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Clinical characteristics and electrodiagnostic features in patients with carpal tunnel syndrome, double crush syndrome, and cervical radiculopathy

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Abstract

Similar unilateral neck and upper limb symptoms are often due to various entrapment neuropathies; carpal tunnel syndrome (CTS) and cervical radiculopathy (CR) are common causes among them. Therefore, we investigated the clinical characteristics and electrodiagnostic features of patients with carpal tunnel syndrome, cervical radiculopathy, and both conditions, called double crush syndrome (DCS). The medical records and electrodiagnostic reports of 866 patients with suspected CTS and CR visited a tertiary-care hospital were retrospectively analyzed. After excluding 101 patients with confounding conditions, 151 (20%) patients were diagnosed to have sole cases of CTS; 362 (47%) patients were diagnosed to have sole cases of CR; 198 (26%) patients were diagnosed to have DCS, while 54 (7%) patients had mere symptoms. Sole cases of CR had the highest incidences of neck pain, upper back pain, wrist and hand weakness. Female patients had the highest incidences of all the diseases in their sixth decade. Male patients had comparably distinguished high occurrence of all the diseases in their fifth to sixth decades. Although comparison of nerve conduction studies between patients with mere symptoms and patients with sole cases of CTS or DCS showed statistical differences, comparison between the latter two revealed no difference. We found most patients referred for electrodiagnostic studies had cervical radiculopathy. High concomitant occurrence of CTS and CR suggests cautious evaluation of patients with upper limb symptoms is important, because the management of these conditions is quite different.

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References

  1. Upton RM, McComas AJ (1973) The double crush in nerve entrapment syndromes. Lancet 2:359–362

    Article  PubMed  CAS  Google Scholar 

  2. Hurst LC, Weissberg D, Carroll RE (1985) The relationship of the double crush to carpal tunnel syndrome: an analysis of 1, 000 cases of carpal tunnel syndrome. J Hand Surg [Br] 10(2):202–204

    Article  CAS  Google Scholar 

  3. Baba H, Maezawa Y, Uchida K, Furusawa N, Wada M, Imura S et al (1998) Cervical myeloradiculopathy with entrapment neuropathy: a study based on the double-crush concept. Spinal Cord 36:399–404

    Article  PubMed  CAS  Google Scholar 

  4. Morgan G, Wilbourn AJ (1998) Cervical radiculopathy and coexisting distal entrapment neuropathies: Double–crush syndrome? Neurology 50:78–83

    PubMed  CAS  Google Scholar 

  5. Richardson JK, Forman GM, Riley B (1999) An electrophysiological exploration of the double crush hypothesis. Muscle Nerve 22:71–77

    Article  PubMed  CAS  Google Scholar 

  6. Kimura J (1989) Electrodiagnosis in diseases of nerve and muscle: principles and practice, vol 2. Philadelphia, FA Davis

    Google Scholar 

  7. Kimura J (2001) Electrodiagnosis in diseases of nerve and muscle: principles and practice, vol 3. Oxford University Press, New York

    Google Scholar 

  8. Radhakrishan K, Litchy WJ, O’Fallon WM, Kurland LT (1994) Epidemiology of cervical radiculopathy. A population-based study from Rochester, Minnesota, 1976 through 1990. Brain 117:325–335

    Article  Google Scholar 

  9. Salemi G, Savettieri G, Meneghini F, Di Benedetto ME, Ragonese P, Morgante L et al (1996) Prevalence of cervical spondylotic radiculopathy: a door-to-door survey in a Sicilian municipality. Acta Neurol Scand 93:184–188

    Article  PubMed  CAS  Google Scholar 

  10. Mondelli M, Giannini F, Giacchi M (2002) Carpal tunnel syndrome incidence in a general population. Neurology 58:289–294

    PubMed  Google Scholar 

  11. Atroshi I, Gummesson C, Johnsson R, Ornstein E, Ranstam J, Rosén I (1999) Prevalence of carpal tunnel syndrome in a general population. JAMA. 282:153–158

    Article  PubMed  CAS  Google Scholar 

  12. de Krom MC, Knipschild PG, Kester AD, Thijs CT, Boekkooi PF, Spaans F (1992) Carpal tunnel syndrome: prevalence in the general population. J Clin Epidemiol 45:373–376

    Article  PubMed  Google Scholar 

  13. Bongers FJ, Schellevis FG, van den Bosch WJ, van der Zee J (2007) Carpal tunnel syndrome in general practice (1987 and 2001): incidence and the role of occupational and non-occupational factors. Br J Gen Pract 57:36–39

    PubMed  Google Scholar 

  14. Moghtaderi A, Izadi S (2008) Double crush syndrome: an analysis of age, gender and body mass index. Clin Neurol Neurosurg 110:25–29

    Article  PubMed  Google Scholar 

  15. Flak M, Durmala J, Czernicki K, Dobosiewicz K (2006) Double crush syndrome evaluation in the median nerve in clinical, radiological and electrophysiological examination. Stud Health Technol Inform 123:435–441

    PubMed  Google Scholar 

  16. Donaldson CCS, Nelson DV, Skubick DL, Clasby RG (1998) Potential contributions of neck muscle dysfunctions to initiation and maintenance of carpal tunnel syndrome. Appl Psychophysiol Biofeedback 23:59–72

    Article  PubMed  CAS  Google Scholar 

  17. Skubick DL, Clasby RG, Donaldson CCS, Marshall WM (1993) Carpal tunnel syndrome as an expression of muscular dysfunction in the neck. J Occup Rehabil 3:31–44

    Article  Google Scholar 

  18. El Miedany Y, Ashour S, Youssef S, Mehanna A, Meky FA (2008) Clinical diagnosis of carpal tunnel syndrome: old tests-new concepts. Joint Bone Spine 75:451–457

    Article  PubMed  Google Scholar 

  19. LaJoie AS, McCabe SJ, Thomas B, Edgell SE (2005) Determining the sensitivity and specificity of common diagnostic tests for carpal tunnel syndrome using latent class analysis. Plast Reconstr Surg 116:502–507

    Article  PubMed  CAS  Google Scholar 

  20. Fitz WR, Mysiw WJ, Johnson EW (1990) First lumbrical latency and amplitude. Control values and findings in carpal tunnel syndrome. Am J Phys Med Rehabil 69:198–201

    Article  PubMed  CAS  Google Scholar 

  21. Chang MH, Liu LH, Lee YC, Wei SJ, Chiang HL, Hsieh PF (2006) Comparison of sensitivity of transcarpal median motor conduction velocity and conventional conduction techniques in electrodiagnosis of carpal tunnel syndrome. Clin Neurophysiol 117:984–991

    Article  PubMed  Google Scholar 

  22. Oh SJ (2003) Clinical electromyography : nerve conduction studies, 3rd edn. Lippincott Williams & Wilkins, Philadelphia

    Google Scholar 

  23. Lew HL, Date ES, Pan SS, Wu P, Ware PF, Kingery WS (2005) Sensitivity, specificity, and variability of nerve conduction velocity measurements in carpal tunnel syndrome. Arch Phys Med Rehabil 86:12–16

    Article  PubMed  Google Scholar 

  24. Sheu JJ, Yuan RY, Chiou HY, Hu CJ, Chen WT (2006) Segmental study of the median nerve versus comparative tests in the diagnosis of mild carpal tunnel syndrome. Clin Neurophysiol 117:1249–1255

    Article  PubMed  Google Scholar 

  25. Lee KY, Lee YJ, Koh SH (2009) Usefulness of the median terminal latency ratio in the diagnosis of carpal tunnel syndrome. Clin Neurophysiol 120:765–769

    Article  PubMed  Google Scholar 

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Acknowledgments

We thank Taiwan Ministry of Education for the financial support under the project numbers of 97-B7-1METH-MED and 97-B7-2METH-MED.

Conflict of Interest

No commercial party having a direct financial interest in the results of the research supporting this article has or will confer a benefit upon the authors or upon any organization with which the authors are associated.

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Authors and Affiliations

  1. Department of Physical Medicine and Rehabilitation, China Medical University Hospital, No. 91 Hsueh-Shih Road, Taichung, 40402, Taiwan, ROC

    Sui-Foon Lo, Li-Wei Chou & Nai-Hsin Meng

  2. School of Chinese Medicine, College of Chinese Medicine, China Medical University, No. 91 Hsueh-Shih Road, Taichung, 40402, Taiwan, ROC

    Sui-Foon Lo & Li-Wei Chou

  3. Department of Physical Therapy, China Medical University, No. 91 Hsueh-Shih Road, Taichung, 40402, Taiwan, ROC

    Li-Wei Chou & Fen-Fen Chen

  4. Department of Medicine, China Medical University, No. 91 Hsueh-Shih Road, Taichung, 40402, Taiwan, ROC

    Nai-Hsin Meng

  5. Department of Public Health, China Medical University, No. 91 Hsueh-Shih Road, Taichung, 40402, Taiwan, ROC

    Ting-Ting Juan, Wen-Chao Ho & Chow-Feng Chiang

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  1. Sui-Foon Lo
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  2. Li-Wei Chou
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  3. Nai-Hsin Meng
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  4. Fen-Fen Chen
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  5. Ting-Ting Juan
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  6. Wen-Chao Ho
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  7. Chow-Feng Chiang
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Correspondence to Chow-Feng Chiang.

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Lo, SF., Chou, LW., Meng, NH. et al. Clinical characteristics and electrodiagnostic features in patients with carpal tunnel syndrome, double crush syndrome, and cervical radiculopathy. Rheumatol Int 32, 1257–1263 (2012). https://doi.org/10.1007/s00296-010-1746-1

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  • DOI: https://doi.org/10.1007/s00296-010-1746-1

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