腕管综合症正中神经大、小神经纤维损害：定量感觉研究.pdf

ARTICLE IN PRESS The Journal of Pain, Vol -, No - ( -), 2010: pp 1-8 Available online at Median Nerve Small- and Large-Fiber Damage in Carpal Tunnel Syndrome: A Quantitative Sensory Testing Study Stefano Tamburin,*,y Carlo Cacciatori,*,y Maria Luigia Praitano,*,y Clizia Cazzarolli,* Cristina Foscato,y Antonio Fiaschi,* and Giampietro Zanette*,y *Department of Neurological, Neuropsychological, Morphological and Movement Sciences, University of Verona, Verona, Italy. y Section of Neurology, Pederzoli Hospital, Peschiera del Garda, Verona, Italy. Abstract: We explored the contribution of median nerve small (Ad, C)-and large (Ab)-fiber damage to the severity and topographic distribution of sensory symptoms in carpal tunnel syndrome (CTS) and the timing of fiber damage across CTS stages. We recruited 106 CTS patients. After selection, 49 patients were included. They underwent electrodiagnostic and quantitative sensory testing (QST) study and were asked on the severity of Boston Carpal Tunnel Questionnaire (BCTQ) Symptoms Severity Scale, daytime pain (DP), night pain and paresthesia, on the distribution of hand symptoms, and the presence of proximal symptoms. BCTQ Symptoms Severity Scale and DP severity was signif- icantly correlated with Ad-fiber damage. Small-fiber QST measures were impaired in electrodiagnostic-negative CTS patients and did not change across CTS neurographic stages. QST findings were not correlated to the topographical distribution of symptoms. Ad-fiber damage con- tributes to CTS symptoms and in particular to DP. Night pain and paresthesia might