Small Fiber Neuropathy relating to CTS

lindap
Offline

I had both carpal releases done several years ago. Even though I never had conduction studies done before the operations, it probably was the correct thing to do as it stopped the extreme pins and needles/pain in both hands/elbows at night (this was severe as it felt someone was hitting my elbows on the funny bone whilst trapping my fingers in the door!!!).

I was hoping for an end to the nerve issues, but unfortunately it did not stop my painful hands (which swell on using them and buzz similar to if you had hit your hands against the wall many times!). I've now developed, over time, burning/painful feet up to my knees. So evenings and night times are horrible, as I can suffer pain in hands/feet/legs. The rheumatologists say the issues are not due to arthritis and the hand surgeon's have no idea (apart from early dupuytrens). The hand surgeons did do a nerve conduction study to see if the operations were a success, and they were as there was no entrapment in the wrists.

My question is: is there any relationship between Small Fiber Neuropathy and CTS? I now wonder if I have been suffering from small fiber neuropathy all along.

jeremydpbland
Online

It is certainly possible that the primary underlying cause of the problem is a generalised neuropathy of some kind, not necessarily exclusively small fibre. It would of course have helped had someone organised some nerve conduction studies at the outset. As things stand now one wonders how extensive the recent NCS were - did they check your feet?

The direct answer to the question about a relationship between small fibre neuropathy and CTS is 'sort of'. We think that having almost any kind of generalised nerve problem probably increases your risk of developing CTS as a superimposed problem but this is more of a theory than something that has been conclusively established from evidence and it turns out to be very hard to study. There is one well known example in that CTS is frequently the presenting symptom of amyloid neuropathy, long before the eventual diagnosis of the systemic problem.

When it comes to specifically small fibre neuropathies there is an extra problem in that conventional NCS are very poor at detecting them - indeed our current tools for detecting small fibre neuropathy in general are rather poor.

It sounds as though the speciality that you really need to see is a neurologist with an interest in peripheral nerve disease. JB

lindap
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Thank you for your in depth reply. It does make sense that nerve issues increase the risk of developing CTS, but it is a shame that conventional NCS are poor at detecting problems with the small fibres.

In desperation, as my GP is unwilling to refer me to a neurologist (but at least is now organising Nerve Conduction Studies), I've found a study in which they do biopsies for neuropathic pain (together with bloods). I have emailed them to see if they would share my results with me (if I am able to join the study) - hopefully they cover sfn.

I agree, nerve conduction studies would have been beneficial at the beginning (2013), but being a patient with no knowledge of this and desperate to be pain free, I was just glad they did the carpal release (but was not impressed with the specialist nurse, who did the op, timing himself saying he did them within 10 mins!!).

Incidentally, the section on this website where you can add entries for treatment/consultations is excellent as you can log back on, years after, and see the events of what happened as a reminder.

To sum up, nobody has ever done a nerve conduction study on my feet and the only nerve conduction study on my hands has been in 2015 to see if there was still any entrapment where they operated for the carpal tunnel release.

Thank you though, for taking the time to reply. At least I'll mention the carpal tunnel issues when I attend the NCS session and see if they can find anything to find the underlying cause.

jeremydpbland
Online

The best current test for small fibre neuropathy is indeed skin biopsy - a small punch biopsy is taken, specially stained in the lab, and then someone has to count the nerve fibres seen in it under a microscope. You can also try to assess small fibre function using laser evoked potentials, contact heat evoked potentials, and subjective thermal threshold testing. There has also been some interest in counting the small nerve fibres in the cornea using confocal corneal microscopy and there is one person in the UK (at least that I know of) who does single fibre microelectrode studies of small fibres. All of these methods are rather 'special interest'. Those of us interested in the area are all convening for a conference in Gothenburg in June so there is a fair amount of work being done on the problem.

To be fair to the specialist nurse - most surgeons do carpal tunnel surgery in that sort of time - the average for one of my very experienced surgeons here is about 7 minutes. Surgeons who use a tourniquet for this usually have an accurate timing because they record the length of time the tourniquet is inflated as part of the surgery records. JB

lindap
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Thank you for your reply. I apologise for my comment about the specialist nurse, I didn't realise that they have to time themselves (it did seem odd at the time, but probably because I was nervous).

Thank you also for the forum and the information provided as patient information, it is much appreciated for us to grasp an understanding to CTS and underlying issues.

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