scholarly journals Spectral Clustering Reveals Different Profiles of Central Sensitization in Women with Carpal Tunnel Syndrome

Symmetry ◽  
2021 ◽  
Vol 13 (6) ◽  
pp. 1042
Author(s):  
Oscar J. Pellicer-Valero ◽  
José D. Martín-Guerrero ◽  
César Fernández-de-las-Peñas ◽  
Ana I. De-la-Llave-Rincón ◽  
Jorge Rodríguez-Jiménez ◽  
...  
Keyword(s):  
Carpal Tunnel Syndrome ◽  
Clinical Features ◽  
Carpal Tunnel ◽  
Spectral Clustering ◽  
Grip Force ◽  
The Other ◽  
Pressure Pain ◽  
Thermal Pain ◽  
Pressure Pain Thresholds ◽  
Tunnel Syndrome

Identification of subgroups of patients with chronic pain provides meaningful insights into the characteristics of a specific population, helping to identify individuals at risk of chronification and to determine appropriate therapeutic strategies. This paper proposes the use of spectral clustering (SC) to distinguish subgroups (clusters) of individuals with carpal tunnel syndrome (CTS), making use of the obtained patient profiling to argue about potential management implications. SC is a powerful algorithm that builds a similarity graph among the data points (the patients), and tries to find the subsets of points that are strongly connected among themselves, but weakly connected to others. It was chosen due to its advantages with respect to other simpler clustering techniques, such as k-means, and the fact that it has been successfully applied to similar problems. Clinical (age, duration of symptoms, pain intensity, function, and symptom severity), psycho-physical (pressure pain thresholds—PPTs—over the three main nerve trunks of the upper extremity, cervical spine, carpal tunnel, and tibialis anterior), psychological (depressive levels), and motor (pinch tip grip force) variables were collected in 208 women with clinical/electromyographic diagnosis of CTS, whose symptoms usually started unilaterally but eventually evolved into bilateral symmetry. SC was used to identify clusters of patients without any previous assumptions, yielding three clusters. Patients in cluster 1 exhibited worse clinical features, higher widespread pressure pain hyperalgesia, higher depressive levels, and lower pinch tip grip force than the other two. Patients in cluster 2 showed higher generalized thermal pain hyperalgesia than the other two. Cluster 0 showed less hypersensitivity to pressure and thermal pain, less severe clinical features, and more normal motor output (tip grip force). The presence of subgroups of individuals with different altered nociceptive processing (one group being more sensitive to pressure pain and another group more sensitive to thermal pain) could lead to different therapeutic programs.

scholarly journals Catechol-O-Methyltransferase Val158Met Polymorphism is Associated with Pain and Disability, but not Widespread Pressure Pain Sensitivity, in Women with Carpal Tunnel Syndrome

2013 ◽  
Vol 5;16 (5;9) ◽  
pp. E591-E600
Author(s):  
César Fernández-de-las-Peñas
Keyword(s):  
Carpal Tunnel Syndrome ◽  
Carpal Tunnel ◽  
Pain Sensitivity ◽  
Pain Thresholds ◽  
Pressure Pain ◽  
Val158met Polymorphism ◽  
Healthy Women ◽  
Study Results ◽  
Pressure Pain Thresholds ◽  
Tunnel Syndrome

Background: The genetic influence of Val158Met polymorphisms, one of the potential genetic determinants for nociceptive processing, has not been previously investigated in women with carpal tunnel syndrome (CTS). Objectives: To investigate the association between the Val158Met polymorphism with CTS and to assess the relationship between the Val158Met polymorphism and the clinical outcomes and widespread pressure pain hypersensitivity in women with CTS. Study Design: Case control study. Setting: Neurology department at an urban hospital. Method: One hundred nine (n = 109) women (mean age: 47 ± 9 years) with a clinical and electrodiagnostic diagnosis of CTS and 109 matched healthy women participated. After amplifying the Val158Met polymorphism by polymerase chain reactions, rs4680 genotype frequencies and allele distributions were calculated. We classified individuals according to their Val158Met polymorphism: Val/Val, Val/Met, Met/Met. The intensity of the pain was assessed with a numeric rating scale (0-10) and disability was determined with the Boston Carpal Tunnel Questionnaire. Pressure pain thresholds were bilaterally assessed over median, radial, and ulnar nerve trunks; C5-C6 facet joints; and carpal tunnel and tibialis anterior muscles. Institutional Review Board: The study project was approved by the local human research committee (HUFA-12/14). All participants signed an informed consent prior to their inclusion in the study. Results: The distribution of the 3 Val158Met genotypes (Val/Val, Val/Met, Met/Met) and alleles was not significantly different between women with CTS and healthy women (χ2 = 0.498; P = 0.780). Women with CTS carrying the Met/Met genotype showed higher levels of pain and disability than those with the Val/Met genotype (P < 0.01) and with the Val/Val genotype (P < 0.001). No differences in the years with pain (P = 0.954), age (P = 0.740), depression (P = 0.530), severity of CTS (P = 0.744) or presence of unilateral-bilateral symptoms (P = 0.279) existed depending on the rs4680 Val158Met genotype. No significant differences in widespread pressure pain sensitivity were observed in any of the points depending on the rs4680 Val158Met genotype (P > 0.315). Limitations: We only recruited women from a specialized department. Conclusion: Current results indicated that the Val158Met polymorphism seems not to be a risk factor for the development of CTS; however, it was associated with increased perception of pain and higher disability scores. Key words: Catechol-O-methyltransferase gene, carpal tunnel syndrome, polymorphism pressure pain thresholds, sensitivity.

Carpal tunnel decompression in patients with normal nerve conduction studies

2019 ◽  
Vol 45 (3) ◽  
pp. 260-264 ◽  
Author(s):  
Samuel P. Mackenzie ◽  
Oliver D. Stone ◽  
Paul J. Jenkins ◽  
Nicholas D. Clement ◽  
Iain R. Murray ◽  
...  
Keyword(s):  
Carpal Tunnel Syndrome ◽  
Clinical Features ◽  
Carpal Tunnel ◽  
Nerve Conduction Study ◽  
Nerve Conduction ◽  
Study Groups ◽  
Nerve Conduction Studies ◽  
Level Of Evidence ◽  
Tunnel Syndrome ◽  
Normal Nerve Conduction

Some patients present with typical clinical features of carpal tunnel syndrome despite normal nerve conduction studies. This study compared the preoperative and 1-year postoperative QuickDASH scores in patients with normal and abnormal nerve conduction studies, who underwent carpal tunnel decompression. Of the 637 patients included in the study, 19 had clinical features of carpal tunnel syndrome but normal nerve conduction studies, and underwent decompression after failure of conservative management. Preoperative QuickDASH scores were comparable in both groups (58 vs 54.8). However, there were significant differences between the normal and abnormal nerve conduction study groups in the QuickDASH at 1 year (34.9 vs 21.5) and change in QuickDASH postoperatively (23.1 vs 33.4). Patients with normal nerve conduction studies had comparable preoperative disability scores compared with those with abnormal studies. Although they had a significant improvement in QuickDASH at 1 year, this was significantly less than those with abnormal nerve conduction studies. Level of evidence: III

Bilateral deficits in fine motor control and pinch grip force in patients with unilateral carpal tunnel syndrome

2008 ◽  
Vol 194 (1) ◽  
pp. 29-37 ◽  
Author(s):  
César Fernández-de-las-Peñas ◽  
Marta Pérez-de-Heredia-Torres ◽  
Rosa Martínez-Piédrola ◽  
Ana Isabel de la Llave-Rincón ◽  
Joshua A. Cleland
Keyword(s):  
Motor Control ◽  
Carpal Tunnel Syndrome ◽  
Carpal Tunnel ◽  
Grip Force ◽  
Fine Motor ◽  
Fine Motor Control ◽  
Pinch Grip ◽  
Tunnel Syndrome

scholarly journals Mathematical Modeling for Neuropathic Pain: Bayesian Linear Regression and Self-Organizing Maps Applied to Carpal Tunnel Syndrome

Symmetry ◽  
2020 ◽  
Vol 12 (10) ◽  
pp. 1581
Author(s):  
Oscar J. Pellicer-Valero ◽  
José D. Martín-Guerrero ◽  
Margarita I. Cigarán-Méndez ◽  
Carmen Écija-Gallardo ◽  
César Fernández-de-las-Peñas ◽  
...  
Keyword(s):  
Mathematical Modeling ◽  
Neuropathic Pain ◽  
Carpal Tunnel Syndrome ◽  
Pain Intensity ◽  
Carpal Tunnel ◽  
Symptom Severity ◽  
Grip Force ◽  
Self Organizing Maps ◽  
Tunnel Syndrome ◽  
And Function

A better understanding of the connection between risk factors associated with pain and function may assist therapists in optimizing therapeutic programs. This study applied mathematical modeling to analyze the relationship of psychological, psychophysical, and motor variables with pain, function, and symptom severity using Bayesian linear regressions (BLR) and self-organizing maps (SOMs) in carpal tunnel syndrome (CTS). The novelty of this work was a transfer of the symmetry mathematical background to a neuropathic pain condition, whose symptoms can be either unilateral or bilateral. Duration of symptoms, pain intensity, function, symptom severity, depressive levels, pinch tip grip force, and pressure pain thresholds (PPTs) over the ulnar, radial, and median nerve trunks, the cervical spine, the carpal tunnel, and the tibialis anterior were collected in 208 women suffering from CTS. The first BLR model revealed that symptom severity, PPTs over the radial nerve, and function had significant correlations with pain intensity. The second BLR showed that symptom severity, depressive levels, pain intensity, and years with pain were associated with function. The third model demonstrated that pain intensity and function were associated with symptom severity. The SOMs visualized these correlations among variables, i.e., clinical, psychophysical, and physical, and identified a subgroup of women with CTS exhibiting worse clinical features, higher pressure sensitivity, and lower pinch tip grip force. Therefore, the application of mathematical modeling identified some interactions among the intensity of pain, function, and symptom severity in women with CTS.

Carpal tunnel syndrome: clinical features, diagnosis, and management

2016 ◽  
Vol 15 (12) ◽  
pp. 1273-1284 ◽  
Author(s):  
Luca Padua ◽  
Daniele Coraci ◽  
Carmen Erra ◽  
Costanza Pazzaglia ◽  
Ilaria Paolasso ◽  
...  
Keyword(s):  
Carpal Tunnel Syndrome ◽  
Clinical Features ◽  
Carpal Tunnel ◽  
Diagnosis And Management ◽  
Tunnel Syndrome

Clinical features of 1039 patients with neurophysiological diagnosis of carpal tunnel syndrome

2004 ◽  
Vol 107 (1) ◽  
pp. 64-69 ◽  
Author(s):  
Daniel B. Nora ◽  
Jefferson Becker ◽  
João Arthur Ehlers ◽  
Irênio Gomes
Keyword(s):  
Carpal Tunnel Syndrome ◽  
Clinical Features ◽  
Carpal Tunnel ◽  
Tunnel Syndrome

Bifid Median Nerve Compression due to a Musculotendinous Anomaly of FDS to the Middle Finger

1994 ◽  
Vol 19 (5) ◽  
pp. 616-617 ◽  
Author(s):  
S. FERNANDEZ-GARCIA ◽  
J. PI-FOLGUERA ◽  
F. ESTALLO-MATINO
Keyword(s):  
Carpal Tunnel Syndrome ◽  
Muscle Contraction ◽  
Median Nerve ◽  
Carpal Tunnel ◽  
Middle Finger ◽  
The Other ◽  
Nerve Compression ◽  
Musculotendinous Junction ◽  
Median Nerve Compression ◽  
Tunnel Syndrome

A case is presented of a bifid median nerve whose longest portion had a normal course while the other portion passed through a hole in the FDS tendon of the middle finger, at its musculotendinous junction. This caused nerve compression during muscle contraction, producing pain and dysaesthesia in the middle finger suggesting carpal tunnel syndrome.

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