Cutaneous silent period in carpal tunnel syndrome

The cutaneous silent period (CuSP), a transient suppression of electromyographic activity that follows painful stimuli, allows an indirect study of the small-diameter A-delta fibers. To assess the function of these fibers in peripheral nerve disorders, we compared the CuSP of 40 controls to that of 40 patients with carpal tunnel syndrome (CTS) and one patient with a traumatic transection of the median nerve. Patients with CTS were divided into three severity groups, based on electrophysiological data. In CTS, digit 2 evoked CuSP onset latency was increased in all groups, and CuSP duration from abductor digiti minimi was reduced in all groups. In our series, although some parameters of the CuSP were altered, only transection of the nerve abolished it. A-delta fibers are robust, probably due to their less vulnerable small diameter. This characteristic may be useful to study various conditions and essential for patients to retain some sensation within the median nerve territory.