Two Cases of Double Crush Syndrome Progressing to Complex Regional Pain Syndrome

Vincifora, Carmine; Buck, Troy

doi:10.4236/ojanes.2015.57033

Cited by 2 publications

(2 citation statements)

References 15 publications

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“…1,2 A hypothesis proposed in 1973 by Upton et al describes the potential susceptibility of a distal nerve segment to lesion after a proximal injury. 1,3 It also emphasizes that the damage produced by double compression exceeds the additive injury caused by each compression, harming the global functioning of the nerve cells. 4,5 This hypothesis can explain why patients with carpal tunnel syndrome (CTS) sometimes feel pain in the forearm, in the elbow, in the arm, in the shoulder, in the chest, and in the upper back region.…”

Section: Introductionmentioning

confidence: 99%

“…1,6 The DCS manifests as a disorder including pain, numbness and weakness due to two or more insults to the same peripheral nerve. 3,7 When it involves the median nerve, the coexistence of CTS and of cervical radiculopathy is the most frequent DCS pattern. 2,4 CTS affects between 3 and 4% of the general population, with a prevalence of female patients in a 5:1 ratio, and in ages ranging from 30 to 60 years old.…”

Section: Introductionmentioning

confidence: 99%

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Double Crush Syndrome of the Median Nerve: A Literature Review

Magalhães

Correia²,

Cruz³

et al. 2016

Arq Bras Neurocir

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Double crush syndrome (DCS) is defined as the compressive involvement of the same peripheral nerve in different segments. When this syndrome affects the median nerve, a proximal compression of a spinal nerve that will constitute this structure (often the spinal nerve at the C6 vertebra) is usually noted at the cervical spine level as a herniated disc and as a distal compression at the level of the carpal tunnel. Epidemiological data on median nerve compromise by DCS are still very scarce in the medical literature. The diagnosis can be inferred by symptoms and signs occurring proximally and distally in the arm, as well as by alterations revealed by upper limb electromyography and neuroimaging studies, such as magnetic resonance imaging (MRI) of the cervical spine. Nowadays, information on which compressed neuroanatomical point should be initially addressed still depends on further studies. Limited data infer that these patients, when submitted to surgical treatment in only one of the median nerve compression points, evolve with worse functional outcomes than the surgically-treated group with carpal tunnel syndrome without DCS. ResumoA síndrome do duplo impacto (SDI) é conceituada como o comprometimento compressivo de um mesmo nervo periférico em segmentos distintos. Quando esta síndrome acomete o nervo mediano, usualmente se nota uma compressão proximal de um nervo espinhal que irá constituir o nervo mediano (frequentemente, o nervo espinhal da vértebra C6) ao nível da coluna cervical por uma hérnia discal e uma compressão distal ao nível do túnel do carpo. Dados epidemiológicos sobre a SDI comprometendo o nervo mediano ainda são muito escassos na literatura médica.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Double Crush Syndrome of the Median Nerve: A Literature Review

Magalhães

Correia²,

Cruz³

et al. 2016

Arq Bras Neurocir

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Complications and Reoperation Following Surgery for Concurrent Carpal Tunnel and Cervical Spine Compression

Yang

Dwivedi

et al. 2023

Hand (New York, N,Y.)

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Background: Patients with carpal tunnel syndrome (CTS) may also have cervical radiculopathy (CR) or vice versa, potentially requiring carpal tunnel release (CTR) and anterior cervical discectomy and fusion (ACDF). This study evaluates whether there is an increased risk of complications following CTR or ACDF in patients with concurrent CTS and CR (CTS-CR) compared with those with only CTS or CR. Methods: A multipayer database was used to identify patients with CTS-CR. From this cohort, patients who underwent CTR and/or ACDF were identified. Patients with CTS-CR undergoing surgery were compared with those undergoing surgery with only CTS or CR. Multivariable logistic regression was used to compare matched populations to assess postoperative complications and risk of undergoing both procedures. Results: A total of 110 379 patients with CTS-CR were identified. Carpal tunnel release was performed in 21 152 patients (19.2%) with CTS-CR, from which 835 (0.76%) underwent ACDF. Anterior cervical discectomy and fusion was performed in 6960 patients (6.31%) with CTS-CR followed by CTR in 1098 patients (0.99%). Patients with CTS-CR were at greater risk of reoperation and complex regional pain syndrome following CTR. In ACDF, patients with CTS-CR were at greater risk of reoperation. Obesity and tobacco use were significant risk factors in patients with CTS-CR who underwent both CTR and ACDF rather than a single surgery. Conclusions: Examination of more than 100 000 patients with CTS-CR found a greater likelihood of reoperation and perioperative complications following surgery than those without concurrent diagnoses. Obesity and smoking increased the risk for patients undergoing both procedures. Patients presenting with CTS-CR are high risk and should be counseled on risk of complication and reoperation and optimized to reduce risk of undergoing both CTR and ACDF.

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Two Cases of Double Crush Syndrome Progressing to Complex Regional Pain Syndrome

Cited by 2 publications

References 15 publications

Double Crush Syndrome of the Median Nerve: A Literature Review

Double Crush Syndrome of the Median Nerve: A Literature Review

Complications and Reoperation Following Surgery for Concurrent Carpal Tunnel and Cervical Spine Compression

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