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CC BY-NC-ND 4.0 · Arquivos Brasileiros de Neurocirurgia: Brazilian Neurosurgery 2019; 38(01): 036-039
DOI: 10.1055/s-0036-1594261
Review Article | Artigo de Revisão
Thieme Revinter Publicações Ltda Rio de Janeiro, Brazil

Double Crush Syndrome of the Median Nerve: A Literature Review

Síndrome do duplo impacto do nervo mediano: uma revisão de literatura
Marcelo José da Silva Magalhães
1   Department of Medicine, Faculdades Unidas do Norte de Minas, Montes Claros, MG, Brazil
2   Department of Medicine, Faculdades Integradas Pitágoras de Montes Claros , Montes Claros, MG, Brazil
3   Department of Neurosurgery, Hospital Aroldo Tourinho, Montes Claros, MG, Brazil
4   Department of Neurosurgery, Hospital Vila da Serra-Nova, Lima, MG, Brazil
,
Alice Augusto Costa Correia
1   Department of Medicine, Faculdades Unidas do Norte de Minas, Montes Claros, MG, Brazil
,
Emannuelly Aparecida Silva da Cruz
1   Department of Medicine, Faculdades Unidas do Norte de Minas, Montes Claros, MG, Brazil
,
Fernanda Caldeira Veloso Santos
1   Department of Medicine, Faculdades Unidas do Norte de Minas, Montes Claros, MG, Brazil
,
José Antônio de Aguiar Filho
1   Department of Medicine, Faculdades Unidas do Norte de Minas, Montes Claros, MG, Brazil
,
Lorena Aparecidade Lourdes
1   Department of Medicine, Faculdades Unidas do Norte de Minas, Montes Claros, MG, Brazil
,
Luísa Malheiro Ferreira
1   Department of Medicine, Faculdades Unidas do Norte de Minas, Montes Claros, MG, Brazil
,
Synara Figueiredo Silva de Quadros
1   Department of Medicine, Faculdades Unidas do Norte de Minas, Montes Claros, MG, Brazil
› Institutsangaben
Weitere Informationen

Publikationsverlauf

29. Mai 2016

30. August 2016

Publikationsdatum:
22. November 2016 (online)

   Lizenzen und Reprints

Abstract

Double crush syndrome (DCS) is defined as the compressive involvement of the same peripheral nerve in different segments. When this syndrome affects the median nerve, a proximal compression of a spinal nerve that will constitute this structure (often the spinal nerve at the C6 vertebra) is usually noted at the cervical spine level as a herniated disc and as a distal compression at the level of the carpal tunnel. Epidemiological data on median nerve compromise by DCS are still very scarce in the medical literature. The diagnosis can be inferred by symptoms and signs occurring proximally and distally in the arm, as well as by alterations revealed by upper limb electromyography and neuroimaging studies, such as magnetic resonance imaging (MRI) of the cervical spine. Nowadays, information on which compressed neuroanatomical point should be initially addressed still depends on further studies. Limited data infer that these patients, when submitted to surgical treatment in only one of the median nerve compression points, evolve with worse functional outcomes than the surgically-treated group with carpal tunnel syndrome without DCS.

Resumo

A síndrome do duplo impacto (SDI) é conceituada como o comprometimento compressivo de um mesmo nervo periférico em segmentos distintos. Quando esta síndrome acomete o nervo mediano, usualmente se nota uma compressão proximal de um nervo espinhal que irá constituir o nervo mediano (frequentemente, o nervo espinhal da vértebra C6) ao nível da coluna cervical por uma hérnia discal e uma compressão distal ao nível do túnel do carpo. Dados epidemiológicos sobre a SDI comprometendo o nervo mediano ainda são muito escassos na literatura médica. Observa-se que o diagnóstico pode ser inferido por sintomas e por sinais presentes proximal e distalmente no membro superior, além de alterações presentes na eletroneuromiografia de membros superiores, bem como achados em exames de neuroimagem como a ressonância magnética da coluna cervical. Atualmente, a informação sobre qual ponto neuroanatômico de compressão deveria ser abordado inicialmente ainda depende de mais estudos. Dados escassos inferem que esses pacientes, quando submetidos ao tratamento cirúrgico em apenas um dos pontos de compressão do nervo mediano, evoluem com resultados funcionais piores do que o grupo de pacientes com síndrome do túnel do carpo sem SDI tratados cirurgicamente.

Keywords

double crush syndrome - median nerve - carpal tunnel - neuropathy

Palavras-chave

síndrome do duplo impacto - nervo mediano - túnel do carpo - neuropatia
 

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