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Double and multiple "crush" syndromes. Double and multiple entrapment neuropathies
1Department of Surgery, Washington University, St. Louis, Missouri.
Hand Clinics
|May 1, 1992
Summary
The double crush hypothesis explains how multiple nerve compressions, individually minor, can cause significant nerve dysfunction. Identifying these compression sites through careful examination and symptom provocation is key for effective treatment.
Area of Science:
- Neurology
- Orthopedics
- Neurosurgery
Background:
- The double crush hypothesis posits that serial nerve compressions, each subclinical, can synergistically impair axoplasmic flow.
- This additive effect can lead to significant nerve dysfunction and patient symptoms.
Purpose of the Study:
- To elucidate the diagnostic challenges and management principles associated with the double crush hypothesis.
- To emphasize the importance of localized compression identification and patient work habit modification.
Main Methods:
- Clinical examination focusing on localization of nerve compression sites.
- Comparative neurological testing: "at rest" versus post-symptom provocation.
- Assessment of work-related etiologic factors and implementation of job modification.
Main Results:
- Patients may be asymptomatic without symptom provocation.
- Provocation testing can reveal abnormalities correlating with symptoms.
- Surgical intervention is often preceded by attempts at maximum job modification.
Conclusions:
- Accurate localization of nerve compression is crucial for diagnosis.
- Addressing work habits that provoke neuropathies is essential for preventing symptom recurrence post-surgery.
- A comprehensive approach combining clinical assessment and patient-specific interventions is vital.