Carpal Tunnel Syndrome Research Today is a free monthly online journal that collates and summarizes the latest research about Carpal Tunnel Syndrome, including details on symptoms, causes, trauma, diagnosis, physiotherapy.

Carpal tunnel syndrome and the "double crush" hypothesis: a review and implications for chiropractic.

Russell BS

Associate Professor, Division of Clinical Sciences, Life University, College of Chiropractic, 1269 Barclay Circle, Marietta, Georgia 30060, USA. brussell@life.edu.

ABSTRACT: Upton and McComas claimed that most patients with carpal tunnel syndrome not only have compressive lesions at the wrist, but also show evidence of damage to cervical nerve roots. This "double crush" hypothesis has gained some popularity among chiropractors because it seems to provide a rationale for adjusting the cervical spine in treating carpal tunnel syndrome. Here I examine use of the concept by chiropractors, summarize findings from the literature, and critique several studies aimed at supporting or refuting the hypothesis. Although the hypothesis also has been applied to nerve compressions other than those leading to carpal tunnel syndrome, this discussion mainly examines the original application - "double crush" involving both cervical spinal nerve roots and the carpal tunnel. I consider several categories: experiments to create double crush syndrome in animals, case reports, literature reviews, and alternatives to the original hypothesis. A significant percentage of patients with carpal tunnel syndrome also have neck pain or cervical nerve root compression, but the relationship has not been definitively explained. The original hypothesis remains controversial and is probably not valid, at least for sensory disturbances, in carpal tunnel syndrome. However, even if the original hypothesis is importantly flawed, evaluation of multiple sites still may be valuable. The chiropractic profession should develop theoretical models to relate cervical dysfunction to carpal tunnel syndrome, and might incorporate some alternatives to the original hypothesis. I intend this review as a starting point for practitioners, educators, and students wishing to advance chiropractic concepts in this area.

Published 5 May 2008 in Chiropr Osteopat, 16: 2.
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Articles on Carpal Tunnel Syndrome published 5 May 2008:

Clinical diagnosis of carpal tunnel syndrome: Old tests-new concepts.   Joint Bone Spine.

BACKGROUND: The diagnosis of carpal tunnel syndrome (CTS) continues to be neurophysiologically and clinically controversial. Earlier data concluding that the higher prevalence of persons with symptoms suggestive of CTS but without evidence of median mononeuropathy highlights the need for a better understanding of the underlying pathophysiology and natural history of CTS to provide a less empirical foundation for diagnosis and clinical management. OBJECTIVE: To examine the relationship between ... [Abstract] [Full-text]

Neuropathic symptoms and findings in women with Fabry disease.   Clin Neurophysiol, 119(6): 1365-72.

OBJECTIVE: To examine the neurologic and neurophysiologic findings and neurologic symptoms in 12 women with Fabry disease and to study the relationship between the subjective symptoms and the findings on the various tests done. METHODS: Neurography, vibratory and thermal quantitative sensory testing (QST), skin biopsy for measuring intraepidermal nerve fiber density (IENFD). Heart rate variability (HRV) and sympathetic skin response (SSR) tests for detecting autonomic dysfunction, pain-, ... [Abstract] [Full-text]

The ultrasonographic wrist-to-forearm median nerve area ratio in carpal tunnel syndrome.   Clin Neurophysiol, 119(6): 1353-7.

OBJECTIVE: Peripheral nerve ultrasound is an emerging tool in the diagnosis of carpal tunnel syndrome (CTS). Although numerous publications have cited an increased median nerve area at the wrist to be the diagnostic of CTS, there has been considerable variability in the published normal values for this measurement. Our objective is to collect data on the wrist-to-forearm ratio (WFR) of median nerve area in patients with CTS and healthy controls. METHODS: Patients with electrodiagnostically ... [Abstract] [Full-text]

Natural evolution of carpal tunnel syndrome in untreated patients.   Clin Neurophysiol, 119(6): 1373-8.

OBJECTIVE: To describe the clinical and electrophysiological evolution of a group of patients diagnosed with carpal tunnel syndrome (CTS) who have not undergone any type of treatment (injections, braces or surgery). METHODS: Clinical and electrophysiological monitoring was done consecutively in a series of patients who were admitted with a diagnosis of CTS. The average time for follow-up was 2 years. The Historic and objective Classification scale (HiOb) was used to establish the severity of ... [Abstract] [Full-text]

Articles on Carpal Tunnel Syndrome published 2 May 2008:

A novel NGFB point mutation, a phenotype study of heterozygous patients.   J Neurol Neurosurg Psychiatry.

OBJECTIVE: We recently described a family with neurological findings similar to HSAN (Hereditary sensory and autonomic neuropathy) type V having a point mutation in the Nerve growth factor beta (NGFB) gene. The homozygous genotype gives disabling symptoms. The purpose of the present study is to evaluate the symptoms in heterozygous patients. METHODS: 26 patients heterozygous for the NGFB-mutation (12 men, mean age 50 (13-90) years) were examined clinically and answered a health status ... [Abstract] [Full-text]

Outcome in six children with mucopolysaccharidosis type IH, hurler syndrome, after haematopoietic stem cell transplantation (HSCT).   Acta Paediatr.

Aim: To follow-up six children with severe mucopolysaccharidosis type IH, Hurler syndrome, who were treated before 24 months of age with haematopoietic stem cell transplantation. Methods: In Sweden, during the last 10-year period, six consecutive children born with severe mucopolysaccharidoses type IH have been successfully transplanted using matched unrelated donors between the ages of 11 and 24 months (mean age 18 months). Three children received intravenous enzyme replacement therapy once a ... [Abstract] [Full-text]

Articles on Carpal Tunnel Syndrome published 1 May 2008:

Carpal tunnel syndrome: matching minimally invasive surgical techniques.   J Neurosurg, 108(5): 1033-6.

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Articles on Carpal Tunnel Syndrome published 29 April 2008:

Proximal Row Carpectomy Versus Four-Corner Arthrodesis as a Treatment for SLAC (Scapholunate Advanced Collapse) Wrist.   J Hand Surg Eur Vol, 33(2): 118-25.

Four-corner arthrodesis and proximal row carpectomy are motion-preserving salvage solutions for the scapholunate advanced collapse wrist. We compared both procedures in a non-randomised, retrospective study of 30 cases with a mean follow-up of 3(1/2) years. Pain relief and functional gain were equal in both treatment groups. However, the complication rate was higher in the four-corner arthrodesis group, partly because of the need for internal fixation. The higher incidence of carpal tunnel ... [Abstract] [Full-text]

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