Cutaneous silent period in carpal tunnel syndrome

Svilpauskaite, Jovita; Truffert, André; Vaičienė, Nerija; Magistris, Michel R.

doi:10.1002/mus.20496

Cited by 32 publications

(27 citation statements)

References 24 publications

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“…Afferent impulses that generate the cutaneous SP are carried primarily by smaller, slower conducting A-delta fibers. 11,12,21 Conditions that interrupt this reflex pathway should be associated with absence or delay of the cutaneous SP. The cutaneous SP shows a high sensitivity for detecting spinal cord lesions, including intramedullary spinal cord lesions 35 and myelopathy due to spondylosis, 16,17 syringomyelia, 15 whiplash injury 36 or other structural abnormalities of the cervical spine that abolish or alter the cutaneous SP.…”

Section: Discussionmentioning

confidence: 99%

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Preserved cutaneous silent period in cervical root avulsion

Vaško

Boček

Mencl

et al. 2015

The Journal of Spinal Cord Medicine

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Objective: Brachial plexus injuries are usually severe and involve the entire brachial plexus, sometimes occurring with root avulsions. Imaging and electrodiagnostic studies are an essential part of the lesion evaluation; however, the results sometimes show a discrepancy. The cutaneous silent period (SP) is a spinal inhibitory reflex mediated by small-diameter A-delta nociceptive fibers. The aim of the study was to determine if cutaneous SP testing may serve as a useful aid in evaluation of brachial plexus injury and/or in the diagnosis of root avulsion. Methods: In 19 patients with traumatic brachial plexus injury (15 males, age 18-62 years) we performed a clinical examination, CT myelography and neurophysiological testing. A needle EMG was obtained from muscles supplied by C5-T1 myotomes. Cutaneous SP was recorded after painful stimuli were delivered to the thumb (C6 dermatome), middle (C7) and little (C8) fingers while subjects maintained voluntary contraction of intrinsic hand muscles. Results: Electrodiagnostic and imaging studies confirmed root avulsion (partial or total) maximally involving C5, C6 roots in 12 patients, whereas only in 4 of them the cutaneous SP was partially absent. In the remaining subjects, the cutaneous SP was preserved. Conclusion: In brachial plexopathy even with plurisegmental root avulsion, the cutaneous SP was mostly preserved. This method cannot be recommended as a reliable test for diagnosis of single root avulsion; however, it can provide a quick physiological confirmation of functional afferent A-delta fibers through damaged roots and/or trunks. The clinicians may add this test to the diagnosis of spinal cord dysfunction.

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Section: Discussionmentioning

confidence: 99%

“…[7][8][9][10] Cutaneous SP is altered in a variety of peripheral nervous system lesions. [11][12][13][14] Absence of radiculopathy, almost normal cutaneous SP has been observed. 18 The CSP technique can quickly determine whether afferent impulses in A-delta fibers pass through individual cervical roots to enter the spinal cord.…”

Section: Introductionmentioning

confidence: 93%

Preserved cutaneous silent period in cervical root avulsion

Vaško

Boček

Mencl

et al. 2015

The Journal of Spinal Cord Medicine

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“…3,12,21 The CSP has provided useful information on the excitability of spinal inhibitory pathways in patients with pyramidal syndrome, 5 in movement disorders, 6,14,17 and in clinical studies of nociceptive afferents (A␦ fibers) in peripheral neuropathies. 9,12,18 Laser-generated radiant heat pulses selectively excite free nerve endings in the superficial skin layers. They activate A␦ and C mechanothermal nociceptors and they evoke scalp potentials related to A␦ fibers generated by the operculoinsular cortex and cingulate gyrus (laser evoked potentials, or LEPs).…”

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confidence: 99%

Dissociation between cutaneous silent period and laser evoked potentials in assessing neuropathic pain

et al. 2008

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In this study we investigate whether the cutaneous silent period (CSP)-an inhibitory response evoked in hand muscles by painful digital nerve stimulation-is useful for assessing nociceptive pathway function in patients with neuropathic pain. In 40 patients with peripheral neuropathy (21 without and 19 with neuropathic pain) we recorded the CSP in the abductor digiti minimi after fifth digit stimulation and also recorded laser evoked potentials (LEPs) after stimulation applied to the ulnar territory of the hand. Although the LEP amplitude was significantly lower in patients with pain than in those without (P < 0.005), the CSP duration did not differ between groups (P > 0.50). Pain intensity correlated significantly with LEP amplitudes (P < 0.005) but not with CSP duration (P > 0.5). Our findings indicate that the CSP is not useful for assessing nociceptive pathway function in patients with neuropathic pain.

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“…Kofler et al [5] found that preserved CSPs may serve to document residual nerve continuity in severe entrapment neuropathies when fast-conducting fibers were so compromised that their continuity could not be detected by standard electrodiagnostic techniques. Similarly, Svilpauskaite et al [14] showed that only transection of a peripheral nerve, but not severe entrapment, abolished the CSP. In agreement with previous reports that demonstrated relative preservation of CSP responses in other peripheral nerve syndromes [2,5,7,14], we now provide evidence that the CSP is not affected by cervical radiculopathies.…”

Section: Discussionmentioning

confidence: 87%

“…Similarly, Svilpauskaite et al [14] showed that only transection of a peripheral nerve, but not severe entrapment, abolished the CSP. In agreement with previous reports that demonstrated relative preservation of CSP responses in other peripheral nerve syndromes [2,5,7,14], we now provide evidence that the CSP is not affected by cervical radiculopathies. Our findings are also congruous with the observation that many patients seeking medical treatment for cervical radiculopathy do not manifest features of overt axonal loss.…”

Section: Discussionmentioning

confidence: 87%

The cutaneous silent period is preserved in cervical radiculopathy: significance for the diagnosis of cervical myelopathy

Leis

Kofler²,

̌Sťetkářová

et al. 2010

Eur Spine J

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Electromyographic (EMG) activity from voluntarily contracting hand muscles undergoes transient suppression following nociceptive fingertip stimulation. This suppression is mediated by a spinal inhibitory reflex designated the cutaneous silent period (CSP). The CSP is abolished or altered in a variety of myelopathic conditions. However, before the CSP can gain acceptance as an aid in the diagnosis of myelopathy, the contribution of non-myelopathic conditions that can interrupt the afferent pathways responsible for the CSP needs to be considered. Accordingly, we examined the effect of radiculopathy on the CSP. Nociceptive stimulation was applied to thumb (C6 dermatome), middle (C7) and little (C8) fingers of 23 patients with cervical radiculopathy. Four or more CSP responses were recorded in abductor pollicis brevis muscle following digital stimulation. The patients had C6 (n = 10), C7 (n = 7), or C8 (n = 6) radiculopathy documented by EMG. A complete CSP was elicited in 21 of 23 patients with comparable latencies and durations irrespective of digit stimulated. We conclude that the CSP is preserved in radiculopathy, probably because afferent impulses are carried by smaller, slower conducting 'injury-resistant' A-delta fibers. These results provide important missing evidence that ensures specificity of CSP alterations in the diagnosis of cervical myelopathy. The finding that the CSP is spared in radiculopathy should open the door for investigators and clinicians to adopt this simple spinal inhibitory reflex as a physiologic aid in the diagnosis of spinal cord dysfunction.

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Cutaneous silent period in carpal tunnel syndrome

Cited by 32 publications

References 24 publications

Preserved cutaneous silent period in cervical root avulsion

Preserved cutaneous silent period in cervical root avulsion

Dissociation between cutaneous silent period and laser evoked potentials in assessing neuropathic pain

The cutaneous silent period is preserved in cervical radiculopathy: significance for the diagnosis of cervical myelopathy

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