Abstract
OBJECTIVE: To investigate whether "diseased nerves" are more prone to entrapment neuropathy than normal nerves. Nerve conduction studies of human neuropathies have shown that electrophysiological abnormalities are often most prominent at potential sites of nerve entrapment, and entrapments are more common in patients with radiculopathies--a concept designated as "double crush". As entrapment neuropathies commonly occur in otherwise healthy subjects, it is unclear whether this relation is coincidental or whether peripheral nerves affected by disease are rendered more susceptible to effects of repeated minor trauma, traction, or mechanical compression. METHODS: Sequential ulnar nerve conduction studies were prospectively performed at baseline and at four, eight, and 12 month intervals in 16 patients with amyotrophic lateral sclerosis. Ulnar nerve entrapment was defined as a focal reduction (> 10 m/s) in conduction velocity in the across-elbow segment. RESULTS: Ulnar sensory and motor nerve fibres showed similar findings of ulnar nerve entrapment at baseline and at follow up over the period of the study. Nerves with ulnar nerve entrapment showed a significantly greater reduction in distal motor amplitudes than nerves without entrapment, even though distal ulnar sensory amplitudes remained unchanged. CONCLUSIONS: Motor nerves in motor neuron disease do not seem to be more susceptible to entrapment at the elbow than do healthy sensory nerves, thus casting doubt on the double crush hypothesis. Nerves with double pathology (amyotrophic lateral sclerosis and ulnar nerve entrapment), however, seem to undergo more rapid axonal loss than do nerves with single pathology (amyotrophic lateral sclerosis or ulnar nerve entrapment alone).
Full text
PDF





Images in this article
Selected References
These references are in PubMed. This may not be the complete list of references from this article.
- Carroll R. E., Hurst L. C. The relationship of thoracic outlet syndrome and carpal tunnel syndrome. Clin Orthop Relat Res. 1982 Apr;(164):149–153. [PubMed] [Google Scholar]
- Hopkins A. P., Morgan-Hughes J. A. The effect of local pressure in diphtheritic neuropathy. J Neurol Neurosurg Psychiatry. 1969 Dec;32(6):614–623. doi: 10.1136/jnnp.32.6.614. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Hurst L. C., Weissberg D., Carroll R. E. The relationship of the double crush to carpal tunnel syndrome (an analysis of 1,000 cases of carpal tunnel syndrome). J Hand Surg Br. 1985 Jun;10(2):202–204. doi: 10.1016/0266-7681(85)90018-x. [DOI] [PubMed] [Google Scholar]
- LISHMAN W. A., RUSSELL W. R. The brachial neuropathies. Lancet. 1961 Oct 28;2(7209):941–947. doi: 10.1016/s0140-6736(61)90790-5. [DOI] [PubMed] [Google Scholar]
- Lord J. W., Jr, Rosati L. M. Thoracic-oulet syndromes. Clin Symp. 1971;23(2):1–32. [PubMed] [Google Scholar]
- MULDER D. W., LAMBERT E. H., BASTRON J. A., SPRAGUE R. G. The neuropathies associated with diabetes mellitus. A clinical and electromyographic study of 103 unselected diabetic patients. Neurology. 1961 Apr;11(4):275–284. doi: 10.1212/wnl.11.4.275. [DOI] [PubMed] [Google Scholar]
- Mackinnon S. E., Dellon A. L., Hudson A. R., Hunter D. A. Chronic nerve compression--an experimental model in the rat. Ann Plast Surg. 1984 Aug;13(2):112–120. doi: 10.1097/00000637-198408000-00004. [DOI] [PubMed] [Google Scholar]
- Mackinnon S. E. Double and multiple "crush" syndromes. Double and multiple entrapment neuropathies. Hand Clin. 1992 May;8(2):369–390. [PubMed] [Google Scholar]
- Massey E. W., Riley T. L., Pleet A. B. Coexistent carpal tunnel syndrome and cervical radiculopathy (double crush syndrome). South Med J. 1981 Aug;74(8):957–959. doi: 10.1097/00007611-198108000-00018. [DOI] [PubMed] [Google Scholar]
- Murray-Leslie C. F., Wright V. Carpal tunnel syndrome, humeral epicondylitis, and the cervical spine: a study of clinical and dimensional relations. Br Med J. 1976 Jun 12;1(6023):1439–1442. doi: 10.1136/bmj.1.6023.1439. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Narakas A. O. The role of thoracic outlet syndrome in the double crush syndrome. Ann Chir Main Memb Super. 1990;9(5):331–340. doi: 10.1016/s0753-9053(05)80506-x. [DOI] [PubMed] [Google Scholar]
- Nemoto K., Matsumoto N., Tazaki K., Horiuchi Y., Uchinishi K., Mori Y. An experimental study on the "double crush" hypothesis. J Hand Surg Am. 1987 Jul;12(4):552–559. doi: 10.1016/s0363-5023(87)80207-1. [DOI] [PubMed] [Google Scholar]
- O'Brien J. P., Mackinnon S. E., MacLean A. R., Hudson A. R., Dellon A. L., Hunter D. A. A model of chronic nerve compression in the rat. Ann Plast Surg. 1987 Nov;19(5):430–435. doi: 10.1097/00000637-198711000-00008. [DOI] [PubMed] [Google Scholar]
- Raynor E. M., Shefner J. M., Preston D. C., Logigian E. L. Sensory and mixed nerve conduction studies in the evaluation of ulnar neuropathy at the elbow. Muscle Nerve. 1994 Jul;17(7):785–792. doi: 10.1002/mus.880170714. [DOI] [PubMed] [Google Scholar]
- Reiners K., Gilliatt R. W., Harding A. E., O'Neill J. H. Regeneration following tibial nerve crush in the rabbit: the effect of proximal constriction. J Neurol Neurosurg Psychiatry. 1987 Jan;50(1):6–11. doi: 10.1136/jnnp.50.1.6. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Shimpo T., Gilliatt R. W., Kennett R. P., Allen P. J. Susceptibility to pressure neuropathy distal to a constricting ligature in the guinea-pig. J Neurol Neurosurg Psychiatry. 1987 Dec;50(12):1625–1632. doi: 10.1136/jnnp.50.12.1625. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Upton A. R., McComas A. J. The double crush in nerve entrapment syndromes. Lancet. 1973 Aug 18;2(7825):359–362. doi: 10.1016/s0140-6736(73)93196-6. [DOI] [PubMed] [Google Scholar]
- Wood V. E., Biondi J. Double-crush nerve compression in thoracic-outlet syndrome. J Bone Joint Surg Am. 1990 Jan;72(1):85–87. [PubMed] [Google Scholar]
- Yu J., Bendler E. M., Mentari A. Neurological disorders associated with carpal tunnel syndrome. Electromyogr Clin Neurophysiol. 1979 Jan-Mar;19(1-2):27–32. [PubMed] [Google Scholar]