A reappraisal of small- and large-fiber damage in carpal tunnel syndrome: New insights into the value of the EMLA test for improving diagnostic sensitivity

Triki, Leila; Zouari, Héla; Kammoun, Rim; Kammoun, Firas; Kammoun, Inès; Masmoudi, Kaouthar; Lefaucheur, Jean‐Pascal

doi:10.1016/j.neucli.2017.10.001

Cited by 5 publications

(7 citation statements)

References 60 publications

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“…Previous studies[ 14 ] found fairly high sensitivity for a 30-min EMLA test with much lower specificity, limiting its diagnostic utility in CTS. However, in our study, extending the duration of topical application of EMLA (90 min) significantly improved both sensitivity and specificity and probably has the potential of being used complementary to NCS or even as an alternative to electrophysiological studies in general practice settings.…”

Section: Discussionmentioning

confidence: 99%

“…[ 13 ] Triki et al . [ 14 ] compared the sensitivity and specificity of the EMLA test (30 min of topical application on digit 2 only) with that of NCS and sympathetic skin response in the diagnosis of CTS. They found a sensitivity of 69.4% and a specificity of 50% for the EMLA test with a good correlation of this test with clinical data.…”

Section: Discussionmentioning

confidence: 99%

“…Recently, a few researchers assessed EMLA-induced vasomotor dysfunction in CTS by measuring blood flow velocity changes[ 13 ] and by visual inspection and grading of the EMLA SSW[ 14 ] after 30 min of topical EMLA application. Fairly high sensitivity was reported for this test; however, the specificity was found to be much lower, thus limiting its clinical diagnostic utility.…”

Section: Introductionmentioning

confidence: 99%

“…Fairly high sensitivity was reported for this test; however, the specificity was found to be much lower, thus limiting its clinical diagnostic utility. [ 14 ] Bjerring et al . [ 15 ] observed that in healthy subjects, the EMLA cream produces maximum vasoconstriction after 90 min of application.…”

Section: Introductionmentioning

confidence: 99%

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Efficiency of 90-Min Extended EMLA-Induced Stimulated Skin-Wrinkling Test in the Diagnosis of Carpal Tunnel Syndrome

Mathew¹,

John²

2022

Annals of Indian Academy of Neurology

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Background: Previous researchers have used a 30-min eutectic mixture of local anesthetic (EMLA) test, which assesses the sympathetically mediated vasomotor function, in diagnosing carpal tunnel syndrome (CTS). However, its specificity was low, limiting its clinical diagnostic utility. In this study, we assessed the efficiency of 90-min extended EMLA-induced stimulated skin-wrinkling (SSW) test in CTS diagnosis. Methods: A cross-sectional study was designed among patients clinically diagnosed with CTS. Hands of healthy volunteers and the asymptomatic hands of selected patients served as control. The Boston symptom severity scale (SSS) and the neuropathic pain severity inventory (NPSI) were used to assess symptom severity, and nerve conduction study (NCS) was used to assess electrophysiological severity. EMLA-induced SSW was visually graded after 90 min of application and correlated with symptom and NCS severities. Results: Forty-two symptomatic hands and 30 asymptomatic hands were enrolled as cases and controls, respectively. The diagnostic efficiency of the extended EMLA test was found to be 83.4% for digit 2 and 87.3% for the lateral 4 digits (mean), whereas the diagnostic efficiency of standard NCS was 88.1%. Boston SSS and NPSI were better correlated with EMLA positivity than NCS positivity. A linear regression analysis showed negative correlation of wrinkling grade with NCS grade. Conclusion: With its improved diagnostic efficiency, the 90-min extended EMLA test can feasibly be used as an alternative to NCS, especially in general practice settings. Its potential clinical utility should be explored in a large population of CTS patients showing varying clinical and electrophysiological severities.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Efficiency of 90-Min Extended EMLA-Induced Stimulated Skin-Wrinkling Test in the Diagnosis of Carpal Tunnel Syndrome

Mathew¹,

John²

2022

Annals of Indian Academy of Neurology

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“…These symptoms reduce the quality of sleep and life of patients suffering from painful peripheral neuropathies. The burning sensations in general seems to suggest involvement of small fibers, even in forms of compression neuropathy [2]. SFN is increasingly recognized as one of the major pathogenetic disturbances leading to burning and stinging pain in many peripheral neuropathic syndromes.…”

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confidence: 99%

Topical phenytoin formulations for pain in small fiber neuropathy, a pathogenetic approach

Hesselink¹,

Notermans²

2018

Gen Int Med Clin Innov

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Peripheral neuropathic localized pain as for instance in PDN and SFN, is characterized by hyperexcitability of nociceptors, which can be inhibited by sodium channel blockers. Such hyperexcitability is based on reduced receptor threshold of the C nociceptor, leading to spontaneous discharges and to intensified nociceptor responses in response to stimulation. These phenomena lead to the classical symptoms of mechanical and heat allodynia and spontaneous burning or stinging pain [1]. These symptoms reduce the quality of sleep and life of patients suffering from painful peripheral neuropathies. The burning sensations in general seems to suggest involvement of small fibers, even in forms of compression neuropathy [2]. SFN is increasingly recognized as one of the major pathogenetic disturbances leading to burning and stinging pain in many peripheral neuropathic syndromes. Diabetes mellitus is the main cause of SFN. Glucose intolerance and the metabolic syndrome are also associated with SFN. In CIAP, sarcoidosis, Lyme disease, HIV and amyloidosis, SFN can develop [3]. Alcohol is the main toxic agent inducing SFN. SFN is therefore a secondary complication in many internal and neurological disorders. The diagnosis CIAP is dependent on the clinical impression, a length dependent neuropathy, including disturbances of the electromyography. In many CIAP patients there are complaints of burning pain, comparable to patients suffering from SNF. This supports a possible comparable pathogenesis in both groups. The diagnosis SFN rests on the clinical impression, a normal electromyography and a reduction of the small nerve fibers, as detected via a skin biopsy [4]. In indications as PDN, CIAP and perhaps also in PHN subgroups of patients therefore might be identified as suffering from SFN.

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Assessment of autonomic nervous system dysfunction associated with peripheral neuropathies in the context of clinical neurophysiology practice

Lefaucheur

2023

Neurophysiologie Clinique

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A reappraisal of small- and large-fiber damage in carpal tunnel syndrome: New insights into the value of the EMLA test for improving diagnostic sensitivity

Cited by 5 publications

References 60 publications

Efficiency of 90-Min Extended EMLA-Induced Stimulated Skin-Wrinkling Test in the Diagnosis of Carpal Tunnel Syndrome

Efficiency of 90-Min Extended EMLA-Induced Stimulated Skin-Wrinkling Test in the Diagnosis of Carpal Tunnel Syndrome

Topical phenytoin formulations for pain in small fiber neuropathy, a pathogenetic approach

Assessment of autonomic nervous system dysfunction associated with peripheral neuropathies in the context of clinical neurophysiology practice

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