The Research Of Quantitative Sensory Testing In Carpal Tunnel Syndrome And Cubital Tunnel Syndrome

Background and Purpose:Small nerve fiber injury refers to the damage of peripheral nerve fibers < 7 μm in diameter.Its typical symptoms include pain and temperature loss,abnormal pain,and autonomic nervous dysfunction,etc.These symptoms are widely present in peripheral nerve compression diseases,such as carpal tunnel syndrome and cubital tunnel syndrome.The traditional nerve electrophysiological examination can only evaluate the function of the thick nerve fibers and cannot make a judgment on the injury of the small nerve fibers.Quantitative sensory test can quantify the damage of small nerve fibers and is an effective means to solve this problem.The purpose of this study is to conduct quantitative sensory tests on patients with Carpal Tunnel Syndrome(CTS)and Cubital Tunnel Syndrome(CuTS)to explore whether there is small sensory nerve fiber damage,providing a reference for a comprehensive assessment of these two diseases.Methods:In this study,patients who were admitted to China-Japan Union Hospital of Jilin University from June 2020 to January 2021 and were diagnosed by doppler ultrasound and nerve electrophysiological examination,as well as control subjects without disease were included.There were 18 patients in carpal tunnel syndrome group(23hands in total),17 patients in cubital tunnel syndrome group(20 hands in total),and12 patients in control group(20 hands in total).Quantitative sensory testing including temperature testing and vibration testing,choose Israel MEDOC company produces the TSA-Ⅱquantitative temperature sense tester and the VSA-3000 vibration tester.The test sites of all subjects were the palmars of the index,middle and little fingers(mainly the finger ventral).The temperature and vibration thresholds of the Vaffected hand of the patient group and the control group were collected respectively.Limit method is used to measure temperature sensation,including cold sensation,heat sensation,cold pain sensation and heat pain sensation.The cold sensation and heat sensation were tested for 4 times in each part,and the cold pain sensation and heat pain sensation were tested for 3 times in each part.The mean value was taken as the temperature sensation threshold of each finger.Limit method was used for vibration sensing test,and each part was repeated for 3 times.The mean value was taken as the vibration sensing threshold of each finger.The United States Nicolit electromyographic evoked potentiometer was used for nerve electrophysiological examination.The test items for patients with carpal tunnel syndrome were:(1)median nerve wrist distal motor latency;(2)motor conduction velocity;(3)index finger-sensory nerve amplitude of median nerve.The test items of patients in CuTS were:(1)the ulnar nerve motor nerve conduction velocity;(2)little finger-carpal ulnar sensory nerve amplitude.The temperature and vibration thresholds in the carpal tunnel syndrome group and cubital tunnel syndrome group were compared with the control group respectively,and the correlation between the vibration thresholds in the two groups and the corresponding nerve electrophysiological results was analyzed.Results:1.The carpal tunnel syndrome group:(1)Results of quantitative sensory test:The thresholds of cold sensation,heat sensation,cold pain sensation,heat pain sensation and vibration sensation of index finger of median nerve innervation in carpal tunnel syndrome group were 23.81±2.81℃,40.39±1.99℃,16.31±2.71℃,46.3±1.64℃ and4.08±2.3μm,respectively,and those in control group were 27.87±1.33℃,36.57±1.25℃,21.45±1.89℃,42.72±1.71℃ and 1.61±0.43μm respectively.The p values were 0.000 compared with those in control group(p<0.01);The threshold values of cold sensation,heat sensation,cold pain sensation,heat pain sensation and vibration sensation of middle finger were 23.75±2.23℃,40.77±2.12℃,15.55±3.33℃,46.01±1.65℃ and 3.85±1.98μm respectively.The threshold values of the control group were 27.52±1.40℃,37±1.85℃,21.48±1.66℃,42.51±1.70℃ and 1.46±0.41μm,Irespectively.The p values were 0.000 compared with the control group(p< 0.01).The results showed that the thresholds of cold sensation and cold pain of the index and middle fingers were decreased,and the thresholds of heat sensation,heat pain sensation and vibration sensation were increased.(2)Correlation between vibration threshold and nerve electrophysiological results: the vibration threshold of index and middle fingers was positively correlated with the latency,and negatively correlated with motor nerve conduction velocity and index sensory nerve amplitude,that is,when the latency was prolonged,the vibration threshold of index and middle fingers became larger;When the motor nerve conduction velocity slowed down and the amplitude of index finger sensory nerve decreased,the vibration perception of index finger and middle finger increased.2.The cubital tunnel syndrome group:(1)Results of quantitative sensory test:The thresholds of cold sensation,heat sensation,cold pain sensation,heat pain sensation and vibration sensation of the little finger innervated by the ulnar nerve in the Cuts group were 20.91±3.43℃,42.44±2.21℃,13.22±3.47℃,47.64±1.93℃ and3.68±1.39μm,respectively,and the thresholds of the control group were26.98±2.87℃,37.64±3.42℃,20.79±3.06℃,43.04±2.81℃ and 1.64±0.48μm,respectively.Compared with the control group,the P values were 0.000,which was significantly different(p < 0.01).The results showed that the cold and cold pain thresholds of the little finger decreased,while the heat,heat pain and vibration thresholds increased.(2)Correlation between vibration threshold and nerve electrophysiological results: the vibration threshold of the little finger was negatively correlated with motor nerve conduction velocity,that is,when motor nerve conduction velocity slowed down,the vibration threshold of the little finger increased.Conclusions:1.Small nerve fiber damage can be found in patients with carpal tunnel syndrome and cubital tunnel syndrome;the vibration sensory test can detect the damage of large nerve fibers,which has a good correlation with the results of nerve electrophysiological examination.2.Quantitative sensory test combined with nerve electrophysiological examination can evaluate the diagnosis of carpal tunnel syndrome and cubital tunnel syndrome more comprehensively.