Carpal Tunnel Syndrome
Conditions
Keywords
Magnetic Resonance Imaging, Somatosensory Cortex, Anesthesia, Hand
Brief summary
70 patients with mild to moderate Carpal tunnel Syndrome (CTS) including 24 patients with unilateral CTS were randomized to treatment with ipsilateral cutaneous forearm deafferentation with an anesthetic cream (EMLA®) or placebo during 8 weeks. Patient-rated outcomes was assessed using the symptom severity scale from the Boston carpal tunnel syndrome questionnaire (BCTQ) and the disability of arm, shoulder and hand questionnaire(Quick-DASH). Clinically patients were assessed for tactile discrimination and dexterity and nerve conduction studies (NCS). Cortical activation during sensory stimulation was evaluated with functional magnetic resonance imaging (fMRI) at 3T. Assessments were performed at baseline, after 90 min of initial treatment, and after 8 weeks.
Interventions
OTHEREMLA® adjuvant
cutaneous forearm deafferentation
BEHAVIORALSensory training
Sensibility training of the median nerve
Sponsors
Region Skane
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
BASIC_SCIENCE
Masking
DOUBLE (Subject, Outcomes Assessor)
Eligibility
Sex/Gender
ALL
Age
18 Years to 70 Years
Healthy volunteers
No
Inclusion criteria
* symptoms of CTS for more than 3 months * classic or probable CTS according to Katz' hand diagram (2, 27) * clinical signs of unilateral CTS with a positive Tinel's and Phalen's test * age between 18 and 70 years * nerve conduction studies (NCS) with a fractionated sensory nerve conduction velocity for the median nerve across the wrist of 40 m/s or less on the affected side and of more than 43 m/s on the contralateral side * no contraindications for MR examinations.
Exclusion criteria
* bilateral symptoms * having been operated for CTS previously * prior wrist or carpal fracture * diabetes * thyroid disease * rheumatoid arthritis * neurological disease * drug abuse * complete conduction block on electroneurography or prior regular exposure to hand-held vibrating tools.
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Boston Carpal Tunnel Syndrome Symptom Severity Score | 8 weeks | score between 1 and 5, with higher scores indicating worse symptoms or function |
| functional MRI activation affected vs healthy side (more activation voxels means more active brain area) | 8 weeks | The difference in activation using interaction contrast between baseline vs 8 weeks in somatosensory cortex (affected vs healthy side) |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Sensory conduction velocity | 8 weeks | Sensory Nerve Conduction Velocity from nerve conduction studies |
| Sensory conduction amplitude | 8 weeks | Sensory Nerve Conduction Amplitude from nerve conduction studies |
| quick-DASH upper extremity symptom score | 8 weeks | score between 1-5, higher scores indicating less symptoms |
| functional MRI dig 5 | 8 weeks | comparison between activation in the sensory cortex of the little finger (EMLA® vs placebo) |
| functional MRI dig 1+2 | 8 weeks | comparison between activation using interaction contrast in S1sensory cortex of the |
| 2 Point Discrimination (2PD) | 8 weeks | mean value of 3 measures indicating touch threshold |
Outcome results
None listed