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Questions posted in the
Neurology and Neurosurgery Forum have been answered by doctors from The Cleveland Clinic Foundation.
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Subject: Re: carpal tunnel syndrome
: My brother-in-law is suffering from severe hand pains in both arms. Though all his symptoms point to CTS, his EMG shows no anomalies. His doctors now say their is nothing they can do but pain treatment. It is not possible to have symptomatic carpal tunnel syndrome to the severity you describe and have a normal EMG. It is very possible. however, to have a very painful condition known as sensory peripheral neuropathy, and have a normal EMG, since this condition affects the very smallest nerve fibers that cause pain, while sparing the much larger fibers that mediate other forms of sensation. The EMG is capable of only studying these larger fibers, that are not related to pain transmission. There is another test performed at certain large teaching medical centers, including the Cleveland Clinic, known as QST, or quantitative sensory testing, that studies specifically wheteher or not there is damage to these small fibers. Sometimes a nerve biopsy is required to diagnose possible underlying causes of such neuropathy, although in most cases no cause is found. Rarely, the condition is associated with another underlying disease process, most often diseases called Sjogren's syndrome (other symptoms include dry eyes, mouth), amyloidosis, diabetes (if your brtother in law has it--- though this usually starts in LEGS rather than arms), and rarely, cancer. If your brother-in-law would be interested in seeing someone here at the Cleveland Clinic, we do have a neurologist, Dr. Robert Shields, who is an expert in this specific condition and a pioneer in the development of testing techniques for it. An appointment with Dr. Shields could be made by calling 216-444-5559. I would encourage you to advise him to have an evaluation with a neurologist and center capable of the above diagnostic testing techniques soon, in case he has an underlying condition in association with his neuropathy, if he indeed is proven ultimately to have neuropathy. I hope you find this information useful.
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