Mateusz Gładysz FESSH prep

FESSH prep Compressive neuropathies Multi site compression

Double crush syndrome

Last reviewed v1.0

FESSH-006Compressive neuropathies●●○ intermediate

Concerning double crush syndrome.

  1. 1.Double crush syndrome suggests that a peripheral nerve compressed at multiple sites is more vulnerable to dysfunction.

  2. 2.Carpal tunnel syndrome and cervical radiculopathy frequently coexist in double crush syndrome.

  3. 3.Surgical decompression of one site reliably resolves symptoms when double crush syndrome is present.

  4. 4.Electrodiagnostic testing can reliably confirm the presence of double crush syndrome.

  5. 5.Patients with diabetes mellitus are more likely to experience double crush syndrome.

FESSH marking: +1 per correct statement, 0 for blank, −1 for incorrect. Click the same TRUE/FALSE button twice to clear it.

Question ID
FESSH-006
First published
Last reviewed
Version
v1.0
Answer key and explanations — open after answering

  1. 1. Double crush syndrome suggests that a peripheral nerve compressed at multiple sites is more vulnerable to dysfunction.

    True

    Upton and McComas proposed that a proximal lesion along an axon impairs distal axoplasmic flow and renders the nerve more susceptible to a second, distal compression; Osterman's clinical analysis showed that with concomitant root compression, less median-nerve involvement at the wrist was required to produce symptoms, and outcomes after carpal tunnel release were poorer in the double-crush group than in patients with isolated CTS.

    • Upton AR, McComas AJ. The double crush in nerve entrapment syndromes. Lancet. 1973;2(7825):359-362. PMID 4124532
    • Osterman AL. The double crush syndrome. Orthop Clin North Am. 1988;19(1):147-155. PMID 3275922

  2. 2. Carpal tunnel syndrome and cervical radiculopathy frequently coexist in double crush syndrome.

    True

    Kane and colleagues' review identified concomitant cervical radiculopathy and CTS as the most commonly described double-crush combination, with peripheral neuropathy contributing to suboptimal outcomes after isolated decompression.

    • Kane PM, Daniels AH, Akelman E. Double crush syndrome. J Am Acad Orthop Surg. 2015;23(9):558-562. PMID 26306807

  3. 3. Surgical decompression of one site reliably resolves symptoms when double crush syndrome is present.

    False

    In Osterman's series, outcomes of carpal tunnel release were poorer in patients with concomitant proximal (cervical) compression than in those with isolated CTS, indicating that decompression of a single site does not reliably relieve symptoms when a second site remains untreated.

    • Osterman AL. The double crush syndrome. Orthop Clin North Am. 1988;19(1):147-155. PMID 3275922

  4. 4. Electrodiagnostic testing can reliably confirm the presence of double crush syndrome.

    False

    Electrodiagnostic studies do not definitively diagnose double crush syndrome; Graham showed that even for single-site CTS the post-test probability change provided by nerve conduction studies is small in patients with high clinical pre-test probability, and Kane noted that no electrodiagnostic criterion reliably identifies coexistent two-site compression.

    • Kane PM, Daniels AH, Akelman E. Double crush syndrome. J Am Acad Orthop Surg. 2015;23(9):558-562. PMID 26306807
    • Graham B. The value added by electrodiagnostic testing in the diagnosis of carpal tunnel syndrome. J Bone Joint Surg Am. 2008;90(12):2587-2593. PMID 19047703

  5. 5. Patients with diabetes mellitus are more likely to experience double crush syndrome.

    True

    Diabetes mellitus produces a generalised peripheral neuropathy that lowers the threshold for symptomatic focal entrapment; in Becker and colleagues' case-control study, diabetes was a significant risk factor for bilateral CTS, and Kane describes coexistent systemic neuropathy (including diabetic) as a recognised contributor to a double-crush presentation and to suboptimal post-decompression outcomes.

    • Becker J, Nora DB, Gomes I, Stringari FF, Seitensus R, Panosso JS, et al.. An evaluation of gender, obesity, age and diabetes mellitus as risk factors for carpal tunnel syndrome. Clin Neurophysiol. 2002;113(9):1429-1434. PMID 12169324
    • Kane PM, Daniels AH, Akelman E. Double crush syndrome. J Am Acad Orthop Surg. 2015;23(9):558-562. PMID 26306807