scholarly journals A case of bilateral “double/multiple crush” entrapment syndrome of the upper limbs in a violinist

2020 ◽  
Vol 71 (1) ◽  
pp. 49-58
Author(s):  
Bogdan Alexandru Barbu ◽  
Claudia-Mariana Handra ◽  
Silviu Bădoiu ◽  
Sarah Adriana Nica
Keyword(s):  
Upper Limb ◽  
Cubital Tunnel Syndrome ◽  
Crush Syndrome ◽  
Occupational Factors ◽  
Clinical Model ◽  
Skeletal Pathology ◽  
Stenosing Tenosynovitis ◽  
De Quervain ◽  
Tunnel Syndrome ◽  
Double Crush

AbstractEntrapment syndromes of the upper limb are common neuro-muscular-skeletal pathology in musician instrumentists. From this group of morbid entities, the most prevalent worldwide is carpal tunnel syndrome closely followed by the cubital tunnel syndrome and de Quervain stenosing tenosynovitis. Due to their distinctive etiopathogenic correlation with exposure to specific occupational factors linked to instrument interpretation and professional environment, these diseases raise a medical challenge and constitute a socioeconomic and professional burden with legal branchings and implications for individuals and society. These syndromes develop isolated or more often in various associations with each other in a clinical pattern that has been described under the model of “double crush” syndrome by Upton and McComas. From its inception in 1973 until the present time, this clinical model has been a point of interesting debate between various specialists worldwide. This model underlines an already lesioned neuron’s susceptibility and vulnerability for further neural damage at a different level from the initial lesion. The sophisticated clinical presentation of this “double or multiple crush” syndrome is due not only to overlapping symptomatology from each contributing neuro-muscular-skeletal pathology or lesional site but also to other local or systemic conditions such as trauma, diabetes, osteoarthritis, thyroid disease, obesity, etc. The occupational factors such as repetitive movements, strain and overload, vibrations, ergonomics, and others all contribute to the creation and progression of the morbid process. We cannot overstate the implications of understanding these complex relations and interdependencies between the factors mentioned above as they are essential not only for the diagnosis of these neuropathies but also for the treatment, rehabilitation, and occupational reinsertion of the patients. The studies support the fact that both lesional sites need to be medically addressed for an optimal outcome and resolution. We present the case of a female violinist with bilateral multiple neuro-muscular-skeletal pathologies of the upper limb treated previously invasively and conservatively over several years by various specialists without a satisfactory clinical resolution of the symptomatology or any professional and legal measures taken.

scholarly journals Diagnostics and treatment of tunnel neuropathies

Pain medicine ◽  
2020 ◽  
Vol 5 (1) ◽  
pp. 44-51
Author(s):  
Oleksandr Lemeshov ◽  
Iurii Chyrka
Keyword(s):  
Nervous System ◽  
Cubital Tunnel Syndrome ◽  
Tarsal Tunnel ◽  
Pronator Teres ◽  
Superficial Branch ◽  
Patients With Diabetes ◽  
Tunnel Syndrome ◽  
Double Crush ◽  
Double Crush Syndrome ◽  
All Diseases

Relevance. Tunnel neuropathy – a damage of the peripheral nervous system that are common and range from 8 to 52 % of all diseases of the nervous system. Objective. To show the main features of the diagnosis and treatment of various tunnel neuropathy.Materials and Methods. Considerable experience of effective surgical treatment of tunnel neuropathies. 481 operations were performed during 2014–2019. The experience is described and structured.Results. The most common tunnel neuropathy of the upper extremity: carpal tunnel syndrome, pronator teres syndrome, cubital tunnel syndrome, Guyon's canal syndrome, radial neuropathy, thoracic outlet syndrome. Lower extremity: tarsal tunnel syndrome, Bernhardt – Roth syndrome, neuropathy of the peroneal nerve and its superficial branch. From 6.7 % to 78 % of patients with tunnel neuropathies, double crush syndrome occurs – nerve compression at two levels, which is more common in patients with diabetes mellitus. Such diseases are diagnosed clinically and instrumentally – electromyography, ultrasound, MRI. All the above pathologies are effectively treated surgically, which aims at decompression of the affected nerve. An important factor in complex treatment is early rehabilitation and physiotherapy procedures.Conclusions. Tunnel neuropathy is a common pathology that is effectively treated surgically. Diseases should be timely diagnosed to prevent severe and irreversible changes.

scholarly journals When the contemporary presence of a cervical radiculopathy and a carpal tunnel syndrome can suggest a "double-crush" syndrome

2018 ◽  
Vol 4 (1) ◽  
Author(s):  
Martiniani M ◽  
Meco L ◽  
Procaccini R ◽  
Carrabs Valleverdina A ◽  
Letizia Senesi ◽  
...  
Keyword(s):  
Carpal Tunnel Syndrome ◽  
Carpal Tunnel ◽  
Cervical Radiculopathy ◽  
Crush Syndrome ◽  
Tunnel Syndrome ◽  
Double Crush ◽  
Double Crush Syndrome

Double Crush Syndrome in the Lower Extremity

2012 ◽  
Vol 102 (4) ◽  
pp. 330-333 ◽  
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)

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

2019 ◽  
Vol 87 (12) ◽  
pp. 4193-4198
Author(s):  
HEBA RAAFAT, M.D.; AMIRA A. LABIB, M.D. ◽  
MOHAMED R.A. SALEH, M.D.
Keyword(s):  
Carpal Tunnel Syndrome ◽  
Carpal Tunnel ◽  
Crush Syndrome ◽  
Tunnel Syndrome ◽  
Double Crush ◽  
Double Crush Syndrome

Double Crush Syndrome Related to the Thoracic Outlet Syndrome

Hand Surgery ◽  
1997 ◽  
Vol 02 (02) ◽  
pp. 131-133 ◽  
Author(s):  
Jun Nishida ◽  
Katsuaki Ichinohe ◽  
Tadashi Shimamura ◽  
Masataka Abe
Keyword(s):  
Carpal Tunnel Syndrome ◽  
Carpal Tunnel ◽  
Thoracic Outlet Syndrome ◽  
Cubital Tunnel Syndrome ◽  
Entrapment Neuropathy ◽  
Cubital Tunnel ◽  
Provocation Tests ◽  
Tunnel Syndrome ◽  
Double Crush ◽  
Ulnar Tunnel

Cases diagnosed as having thoracic outlet syndrome were examined by neurological examination, including provocation tests, electromyography and radiological examinations, to detect other sites of entrapment neuropathy of the upper extremity. During the last four years, 555 upper extremities of 494 patients were diagnosed as having thoracic outlet syndrome. Forty-five patients (9.3%) were diagnosed as having other entrapment neuropathy in one extremity. Ten cases were complicated by cervical radiculopathy, 15 by carpal tunnel syndrome, 11 by cubital tunnel syndrome, five by radial tunnel syndrome, two by ulnar tunnel syndrome, two by both carpal tunnel and cubital tunnel syndrome, and one by both cubital and ulnar tunnel syndrome. Surgery was performed for 15 limbs, and the distal lesion was operated on the first in two-thirds of these patients. The relationship between thoracic outlet syndrome and cubital tunnel syndrome or carpal tunnel syndrome has been reported by several authors, but the rates of incidence vary among reports. The rate of incidence seems to depend upon the diagnostic technique. After adoption of the appropriate provocation tests, patients with thoracic outlet syndrome complicated by other entrapment neuropathies were detected at a relatively high rate of incidence. Provocation tests seem to be an essential measure for the diagnosis of double crush syndromes.

scholarly journals Cubital tunnel syndrome: A report of two cases

2012 ◽  
Vol 16 (2) ◽  
pp. 77-78
Author(s):  
Farhana Ebrahim Suleman ◽  
Mark D Velleman
Keyword(s):  
Peripheral Neuropathy ◽  
Upper Limb ◽  
Elbow Flexion ◽  
Cubital Tunnel Syndrome ◽  
Ulnar Neuropathy ◽  
Cubital Tunnel ◽  
Physiological Changes ◽  
Pathological Conditions ◽  
Tunnel Syndrome

Cubital tunnel syndrome is the second most common peripheral neuropathy of the upper limb. This is due to the anatomy of the tunnel, the physiological changes that the nerve undergoes during elbow flexion, as well as pathological conditions that occur within the tunnel. We present two cases of ulnar neuropathy occurring at the level of the cubital tunnel, demonstrating that this entity may occur owing to an identifiable cause or may show only signal alteration without a visible cause on MRI.

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