Carpal tunnel syndrome, humeral epicondylitis, and the cervical spine: a study of clinical and dimensional relations.

Murray-Leslie, C F; Wright, V.

doi:10.1136/bmj.1.6023.1439

Cited by 37 publications

(13 citation statements)

References 10 publications

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“…Personal communication revealed that almost all patients in these studies (de la Fernandez-de-las-Penas et al, 2009, 2010 reported concomitant neck pain (personal communication with C. Fernandez-de-las-Peñas). This high proportion of coexisting neck pain in patients with CTS is in accordance with previously reported high prevalences of coexisting disorders such as neck pain (Pierre-Jerome and Bekkelund, 2003;Nora et al, 2004;Chow et al, 2005), shoulder/arm pain (Nora et al, 2004) or lateral epicondylalgia (Murray-Leslie and Wright, 1976) in patients with CTS. Neck disorders and lateral epicondylalgia have both been reported to lead to widespread hyperalgesia over the locations tested in those studies (Johnston et al, 2008;Fernandez-Carnero et al, 2009).…”

Section: Pain Thresholdssupporting

confidence: 92%

Can widespread hypersensitivity in carpal tunnel syndrome be substantiated if neck and arm pain are absent?

Schmid

Soon

Wasner

et al. 2012

European Journal of Pain

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Recent studies demonstrated that patients with carpal tunnel syndrome (CTS) have signs of thermal and mechanical hyperalgesia in extra-median territories suggesting an involvement of central pain mechanisms. As previous studies included patients with shoulder/arm symptoms or neck pain, a potential influence of these coexisting disorders cannot be excluded. This study therefore evaluated whether widespread sensory changes (hypoesthesia or hyperalgesia) are present in patients with unilateral CTS in the absence of coexisting disorders. Twenty-six patients with unilateral CTS with symptoms localised to their hand and 26 healthy controls participated in the study. A comprehensive quantitative sensory testing (QST) protocol including thermal and mechanical detection and pain thresholds was performed over the hands (median, ulnar and radial innervation area), lateral elbows, neck and tibialis anterior muscle. Patients with CTS demonstrated thermal and mechanical hypoesthesia in the hand but not at distant sites. Thermal or mechanical hyperalgesia was not identified at any location with traditional QST threshold testing. However, patients with CTS rated the pain during thermal pain testing significantly higher than healthy participants. This was especially apparent for heat pain ratings which were elevated not only in the affected hand but also in the neck and tibialis anterior muscle. In conclusion, CTS alone in the absence of coexisting neck and arm pain does not account for sensory changes outside the affected hand as determined by traditional QST threshold testing. Elevated pain ratings may however be an early indication of central pain mechanisms.

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Section: Pain Thresholdssupporting

confidence: 92%

Can widespread hypersensitivity in carpal tunnel syndrome be substantiated if neck and arm pain are absent?

Schmid

Soon

Wasner

et al. 2012

European Journal of Pain

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“…Clinically, the majority of patients with CTS, however, report symptoms outside the median innervation territory (up to 70 per cent; [11]). In addition to extraterritorial symptoms in the hands, patients with CTS have a high prevalence of widespread pain in the elbow, shoulder and neck region [17,72,86]. In addition to these widespread symptoms, signs have also been identified in a non-anatomical manner.…”

Section: Cts -Driven By Local Mechanisms Only? !mentioning

confidence: 99%

Pathophysiology of the Carpal Tunnel Syndrome

Schmid¹

2015

physioscience

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Carpal tunnel syndrome (CTS) is the most common peripheral nerve disorder. Despite its frequency, the exact pathophysiology remains elusive. It is, however, commonly accepted that CTS affects the large nerve fibres, induces non-inflammatory changes and is driven by mechanisms that remain localised to the lesion site. Clinical diagnosis therefore largely relies on local tests for the large fibre domain such as standard electrodiagnostics, vibrometry or von Frey hair testing within the median nerve territory. In this review, the current beliefs and resulting clinical guidelines are challenged by summarising novel evidence which suggests the presence of hitherto unrecognised pathophysiological mechanisms. A focus is thereby placed on the contribution of small fibre degeneration, the presence of intraneural inflammation and remote mechanisms to the pathophysiology of CTS.?Since these mechanisms seem to be pertinent to CTS, potential approaches to integrate them in the diagnostic work-up of patients with suspected CTS are suggested. Future work is, however, required to establish their diagnostic validity as well as impact on management and prognosis of patients with CTS.

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“…Boyd and McLeod (5) reported that 38 % of their 871 tennis elbow patients also had pain in other locations because of, e.g., calcification of the rotator cuff, bicipital tendinitis, de Quervain's disease, or carpal tunnel syndrome. Murray-Leslie and Wright (14) found that patients with carpal tunnel syndrome had a tennis elbow prevalence of 33 % as compared to the 7 % prevalence of controls. They hypothesized that similar connective tissue changes might occur in the common extensor origin at the elbow and in the contents of the carpal tunnel.…”

Section: Pathogenesismentioning

confidence: 99%