Double Crush Syndrome
My hands are numb, is it Carpal Tunnel syndrome?
It is common to think that when the wrists and palms are numb, carpal tunnel syndrome is the issue. The cause of Carpal Tunnel syndrome is that the median nerve in the peripheral nervous system becomes narrower. In particular, it is said that the skin of the thumb, index finger, middle finger, half of the skin on the fourth finger and the skin of the part connected to the palm of the hand is prone to numbness especially during actions such as gripping, holding the steering wheel and doing the dishes.
These carpal tunnel syndromes form a structure in which the bones of the wrist and horizontal wrist ligaments form a single roof to protect the tendon and the median nerve that move the fingers. This tunnel can be narrowed down due to diseases such as trauma, tendonitis, hypothyroidism, diabetes, rheumatism, osteoarthritis, and repetitive hand movements, which can be seen when pressing for a mid-menstrual nerve. Treatment for these carpal tunnel syndrome is divided into conservation and surgical methods depending on the symptoms. Preserving methods include treatment, various exercise methods, steroid injections and, if not improved by this conservation method, surgery is performed that opens the wrist tunnel.
My hands are still numb
The term double crush syndrome originated from a 1973 study by Upton and McCormack, and it is said that the due diligence test of 115 carpal tunnel syndrome patients showed 81 cases of carpal tunnel syndrome on the neck as well as the wrist tunnel. This kind of pressure symptom or neural entrapment can occur simultaneously in many places, not just in one place. This condition is referred to as double crush syndrome, and during treatment, not only wrist tunnels, but also the condition of the anterior nerve, or musculocutaneous nerve, and ulnar nerve. The nerves coming down to the arms also come from the neck, so the health condition of the cervical nerves (especially cervical nerves 6, 7, 8 and thoracic nerves 1) should also be checked.
Where does Double Crush occur?
- Pronator teres syndrome
The Pronator Teres Muscle consist of one long muscle that connects the inner part of the elbow to the middle of the lumbar bones and rotate the arm inward. The median nerve is located between the two heads of the Pronator Teres Muscles and is compressed when the muscle is abnormal.
- Anterior interosseous syndrome (Kiloh-Nevin syndrome)
The anterior interphalangeal nerve, one of the branch nerves of the median nerve, is directed to the wrist tunnel between the cervical flexor muscles and the Pollicis Longus Flexor that bend the second, third, fourth, and fifth fingers in front of the cuff. Therefore, the compression caused by these two muscles can cause the anterior interphalangeal syndrome, and the symptoms are similar to the wrist tunnel syndrome.
Median nerve, anterior interphalangeal nerve, flexor muscle and Pollicis Longus Flexor
- Carpal tunnel syndrome
A path through which the tendon and the median nerve pass through which the tendon/muscle can exert pressure on the median nerve
In addition, similar symptoms can be caused by damage to the cervical vertebra, disc, musculocutaneous nerve and ulnar nerve pressure, or chest pain with sympathetic nerves passing through the entire limb.
What about treatment?
Treatment is a way to improve symptoms by opening up areas where pressure can be applied.
1. Self-massage treatment: All muscles that can exert pressure should be found from neck to wrist to perform muscle relaxation.
- Stretch the muscles at the front of the wrist by continuously placing the palm up and pulling the thumb, second finger etc. in a straight line.
- Change the environment that can create constant pressure by improving the working environment.
Treatment for double crush syndrome is not limited to one treatment. Therefore, it is advisable to consult fully with experts to determine a specific treatment method if the improvement of symptoms is not achieved in a simple way.
