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Cerebral Changes Following Carpal Tunnel Syndrome Treated with Guided Plasticity : A Prospective, Randomized, Placebo-Controlled Study

Flondell, Magnus LU orcid ; Mannfolk, Peter LU ; Rosén, Birgitta LU ; Björkman-Burtscher, Isabella M LU and Björkman, Anders LU (2024) In Journal of Brachial Plexus and Peripheral Nerve Injury 19(1). p.31-41
Abstract

Background  Compression neuropathy, such as carpal tunnel syndrome (CTS), results in changed afferent nerve signaling, which may result in changes in somatosensory brain areas. The purpose of this study was to assess cerebral changes following unilateral CTS and to assess short-term and long-term cerebral effects of guided plasticity treatment using ipsilateral cutaneous forearm deafferentation. Methods  Twenty-four patients with mild-to-moderate unilateral CTS were randomized to treatment with anesthetic cream (EMLA) or placebo. Patient-rated outcomes were assessed using Boston CTS questionnaire and disability of arm, shoulder, and hand questionnaire (QuickDASH). Patients were assessed for tactile discrimination and dexterity. Cortical... (More)

Background  Compression neuropathy, such as carpal tunnel syndrome (CTS), results in changed afferent nerve signaling, which may result in changes in somatosensory brain areas. The purpose of this study was to assess cerebral changes following unilateral CTS and to assess short-term and long-term cerebral effects of guided plasticity treatment using ipsilateral cutaneous forearm deafferentation. Methods  Twenty-four patients with mild-to-moderate unilateral CTS were randomized to treatment with anesthetic cream (EMLA) or placebo. Patient-rated outcomes were assessed using Boston CTS questionnaire and disability of arm, shoulder, and hand questionnaire (QuickDASH). Patients were assessed for tactile discrimination and dexterity. Cortical activation during sensory stimulation was evaluated with functional magnetic resonance imaging at 3T. Assessments were performed at baseline, 90 minutes, and 8 weeks after treatment. Results  Functional magnetic resonance imaging showed that sensory stimulation of the hand with CTS resulted in significantly less cortical activation in the primary somatosensory cortex (S1) than stimulation of the healthy hand. Treatment with cutaneous forearm deafferentation on the side with CTS resulted in increased cortical activation in S1 both after the initial treatment and following 8 weeks of treatment. In addition, QuickDASH and tactile discrimination showed improvement in the EMLA group over time. Conclusions  Stimulation of median nerve-innervated fingers in patients with unilateral CTS results in smaller-than-normal activation in the contralateral S1. Cutaneous forearm anesthesia on the side with CTS results in larger activation in S1, suggesting recruitment of more neurons, and a slight improvement in sensory function.

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author
; ; ; and
organization
publishing date
type
Contribution to journal
publication status
published
subject
in
Journal of Brachial Plexus and Peripheral Nerve Injury
volume
19
issue
1
pages
31 - 41
publisher
BioMed Central (BMC)
external identifiers
  • pmid:39545073
ISSN
1749-7221
DOI
10.1055/s-0044-1792169
language
English
LU publication?
yes
additional info
The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. ( https://creativecommons.org/licenses/by/4.0/ ).
id
6100cee0-6941-43d3-bfb8-935ad905b572
date added to LUP
2024-12-20 11:19:16
date last changed
2025-04-04 14:58:53
@article{6100cee0-6941-43d3-bfb8-935ad905b572,
  abstract     = {{<p>Background  Compression neuropathy, such as carpal tunnel syndrome (CTS), results in changed afferent nerve signaling, which may result in changes in somatosensory brain areas. The purpose of this study was to assess cerebral changes following unilateral CTS and to assess short-term and long-term cerebral effects of guided plasticity treatment using ipsilateral cutaneous forearm deafferentation. Methods  Twenty-four patients with mild-to-moderate unilateral CTS were randomized to treatment with anesthetic cream (EMLA) or placebo. Patient-rated outcomes were assessed using Boston CTS questionnaire and disability of arm, shoulder, and hand questionnaire (QuickDASH). Patients were assessed for tactile discrimination and dexterity. Cortical activation during sensory stimulation was evaluated with functional magnetic resonance imaging at 3T. Assessments were performed at baseline, 90 minutes, and 8 weeks after treatment. Results  Functional magnetic resonance imaging showed that sensory stimulation of the hand with CTS resulted in significantly less cortical activation in the primary somatosensory cortex (S1) than stimulation of the healthy hand. Treatment with cutaneous forearm deafferentation on the side with CTS resulted in increased cortical activation in S1 both after the initial treatment and following 8 weeks of treatment. In addition, QuickDASH and tactile discrimination showed improvement in the EMLA group over time. Conclusions  Stimulation of median nerve-innervated fingers in patients with unilateral CTS results in smaller-than-normal activation in the contralateral S1. Cutaneous forearm anesthesia on the side with CTS results in larger activation in S1, suggesting recruitment of more neurons, and a slight improvement in sensory function.</p>}},
  author       = {{Flondell, Magnus and Mannfolk, Peter and Rosén, Birgitta and Björkman-Burtscher, Isabella M and Björkman, Anders}},
  issn         = {{1749-7221}},
  language     = {{eng}},
  number       = {{1}},
  pages        = {{31--41}},
  publisher    = {{BioMed Central (BMC)}},
  series       = {{Journal of Brachial Plexus and Peripheral Nerve Injury}},
  title        = {{Cerebral Changes Following Carpal Tunnel Syndrome Treated with Guided Plasticity : A Prospective, Randomized, Placebo-Controlled Study}},
  url          = {{http://dx.doi.org/10.1055/s-0044-1792169}},
  doi          = {{10.1055/s-0044-1792169}},
  volume       = {{19}},
  year         = {{2024}},
}