Double Crush Syndrome - Everything You Need To Know - Dr. Nabil Ebraheim

Описание: Dr. Ebraheim’s educational animated video describes the condition of double crush syndrome, the etiology, signs and symptoms, diagnosis, and management.
A patient with one peripheral nerve lesion may also have a second lesion elsewhere in the course of the nerve. Both lesions could contribute to the symptoms of the patient.
The nerve cell body produces material that is necessary for normal function of the axon. The material travels distally along the axon. Break down products return in a proximal direction by the axonal transport system. Disruption of the synthesis or blocking of transport of these materials (antegrade/retrograde) increases sustainability of the axon to compression. Edema and impaired neural blood flow, neuropathy, diabetes and decreased nerve elasticity such as in fibrosis.
Compression of the nerve at a point lowers the threshold of occurrence of compression neuropathy at another point distal or proximal at the same point by interfering with the axon transport mechanism. The outcome of surgical decompression may be disappointing unless both compression areas are treated.
C5-C6 is the most common level that is affected in the neck. The EMG of the patient will show fibrillation or sharp waves in the biceps, extensor carpi radialis longus, and the extensor carpi radialis brevis muscles. This is different than the findings in carpal tunnel.
Common double crush associations
1-Cervical root compression and carpal tunnel syndrome (median nerve)
A lessor compression in median nerve at the carpal tunnel as seen in EMG (distal sensory latency) will produce symptoms when proximal cervical lesion is present. Coexisting cervical root compression is one of the main reasons for persistent residual symptoms following carpal tunnel relief. Physicians should not develop tunnel thinking, blaming tunnel syndrome when seeing patients, instead consider possibility of causes with a widener diagnostic approach which includes EMG and nerve studies from neck down. Persistence of the system of symptoms after initial treatment of nerve entrapment is an indication to search for another site of compression.
2-Thoracic outlet syndrome and carpal tunnel syndrome (median nerve)
3-cervical root compression and cubital tunnel syndrome (ulnar nerve )
4-cubital tunnel syndrome and Guyon’s cannel syndrome (ulnar nerve)
the ulnar nerve enters the palm of the hand through the Guyon’s canal.
5-Cervical nerve root compression and radial tunnel syndrome (Radial nerve).

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Background music provided as a free download from YouTube Audio Library.
Song Title: Every Step