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CC BY 4.0 · J Brachial Plex Peripher Nerve Inj 2024; 19(01): e31-e41
DOI: 10.1055/s-0044-1792169
Original Article

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

Magnus Flondell 
1   Department of Hand Surgery, Skåne University Hospital, Malmö, Sweden
2   Department of Hand Surgery, Translational Medicine, Lund University, Malmö, Sweden
,
Peter Mannfolk
3   Department of Medical Imaging and Physiology, Skåne University Hospital, Lund, Sweden
,
Birgitta Rosén
1   Department of Hand Surgery, Skåne University Hospital, Malmö, Sweden
2   Department of Hand Surgery, Translational Medicine, Lund University, Malmö, Sweden
,
Isabella M. Björkman-Burtscher
4   Department of Radiology, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
5   Department of Radiology, Sahlgrenska University Hospital, Region Västra Götaland, Gothenburg, Sweden
,
Anders Björkman
1   Department of Hand Surgery, Skåne University Hospital, Malmö, Sweden
2   Department of Hand Surgery, Translational Medicine, Lund University, Malmö, Sweden
6   Department of Hand Surgery, Sahlgrenska University Hospital, Gothenburg, Sweden
7   Department of Hand Surgery, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
› Author Affiliations Funding Funding for this study was received from Skåne County Council's Research and Development Foundation and Skåne University Hospital.
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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 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.

Keywords

carpal tunnel syndrome1 - magnetic resonance imaging - somatosensory cortex - anesthesia - hand

Ethics Approval and Consent to Participate

The study was approved by the Swedish Ethical Review Authority (DNr 269–2008, amendment 23–2011). It was conducted according to the tenets of the Declaration of Helsinki. All participants gave written informed consent.


Consent for Publication

The authors give consent to publish in writing.


Availability of Data and Materials

Clinical datasets on group levels generated in this study are available from the corresponding author upon reasonable request.


Competing interests

The authors declare no competing interest.


Authors' Contributions

All authors have contributed to the design and execution of the study, drafting of the manuscript, and have read and approved the final draft before submission of the manuscript.




Publication History

Received: 15 August 2024

Accepted: 03 October 2024

Article published online:
14 November 2024

© 2024. 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/)

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

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