiner should wait at least 6 to 12 months, until symptoms appear to stop improving. A patient with carpal tunnel syndrome who declines a release can be rated for impairment, and, as appropriate, the physician may wish to make a written note of this in the medical evaluation report.

Clinical Update: Understanding Causation: An Example Using Carpal Tunnel Syndrome

2007 ◽  
Vol 12 (6) ◽  
pp. 5-8 ◽  
Author(s):  
J. Mark Melhorn
Keyword(s):  
Risk Factors ◽  
Carpal Tunnel Syndrome ◽  
Carpal Tunnel ◽  
Legal Responsibility ◽  
Medical Evidence ◽  
Anatomic Structure ◽  
Legal Professionals ◽  
Compensation Systems ◽  
Tunnel Syndrome ◽  
Four Levels

Abstract Medical evidence is drawn from observation, is multifactorial, and relies on the laws of probability rather than a single cause, but, in law, finding causation between a wrongful act and harm is essential to the attribution of legal responsibility. These different perspectives often result in dissatisfaction for litigants, uncertainty for judges, and friction between health care and legal professionals. Carpal tunnel syndrome (CTS) provides an example: Popular notions suggest that CTS results from occupational arm or hand use, but medical factors range from congenital or acquired anatomic structure, age, sex, and body mass index, and perhaps also involving hormonal disorders, diabetes, pregnancy, and others. The law separately considers two separate components of causation: cause in fact (a cause-and-effect relationship exists) and proximate or legal cause (two events are so closely related that liability can be attached to the first event). Workers’ compensation systems are a genuine, no-fault form of insurance, and evaluators should be aware of the relevant thresholds and legal definitions for the jurisdiction in which they provide an opinion. The AMA Guides to the Evaluation of Permanent Impairment contains a large number of specific references and outlines the methodology to evaluate CTS, including both occupational and nonoccupational risk factors and assigning one of four levels of evidence that supports the conclusion.

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