Neurology Medical News about Carpal Tunnel Syndrome Sensation Central sensitization

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Central sensitization in carpal tunnel syndrome with extraterritorial spread of sensory symptoms
Pain, 12/10/09

Zanette et al. – Extramedian pattern and proximal pain were found in 33.3% and 37.5% of patients, respectively. The QST profile associated with extramedian pattern includes: (1) thermal and mechanic hyperalgesia in the territory of the injured median nerve and in those of the uninjured ulnar and radial nerves and (2) enhanced wind–up. No signs of sensitization were found in patients with the median distribution and those with proximal symptoms. Different mechanisms may underlie hand extramedian and proximal spread of symptoms, respectively. Extramedian spread of symptoms in the hand may be secondary to spinal sensitization but peripheral and supraspinal mechanisms may contribute. Proximal spread may represent referred pain. Central sensitization may be secondary to abnormal activity in the median nerve afferents or the consequence of a predisposing trait. These data may explain the persistence of sensory symptoms after median nerve surgical release and the presence of non–anatomical sensory patterns in neuropathic pain.

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