The Carpal Tunnel Syndrome and the Double Crush Syndrome Hypothesis: Revisited

In this series of 1,000 cases of carpal tunnel syndrome (888 patients) there is a statistically significant incidence of bilaterality in patients with cervical arthritis. There is also a statistically significant increase in the incidence of diabetes mellitus over the general population. These findings lend further support to Upton’s Double Crush hypothesis. Further, the double crush syndrome predisposes to bilateral carpal tunnel syndrome and may be an important prognostic factor. It may also be an explanation for some of the failures following carpal tunnel surgery and lead surgeons to look for other associated systemic diseases or mechanical blocks, when attempting to alleviate recalcitrant symptoms.

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Double crush syndrome: clinical review of an unsolved puzzle

International Journal of Research in Orthopaedics ◽

10.18203/issn.2455-4510.intjresorthop20204614 ◽

2020 ◽

Vol 6 (6) ◽

pp. 1362

Author(s):

Deven R. Kuruwa ◽

Easwar Elango ◽

Kunal A. Shah

Keyword(s):

Risk Factors ◽

Cervical Spine ◽

Peripheral Nerve ◽

Carpal Tunnel ◽

Current Knowledge ◽

Disease Process ◽

Crush Syndrome ◽

Definitive Treatment ◽

Double Crush ◽

Double Crush Syndrome

<p class="abstract">Double crush syndrome (DCS) involves compression of a peripheral nerve at two different segments. Median nerve is most commonly involved with proximal compression at the level of cervical spine and distal compression in the carpal tunnel. Little consensus exists in literature regarding its epidemiology, risk factors, pathophysiology and definitive treatment. The purpose of this article is to summarize our current knowledge about this disease process as well as to touch upon the controversies that have been generated in recent times.</p>

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Double Crush Syndrome in the Lower Extremity

Journal of the American Podiatric Medical Association ◽

10.7547/1020330 ◽

2012 ◽

Vol 102 (4) ◽

pp. 330-333 ◽

Cited By ~ 3

Author(s):

Anthony V. Borgia ◽

Jerome K. Hruska ◽

Karina Braun

Keyword(s):

Lower Extremity ◽

Crush Syndrome ◽

Tarsal Tunnel ◽

Massage Therapist ◽

Proximal Lesion ◽

Tunnel Syndrome ◽

Double Crush ◽

Double Crush Syndrome ◽

Failure To Progress ◽

Satisfactory Manner

Upton and McComas first described double crush syndrome in 1973. The theory behind double crush syndrome postulated that a proximal lesion in a nerve would make that same nerve more vulnerable to additional distal lesions. Many of the studies investigating the possibility of the double crush syndrome involve lesions in the upper extremity with very few articles written specifically about double crush syndrome in the lower extremity. We present the case of a 33-year-old massage therapist who uses her feet to provide therapy to clients who presented to our clinic with symptoms consistent with tarsal tunnel syndrome. Her failure to progress in a satisfactory manner after a variety of therapies made us search for additional etiologies for her foot pain. In cases where tarsal tunnel persists after surgical therapy, the treating physician should search for more proximal lesions along the course of the nerve. (J Am Podiatr Med Assoc 102(4): 330–333, 2012)

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