Clinical characteristics and electrodiagnostic features in patients with carpal tunnel syndrome, double crush syndrome, and cervical radiculopathy

Abstract

Similar unilateral neck and upper limb symptoms are often due to various entrapment neuropathies; carpal tunnel syndrome (CTS) and cervical radiculopathy (CR) are common causes among them. Therefore, we investigated the clinical characteristics and electrodiagnostic features of patients with carpal tunnel syndrome, cervical radiculopathy, and both conditions, called double crush syndrome (DCS). The medical records and electrodiagnostic reports of 866 patients with suspected CTS and CR visited a tertiary-care hospital were retrospectively analyzed. After excluding 101 patients with confounding conditions, 151 (20%) patients were diagnosed to have sole cases of CTS; 362 (47%) patients were diagnosed to have sole cases of CR; 198 (26%) patients were diagnosed to have DCS, while 54 (7%) patients had mere symptoms. Sole cases of CR had the highest incidences of neck pain, upper back pain, wrist and hand weakness. Female patients had the highest incidences of all the diseases in their sixth decade. Male patients had comparably distinguished high occurrence of all the diseases in their fifth to sixth decades. Although comparison of nerve conduction studies between patients with mere symptoms and patients with sole cases of CTS or DCS showed statistical differences, comparison between the latter two revealed no difference. We found most patients referred for electrodiagnostic studies had cervical radiculopathy. High concomitant occurrence of CTS and CR suggests cautious evaluation of patients with upper limb symptoms is important, because the management of these conditions is quite different.

The “Hierarchical” Scratch Collapse Test for Identifying Multilevel Ulnar Nerve Compression

“…The double crush hypothesis also suggests that serial constraints to axoplasmic flow, while individually are insufficient to result in clinically appreciable nerve dysfunction, can be an additive in causing ultimate nerve dysfunction. There exists both clinical and experimental evidence to support multiple compression sites in peripheral nerves [1,6,7,14,17,21,23,27,32]. Other potential etiologies include medical conditions which increase the susceptibility of compression (e.g., diabetic neuropathy), neurologic conditions (e.g., syringomyelia), and genetic Fig.…”

Combination treatment for tunnel neuropathies of the lower extremities

“…Имеет значение изначальное состояние периферического нерва, подвергаю-щегося компрессии: тоннельные невропатии развиваются быстрее, если уже имеется поражение аксональных транс-портных систем в проксимальном отделе (МАС-синдром -синдром множественного аксоплазматического сдавления при плексопатии или радикулопатии) или дистально (поли-невропатии или множественные мононевропатии) на фоне дефицита аксоплазматического тока и нейротрофических факторов, требующихся для регенерации аксона [9,11,13]. Поэтому у каждого больного для уточнения патогенеза тон-нельного синдрома и подбора оптимальной терапии необ-ходимо учитывать наличие острых, подострых и хрониче-ских повреждений на всех уровнях периферической нерв-ной системы, указывающих на наследственную или приоб-ретенную узость фиброзно-костного канала.…”

“…Важным диагностическим нейрофизиоло- М е т о д ы д и а г н о с т и к и Для оценки тяжести поражения и процессов восстано-вления функций нерва проводят нейрофизиологические исследования: электронейромиографию (ЭНМГ), количе-ственное сенсорное тестирование. При ЭНМГ определяют-ся снижение амплитуды и скорости проведения импульса по двигательным и чувствительным волокнам и увеличение резидуальной латенции в месте компрессии нерва и дис-тальнее [2,3,13,20].…”

The Double Crush Syndrome

“…1,2 Frequently, patients with symptoms suggestive of compressive neuropathy will also have coexisting pain in the cervical spine region and a diagnosis of cervical radiculopathy (CR) by electrodiagnostic studies (EDS) or clinical examination. 3,4 Such patients may have double crush syndrome (DCS) with compression of nerve fibers at 2 distinct sites: 1 proximal in the C-spine, and 1 distal in the cubital tunnel, carpal tunnel, or elsewhere. Discerning which area of nerve compression or irritation, proximal or distal, is most responsible for a patient’s symptoms is often challenging for the clinician.…”

“…5 Multiple studies have failed to recognize an electrodiagnostic correlation between patients with isolated CTS and those diagnosed with DCS. 3 Furthermore, physical examination findings, such as the Tinel and Phalen signs, have also been shown to be unreliable as the sole method of evaluation in cases of suspected DCS, although they do correlate well with symptoms in patients with isolated CTS diagnosed by EDS. 3 In addition, Kwon et al, in 2006, evaluated the severity of CTS based on the level of confirmed CR (C6, C7, C8) with electrophysiologic parameters of median motor and sensory nerves.…”