Russell, 2008, double crush hypothesis review

Russell, 2008, double crush hypothesis review -...

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Bio Med Central Page 1 of 9 (page number not for citation purposes) Open Access Review Carpal tunnel syndrome and the "double crush" hypothesis: a review and implications for chiropractic Brent S Russell Address: Associate Professor, Division of Clinical Sciences, Life University, College of Chiropractic, 1269 Barclay Circle, Marietta, Georgia 30060, USA Email: Brent S Russell - [email protected] 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. Introduction Upton and McComas [1] formalized the hypothesis of the "double crush" syndrome (DCS). They suggested that compression of an axon at one location makes it more sensitive to effects of compression in another location, because of impaired axoplasmic flow. Hypothetically, two lesions with little or no independent clinical ramifica- tions, when combined, lead to appearance or magnifica- tion of symptoms [2]. Two areas of compression affecting the same axons do not, alone, meet the criteria of the hypothesis. By definition, a first lesion must render axons more susceptible to effects of a second, leading to more than just the combined, independent effects of two lesions [2]. Upton and McComas [1] used the double crush hypothesis to explain why patients with carpal tun- nel syndrome (CTS) sometimes feel pain in the forearm, elbow, upper arm, shoulder, chest, and upper back. They
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This note was uploaded on 11/22/2011 for the course RSCH 2501 taught by Professor Brents.russell during the Winter '11 term at Life Chiropractic College West.

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Russell, 2008, double crush hypothesis review -...

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