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Double Crush Syndrome

The original definition of Double Crush Syndrome (DCS), although based on sound pathophysiologic processes, may be limited in scope because investigators have shown that compressive pathology is not the only contributor to nerve pathology. Despite the controversy surrounding the diagnosis, DCS is an important concept because it emphasizes the fact that patients' symptoms may not simply be related to one anatomic site of compression but may also be caused by a remote compressive lesion or a systemic process, such as peripheral neuropathy.

Multiple studies have illustrated the increased susceptibility of nerves to compressive pathology secondary to systemic illness. Baba et al reported an increased incidence of multiple compressive peripheral neuropathies in patients with diabetes, finding a 16% incidence of patients with both Carpal and Cubital Tunnel Syndrome.

Various pharmacologic agents, infectious pathology, and many conditions, such as anatomic abnormalities, hypothyroidism, hereditary neuropathy, uremic neuropathy, vitamin deficiency, and chronic alcoholism, can alter neural physiology and consequently put peripheral nerves at similar risk. What is your experience with patients with DCS? #HandConsultSA

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