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Sobeeh MG, Benmelouka A, Metwally E, Abuhassira MJ, Abdeljalil AM, Nasr SA, El-Helw GO, Doheim MF. Altered brain function and structure in carpal tunnel syndrome: a systematic review and meta-analysis of structural and functional brain imaging. Brain Struct Funct 2024; 229:257-272. [PMID: 38165482 DOI: 10.1007/s00429-023-02737-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2023] [Accepted: 11/21/2023] [Indexed: 01/03/2024]
Abstract
This systematic review with a meta-analysis aimed to identify the altered brain structure and function in carpal tunnel syndrome (CTS) by summarizing the literature about magnetic resonance imaging (MRI), functional magnetic resonance imaging (fMRI), and magnetoencephalography (MEG) outcomes compared to healthy controls (HC). CTS is the most common nerve entrapment in the arm associated with altered peripheral and central nociceptive system. PRISMA guidelines were used to report the outcomes. Six databases were searched for relevant literature (Web of Science, Scopus, PubMed, Sage, EBSCO host, and Cochrane). Eligible studies comparing MRI, fMRI, and MEG findings in people with CTS (present for at least 2 months) and HC through the following parameters: (1) interdigit cortical separation distance, (2) white and grey matter changes, (3) peak latency of M20 wave and recovery function of N20 from the somatosensory cortex (SI), and (4) surface area of activated digit cortical representation. The results from different studies were pooled and a meta-analysis was done. From 17 included, there was a significant reduction of interdigit cortical separation distance of index-middle and index-little fingers in the CTS (SMD = - 0.869, 95% CI (- 1.325, - 0.413), p-value = 0.000) and (SMD = - 0.79, 95% CI (- 1.217, - 0.364), p-value = 0.000), respectively. Middle-little fingers interdigit separation showed no difference (SMD = - 0.2, 95% CI (- 0.903, 1.309), p-value = 0.718). There is evidence supporting the altered brain structure and function in CTS as evidenced by reduction of interdigit cortical separation distance, and excessive blurring and disinhibition of SI, with low resting state functional connectivity. Thus, centrally directed therapeutic approaches might complement peripheral treatments.
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Affiliation(s)
- Mohamed Gomaa Sobeeh
- Department of Physical Therapy for Musculoskeletal Disorders and its Surgery, Faculty of Physical Therapy, Cairo University, Giza, Egypt.
- Department of Physical Therapy for Orthopedics and Orthopedic Surgery, Faculty of Physical Therapy, Sinai University, Ismailia, Egypt.
| | | | | | | | | | - Sara Amr Nasr
- Faculty of Medicine, Alexandria University, Alexandria, Egypt
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2
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Harinesan N, Silsby M, Simon NG. Carpal tunnel syndrome. HANDBOOK OF CLINICAL NEUROLOGY 2024; 201:61-88. [PMID: 38697747 DOI: 10.1016/b978-0-323-90108-6.00005-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/05/2024]
Abstract
Median neuropathy at the wrist, commonly referred to as carpal tunnel syndrome (CTS), is the most common entrapment neuropathy. It is caused by chronic compression of the median nerve at the wrist within the space-limited carpal tunnel. Risk factors that contribute to the etiology of compression include female gender, obesity, work-related factors, and underlying medical conditions, such as hypothyroidism, pregnancy, and amyloidosis. The diagnosis is made on clinical grounds, although these can be confounded by anatomical variations. Electrodiagnostic studies, which are specific and sensitive in diagnosing CTS, support the diagnosis; however, a subgroup may present with normal results. The advent of imaging techniques, including ultrasound and MRI, further assists the diagnostic process. The management of CTS is divided into the nonsurgical approaches that include hand therapy, splinting and corticosteroid injection, and surgical decompression of the carpal tunnel. Although several surgical techniques have been developed, no one method is more effective than the other. Each of these management approaches are effective at providing symptom relief and are utilized at different severities of the condition. There is, however, a lack of consensus on standardized diagnostic criteria, as well as when and to whom to refer patients for surgery.
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Affiliation(s)
- Nimalan Harinesan
- Westmead Clinical School, University of Sydney, Sydney, NSW, Australia
| | - Matthew Silsby
- Westmead Clinical School, University of Sydney, Sydney, NSW, Australia
| | - Neil G Simon
- Northern Beaches Clinical School, Macquarie University, Sydney, NSW, Australia.
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3
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Canlı K, Van Oijen J, Van Oosterwijck J, Meeus M, Van Oosterwijck S, De Meulemeester K. Influence of sensory retraining on cortical reorganization in peripheral neuropathy: A systematic review. PM R 2023. [PMID: 38155585 DOI: 10.1002/pmrj.13126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Revised: 11/19/2023] [Accepted: 12/14/2023] [Indexed: 12/30/2023]
Abstract
OBJECTIVE This study systematically reviewed the literature about sensory retraining effect in comparison to other rehabilitative techniques on cortical reorganization in patients with peripheral neuropathic pain. TYPE: Systematic review. LITERATURE SURVEY After performing an electronic search of PubMed, Web of Science, and Embase, risk of bias was assessed using the revised Cochrane risk of bias tool for randomized controlled trials and the risk of bias in non-randomized studies-of interventions for non-randomized studies of intervention. METHODOLOGY The strength of conclusion was determined using the evidence-based guideline development approach. SYNTHESIS Limited evidence indicates a higher increase in cortical inhibition and a higher reduction in cortical activation during a motor task of the affected hemisphere after graded motor imagery compared to wait-list. Higher reductions in map volume (total excitability of the cortical representation) of the affected hemisphere after peripheral electrical stimulation (PES) were observed when compared to transcranial direct current stimulation (tDCS) or to sham treatment with limited evidence. No other differences in cortical excitability and representation of the affected and non-affected hemisphere were observed when comparing mirror therapy with sham therapy or tDCS, PES with sham therapy or tDCS, and graded motor imagery with wait-list. CONCLUSIONS Graded motor imagery and PES result in higher cortical excitability reductions of the affected hemisphere compared to wait-list, tDCS and sham treatment, respectively.
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Affiliation(s)
- Kübra Canlı
- Faculty of Physical Therapy and Rehabilitation, Hacettepe University, Ankara, Türkiye
| | - Joris Van Oijen
- Department of Rehabilitation Sciences, Spine, Pain and Head Research Unit Ghent, Ghent University, Ghent, Belgium
| | - Jessica Van Oosterwijck
- Department of Rehabilitation Sciences, Spine, Pain and Head Research Unit Ghent, Ghent University, Ghent, Belgium
- Pain in Motion International Research Group, Brussels, Belgium
| | - Mira Meeus
- Department of Rehabilitation Sciences, Spine, Pain and Head Research Unit Ghent, Ghent University, Ghent, Belgium
- Pain in Motion International Research Group, Brussels, Belgium
- Research Group MOVANT, Department of Rehabilitation Sciences and Physiotherapy (REVAKI), University of Antwerp, Antwerpen, Belgium
| | - Sophie Van Oosterwijck
- Department of Rehabilitation Sciences, Spine, Pain and Head Research Unit Ghent, Ghent University, Ghent, Belgium
- Pain in Motion International Research Group, Brussels, Belgium
- Research Foundation-Flanders (FWO), Brussels, Belgium
| | - Kayleigh De Meulemeester
- Department of Rehabilitation Sciences, Spine, Pain and Head Research Unit Ghent, Ghent University, Ghent, Belgium
- Pain in Motion International Research Group, Brussels, Belgium
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Matesanz-García L, Fernández-Chamorro L, Rubio-Vallejo A, Cecilia-López D, Cuenca-Martínez F, Di-Bonaventura S, Fernández-Carnero J. Motor Imagery and Pain Processing in Patients With Entrapment Neuropathies: A Cross-sectional Study. Clin J Pain 2023; 39:620-627. [PMID: 37712289 DOI: 10.1097/ajp.0000000000001158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2023] [Accepted: 08/01/2023] [Indexed: 09/16/2023]
Abstract
OBJECTIVES (1) To assess the ability to generate both kinesthetic and visual motor imagery in participants with carpal tunnel syndrome (CTS), compared with asymptomatic participants. (2) To assess the influence of psychophysiological and functional variables in the motor imagery process. METHODS Twenty patients with unilateral CTS and 18 pain-free individuals were recruited. An observational case-control study with a nonprobability sample was conducted to assess visual and kinesthetic movement imagery ability and psychophysiological variables in patients with CTS compared with asymptomatic participants in a control group. The trial was conducted in accordance with the Strengthening the Reporting of Observational Studies in Epidemiology statement. RESULTS CTS patients have more difficulties in generating visual motor images compared with asymptomatic individuals ( t =-2.099; P <0.05; d=0.70). They need more time to complete the mental tasks (visual t =-2.424; P <0.05 and kinesthetic t =-2.200; P <0.05). A negative correlation was found between the ability to imagine and functional deficits ( r =-0.569; P =0.021) for the kinesthetic subscale and temporal summation ( r =-0.515; P <0.5). A positive correlation was found between pain pressure threshold homolateral (homolateral) and time to generate the visual mental images ( r =0.537; P <0.05). DISCUSSION CTS patients have greater difficulty generating motor images than asymptomatic individuals. Patients also spend more time during mental tasks. CTS patients present a relationship between temporal summation and the capacity to generate kinesthetic images. In addition, the CST patients presented a correlation between chronometry mental tasking and mechanical hyperalgesia.
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Affiliation(s)
- Luis Matesanz-García
- CranioSPain Research Group, Centro Superior de Estudios Universitarios La Salle
- Cognitive Neuroscience, Pain and Rehabilitation Research Group (NECODOR), Faculty of Health Sciences, Universidad Rey Juan Carlos
| | | | - Alberto Rubio-Vallejo
- Department of Physiotherapy, Centro superior de Estudios Universitarios (CSEU) La Salle, Universidad Autónoma de Madrid
| | - David Cecilia-López
- Unit of Elbow-Hand, Service de Traumatología, Hospital 12 de Octubre
- Complutense University of Madrid
- Department of Surgery, Hospital Vithas La Milagrosa
- Hospital Viamed Santa Elena
| | | | - Silvia Di-Bonaventura
- Cognitive Neuroscience, Pain and Rehabilitation Research Group (NECODOR), Faculty of Health Sciences, Universidad Rey Juan Carlos
- Department of Physical Therapy, Occupational Therapy, Rehabilitation and Physical Medicine, Rey Juan Carlos University
| | - Josué Fernández-Carnero
- Cognitive Neuroscience, Pain and Rehabilitation Research Group (NECODOR), Faculty of Health Sciences, Universidad Rey Juan Carlos
- Department of Physical Therapy, Occupational Therapy, Rehabilitation and Physical Medicine, Rey Juan Carlos University
- La Paz Hospital Institute for Health Research, IdiPAZ
- Musculoskeletal Pain and Motor Control Research Group, Faculty of Health Sciences, Universidad Europea de Madrid, Madrid, Spain
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Lakshminarayanan K, Shah R, Daulat SR, Moodley V, Yao Y, Ezhil SL, Ramu V, Sengupta P, Madathil D. Feasibility and usability of a virtual-reality-based sensorimotor activation apparatus for carpal tunnel syndrome patients. PLoS One 2023; 18:e0292494. [PMID: 37819927 PMCID: PMC10566719 DOI: 10.1371/journal.pone.0292494] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Accepted: 09/15/2023] [Indexed: 10/13/2023] Open
Abstract
PURPOSE This study aimed to assess the usability of a virtual reality-assisted sensorimotor activation (VRSMA) apparatus for individual digit rehabilitation. The study had two main objectives: Firstly, to collect preliminary data on the expectations and preferences of patients with carpal tunnel syndrome (CTS) regarding virtual reality (VR) and an apparatus-assisted therapy for their affected digits. Secondly, to evaluate the usability of the VRSMA apparatus that was developed. METHODS The VRSMA system consists of an apparatus that provides sensory and motor stimulation via a vibratory motor and pressure sensor attached to a button, and a virtual reality-based visual cue provided by texts overlaid on top of a 3D model of a hand. The study involved 10 CTS patients who completed five blocks of VRSMA with their affected hand, with each block corresponding to the five digits. The patients were asked to complete a user expectations questionnaire before experiencing the VRSMA, and a user evaluation questionnaire after completing the VRSMA. Expectations for VRSMA were obtained from the questionnaire results using a House of Quality (HoQ) analysis. RESULTS In the survey for expectations, participants rated certain attributes as important for a rehabilitation device for CTS, with mean ratings above 4 for attributes such as ease of use, ease of understanding, motivation, and improvement of hand function based on clinical evidence. The level of immersion and an interesting rehabilitation regime received lower ratings, with mean ratings above 3.5. The survey evaluating VRSMA showed that the current prototype was overall satisfactory with a mean rating of 3.9 out of 5. Based on the HoQ matrix, the highest priority for development of the VRSMA was to enhance device comfort and usage time. This was followed by the need to perform more clinical studies to provide evidence of the efficacy of the VRSMA. Other technical characteristics, such as VRSMA content and device reliability, had lower priority scores. CONCLUSION The current study presents a potential for an individual digit sensorimotor rehabilitation device that is well-liked by CTS patients.
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Affiliation(s)
- Kishor Lakshminarayanan
- Neuro-rehabilitation Lab, Department of Sensors and Biomedical Engineering, School of Electronics Engineering, Vellore Institute of Technology, Vellore, Tamil Nadu, India
| | - Rakshit Shah
- Department of Chemical and Biomedical Engineering, Cleveland State University, Cleveland, OH, United States of America
| | - Sohail R. Daulat
- University of Arizona College of Medicine–Tucson, Tucson, AZ, United States of America
| | - Viashen Moodley
- Arizona Center for Hand to Shoulder Surgery, Phoenix, AZ, United States of America
| | - Yifei Yao
- Soft Tissue Biomechanics Laboratory, Med-X Research Institute, School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai, China
| | - Srignana Lokesh Ezhil
- Neuro-rehabilitation Lab, Department of Sensors and Biomedical Engineering, School of Electronics Engineering, Vellore Institute of Technology, Vellore, Tamil Nadu, India
| | - Vadivelan Ramu
- Neuro-rehabilitation Lab, Department of Sensors and Biomedical Engineering, School of Electronics Engineering, Vellore Institute of Technology, Vellore, Tamil Nadu, India
| | - Puja Sengupta
- Neuro-rehabilitation Lab, Department of Sensors and Biomedical Engineering, School of Electronics Engineering, Vellore Institute of Technology, Vellore, Tamil Nadu, India
| | - Deepa Madathil
- Jindal Institute of Behavioural Sciences, O. P. Jindal Global University, Sonipat, Haryana, India
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Sarak Kucukosmanoglu H, Coskun G, Yosmaoglu HB. The Effect of Yoga Practice on Cervical Tactile Acuity and Body Awareness. Percept Mot Skills 2023; 130:2031-2046. [PMID: 37395628 DOI: 10.1177/00315125231187435] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/04/2023]
Abstract
Body-mind-based holistic methods of relaxation and improved well-being, such as yoga and meditation, improve body awareness and have often been used to enhance quality of life and the ability to cope with pain. We aimed to compare tactile sensory acuity and body awareness in healthy sedentary individuals who practiced yoga regularly and in control participants who had not practiced yoga. Participants were 60 individuals, aged between 18 and 35 years who were divided into two groups according to whether they had previously practiced yoga. We used the two-point discrimination (TPD) test to determine participants' tactile acuity, as measured with a digital calliper at the C7, C5, C3, C1 and T1 spinal segments and with the Body Awareness Questionnaire (BAQ). The TPD measurements of individuals who practiced yoga and meditation had a lower discriminatory threshold compared to those who had not practiced yoga (p < .001), and the self-reported BAQ score of yoga practitioners was higher than that of the controls (p < .001). We found a positive correlation between the length of the prior duration of yoga experience and self-reported body awareness (r = .567, p < .001). There was a significant negative correlation (r = -.379, p = .015) between the C5 segment and the TPD measurements, but not for the other cervical spinal segments (p > .05). There was a negative correlation between the length of prior yoga practice and the TPD measurements in all cervical segments (p < .001). The most negative correlation was found at the C7 segment (r = -.844, p < .001) and the least negative correlation was found at the C3 segment (r = -.669, p < .001). These data suggest that yoga and meditation practices may improve well-being and diminish pain by increasing body awareness and tactile sensory acuity in the cervical region.
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Affiliation(s)
| | - Gursoy Coskun
- Hacettepe University Faculty of Physiotherapy and Rehabilitation, Ankara Turkey
| | - Hayri Baran Yosmaoglu
- Department of Physical Therapy and Rehabilitation, Faculty of Health Sciences, Baskent University, Ankara, Turkey
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7
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Donegan T, Ryan BE, Sanchez-Vives MV, Świdrak J. Altered bodily perceptions in chronic neuropathic pain conditions and implications for treatment using immersive virtual reality. Front Hum Neurosci 2022; 16:1024910. [PMID: 36466621 PMCID: PMC9714822 DOI: 10.3389/fnhum.2022.1024910] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Accepted: 10/18/2022] [Indexed: 08/12/2023] Open
Abstract
Chronic neuropathic pain is highly disabling and difficult to treat and manage. Patients with such conditions often report altered bodily perceptions that are thought to be associated with maladaptive structural and functional alterations in the somatosensory cortex. Manipulating these altered perceptions using body illusions in virtual reality is being investigated and may have positive clinical implications for the treatment of these conditions. Here, we have conducted a narrative review of the evidence for the types of bodily distortions associated with a variety of peripheral and central neuropathic pain conditions. In addition, we summarize the experimental and clinical studies that have explored embodiment and body transformation illusions in immersive virtual reality for neuropathic pain relief, which are thought to target these maladaptive changes, as well as suggesting directions for future research.
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Affiliation(s)
- Tony Donegan
- Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Brenda E. Ryan
- Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Maria V. Sanchez-Vives
- Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
- Institució Catalana de Recerca i Estudis Avançats (ICREA), Barcelona, Spain
| | - Justyna Świdrak
- Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
- Institute of Psychology, Polish Academy of Sciences, Warsaw, Poland
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8
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Schmid AB, Fundaun J, Tampin B. [Entrapment neuropathies: a contemporary approach to pathophysiology, clinical assessment, and management : German version]. Schmerz 2021; 35:419-433. [PMID: 34505948 DOI: 10.1007/s00482-021-00584-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/16/2021] [Indexed: 10/20/2022]
Abstract
Entrapment neuropathies such as carpal tunnel syndrome, radiculopathies, or radicular pain are the most common peripheral neuropathies and also the most common cause for neuropathic pain. Despite their high prevalence, they often remain challenging to diagnose and manage in a clinical setting. Summarising the evidence from both preclinical and clinical studies, this review provides an update on the aetiology and pathophysiology of entrapment neuropathies. Potenzial mechanisms are put in perspective with clinical findings. The contemporary assessment is discussed and diagnostic pitfalls highlighted. The evidence for the noninvasive and surgical management of common entrapment neuropathies is summarised and future areas of research are identified.
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Affiliation(s)
- Annina B Schmid
- Nuffield Department of Clinical Neurosciences, John Radcliffe Hospital, Oxford University, West Wing Level 6, OX3 9DU, Oxford, Großbritannien.
| | - Joel Fundaun
- Nuffield Department of Clinical Neurosciences, John Radcliffe Hospital, Oxford University, West Wing Level 6, OX3 9DU, Oxford, Großbritannien.,High Country Physical Therapy, Laramie, WY, USA
| | - Brigitte Tampin
- Department of Physiotherapy, Sir Charles Gairdner Hospital, Perth, Westaustralien, Australien.,School of Physiotherapy and Exercise Science, Curtin University, Westaustralien, Australien.,Fakultät Wirtschafts- und Sozialwissenschaften, Hochschule Osnabrück, Osnabrück, Deutschland
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9
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Lawson I, Cooke R. Response to letter from Dr M. D. O'Brien. Occup Med (Lond) 2021; 71:235-236. [PMID: 34416005 DOI: 10.1093/occmed/kqab062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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10
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Structural white matter alterations in carpal tunnel syndrome: A modified TBSS study. Brain Res 2021; 1767:147558. [PMID: 34116054 DOI: 10.1016/j.brainres.2021.147558] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Revised: 06/03/2021] [Accepted: 06/06/2021] [Indexed: 11/22/2022]
Abstract
Functional and structural brain alterations have been noted in carpal tunnel syndrome (CTS), the most common entrapment peripheral neuropathy. Previous studies were mainly focused on somatosensory cortices. However, the changes of white matter diffusion properties in nonsensorimotor cortices remain uninvestigated. We utilized a modified tract-based spatial statistics (TBSS) pipeline to explore CTS-related white matter plasticity, omitting the skeletonization step and registering diffusion tensor imaging (DTI) data to a study-specific, high resolution T1 template by an optimized registration method. The modified TBSS was demonstrated to be more sensitive to detect changes in white matter integrity than the standard TBSS approach. In this study, 25 moderate/severe CTS patients and 17 age- and sex-matched healthy controls (HC) were evaluated with DTI. Fractional anisotropy (FA) and radial diffusivity (RD) were calculated for group comparison. And the relationship between diffusion parameters and clinical assessments was also analyzed. Comparing with the healthy controls, CTS patients showed significantly increased FA and decreased RD in areas of multisensory integration and motor control involving the central opercular cortex and supplementary motor area (SMA) of the dominant hemisphere. Moreover, altered diffusion parameters in the central opercular cortex of the dominant hemisphere were significantly correlated with Boston Carpal Tunnel Questionnaire (BCTQ) scores. It is considered to be a form of maladaptive neuroplastic response to CTS-associated afference and motor control deficits. Such insight may be helpful in developing new strategies for the treatment of CTS.
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Deer TR, Eldabe S, Falowski SM, Huntoon MA, Staats PS, Cassar IR, Crosby ND, Boggs JW. Peripherally Induced Reconditioning of the Central Nervous System: A Proposed Mechanistic Theory for Sustained Relief of Chronic Pain with Percutaneous Peripheral Nerve Stimulation. J Pain Res 2021; 14:721-736. [PMID: 33737830 PMCID: PMC7966353 DOI: 10.2147/jpr.s297091] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Accepted: 02/26/2021] [Indexed: 12/23/2022] Open
Abstract
Peripheral nerve stimulation (PNS) is an effective tool for the treatment of chronic pain, although its efficacy and utilization have previously been significantly limited by technology. In recent years, purpose-built percutaneous PNS devices have been developed to overcome the limitations of conventional permanently implanted neurostimulation devices. Recent clinical evidence suggests clinically significant and sustained reductions in pain can persist well beyond the PNS treatment period, outcomes that have not previously been observed with conventional permanently implanted neurostimulation devices. This narrative review summarizes mechanistic processes that contribute to chronic pain, and the potential mechanisms by which selective large diameter afferent fiber activation may reverse these changes to induce a prolonged reduction in pain. The interplay of these mechanisms, supported by data in chronic pain states that have been effectively treated with percutaneous PNS, will also be discussed in support of a new theory of pain management in neuromodulation: Peripherally Induced Reconditioning of the Central Nervous System (CNS).
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Affiliation(s)
- Timothy R Deer
- The Spine and Nerve Center of the Virginias, Charleston, WV, USA
| | - Sam Eldabe
- Department of Pain Medicine, The James Cook University Hospital, Middlesbrough, UK
| | - Steven M Falowski
- Department of Neurosurgery, Neurosurgical Associates of Lancaster, Lancaster, PA, USA
| | - Marc A Huntoon
- Anesthesiology, Virginia Commonwealth University Medical Center, Richmond, VA, USA
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12
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Paquette P, Higgins J, Gagnon DH. Peripheral and Central Adaptations After a Median Nerve Neuromobilization Program Completed by Individuals With Carpal Tunnel Syndrome: An Exploratory Mechanistic Study Using Musculoskeletal Ultrasound Imaging and Transcranial Magnetic Stimulation. J Manipulative Physiol Ther 2020; 43:566-578. [PMID: 32861518 DOI: 10.1016/j.jmpt.2019.10.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2019] [Revised: 10/11/2019] [Accepted: 10/22/2019] [Indexed: 10/23/2022]
Abstract
OBJECTIVE Neuromobilization exercises are increasingly advocated in the conservative management of individuals with carpal tunnel syndrome (CTS), as they may mitigate CTS-related signs and symptoms via potential peripheral (ie, musculoskeletal) and central (ie, neurophysiological) adaptations. However, the mechanisms underlying these adaptations have not been studied extensively. Hence, this exploratory and mechanistic study aims to evaluate the potential peripheral and central adaptations that may result in individuals with CTS who have completed a neuromobilization program. METHODS Fourteen individuals with CTS were evaluated before and 1 week after the completion of a 4-week neuromobilization program that incorporated median nerve sliding exercises. Pain and upper limb functional abilities were assessed using standardized questionnaires. The biological integrity and mechanical properties of the median nerve and the corticospinal excitability were quantified using musculoskeletal ultrasound imaging and transcranial magnetic stimulation, respectively. RESULTS Upon completion of the program, participants reported both large and moderate improvements in pain (P ≤ .03) and upper limb functional abilities (P = .02), respectively. The biological integrity and mechanical properties of the median nerve remained unchanged (P ≥ .22), whereas a small significant increase in corticospinal excitability (P = .04) was observed. CONCLUSION The proposed neuromobilization program appears promising to improve pain and upper limb functional abilities in individuals with CTS. These improvements may be preferentially mediated via central, rather than peripheral, adaptations. Future studies, especially with a larger sample size, longer intervention duration, and additional measurement times, are needed to strengthen current evidence.
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Affiliation(s)
- Philippe Paquette
- School of Rehabilitation, Université de Montréal, Montréal, Québec, Canada.
| | - Johanne Higgins
- School of Rehabilitation, Université de Montréal, Montréal, Québec, Canada
| | - Dany H Gagnon
- School of Rehabilitation, Université de Montréal, Montréal, Québec, Canada
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13
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Schmid AB, Fundaun J, Tampin B. Entrapment neuropathies: a contemporary approach to pathophysiology, clinical assessment, and management. Pain Rep 2020; 5:e829. [PMID: 32766466 PMCID: PMC7382548 DOI: 10.1097/pr9.0000000000000829] [Citation(s) in RCA: 41] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2019] [Revised: 05/04/2020] [Accepted: 05/30/2020] [Indexed: 12/18/2022] Open
Abstract
Entrapment neuropathies such as carpal tunnel syndrome, radiculopathies, or radicular pain are the most common peripheral neuropathies and also the most common cause for neuropathic pain. Despite their high prevalence, they often remain challenging to diagnose and manage in a clinical setting. Summarising the evidence from both preclinical and clinical studies, this review provides an update on the aetiology and pathophysiology of entrapment neuropathies. Potential mechanisms are put in perspective with clinical findings. The contemporary assessment is discussed and diagnostic pitfalls highlighted. The evidence for the noninvasive and surgical management of common entrapment neuropathies is summarised and future areas of research are identified.
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Affiliation(s)
- Annina B. Schmid
- Nuffield Department of Clinical Neurosciences, Oxford University, Oxford, United Kingdom
| | - Joel Fundaun
- Nuffield Department of Clinical Neurosciences, Oxford University, Oxford, United Kingdom
- High Country Physical Therapy, Laramie, WY, USA
| | - Brigitte Tampin
- Department of Physiotherapy, Sir Charles Gairdner Hospital, Perth, Western Australia, Australia
- School of Physiotherapy and Exercise Science, Curtin University, Western Australia, Australia
- Faculty of Business Management and Social Sciences, Hochschule Osnabrück, University of Applied Sciences, Osnabrück, Germany
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Fernández-de-las-peñas C, Arias-Buría JL, Ortega-Santiago R, De-la-Llave-Rincón AI. Understanding central sensitization for advances in management of carpal tunnel syndrome. F1000Res 2020; 9:F1000 Faculty Rev-605. [PMID: 32595941 PMCID: PMC7308881 DOI: 10.12688/f1000research.22570.1] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/05/2020] [Indexed: 12/27/2022] Open
Abstract
Carpal tunnel syndrome is the most common nerve compression disorder of the upper extremity, and it is traditionally considered a peripheral neuropathy associated with a localized compression of the median nerve just at the level of the carpal tunnel. Surgery and physiotherapy are treatment approaches commonly used for this condition; however, conflicting clinical outcomes suggest that carpal tunnel syndrome may be more complex. There is evidence supporting the role of peripheral nociception from the median nerve in carpal tunnel syndrome; however, emerging evidence also suggests a potential role of central sensitization. The presence of spreading pain symptoms (e.g. proximal pain), widespread sensory changes, or bilateral motor control impairments in people presenting with strictly unilateral sensory symptoms supports the presence of spinal cord changes. Interestingly, bilateral sensory and motor changes are not directly associated with electrodiagnostic findings. Other studies have also reported that patients presenting with carpal tunnel syndrome exhibit neuroplastic brainstem change supporting central sensitization. Current data would support the presence of a central sensitization process, mediated by the peripheral drive originating in the compression of the median nerve, in people with carpal tunnel syndrome. The presence of altered nociceptive gain processing should be considered in the treatment of carpal tunnel syndrome by integrating therapeutic approaches aiming to modulate long-lasting nociceptive barrage into the central nervous system (peripheral drive) and strategies aiming to activate endogenous pain networks (central drive).
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Affiliation(s)
- César Fernández-de-las-peñas
- Department of Physical Therapy, Occupational Therapy, Rehabilitation and Physical Medicine, Universidad Rey Juan Carlos, Alcorcón, Spain
- Cátedra Institucional en Docencia, Clínica e Investigación en Fisioterapia: Terapia Manual, Punción Seca y Ejercicio Terapéutico, Universidad Rey Juan Carlos, Alcorcón, Madrid, Spain
| | - José L Arias-Buría
- Department of Physical Therapy, Occupational Therapy, Rehabilitation and Physical Medicine, Universidad Rey Juan Carlos, Alcorcón, Spain
- Cátedra Institucional en Docencia, Clínica e Investigación en Fisioterapia: Terapia Manual, Punción Seca y Ejercicio Terapéutico, Universidad Rey Juan Carlos, Alcorcón, Madrid, Spain
| | - Ricardo Ortega-Santiago
- Department of Physical Therapy, Occupational Therapy, Rehabilitation and Physical Medicine, Universidad Rey Juan Carlos, Alcorcón, Spain
- Cátedra Institucional en Docencia, Clínica e Investigación en Fisioterapia: Terapia Manual, Punción Seca y Ejercicio Terapéutico, Universidad Rey Juan Carlos, Alcorcón, Madrid, Spain
| | - Ana I De-la-Llave-Rincón
- Department of Physical Therapy, Occupational Therapy, Rehabilitation and Physical Medicine, Universidad Rey Juan Carlos, Alcorcón, Spain
- Cátedra Institucional en Docencia, Clínica e Investigación en Fisioterapia: Terapia Manual, Punción Seca y Ejercicio Terapéutico, Universidad Rey Juan Carlos, Alcorcón, Madrid, Spain
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15
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El-Hady AO, El Molla SSA, Ibrahim RA. Evaluation of axonal loss in ulnar sensory nerve fibers recorded from ring and little fingers secondary to idiopathic carpal tunnel syndrome in Egyptian patients. EGYPTIAN RHEUMATOLOGY AND REHABILITATION 2020. [DOI: 10.1186/s43166-020-00004-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
The association between carpal tunnel syndrome (CTS) and ulnar nerve entrapment is unclear, and the extra-median paresthesia in the ulnar nerve territory innervation in CTS is unexplained. Our purpose is to evaluate the neurophysiologic changes in ulnar nerve sensory fibers secondary to idiopathic CTS in comparison to normal subjects, and their relation to the severity of CTS.
Results
The difference between CTS and control hands regarding all parameters of ulnar motor nerve conduction studies (MNCS) was not statistically significant (p > 0.05). There was a statistically significant difference in all parameters of median sensory conduction study (SCS) and MNCS between CTS and control hands (p < 0.0001) except for conduction velocity and in all parameters of median and ulnar SCS recording digit 4 (D4) (p < 0.05). The mean value of abnormalities of ulnar SCS recording D4 and digit 5 (D5) was significantly higher in moderate and severe CTS hands (p < 0.05). There were significant negative correlations between median motor and sensory latency and ulnar sensory amplitude recording D4 and D5.
Conclusion
Ulnar sensory nerve abnormalities exist among CTS patients, which were more in moderate and severe grades. The drop in amplitude of ulnar nerve sensory response argues in favor of the possible impact of CTS on the ulnar nerve and did not indicate axonal deterioration of the ulnar nerve.
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16
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Yoshida A, Iwatsuki K, Hoshiyama M, Hirata H. Disturbance of somatotopic spatial cognition and extra-territorial pain in carpal tunnel syndrome. NeuroRehabilitation 2020; 46:423-431. [PMID: 32250335 DOI: 10.3233/nre-193007] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Several studies on carpal tunnel syndrome have reported pain that exists beyond the median nerve territory of the affected hand. However, the mechanism is unknown. PURPOSE We investigated the cause of extra-territorial pain by the analysis of clinical assessments and cortical activity using magnetoencephalography. METHODS To compare patients with and without extra-territorial pain, fourteen patients with carpal tunnel syndrome were assessed using clinical examination, such as patients' profile, paresthesia, physical tests, and psychological tests. The physical assessment included tactile threshold and static and moving two-point discrimination sensations on digital pulp. Neural activation in the cerebral cortex was also measured using z-scores calculated by magnetoencephalography. RESULTS Among fourteen patients, ten patients had pain in the affected median nerve territory only and four patients had extra-territorial pain. When comparing the groups, the static and moving two-point discrimination sensation values in patients with extra-territorial pain were larger than those of patients without the pain (p < 0.05). The supra-marginal gyrus, mid-part of the precentral sulcus, angular gyrus in the left hemisphere, bilateral sensorimotor areas for legs, and bilateral isthmus-cingulate areas showed larger z-scores in patients with extra-territorial pain than in patients without the pain (p < 0.05). CONCLUSIONS The static and moving two-point discrimination sensations signify the ability of tactile spatial acuity. Bilateral sensorimotor areas were activated in sites that were not the hand. Furthermore, the inferior parietal lobule in the left hemisphere, which synthesizes and integrates multiple sensations showed high activation. Our findings suggested that the mechanism of extra-territorial pain was associated with dysfunction of spatial cognition.
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Affiliation(s)
- Akihito Yoshida
- Department of Hand Surgery, Nagoya University Graduate School of Medicine, Aichi, Japan.,Department of Rehabilitation, Nagoya University Hospital, Aichi, Japan.,Department of Rehabilitation Science, Nagoya University Graduate School of Medicine, Aichi, Japan
| | - Katsuyuki Iwatsuki
- Department of Hand Surgery, Nagoya University Graduate School of Medicine, Aichi, Japan
| | - Minoru Hoshiyama
- Brain and Mind Research Center, Nagoya University Graduate School of Medicine, Aichi, Japan
| | - Hitoshi Hirata
- Department of Hand Surgery, Nagoya University Graduate School of Medicine, Aichi, Japan
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17
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Osborne NR, Anastakis DJ, Davis KD. Peripheral nerve injuries, pain, and neuroplasticity. J Hand Ther 2019; 31:184-194. [PMID: 29706196 DOI: 10.1016/j.jht.2018.01.011] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2017] [Revised: 01/15/2018] [Accepted: 01/20/2018] [Indexed: 02/03/2023]
Abstract
INTRODUCTION Peripheral nerve injuries (PNIs) cause both structural and functional brain changes that may be associated with significant sensorimotor abnormalities and pain. PURPOSE OF THE STUDY The aim of this narrative review is to provide hand therapists an overview of PNI-induced neuroplasticity and to explain how the brain changes following PNI, repair, and during rehabilitation. METHODS Toward this goal, we review key aspects of neuroplasticity and neuroimaging and discuss sensory testing techniques used to study neuroplasticity in PNI patients. RESULTS We describe the specific brain changes that occur during the repair and recovery process of both traumatic (eg, transection) and nontraumatic (eg, compression) nerve injuries. We also explain how these changes contribute to common symptoms including hypoesthesia, hyperalgesia, cold sensitivity, and chronic neurogenic pain. In addition, we describe how maladaptive neuroplasticity as well as psychological and personality characteristics impacts treatment outcome. DISCUSSION AND CONCLUSION Greater understanding of the brain's contribution to symptoms in recovering PNI patients could help guide rehabilitation strategies and inform the development of novel techniques to counteract these maladaptive brain changes and ultimately improve outcomes.
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Affiliation(s)
- Natalie R Osborne
- Krembil Research Institute, Toronto Western Hospital, Toronto, Ontario, Canada; Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada
| | - Dimitri J Anastakis
- Krembil Research Institute, Toronto Western Hospital, Toronto, Ontario, Canada; Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada; Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Karen D Davis
- Krembil Research Institute, Toronto Western Hospital, Toronto, Ontario, Canada; Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada; Department of Surgery, University of Toronto, Toronto, Ontario, Canada.
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18
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Colorado BS, Osei DA. Prevalence of carpal tunnel syndrome presenting with symptoms in an ulnar nerve distribution: A prospective study. Muscle Nerve 2018; 59:60-63. [PMID: 30051917 DOI: 10.1002/mus.26310] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2017] [Revised: 07/22/2018] [Accepted: 07/24/2018] [Indexed: 01/17/2023]
Abstract
INTRODUCTION Patients presenting with symptoms of pain/paresthesias primarily in an ulnar nerve distribution may be noted to have exclusive median mononeuropathy at the wrist on subsequent electrodiagnostic testing. There has been limited research looking at the prevalence of this clinical presentation. METHODS A cohort of adults were surveyed to assess for severity and localization of hand symptoms using the Katz hand diagram and Boston Carpal Tunnel Questionnaire Symptoms Severity Scale. Thirty volunteers met our case definition for ulnar neuropathy and underwent a standardized physical examination, electrodiagnostic testing, and nerve ultrasound. RESULTS Eleven of 30 subjects (37%) were found to have exclusive median mononeuropathy at the wrist. DISCUSSION Carpal tunnel syndrome should remain high on the differential for patients presenting with symptoms of pain/paresthesias primarily in an ulnar nerve distribution. Muscle Nerve 59:60-63, 2019.
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Affiliation(s)
- Berdale S Colorado
- Department of Orthopedic Surgery, Washington University School of Medicine, Campus Box 8233, 425 South Euclid Avenue, St. Louis, Missouri, USA.,Department of Neurology, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Daniel A Osei
- Department of Orthopedic Surgery, Washington University School of Medicine, Campus Box 8233, 425 South Euclid Avenue, St. Louis, Missouri, USA
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19
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Barratt EL, Francis ST, Morris PG, Brookes MJ. Mapping the topological organisation of beta oscillations in motor cortex using MEG. Neuroimage 2018; 181:831-844. [PMID: 29960087 PMCID: PMC6150950 DOI: 10.1016/j.neuroimage.2018.06.041] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2018] [Revised: 06/05/2018] [Accepted: 06/12/2018] [Indexed: 12/19/2022] Open
Abstract
The spatial topology of the human motor cortex has been well studied, particularly using functional Magnetic Resonance Imaging (fMRI) which allows spatial separation of haemodynamic responses arising from stimulation of different body parts, individual digits and even spatially separate areas of the same digit. However, the spatial organisation of electrophysiological responses, particularly neural oscillations (rhythmic changes in electrical potential across cellular assemblies) has been less well studied. Mapping the spatial signature of neural oscillations is possible using magnetoencephalography (MEG), however spatial differentiation of responses induced by movement of separate digits is a challenge, because the brain regions involved are separated by only a few millimetres. In this paper we first show, in simulation, how to optimise experimental design and beamformer spatial filtering techniques to increase the spatial specificity of MEG derived functional images. Combining this result with experimental data, we then capture the organisation of the post-movement beta band (13–30 Hz) oscillatory response to movement of digits 2 and 5 of the dominant hand, in individual subjects. By comparing these MEG results to ultra-high field (7T) fMRI, we also show significant spatial agreement between beta modulation and the blood oxygenation level dependent (BOLD) response. Our results show that, when using an optimised inverse solution and controlling subject movement (using custom fitted foam padding) the spatial resolution of MEG can be of order 3–5 mm. The method described offers exciting potential to understand better the cortical organisation of oscillations, and to probe such organisation in patient populations where those oscillations are known to be abnormal. Aim is to map the topological organisation of neural oscillations in motor cortex. MEG spatial resolution optimised by temporal separation of sources. Subject motion controlled using foam headcasts. Cortical representation of Digit 2 and Digit 5 separated spatially. Post movement beta rebound maps motortopically in agreement with BOLD responses.
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Affiliation(s)
- Eleanor L Barratt
- Sir Peter Mansfield Imaging Centre, School of Physics and Astronomy, University of Nottingham, University Park, Nottingham, NG7 2RD, United Kingdom
| | - Susan T Francis
- Sir Peter Mansfield Imaging Centre, School of Physics and Astronomy, University of Nottingham, University Park, Nottingham, NG7 2RD, United Kingdom
| | - Peter G Morris
- Sir Peter Mansfield Imaging Centre, School of Physics and Astronomy, University of Nottingham, University Park, Nottingham, NG7 2RD, United Kingdom
| | - Matthew J Brookes
- Sir Peter Mansfield Imaging Centre, School of Physics and Astronomy, University of Nottingham, University Park, Nottingham, NG7 2RD, United Kingdom.
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20
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Are the Sensory Fibers of the Ulnar Nerve Affected in Carpal Tunnel Syndrome? J Clin Neurophysiol 2018; 34:502-507. [PMID: 28914658 DOI: 10.1097/wnp.0000000000000410] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
PURPOSE Distribution of paresthesia throughout the skin area without median nerve innervation is frequently seen in carpal tunnel syndrome (CTS). However, its pathophysiologic mechanisms are still unclear. We aimed to research whether a dysfunction in sensory fibers of the ulnar nerve (UN) was present or not in hands with CTS. METHODS Totally, upper extremity nerve conduction study recordings of 508 patients were considered. After exclusions, 331 upper extremity recordings of 277 patients were included. We compared the results of sensory conduction studies of median nerve and UN between normal hands and hands with CTS. RESULTS The mean distal sensory latency of the median nerve was longer, the mean conduction velocity was slower, and mean nerve action potential amplitude was higher in the hands with CTS than in normal hands (P < 0.001 for all comparisons). There was no statistically significant difference on any sensory conduction parameters of UN recorded on digit IV or digit V between the disease and control groups (P > 0.05 for all comparisons). The rates of conduction abnormalities of the UN sensory fibers were also similar in hands with CTS and in normal hands (P > 0.05 for all comparisons). CONCLUSIONS The hands with CTS do not have an increased rate of conduction abnormalities of UN sensory fibers compared with the normal hands in our study population. Therefore, our study did not confirm the distortion of UN sensory fibers as a mechanism underlying the spread of paresthesia throughout the skin area without median nerve innervation in CTS.
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21
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Fernández-de-Las-Peñas C, Plaza-Manzano G. Carpal tunnel syndrome: just a peripheral neuropathy? Pain Manag 2018; 8:209-216. [PMID: 29869575 DOI: 10.2217/pmt-2017-0063] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
Carpal tunnel syndrome (CTS) is considered just a peripheral neuropathy of the upper extremity associated to the compression of the median nerve. There is evidence suggesting the presence of complex sensitization mechanisms in CTS. These processes are manifested by symptoms in extra-median regions and the presence of bilateral sensory and motor impairments. These sensory and motor changes are not associated to electrodiagnostic findings. The presence of sensitization mechanisms suggests that CTS should not be considered just as a peripheral neuropathy. The presence of altered nociceptive gain processing should be considered for therapeutic management of CTS by considering the application of therapeutic interventions that modulate nociceptive barrage into the CNS.
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Affiliation(s)
- César Fernández-de-Las-Peñas
- Department of Physical Therapy, Occupational Therapy, Rehabilitation & Physical Medicine, Universidad Rey Juan Carlos, Alcorcón, Madrid, Spain.,Cátedra de Investigación y Docencia en Fisioterapia: Terapia Manual y Punción Seca, Universidad Rey Juan Carlos, Alcorcón, Madrid, Spain
| | - Gustavo Plaza-Manzano
- Department of Rehabilitation & Physical Medicine, Medical Hydrology, Complutense University of Madrid, Madrid, Spain.,Instituto de Investigación Sanitaria del Hospital Clínico San Carlos, Madrid, Spain
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22
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Tactile acuity is reduced in people with chronic neck pain. Musculoskelet Sci Pract 2018; 33:61-66. [PMID: 29180111 DOI: 10.1016/j.msksp.2017.11.009] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2017] [Revised: 11/02/2017] [Accepted: 11/18/2017] [Indexed: 01/28/2023]
Abstract
BACKGROUND Tactile acuity deficits have been demonstrated in a range of persistent pain conditions and may reflect underlying cortical re-organisation. OBJECTIVE This study aimed to determine whether tactile acuity is impaired in people with chronic neck pain relative to controls, and whether deficits relate to pain location, duration and intensity. METHODS In this cross-sectional study, 20 people with chronic neck pain (5 idiopathic neck pain; 15 whiplash-associated disorder) and 20 pain-free controls underwent two-point discrimination (TPD) testing at the neck, back and arm, and point-to-point (PTP) and graphesthesia tests of tactile acuity at the neck and arm. RESULTS Linear mixed effects models demonstrated a significant group*body region interaction for TPD, Graphesthesia and PTP tests (Ps < 0.001), with post hoc tests showing impaired TPD in people with neck pain relative to controls at the neck, low back, and arm (P ≤ 0.001). Graphesthesia and PTP was also impaired at the neck (P < 0.001) but not the arm (P ≥ 0.48). TPD correlated with intensity and duration of pain (Pearson's r = 0.48, P < 0.05; Pearson's r = 0.77, P < 0.01). There was no sig difference between the two neck pain groups for any tactile acuity measure (TPD: P = 0.054; Graphesthesia; P = 0.67; Point to Point: P = 0.77), however, low power limited confidence in this comparison. CONCLUSION People with chronic neck pain demonstrated tactile acuity deficits in painful and non-painful regions when measured using the TPD test, with the magnitude of deficits appearing greatest at the neck. The study also revealed a positive relationship between TPD and pain intensity/duration, further supporting the main study finding.
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23
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Bao BB, Qu DQ, Zhu HY, Gao T, Zheng XY. Brain remodeling after chronic median nerve compression in a rat model. Neural Regen Res 2018; 13:704-708. [PMID: 29722324 PMCID: PMC5950682 DOI: 10.4103/1673-5374.230298] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Carpal tunnel syndrome is the most common compressive neuropathy, presenting with sensorimotor dysfunction. In carpal tunnel syndrome patients, irregular afferent signals on functional magnetic resonance imaging are associated with changes in neural plasticity during peripheral nerve injury. However, it is difficult to obtain multi-point neuroimaging data of the brain in the clinic. In the present study, a rat model of median nerve compression was established by median nerve ligation, i.e., carpal tunnel syndrome model. Sensory cortex remodeling was determined by functional magnetic resonance imaging between normal rats and carpal tunnel syndrome models at 2 weeks and 2 months after operation. Stimulation of bilateral paws by electricity for 30 seconds, alternating with 30 seconds of rest period (repeatedly 3 times), resulted in activation of the contralateral sensorimotor cortex in normal rats. When carpal tunnel syndrome rats received this stimulation, the contralateral cerebral hemisphere was markedly activated at 2 weeks after operation, including the primary motor cortex, cerebellum, and thalamus. Moreover, this activation was not visible at 2 months after operation. These findings suggest that significant remodeling of the cerebral cortex appears at 2 weeks and 2 months after median nerve compression.
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Affiliation(s)
- Bing-Bo Bao
- Department of Orthopedic Surgery, Shanghai Jiao Tong University, Affiliated Sixth People's Hospital, Shanghai, China
| | - Dan-Qian Qu
- Yueyang Hospital of Intergrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Hong-Yi Zhu
- Department of Orthopedic Surgery, Shanghai Jiao Tong University, Affiliated Sixth People's Hospital, Shanghai, China
| | - Tao Gao
- Department of Orthopedic Surgery, Shanghai Jiao Tong University, Affiliated Sixth People's Hospital, Shanghai, China
| | - Xian-You Zheng
- Department of Orthopedic Surgery, Shanghai Jiao Tong University, Affiliated Sixth People's Hospital, Shanghai, China
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24
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Dec P, Zyluk A. Bilateral carpal tunnel syndrome – A review. Neurol Neurochir Pol 2018; 52:79-83. [DOI: 10.1016/j.pjnns.2017.09.009] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2017] [Revised: 09/24/2017] [Accepted: 09/25/2017] [Indexed: 11/29/2022]
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25
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Harvie DS, Kelly J, Buckman H, Chan J, Sutherland G, Catley M, Novak J, Tuttle N, Sterling M. Tactile acuity testing at the neck: A comparison of methods. Musculoskelet Sci Pract 2017; 32:23-30. [PMID: 28800436 DOI: 10.1016/j.msksp.2017.07.007] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2017] [Revised: 07/13/2017] [Accepted: 07/25/2017] [Indexed: 12/31/2022]
Abstract
BACKGROUND Interest in measurement of tactile acuity in musculoskeletal practice has emerged following its link to functional reorganization of the somatosensory cortex in ongoing pain states. Several tactile acuity measurement methods have been described but have not been thoroughly investigated in the cervical region. OBJECTIVE This study examined reliability, concurrent validity and responsiveness of four tests of tactile acuity-Two-point discrimination, Point-to-point, Graphesthesia, and Localisation tests-at the cervical region. METHOD Forty-two healthy participants were included. In Part 1 (n = 22), participants' tactile acuity was assessed at two time points, 30 min apart, to determine the test-retest reliability and concurrent validity of each of the tests. In Part 2 (n = 20), participants received five daily tactile training sessions, delivered via a vibro-tactile device. Tactile acuity was assessed pre- and post-training to examine responsiveness of each test. RESULTS Two-point discrimination demonstrated excellent test-retest reliability (ICC = 0.85, SEM = 3.7 mm), Point-to-point and Localisation tests demonstrated good reliability (ICC = 0.60, SEM = 2.8 mm; ICC = 0.60, SEM = 8.8%), and Graphesthesia demonstrated fair reliability (ICC = 0.48, SEM = 1.9/20). There was no significant correlation among measures. Only Graphesthesia failed to show responsiveness to change following training. CONCLUSION The reliability of Two-point discrimination appears superior to other examined tests of tactile acuity, however measurement variability should be considered. Two-point discrimination, Point-to-point, and Localisation tests appear responsive to change, although testing in clinical samples is needed. The lack of concurrent validity among tests suggests that they cannot be used interchangeably.
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Affiliation(s)
- Daniel S Harvie
- Recover Injury Research Centre, NHMRC Centre of Research Excellence in Recovery Following Road Traffic Injuries, Menzies Health Institute Queensland, Griffith University, Gold Coast, Australia.
| | - Joan Kelly
- Recover Injury Research Centre, NHMRC Centre of Research Excellence in Recovery Following Road Traffic Injuries, Menzies Health Institute Queensland, Griffith University, Gold Coast, Australia
| | - Hayden Buckman
- School of Allied Health Sciences, Griffith University, Gold Coast, Australia
| | - Jonathan Chan
- School of Allied Health Sciences, Griffith University, Gold Coast, Australia
| | - Grace Sutherland
- School of Allied Health Sciences, Griffith University, Gold Coast, Australia
| | - Mark Catley
- School of Health Sciences, University of South Australia, Adelaide, Australia
| | - James Novak
- Queensland College of Art, Griffith University, Gold Coast, Australia
| | - Neil Tuttle
- School of Allied Health Sciences, Griffith University, Gold Coast, Australia
| | - Michele Sterling
- Recover Injury Research Centre, NHMRC Centre of Research Excellence in Recovery Following Road Traffic Injuries, Menzies Health Institute Queensland, Griffith University, Gold Coast, Australia
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26
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Soon B, Vicenzino B, Schmid AB, Coppieters MW. Facilitatory and inhibitory pain mechanisms are altered in patients with carpal tunnel syndrome. PLoS One 2017; 12:e0183252. [PMID: 28854251 PMCID: PMC5576684 DOI: 10.1371/journal.pone.0183252] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2017] [Accepted: 08/01/2017] [Indexed: 11/19/2022] Open
Abstract
Preliminary evidence from studies using quantitative sensory testing suggests the presence of central mechanisms in patients with carpal tunnel syndrome (CTS) as apparent by widespread hyperalgesia. Hallmarks of central mechanisms after nerve injuries include nociceptive facilitation and reduced endogenous pain inhibition. Methods to study nociceptive facilitation in CTS so far have been limited to quantitative sensory testing and the integrity of endogenous inhibition remains unexamined. The aim of this study was therefore to investigate changes in facilitatory and inhibitory processing in patients with CTS by studying hypersensitivity following experimentally induced pain (facilitatory mechanisms) and the efficacy of conditioned pain modulation (CPM, inhibitory mechanisms). Twenty-five patients with mild to moderate CTS and 25 age and sex matched control participants without CTS were recruited. Increased pain facilitation was evaluated via injection of hypertonic saline into the upper trapezius. Altered pain inhibition through CPM was investigated through cold water immersion of the foot as the conditioning stimulus and pressure pain threshold over the thenar and hypothenar eminence bilaterally as the test stimulus. The results demonstrated that patients with CTS showed a greater duration (p = 0.047), intensity (p = 0.044) and area (p = 0.012) of pain in response to experimentally induced pain in the upper trapezius and impaired CPM compared to the control participants (p = 0.006). Although typically considered to be driven by peripheral mechanisms, these findings indicate that CTS demonstrates characteristics of altered central processing with increased pain facilitation and reduced endogenous pain inhibition.
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Affiliation(s)
- Benjamin Soon
- Centre of Clinical Research Excellence in Spinal Pain, Injury and Health, School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Australia
- Singapore Institute of Technology, Singapore, Singapore
| | - Bill Vicenzino
- Centre of Clinical Research Excellence in Spinal Pain, Injury and Health, School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Australia
- Physiotherapy, School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Australia
| | - Annina B. Schmid
- Centre of Clinical Research Excellence in Spinal Pain, Injury and Health, School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Australia
- Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, United Kingdom
| | - Michel W. Coppieters
- Physiotherapy, School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Australia
- Amsterdam Movement Sciences, Department of Human Movement Sciences, Faculty of Behavioural and Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Menzies Health Institute Queensland and School of Allied Health Sciences, Faculty of Health, Griffith University, Gold Coast Campus, Queensland, Australia
- * E-mail:
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27
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Lu YC, Zhang H, Zheng MX, Hua XY, Qiu YQ, Shen YD, Jiang S, Xu JG, Gu YD, Xu WD. Local and Extensive Neuroplasticity in Carpal Tunnel Syndrome: A Resting-State fMRI Study. Neurorehabil Neural Repair 2017; 31:898-909. [PMID: 28845734 DOI: 10.1177/1545968317723749] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Carpal tunnel syndrome (CTS) is a most common peripheral nerve entrapment neuropathy characterized by sensorimotor deficits in median nerve innervated digits. Block-design task-related functional magnetic resonance imaging (fMRI) studies have been used to investigate CTS-related neuroplasticity in the primary somatosensory cortices. However, considering the persistence of digital paresthesia syndrome caused by median nerve entrapment, spontaneous neuronal activity might provide a better understanding of CTS-related neuroplasticity, which remains unexplored. The present study aimed to investigate both local and extensive spontaneous neuronal activities with resting-state fMRI. A total of 28 bilateral CTS patients and 24 normal controls were recruited, and metrics, including amplitude of low-frequency fluctuation (ALFF) and voxel-wise functional connectivity (FC), were used to explore synaptic activity at different spatial scales. Correlations with clinical measures were further investigated by linear regression. Decreased amplitudes of low-frequency fluctuation were observed in the bilateral primary sensory cortex (SI) and secondary sensory cortex (SII) in CTS patients (AlphaSim corrected P < .05). This was found to be negatively related to the sensory thresholds of corresponding median nerve innervated fingers. In the voxel-wise FC analysis, with predefined seed regions of interest in the bilateral SI and primary motor cortex, we observed decreased interhemispheric and increased intrahemispheric FC. Additionally, both interhemispheric and intrahemispheric FC were found to be significantly correlated with the mean ALFF.
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Affiliation(s)
- Ye-Chen Lu
- 1 Department of Hand Surgery, Huashan Hospital, Fudan University, Shanghai, China.,2 Key Laboratory of Hand Reconstruction, Ministry of Health, Shanghai, China.,3 Shanghai Key Laboratory of Peripheral Nerve and Microsurgery, Shanghai, China
| | - Han Zhang
- 4 Hangzhou Normal University, Zhejiang Province, China
| | - Mou-Xiong Zheng
- 1 Department of Hand Surgery, Huashan Hospital, Fudan University, Shanghai, China.,2 Key Laboratory of Hand Reconstruction, Ministry of Health, Shanghai, China.,3 Shanghai Key Laboratory of Peripheral Nerve and Microsurgery, Shanghai, China
| | - Xu-Yun Hua
- 1 Department of Hand Surgery, Huashan Hospital, Fudan University, Shanghai, China.,2 Key Laboratory of Hand Reconstruction, Ministry of Health, Shanghai, China.,3 Shanghai Key Laboratory of Peripheral Nerve and Microsurgery, Shanghai, China
| | - Yan-Qun Qiu
- 1 Department of Hand Surgery, Huashan Hospital, Fudan University, Shanghai, China.,2 Key Laboratory of Hand Reconstruction, Ministry of Health, Shanghai, China.,3 Shanghai Key Laboratory of Peripheral Nerve and Microsurgery, Shanghai, China.,5 Jing'an District Central Hospital, Shanghai, China
| | - Yun-Dong Shen
- 1 Department of Hand Surgery, Huashan Hospital, Fudan University, Shanghai, China.,2 Key Laboratory of Hand Reconstruction, Ministry of Health, Shanghai, China.,3 Shanghai Key Laboratory of Peripheral Nerve and Microsurgery, Shanghai, China
| | - Su Jiang
- 1 Department of Hand Surgery, Huashan Hospital, Fudan University, Shanghai, China.,2 Key Laboratory of Hand Reconstruction, Ministry of Health, Shanghai, China.,3 Shanghai Key Laboratory of Peripheral Nerve and Microsurgery, Shanghai, China
| | - Jian-Guang Xu
- 1 Department of Hand Surgery, Huashan Hospital, Fudan University, Shanghai, China.,2 Key Laboratory of Hand Reconstruction, Ministry of Health, Shanghai, China.,3 Shanghai Key Laboratory of Peripheral Nerve and Microsurgery, Shanghai, China
| | - Yu-Dong Gu
- 1 Department of Hand Surgery, Huashan Hospital, Fudan University, Shanghai, China.,2 Key Laboratory of Hand Reconstruction, Ministry of Health, Shanghai, China.,3 Shanghai Key Laboratory of Peripheral Nerve and Microsurgery, Shanghai, China
| | - Wen-Dong Xu
- 1 Department of Hand Surgery, Huashan Hospital, Fudan University, Shanghai, China.,2 Key Laboratory of Hand Reconstruction, Ministry of Health, Shanghai, China.,3 Shanghai Key Laboratory of Peripheral Nerve and Microsurgery, Shanghai, China.,5 Jing'an District Central Hospital, Shanghai, China
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Nierula B, Martini M, Matamala-Gomez M, Slater M, Sanchez-Vives MV. Seeing an Embodied Virtual Hand is Analgesic Contingent on Colocation. THE JOURNAL OF PAIN 2017; 18:645-655. [DOI: 10.1016/j.jpain.2017.01.003] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/13/2016] [Revised: 12/20/2016] [Accepted: 01/03/2017] [Indexed: 10/20/2022]
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Maeda Y, Kim H, Kettner N, Kim J, Cina S, Malatesta C, Gerber J, McManus C, Ong-Sutherland R, Mezzacappa P, Libby A, Mawla I, Morse LR, Kaptchuk TJ, Audette J, Napadow V. Rewiring the primary somatosensory cortex in carpal tunnel syndrome with acupuncture. Brain 2017; 140:914-927. [PMID: 28334999 PMCID: PMC5837382 DOI: 10.1093/brain/awx015] [Citation(s) in RCA: 86] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2016] [Revised: 12/08/2016] [Accepted: 12/17/2016] [Indexed: 12/31/2022] Open
Abstract
Carpal tunnel syndrome is the most common entrapment neuropathy, affecting the median nerve at the wrist. Acupuncture is a minimally-invasive and conservative therapeutic option, and while rooted in a complex practice ritual, acupuncture overlaps significantly with many conventional peripherally-focused neuromodulatory therapies. However, the neurophysiological mechanisms by which acupuncture impacts accepted subjective/psychological and objective/physiological outcomes are not well understood. Eligible patients (n = 80, 65 female, age: 49.3 ± 8.6 years) were enrolled and randomized into three intervention arms: (i) verum electro-acupuncture 'local' to the more affected hand; (ii) verum electro-acupuncture at 'distal' body sites, near the ankle contralesional to the more affected hand; and (iii) local sham electro-acupuncture using non-penetrating placebo needles. Acupuncture therapy was provided for 16 sessions over 8 weeks. Boston Carpal Tunnel Syndrome Questionnaire assessed pain and paraesthesia symptoms at baseline, following therapy and at 3-month follow-up. Nerve conduction studies assessing median nerve sensory latency and brain imaging data were acquired at baseline and following therapy. Functional magnetic resonance imaging assessed somatotopy in the primary somatosensory cortex using vibrotactile stimulation over three digits (2, 3 and 5). While all three acupuncture interventions reduced symptom severity, verum (local and distal) acupuncture was superior to sham in producing improvements in neurophysiological outcomes, both local to the wrist (i.e. median sensory nerve conduction latency) and in the brain (i.e. digit 2/3 cortical separation distance). Moreover, greater improvement in second/third interdigit cortical separation distance following verum acupuncture predicted sustained improvements in symptom severity at 3-month follow-up. We further explored potential differential mechanisms of local versus distal acupuncture using diffusion tensor imaging of white matter microstructure adjacent to the primary somatosensory cortex. Compared to healthy adults (n = 34, 28 female, 49.7 ± 9.9 years old), patients with carpal tunnel syndrome demonstrated increased fractional anisotropy in several regions and, for these regions we found that improvement in median nerve latency was associated with reduction of fractional anisotropy near (i) contralesional hand area following verum, but not sham, acupuncture; (ii) ipsilesional hand area following local, but not distal or sham, acupuncture; and (iii) ipsilesional leg area following distal, but not local or sham, acupuncture. As these primary somatosensory cortex subregions are distinctly targeted by local versus distal acupuncture electrostimulation, acupuncture at local versus distal sites may improve median nerve function at the wrist by somatotopically distinct neuroplasticity in the primary somatosensory cortex following therapy. Our study further suggests that improvements in primary somatosensory cortex somatotopy can predict long-term clinical outcomes for carpal tunnel syndrome.
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Affiliation(s)
- Yumi Maeda
- Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, Charlestown, MA, 02129, USA
- Department of Radiology, Logan University, Chesterfield, MO, 63017, USA
| | - Hyungjun Kim
- Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, Charlestown, MA, 02129, USA
- Clinical Research Division, Korean Institute of Oriental Medicine, Daejeon, 34054, South Korea
| | - Norman Kettner
- Department of Radiology, Logan University, Chesterfield, MO, 63017, USA
| | - Jieun Kim
- Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, Charlestown, MA, 02129, USA
- Clinical Research Division, Korean Institute of Oriental Medicine, Daejeon, 34054, South Korea
| | - Stephen Cina
- Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, Charlestown, MA, 02129, USA
| | - Cristina Malatesta
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Medford, MA, 02155, USA
| | - Jessica Gerber
- Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, Charlestown, MA, 02129, USA
| | - Claire McManus
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Medford, MA, 02155, USA
| | - Rebecca Ong-Sutherland
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Medford, MA, 02155, USA
| | - Pia Mezzacappa
- Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, Charlestown, MA, 02129, USA
| | - Alexandra Libby
- Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, Charlestown, MA, 02129, USA
| | - Ishtiaq Mawla
- Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, Charlestown, MA, 02129, USA
| | - Leslie R. Morse
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Spaulding Rehabilitation Hospital, Boston, MA, 02114, USA
| | - Ted J. Kaptchuk
- Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA 02215, USA
| | - Joseph Audette
- Department of Pain Medicine, Harvard Vanguard Medical Associates, Atrium Health, Boston, MA, 02215, USA
| | - Vitaly Napadow
- Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, Charlestown, MA, 02129, USA
- Department of Radiology, Logan University, Chesterfield, MO, 63017, USA
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Grandy EL, Xiu K, Marquardt TL, Li C, Evans PJ, Li ZM. Carpal tunnel syndrome impairs index finger responses to unpredictable perturbations. J Electromyogr Kinesiol 2017; 38:197-202. [PMID: 28343885 DOI: 10.1016/j.jelekin.2017.03.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2017] [Revised: 03/09/2017] [Accepted: 03/10/2017] [Indexed: 11/15/2022] Open
Abstract
The fine-tuning of digit forces to object properties can be disrupted by carpal tunnel syndrome (CTS). CTS' effects on hand function have mainly been investigated using predictable manipulation tasks; however, unpredictable perturbations are commonly encountered during manual tasks, presenting situations which may be more challenging to CTS patients given their hand impairments. The purpose of this study was to investigate muscle and force responses of the index finger to unpredictable perturbations in patients with CTS. Nine CTS patients and nine asymptomatic controls were instructed to stop the movement of a sliding plate by increasing index finger force following an unexpected perturbation. The electrical activity of the first dorsal interosseous muscle and forces exerted by the index finger were recorded. CTS patients demonstrated 20.9% greater muscle response latency and 12.0% greater force response latency compared to controls (p<0.05). The duration of plate sliding was significantly different between groups (p<0.05); the CTS group's duration was 142.2±5.8ms compared to the control group's duration of 133.1±8.4ms. Although CTS patients had increased muscle and force response durations comparatively, these differences were not statistically significant. Findings from this study suggest CTS-induced sensorimotor deficits interfere with accurate detection, processing and response to unpredictable perturbations. These deficits could be accounted for at multiple levels of the peripheral and central nervous systems. Delayed and decreased responses may indicate inefficient object manipulation by CTS patients and may help to explain why CTS patients tend to drop objects.
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Affiliation(s)
- Emily L Grandy
- Hand Research Laboratory, Department of Biomedical Engineering, Cleveland Clinic, Cleveland, OH, United States.
| | - Kaihua Xiu
- Hand Research Laboratory, Department of Biomedical Engineering, Cleveland Clinic, Cleveland, OH, United States.
| | - Tamara L Marquardt
- Hand Research Laboratory, Department of Biomedical Engineering, Cleveland Clinic, Cleveland, OH, United States.
| | - Chengliu Li
- Hand Research Laboratory, Department of Biomedical Engineering, Cleveland Clinic, Cleveland, OH, United States.
| | - Peter J Evans
- Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, OH, United States.
| | - Zong-Ming Li
- Hand Research Laboratory, Department of Biomedical Engineering, Cleveland Clinic, Cleveland, OH, United States; Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, OH, United States; Department of Physical Medicine and Rehabilitation, Cleveland Clinic, Cleveland, OH, United States.
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31
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Harvie DS, Smith RT, Hunter EV, Davis MG, Sterling M, Moseley GL. Using visuo-kinetic virtual reality to induce illusory spinal movement: the MoOVi Illusion. PeerJ 2017; 5:e3023. [PMID: 28243537 PMCID: PMC5324774 DOI: 10.7717/peerj.3023] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2016] [Accepted: 01/24/2017] [Indexed: 12/16/2022] Open
Abstract
Background Illusions that alter perception of the body provide novel opportunities to target brain-based contributions to problems such as persistent pain. One example of this, mirror therapy, uses vision to augment perceived movement of a painful limb to treat pain. Since mirrors can’t be used to induce augmented neck or other spinal movement, we aimed to test whether such an illusion could be achieved using virtual reality, in advance of testing its potential therapeutic benefit. We hypothesised that perceived head rotation would depend on visually suggested movement. Method In a within-subjects repeated measures experiment, 24 healthy volunteers performed neck movements to 50o of rotation, while a virtual reality system delivered corresponding visual feedback that was offset by a factor of 50%–200%—the Motor Offset Visual Illusion (MoOVi)—thus simulating more or less movement than that actually occurring. At 50o of real-world head rotation, participants pointed in the direction that they perceived they were facing. The discrepancy between actual and perceived direction was measured and compared between conditions. The impact of including multisensory (auditory and visual) feedback, the presence of a virtual body reference, and the use of 360o immersive virtual reality with and without three-dimensional properties, was also investigated. Results Perception of head movement was dependent on visual-kinaesthetic feedback (p = 0.001, partial eta squared = 0.17). That is, altered visual feedback caused a kinaesthetic drift in the direction of the visually suggested movement. The magnitude of the drift was not moderated by secondary variables such as the addition of illusory auditory feedback, the presence of a virtual body reference, or three-dimensionality of the scene. Discussion Virtual reality can be used to augment perceived movement and body position, such that one can perform a small movement, yet perceive a large one. The MoOVi technique tested here has clear potential for assessment and therapy of people with spinal pain.
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Affiliation(s)
- Daniel S Harvie
- Recover Injury Research Centre, Centre of Research Excellence in Road Traffic Injury, Menzies Health Institute QLD, Griffith University, Griffith University , Gold Coast , Australia
| | - Ross T Smith
- Wearable Computer Lab, University of South Australia , Adelaide , Australia
| | - Estin V Hunter
- Recover Injury Research Centre, Centre of Research Excellence in Road Traffic Injury, Menzies Health Institute QLD, Griffith University, Griffith University , Gold Coast , Australia
| | - Miles G Davis
- Wearable Computer Lab, University of South Australia , Adelaide , Australia
| | - Michele Sterling
- Recover Injury Research Centre, Centre of Research Excellence in Road Traffic Injury, Menzies Health Institute QLD, Griffith University, Griffith University , Gold Coast , Australia
| | - G Lorimer Moseley
- Sansom Institute for Health Research, University of South Australia, Adelaide, Australia; Neuroscience Research Australia, Sydney, Australia
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Padua L, Coraci D, Erra C, Pazzaglia C, Paolasso I, Loreti C, Caliandro P, Hobson-Webb LD. Carpal tunnel syndrome: clinical features, diagnosis, and management. Lancet Neurol 2016; 15:1273-1284. [PMID: 27751557 DOI: 10.1016/s1474-4422(16)30231-9] [Citation(s) in RCA: 386] [Impact Index Per Article: 48.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2015] [Revised: 08/05/2016] [Accepted: 08/12/2016] [Indexed: 12/16/2022]
Abstract
Carpal tunnel syndrome is the most common peripheral nerve entrapment syndrome worldwide. The clinical symptoms and physical examination findings in patients with this syndrome are recognised widely and various treatments exist, including non-surgical and surgical options. Despite these advantages, there is a paucity of evidence about the best approaches for assessment of carpal tunnel syndrome and to guide treatment decisions. More objective methods for assessment, including electrodiagnostic testing and nerve imaging, provide additional information about the extent of axonal involvement and structural change, but their exact benefit to patients is unknown. Although the best means of integrating clinical, functional, and anatomical information for selecting treatment choices has not yet been identified, patients can be diagnosed quickly and respond well to treatment. The high prevalence of carpal tunnel syndrome, its effects on quality of life, and the cost that disease burden generates to health systems make it important to identify the research priorities that will be resolved in clinical trials.
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Affiliation(s)
- Luca Padua
- Department of Geriatrics, Neurosciences and Orthopaedics, Università Cattolica del Sacro Cuore, Rome, Italy; Don Carlo Gnocchi Onlus Foundation, Milan, Italy.
| | - Daniele Coraci
- Don Carlo Gnocchi Onlus Foundation, Milan, Italy; Board of Physical Medicine and Rehabilitation, Department of Orthopaedic Science, "Sapienza" University, Rome, Italy
| | - Carmen Erra
- Department of Geriatrics, Neurosciences and Orthopaedics, Università Cattolica del Sacro Cuore, Rome, Italy
| | | | | | | | - Pietro Caliandro
- Institute of Neurology, Policlinico A Gemelli Foundation University Hospital, Rome, Italy
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Fornander L, Brismar T, Hansson T, Wikström H. Cortical plasticity in patients with median nerve lesions studied with MEG. Somatosens Mot Res 2016; 33:178-185. [PMID: 27650127 DOI: 10.1080/08990220.2016.1230094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
We have previously shown age- and time-dependent effects on brain activity in the primary somatosensory cortex (SI), in a functional magnetic resonance imaging (fMRI) study of patients with median nerve injury. Whereas fMRI measures the hemodynamic changes in response to increased neural activity, magnetoencephalography (MEG) offers a more concise way of examining the evoked response, with superior temporal resolution. We therefore wanted to combine these imaging techniques to gain additional knowledge of the plasticity processes in response to median nerve injury. Nine patients with median nerve trauma at the wrist were examined with MEG. The N1 and P1 responses at stimulation of the injured median nerve at the wrist were lower in amplitude compared to the healthy side (p < .04). Ulnar nerve stimulation of the injured hand resulted in larger N1 amplitude (p < .04). The amplitude and latency of the response did not correlate with the sensory discrimination ability. There was no correlation between N1 amplitude and size of cortical activation in fMRI. There was no significant difference in N1 latency between the injured and healthy median nerve. N1 latency correlated positively with age in both the median and ulnar nerve, and in both the injured and the healthy hand (p < .02 or p < .001). It is concluded that conduction failure in the injured segment of the median nerve decreases the amplitude of the MEG response. Disinhibition of neighboring cortical areas may explain the increased MEG response amplitude to ulnar nerve stimulation. This can be interpreted as a sign of brain plasticity.
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Affiliation(s)
- Lotta Fornander
- a Department of Clinical Neuroscience , Karolinska Institutet , Stockholm , Sweden.,b Department of Orthopaedics , Vrinnevi Hospital , Norrköping , Sweden
| | - Tom Brismar
- a Department of Clinical Neuroscience , Karolinska Institutet , Stockholm , Sweden
| | - Thomas Hansson
- c Department of Plastic Surgery, Hand Surgery and Burns, Department of Clinical and Experimental Medicine , University of Linköping , Linköping , Sweden
| | - Heidi Wikström
- d Biomag Laboratory , Helsinki University Hospital , Helsinki , Finland
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Lee J, Lin RL, Garcia RG, Kim J, Kim H, Loggia ML, Mawla I, Wasan AD, Edwards RR, Rosen BR, Hadjikhani N, Napadow V. Reduced insula habituation associated with amplification of trigeminal brainstem input in migraine. Cephalalgia 2016; 37:1026-1038. [PMID: 27521844 DOI: 10.1177/0333102416665223] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background Impaired sensory processing in migraine can reflect diminished habituation, increased activation, or even increased gain or amplification of activity from the primary synapse in the brainstem to higher cortical/subcortical brain regions. Methods We scanned 16 episodic migraine (interictal) and 16 healthy controls (cross-sectional study), and evaluated brain response to innocuous air-puff stimulation over the right forehead in the ophthalmic nerve (V1) trigeminal territory. We further evaluated habituation, and cortical/subcortical amplification relative to spinal trigeminal nucleus (Sp5) activation. Results Migraine subjects showed greater amplification from Sp5 to the posterior insula and hypothalamus. In addition, while controls showed habituation to repetitive sensory stimulation in all activated cortical regions (e.g. the bilateral posterior insula and secondary somatosensory cortices), for migraine subjects, habituation was not found in the posterior insula. Moreover, in migraine, the habituation slope was correlated with the amplification ratio in the posterior insula and secondary somatosensory cortex, i.e. greater amplification was associated with reduced habituation in these regions. Conclusions These findings suggest that in episodic migraine, amplified information processing from spinal trigeminal relay nuclei is linked to an impaired habituation response. This phenomenon was localized in the posterior insula, highlighting the important role of this structure in mechanisms supporting altered sensory processing in episodic migraine.
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Affiliation(s)
- Jeungchan Lee
- 1 Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Richard L Lin
- 1 Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.,2 Harvard-MIT Division of Health Sciences and Technology, Harvard Medical School, Boston, MA, USA
| | - Ronald G Garcia
- 1 Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.,3 Neurovascular Science Group, Fundación Cardiovascular de Colombia, Floridablanca, Santander, Colombia.,4 Connors Center for Women's Health and Gender Biology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Jieun Kim
- 5 Clinical Research Division, Korea Institute of Oriental Medicine, Daejeon, Korea
| | - Hyungjun Kim
- 5 Clinical Research Division, Korea Institute of Oriental Medicine, Daejeon, Korea
| | - Marco L Loggia
- 1 Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Ishtiaq Mawla
- 1 Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Ajay D Wasan
- 6 Department of Anesthesiology, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Robert R Edwards
- 7 Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Bruce R Rosen
- 1 Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Nouchine Hadjikhani
- 1 Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Vitaly Napadow
- 1 Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.,7 Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
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Parker RS, Lewis GN, Rice DA, McNair PJ. Is Motor Cortical Excitability Altered in People with Chronic Pain? A Systematic Review and Meta-Analysis. Brain Stimul 2016; 9:488-500. [DOI: 10.1016/j.brs.2016.03.020] [Citation(s) in RCA: 71] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2015] [Revised: 03/02/2016] [Accepted: 03/30/2016] [Indexed: 01/18/2023] Open
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Chimenti PC, McIntyre AW, Childs SM, Hammert WC, Elfar JC. Combined Cubital and Carpal Tunnel Release Results in Symptom Resolution Outside of the Median or Ulnar Nerve Distributions. Open Orthop J 2016; 10:111-9. [PMID: 27347239 PMCID: PMC4897207 DOI: 10.2174/1874325001610010111] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2015] [Revised: 09/20/2015] [Accepted: 11/18/2015] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Resolution of symptoms including pain, numbness, and tingling outside of the median nerve distribution has been shown to occur following carpal tunnel release. We hypothesized that a similar effect would be found after combined release of the ulnar nerve at the elbow with simultaneous release of the median nerve at the carpal tunnel. METHODS 20 patients with combined cubital and carpal tunnel syndrome were prospectively enrolled. The upper extremity was divided into six zones and the location of pain, numbness, tingling, or strange sensations was recorded pre-operatively. Two-point discrimination, Semmes-Weinstein monofilament testing, and validated questionnaires were collected pre-operatively and at six-week follow-up. RESULTS Probability of resolution was greater in the median nerve distribution than the ulnar nerve for numbness (71% vs. 43%), tingling (86% vs. 75%). Seventy percent of the cohort reported at least one extra-anatomic symptom pre-operatively, and greater than 80% of these resolved at early follow-up. There was a decrease in pain as measured by validated questionnaires. CONCLUSION This study documents resolution of symptoms in both extra-ulnar and extra-median distributions after combined cubital and carpal tunnel release. Pre-operative patient counseling may therefore include the likelihood of symptomatic improvement in a non-expected nerve distribution after this procedure, assuming no other concomitant pathology which may cause persistent symptoms. Future studies could be directed at correlating pre-operative disease severity with probability of symptom resolution using a larger population.
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Affiliation(s)
- Peter C Chimenti
- University of Rochester Medical Center, Rochester, New York, United States
| | - Allison W McIntyre
- University of Rochester Medical Center, Rochester, New York, United States
| | - Sean M Childs
- University of Rochester Medical Center, Rochester, New York, United States
| | - Warren C Hammert
- University of Rochester Medical Center, Rochester, New York, United States
| | - John C Elfar
- University of Rochester Medical Center, Rochester, New York, United States
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37
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Cardini F, Longo MR. Congruency of body-related information induces somatosensory reorganization. Neuropsychologia 2016; 84:213-21. [DOI: 10.1016/j.neuropsychologia.2016.02.013] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2015] [Revised: 01/16/2016] [Accepted: 02/18/2016] [Indexed: 10/22/2022]
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Weiss T. Plasticity and Cortical Reorganization Associated With Pain. ZEITSCHRIFT FUR PSYCHOLOGIE-JOURNAL OF PSYCHOLOGY 2016. [DOI: 10.1027/2151-2604/a000241] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Abstract. This review focuses on plasticity and reorganization associated with pain. It is well established that noxious stimulation activates a large network of neural structures in the human brain, which is often denominated as the neuromatrix of pain. Repeated stimulation is able to induce plasticity in nearly all structures of this neuromatrix. While the plasticity to short-term stimulation is usually transient, long-term stimulation might induce persistent changes within the neuromatrix network and reorganize its functions and structures. Interestingly, a large longitudinal study on patients with subacute back pain found predictors for the persistence of pain versus remission in mesolimbic structures not usually included in the neuromatrix of pain. From these results, new concepts of nociception, pain, and transition from acute to chronic pain emerged. Overall, this review outlines a number of plastic changes in response to pain. However, the role of plasticity for chronic pain has still to be established.
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Affiliation(s)
- Thomas Weiss
- Department of Biological and Clinical Psychology, Friedrich Schiller University Jena, Germany
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Viewing the body modulates both pain sensations and pain responses. Exp Brain Res 2016; 234:1795-1805. [PMID: 26884131 PMCID: PMC4893070 DOI: 10.1007/s00221-016-4585-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2015] [Accepted: 01/30/2016] [Indexed: 01/23/2023]
Abstract
Viewing the body can influence pain perception, even when vision is non-informative about the noxious stimulus. Prior studies used either continuous pain rating scales or pain detection thresholds, which cannot distinguish whether viewing the body changes the discriminability of noxious heat intensities or merely shifts reported pain levels. In Experiment 1, participants discriminated two intensities of heat-pain stimulation. Noxious stimuli were delivered to the hand in darkness immediately after participants viewed either their own hand or a non-body object appearing in the same location. The visual condition varied randomly between trials. Discriminability of the noxious heat intensities (d′) was lower after viewing the hand than after viewing the object, indicating that viewing the hand reduced the information about stimulus intensity available within the nociceptive system. In Experiment 2, the hand and the object were presented in separate blocks of trials. Viewing the hand shifted perceived pain levels irrespective of actual stimulus intensity, biasing responses toward ‘high pain’ judgments. In Experiment 3, participants saw the noxious stimulus as it approached and touched their hand or the object. Seeing the pain-inducing event counteracted the reduction in discriminability found when viewing the hand alone. These findings show that viewing the body can affect both perceptual processing of pain and responses to pain, depending on the visual context. Many factors modulate pain; our study highlights the importance of distinguishing modulations of perceptual processing from modulations of response bias.
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Kang S, Yang SN, Yoon JS, Kang HJ, Won SJ. Effect of Carpal Tunnel Syndrome on the Ulnar Nerve at the Wrist: Sonographic and Electrophysiologic Studies. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2016; 35:37-42. [PMID: 26589645 DOI: 10.7863/ultra.15.02064] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/25/2015] [Accepted: 04/13/2015] [Indexed: 06/05/2023]
Abstract
OBJECTIVES The aim of this study was to compare the ulnar nerve at the wrist by sonographic and electrophysiologic studies between patients with carpal tunnel syndrome and control participants and to verify the effect of carpal tunnel syndrome of the ulnar nerve at the wrist. METHODS Forty-two hands of patients with carpal tunnel syndrome and 37 hands of control participants were examined. Electrophysiologic studies of the ulnar nerve were done in all participants. The cross-sectional areas of the median and ulnar nerves at the wrist were evaluated by sonography. Fifteen hands of patients with carpal tunnel syndrome who underwent carpal tunnel release were also evaluated by sonography after the operation. RESULTS The ulnar nerve cross-sectional area of the patients with carpal tunnel syndrome (mean ± SD, 5.16 ± 1.04 mm(2)) was significantly larger than that of the controls (3.56 ± 0.52 mm(2); P < .0001). After release of the transverse carpal ligament, the cross-sectional area of the ulnar nerve was significantly smaller than the size measured prior to surgery (P < .0001). The cross-sectional area of the median nerve was significantly correlated with that of the ulnar nerve (P < .05). However, no statistically significant difference was found between the patients with carpal tunnel syndrome and controls in ulnar nerve conduction. There were no statistically significant differences in nerve conduction study results or cross-sectional area of the ulnar nerve between patients with carpal tunnel syndrome with and without extramedian symptoms. CONCLUSIONS The cross-sectional areas of the ulnar and median nerves at the wrist are increased in patients with carpal tunnel syndrome. Also, the cross-sectional area of the ulnar nerve is decreased after carpal tunnel release.
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Affiliation(s)
- Seok Kang
- Department of Physical Medicine and Rehabilitation, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea (S.K., S.N.Y., J.S.Y.); Department of Physical Medicine and Rehabilitation, Seoul Veterans Hospital, Seoul, Korea (J.K.); and Department of Physical Medicine and Rehabilitation, Yeouido St Mary's Hospital, College of Medicine, Catholic University of Korea, Seoul, Korea (S.J.W.)
| | - Seung Nam Yang
- Department of Physical Medicine and Rehabilitation, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea (S.K., S.N.Y., J.S.Y.); Department of Physical Medicine and Rehabilitation, Seoul Veterans Hospital, Seoul, Korea (J.K.); and Department of Physical Medicine and Rehabilitation, Yeouido St Mary's Hospital, College of Medicine, Catholic University of Korea, Seoul, Korea (S.J.W.).
| | - Joon Shik Yoon
- Department of Physical Medicine and Rehabilitation, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea (S.K., S.N.Y., J.S.Y.); Department of Physical Medicine and Rehabilitation, Seoul Veterans Hospital, Seoul, Korea (J.K.); and Department of Physical Medicine and Rehabilitation, Yeouido St Mary's Hospital, College of Medicine, Catholic University of Korea, Seoul, Korea (S.J.W.)
| | - Hyo Jeong Kang
- Department of Physical Medicine and Rehabilitation, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea (S.K., S.N.Y., J.S.Y.); Department of Physical Medicine and Rehabilitation, Seoul Veterans Hospital, Seoul, Korea (J.K.); and Department of Physical Medicine and Rehabilitation, Yeouido St Mary's Hospital, College of Medicine, Catholic University of Korea, Seoul, Korea (S.J.W.)
| | - Sun Jae Won
- Department of Physical Medicine and Rehabilitation, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea (S.K., S.N.Y., J.S.Y.); Department of Physical Medicine and Rehabilitation, Seoul Veterans Hospital, Seoul, Korea (J.K.); and Department of Physical Medicine and Rehabilitation, Yeouido St Mary's Hospital, College of Medicine, Catholic University of Korea, Seoul, Korea (S.J.W.)
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Prospective cohort study of symptom resolution outside of the ulnar nerve distribution following cubital tunnel release. Hand (N Y) 2015; 10:177-83. [PMID: 26034427 PMCID: PMC4447657 DOI: 10.1007/s11552-014-9688-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
BACKGROUND Resolution of symptoms including pain, numbness, and tingling outside of the median nerve distribution has been shown to occur following carpal tunnel release. We hypothesized that a similar effect would be found after release of the ulnar nerve at the elbow. METHODS Twenty patients with isolated cubital tunnel syndrome were prospectively enrolled. The upper extremity was divided into six zones, and the location of pain, numbness, tingling, or strange sensations was recorded pre-operatively. Two-point discrimination, Semmes-Weinstein monofilament testing, and validated questionnaires were collected. The same data were collected at 6-week follow-up. Paired t tests or non-parametric Wilcoxon Signed-Rank tests were used where appropriate to examine for significant (p ≤ 0.05) changes between pre- and post-operative scores. RESULTS Probability of resolution was greater outside of the ulnar nerve distribution than within at early follow-up. There was a decrease in pain, numbness, and tingling symptoms both within and outside the ulnar distribution after cubital tunnel release. There was a decrease in pain as measured by several validated questionnaires. CONCLUSION This study documents resolution of symptoms in an extra-ulnar distribution after cubital tunnel release. Improvement in pain and function after cubital tunnel release may be associated with an improvement in symptoms both within and outside the ulnar nerve distribution. Future studies could be directed at correlating pre-operative disease severity with probability of extra-territorial symptom resolution using a larger sample population.
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An Association between Carpal Tunnel Syndrome and Migraine Headaches-National Health Interview Survey, 2010. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2015; 3:e333. [PMID: 25878944 PMCID: PMC4387155 DOI: 10.1097/gox.0000000000000257] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2014] [Accepted: 11/13/2014] [Indexed: 12/31/2022]
Abstract
Background: Migraine headaches have not historically been considered a compression neuropathy. Recent studies suggest that some migraines are successfully treated by targeted peripheral nerve decompression. Other compression neuropathies have previously been associated with one another. The goal of this study is to evaluate whether an association exists between migraines and carpal tunnel syndrome (CTS), the most common compression neuropathy. Methods: Data from 25,880 respondents of the cross-sectional 2010 National Health Interview Survey were used to calculate nationally representative prevalence estimates and 95% confidence intervals (95% CIs) of CTS and migraine headaches. Logistic regression was used to calculate adjusted odds ratios (aORs) and 95% CI for the degree of association between migraines and CTS after controlling for known demographic and health-related factors. Results: CTS was associated with older age, female gender, obesity, diabetes, and smoking. CTS was less common in Hispanics and Asians. Migraine was associated with younger age, female gender, obesity, diabetes, and current smoking. Migraine was less common in Asians. Migraine prevalence was 34% in those with CTS compared with 16% in those without CTS (aOR, 2.60; 95% CI, 2.16–3.13). CTS prevalence in patients with migraine headache was 8% compared with 3% in those without migraine headache (aOR, 2.67; 95% CI, 2.22–3.22). Conclusions: This study is the first to demonstrate an association between CTS and migraine headache. Longitudinal and genetic studies with physician verification of migraine headaches and CTS are needed to further define this association.
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Pelletier R, Higgins J, Bourbonnais D. Is neuroplasticity in the central nervous system the missing link to our understanding of chronic musculoskeletal disorders? BMC Musculoskelet Disord 2015; 16:25. [PMID: 25887644 PMCID: PMC4331171 DOI: 10.1186/s12891-015-0480-y] [Citation(s) in RCA: 103] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2014] [Accepted: 01/27/2015] [Indexed: 12/22/2022] Open
Abstract
Background Musculoskeletal rehabilitative care and research have traditionally been guided by a structural pathology paradigm and directed their resources towards the structural, functional, and biological abnormalities located locally within the musculoskeletal system to understand and treat Musculoskeletal Disorders (MSD). However the structural pathology model does not adequately explain many of the clinical and experimental findings in subjects with chronic MSD and, more importantly, treatment guided by this paradigm fails to effectively treat many of these conditions. Discussion Increasing evidence reveals structural and functional changes within the Central Nervous System (CNS) of people with chronic MSD that appear to play a prominent role in the pathophysiology of these disorders. These neuroplastic changes are reflective of adaptive neurophysiological processes occurring as the result of altered afferent stimuli including nociceptive and neuropathic transmission to spinal, subcortical and cortical areas with MSD that are initially beneficial but may persist in a chronic state, may be part and parcel in the pathophysiology of the condition and the development and maintenance of chronic signs and symptoms. Neuroplastic changes within different areas of the CNS may help to explain the transition from acute to chronic conditions, sensory-motor findings, perceptual disturbances, why some individuals continue to experience pain when no structural cause can be discerned, and why some fail to respond to conservative interventions in subjects with chronic MSD. We argue that a change in paradigm is necessary that integrates CNS changes associated with chronic MSD and that these findings are highly relevant for the design and implementation of rehabilitative interventions for this population. Summary Recent findings suggest that a change in model and approach is required in the rehabilitation of chronic MSD that integrate the findings of neuroplastic changes across the CNS and are targeted by rehabilitative interventions. Effects of current interventions may be mediated through peripheral and central changes but may not specifically address all underlying neuroplastic changes in the CNS potentially associated with chronic MSD. Novel approaches to address these neuroplastic changes show promise and require further investigation to improve efficacy of currents approaches.
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Affiliation(s)
- René Pelletier
- École de réadaptation, Faculté de médecine, Université de Montréal, C.P. 6128, succursale Centre-ville, Montréal, H3C 3 J7, Québec, Canada.
| | - Johanne Higgins
- École de réadaptation, Faculté de médecine, Université de Montréal, C.P. 6128, succursale Centre-ville, Montréal, H3C 3 J7, Québec, Canada. .,Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal (CRIR), Institut de réadaptation Gingras-Lindsay-de-Montréal, Montréal, Québec, Canada.
| | - Daniel Bourbonnais
- École de réadaptation, Faculté de médecine, Université de Montréal, C.P. 6128, succursale Centre-ville, Montréal, H3C 3 J7, Québec, Canada. .,Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal (CRIR), Institut de réadaptation Gingras-Lindsay-de-Montréal, Montréal, Québec, Canada.
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Bova J, Sergent A. Chiropractic management of a 24-year-old woman with idiopathic, intermittent right-sided hemiparesthesia. J Chiropr Med 2014; 13:282-6. [PMID: 25435843 DOI: 10.1016/j.jcm.2014.08.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2014] [Revised: 07/01/2014] [Accepted: 07/03/2014] [Indexed: 10/24/2022] Open
Abstract
OBJECTIVE The purpose of this case report is to describe the chiropractic management of a patient with idiopathic, intermittent right-sided hemiparesthesia. CLINICAL FEATURES A 24-year-old woman presented with a 2-year history of intermittent idiopathic right arm paresthesia. She also had a 3-month history of intermittent idiopathic right leg/face paresthesia. These symptoms were strongest at night and caused insomnia and worsened over time. She rated her discomfort at 5/10 on a numeric scale. INTERVENTION AND OUTCOME Care included vibration stimulation therapy, spinal manipulation and cold laser therapy. She had a noticeable reduction in her paresthesia both subjectively and objectively. She showed improvement in paresthesia on the right side of her body after the first visit. The following week, after 2 visits she returned and stated that she was symptom free with 0/10 discomfort on a numeric scale. CONCLUSION This patient's symptoms of idiopathic, intermittent right-sided hemi-paresthesia seemed to improve with a short course of chiropractic care using manipulation, vibration therapy and cold laser therapy.
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Affiliation(s)
| | - Adam Sergent
- Assistant Professor, Clinic Services, Palmer Chiropractic College of Florida, Port Orange, FL
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Catley MJ, Tabor A, Miegel RG, Wand BM, Spence C, Moseley GL. Show me the skin! Does seeing the back enhance tactile acuity at the back? ACTA ACUST UNITED AC 2014; 19:461-6. [DOI: 10.1016/j.math.2014.04.015] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2013] [Revised: 04/18/2014] [Accepted: 04/28/2014] [Indexed: 01/11/2023]
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Catley MJ, O'Connell NE, Berryman C, Ayhan FF, Moseley GL. Is Tactile Acuity Altered in People With Chronic Pain? A Systematic Review and Meta-analysis. THE JOURNAL OF PAIN 2014; 15:985-1000. [DOI: 10.1016/j.jpain.2014.06.009] [Citation(s) in RCA: 127] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/14/2014] [Revised: 06/10/2014] [Accepted: 06/17/2014] [Indexed: 01/28/2023]
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Restoring tactile and proprioceptive sensation through a brain interface. Neurobiol Dis 2014; 83:191-8. [PMID: 25201560 DOI: 10.1016/j.nbd.2014.08.029] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2014] [Revised: 08/08/2014] [Accepted: 08/27/2014] [Indexed: 11/21/2022] Open
Abstract
Somatosensation plays a critical role in the dexterous manipulation of objects, in emotional communication, and in the embodiment of our limbs. For upper-limb neuroprostheses to be adopted by prospective users, prosthetic limbs will thus need to provide sensory information about the position of the limb in space and about objects grasped in the hand. One approach to restoring touch and proprioception consists of electrically stimulating neurons in somatosensory cortex in the hopes of eliciting meaningful sensations to support the dexterous use of the hands, promote their embodiment, and perhaps even restore the affective dimension of touch. In this review, we discuss the importance of touch and proprioception in everyday life, then describe approaches to providing artificial somatosensory feedback through intracortical microstimulation (ICMS). We explore the importance of biomimicry--the elicitation of naturalistic patterns of neuronal activation--and that of adaptation--the brain's ability to adapt to novel sensory input, and argue that both biomimicry and adaptation will play a critical role in the artificial restoration of somatosensation. We also propose that the documented re-organization that occurs after injury does not pose a significant obstacle to brain interfaces. While still at an early stage of development, sensory restoration is a critical step in transitioning upper-limb neuroprostheses from the laboratory to the clinic.
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Sator-Katzenschlager S. Pain and neuroplasticity. REVISTA MÉDICA CLÍNICA LAS CONDES 2014. [DOI: 10.1016/s0716-8640(14)70091-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Claes F, Kasius KM, Meulstee J, Grotenhuis JA, Verhagen WIM. Treatment outcome in carpal tunnel syndrome: does distribution of sensory symptoms matter? J Neurol Sci 2014; 344:143-8. [PMID: 25060420 DOI: 10.1016/j.jns.2014.06.044] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2013] [Revised: 06/10/2014] [Accepted: 06/23/2014] [Indexed: 10/25/2022]
Abstract
BACKGROUND Patients with complaints of carpal tunnel syndrome (CTS) with signs and symptoms not exclusively confined to the median nerve territory, but otherwise fulfilling the clinical criteria may erroneously be withheld from therapy. METHODS One hundred and twenty one patients who fulfilled the clinical criteria for the diagnosis of CTS with signs and symptoms restricted to the median nerve territory (group A) and 91 patients without this restriction (group B) were included in a prospective cohort study. All patients fulfilled electrodiagnostic criteria of CTS. Outcome was determined after 7 to 9 months by means of Symptom Severity Score (SSS) and Functional Status Score (FSS) according to Levine and a patient satisfaction questionnaire. RESULTS Response rates were 81.8% (group A) and 82.4% (group B). All patients in group B had sensory symptoms involving digit 5. There were no significant differences in improvement of SSS, FSS and patient satisfaction scores between groups after treatment. CONCLUSION CTS patients with characteristic sensory signs and symptoms not exclusively restricted to the median nerve innervated area should be treated in the same manner as patients with CTS symptoms restricted to the median nerve innervated area and should therefore not be withheld from surgical treatment.
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Affiliation(s)
- Franka Claes
- Department of Neurology, Vlietland Hospital, Schiedam, The Netherlands.
| | - Kristel M Kasius
- Department of Neurology, St Lucas Andreas Hospital, Amsterdam, The Netherlands
| | - Jan Meulstee
- Department of Neurology and Clinical Neurophysiology, Canisius Wilhelmina Hospital, Nijmegen, The Netherlands
| | - J André Grotenhuis
- Department of Neurosurgery, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Wim I M Verhagen
- Department of Neurology and Clinical Neurophysiology, Canisius Wilhelmina Hospital, Nijmegen, The Netherlands
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Boström KJ, de Lussanet MHE, Weiss T, Puta C, Wagner H. A computational model unifies apparently contradictory findings concerning phantom pain. Sci Rep 2014; 4:5298. [PMID: 24931344 PMCID: PMC4058874 DOI: 10.1038/srep05298] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2014] [Accepted: 05/13/2014] [Indexed: 12/13/2022] Open
Abstract
Amputation often leads to painful phantom sensations, whose pathogenesis is still unclear. Supported by experimental findings, an explanatory model has been proposed that identifies maladaptive reorganization of the primary somatosensory cortex (S1) as a cause of phantom pain. However, it was recently found that BOLD activity during voluntary movements of the phantom positively correlates with phantom pain rating, giving rise to a model of persistent representation. In the present study, we develop a physiologically realistic, computational model to resolve the conflicting findings. Simulations yielded that both the amount of reorganization and the level of cortical activity during phantom movements were enhanced in a scenario with strong phantom pain as compared to a scenario with weak phantom pain. These results suggest that phantom pain, maladaptive reorganization, and persistent representation may all be caused by the same underlying mechanism, which is driven by an abnormally enhanced spontaneous activity of deafferented nociceptive channels.
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Affiliation(s)
- Kim J Boström
- Motion Science, University of Münster, Horstmarer Landweg 62b, 48149 Münster, Germany
| | - Marc H E de Lussanet
- Motion Science, University of Münster, Horstmarer Landweg 62b, 48149 Münster, Germany
| | - Thomas Weiss
- Biological & Clinical Psychology, Friedrich Schiller University Jena, D-07743 Jena, Germany
| | - Christian Puta
- Department of Sports Medicine and Health Promotion, Friedrich Schiller University, Jena, 07743 Jena, Germany
| | - Heiko Wagner
- Motion Science, University of Münster, Horstmarer Landweg 62b, 48149 Münster, Germany
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