Symptom Distribution and Pain Sensitization in Carpal Tunnel Syndrome

Evaluation of Central Sensitization Parameters Based on Extra Median Symptom Distribution in Carpal Tunnel Syndrome: A Cross-sectional Study

This study aims to compare central sensitization parameters between carpal tunnel syndrome (CTS) patients with extra median symptom distribution and those with typical, median nerve-related symptoms. Extra median sensory spread, observed in some CTS patients beyond the anatomical boundaries of the median nerve, may reflect central sensitization mechanisms. Using the Central Sensitization Inventory and pressure pain threshold measurements, this study will assess whether extra median symptom patterns are associated with increased central sensitization.

Carpal Tunnel Syndrome (CTS) is the most common entrapment neuropathy, typically presenting with numbness and tingling in the thumb, index, and middle fingers due to median nerve compression at the wrist. However, some patients report symptom spread beyond the median nerve distribution, involving ulnar regions of the hand, forearm, shoulder, or even scapular areas. This phenomenon, known as extra median symptom distribution, has been increasingly associated with central sensitization (CS).This study aims to compare central sensitization parameters between CTS patients with typical symptoms and those showing extra median spread. Pressure pain threshold (PPT) and Central Sensitization Inventory (CSI) scores will be used to evaluate sensitization levels. The initial hypothesis of this study was that patients with extra-median symptoms would exhibit lower PPT values and higher CSI scores, indicating greater central sensitivity. Findings may highlight the need to consider central mechanisms in CTS management and promote more personalized treatment approaches.

Inclusion Criteria:

• Having been diagnosed with carpal tunnel syndrome based on clinical and electrodiagnostic findings
• Being between 18 and 65 years of age
• Being literate
• Agreeing to participate in the study

Exclusion Criteria:

• Having a history of concomitant diabetes, systemic inflammatory disease, active infection, or malignancy
• Being <18 and >65 years of age
• Being illiterate
• Refusing to participate in the study
• Having a disease associated with neuropathic pain, such as polyneuropathy, radiculopathy, or multiple sclerosis
• History of injection or surgery for CTS within the last 6 months