Doble compresión del nervio mediano en el brazo. Revisión crítica de la bibliografía. [Double compression syndrome of the median nerve in the arm]
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Publicado:
nov 12, 2019
Palabras clave:
Túnel carpiano, nervio mediano, síndrome del pronador redondo. Carpal tunnel, median nerve, pronator syndrome.
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Resumen
La compresión mecánica de un nervio periférico en dos sitios diferentes a lo largo de su trayecto se define como síndrome de doble compresión. Esta enfermedad se basa en la teoría de la mayor susceptibilidad que tendría un nervio a nivel distal cuando este también se encuentra comprimido, en forma asintomática, a nivel proximal, debido a una alteración en el flujo axonal. Si bien la descompresión del túnel carpiano es una cirugía con resultados previsibles, hay pacientes operados por síndrome de túnel carpiano que no mejoran después de una cirugía, como cabría esperar. Si se excluye de este análisis a las comorbilidades, como diabetes, casos avanzados con atrofia muscular o descompresiones insuficientes, muchos de estos fracasos terapéuticos podrían estar fundamentados por el escaso diagnóstico de un segundo sitio de compresión concomitante. No obstante, existe gran controversia alrededor del síndrome de doble compresión que involucran no solo a su existencia, sino también a su incidencia y fisiopatología. El objetivo de esta publicación es presentar una revisión bibliográfica crítica del síndrome de doble compresión centrada en el compromiso del nervio mediano tanto en la muñeca como en el codo. AbstractThe mechanical compression of a peripheral nerve at two different sites is defined as double compression syndrome. This concept is based on the theory of the higher susceptibility that a nerve would present at a distal level when it is also compressed asymptomatically at a more proximal site. While carpal tunnel release is a surgery with predictable results, there are patients undergoing carpal tunnel decompression who do not have the expected improvement after surgery. Excluding from this analysis comorbidities such as diabetes, advanced cases with thenar atrophy, or incomplete decompressions, many of these therapeutic failures could be explained on the sub diagnosis of a second concomitant compression site. Despite this, there exists a big controversy around the double compression syndrome involving not only its existence but also its incidence and pathophysiology. Our objective is to perform a critical literature review of the double compression syndrome focused on the entrapment of the median nerve in the wrist and elbow.
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Rellán, I., Bendersky, M., Zaidenberg, E. E., Donndorff, A. G., Gallucci, G. L., De Carli, P., & Boretto, J. G. (2019). Doble compresión del nervio mediano en el brazo. Revisión crítica de la bibliografía. [Double compression syndrome of the median nerve in the arm]. Revista De La Asociación Argentina De Ortopedia Y Traumatología, 84(4), 427-433. https://doi.org/10.15417/issn.1852-7434.2019.84.4.937
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Derechos de autor 2019 Revista de la Asociación Argentina de Ortopedia y Traumatología
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Citas
1. Mackinnon SE, Novak CB. Compression neuropathies. En: Wolfe SW, Hotchkiss RN, Pederson WC, Kozin SH, Cohen MS, eds. Green’s operative hand surgery, 7th ed. Philadelphia, PA: Elsevier/Churchill Livingston; 2016:921-1172.
2. Zancolli ER, Zancolli EP, Perrotto CJ. New mini-invasive decompression for pronator teres syndrome. J Hand Surg Am 2012;37(8):1706-10. https://doi.org/10.1016/j.jhsa.2012.05.033
3. Nemoto K, Matsumoto N, Tazaki K, Horiuchi Y, Uchinishi K, Mori Y. An experimental study on the “double crush” hypothesis. J Hand Surg Am 1987;12(4):552-9. https://doi.org/10.1016/s0363-5023(87)80207-1
4. Dellon AL, Mackinnon SE. Chronic nerve compression model for the double crush hypothesis. Ann Plast Surg 1991;26(3):259-64. https://doi.org/10.1097/00000637-199103000-00008
5. Wilbourn AJ, Gilliatt RW. Double-crush syndrome: a critical analysis. Neurology 1997;49(1):21-9. https://doi.org/10.1212/wnl.49.1.21
6. Dorwart BB. Carpal tunnel syndrome: a review. Semin Arthritis Rheum 1984;14(2):134-40. https://doi.org/10.1016/0049-0172(84)90003-9
7. Bednarik J, Kadanka Z, Vohánka S. Median nerve mononeuropathy in spondylotic cervical myelopathy: double crush syndrome? J Neurol 1999;246(7):544-51. https://doi.org/10.1007/s004150050401
8. Baba H, Maezawa Y, Uchida K, Furusawa N, Wada M, Imura S, et al. Cervical myeloradiculopathy with entrapment neuropathy: a study based on the double-crush concept. Spinal Cord 1998;36(6):399-404. https://doi.org/10.1038/sj.sc.3100539
9. Schmid AB, Coppieters MW. The double crush syndrome revisited--a Delphi study to reveal current expert views on mechanisms underlying dual nerve disorders. Man Ther 2011;16(6):557-62. https://doi.org/10.1016/j.math.2011.05.005
10. Cohen BH, Gaspar MP, Daniels AH, Akelman E, Kane PM. Multifocal neuropathy: expanding the scope of double crush syndrome. J Hand Surg Am 2016;41(12):1171-5. https://doi.org/10.1016/j.jhsa.2016.09.009
11. Naam NH. First commentary on "Multifocal Neuropathy: Expanding the Scope of Double Crush Syndrome". J Hand Surg Am 2016;41(12):1176. https://doi.org/10.1016/j.jhsa.2016.09.010
12. Curtin C. Second commentary on "Multifocal Neuropathy: Expanding the Scope of Double Crush Syndrome". J Hand Surg Am. 2016;41(12):1177. https://doi.org/10.1016/j.jhsa.2016.09.011
13. Martin CH, Seiler JG, Lesesne JS. The cutaneous innervation of the palm: an anatomic study of the ulnar and median nerves. J Hand Surg Am 1996;21(4):634-8. https://doi.org/10.1016/S0363-5023(96)80017-7
14. Preston DC, Shapiro BE. Median neuropathy at the wrist. En: Preston DC, Shapiro BE. Electromyography and neuromuscular disorders. 3rd ed. Cleveland, OH: Elsevier; 2013.
15. American Academy of Orthopaedic Surgeons Work Group Panel. Clinical guidelines on diagnosis of carpal tunnel syndrome. 2007. Disponible en: www.aaos.org/research/guidelines/CTS_guideline.pdf.
16. Hagert E. Clinical diagnosis and wide-awake surgical treatment of proximal median nerve entrapment at the elbow: a prospective study. Hand (N Y) 2013;8(1):41-6. https://doi.org/10.1007/s11552-012-9483-4
17. Rehak DC. Pronator syndrome. Clin Sports Med 2001;20(3):531-40. https://doi.org/10.1016/S0278-5919(05)70267-2
18. Rodner CM, Tinsley BA, O´Malley MP. Pronator syndrome and anterior interosseous nerve syndrome. J Am Acad Orthop Surg 2013;21(5):268-75. https://doi.org/10.5435/JAAOS-21-05-268
19. Rydevik B, Lundborg G. Permeability of intraneural microvessels and perineurium following acute, graded experimental nerve compression. Scand J Plast Reconstr Surg 1977;11(3):179-87. https://doi.org/10.3109/02844317709025516
20. Dahlin LB, Lundborg G. The neurone and its response to peripheral nerve compression. J Hand Surg Br 1990;15(1):5-10. https://doi.org/10.1016/0266-7681(90)90040-b
21. Lo SF, Chou LW, Meng NH, Chen FF, Juan TT, Ho WC, et al. Clinical characteristics and electrodiagnostic features in patients with carpal tunnel syndrome, double crush syndrome, and cervical radiculopathy. Rheumatol Int 2012;32(5):1257-63. https://doi.org/10.1007/s00296-010-1746-1
22. Akyuz M, Yalcin E, Selcuk B, Onder B, Ozçakar L. Electromyography and ultrasonography in the diagnosis of a rare double-crush ulnar nerve injury. Arch Phys Med Rehabil 2011;92(11):1914-6. https://doi.org/10.1016/j.apmr.2011.05.007
23. Liotta G, Granata G, Librante A, di Pasquale A, Caliandro P, Martinoli C, et al. Atypical double nerve lesion after humeral fracture: diagnosis by ultrasound. Muscle Nerve 2010;41(2):287-8. https://doi.org/10.1002/mus.21580
24. Seror P. Sonography and electrodiagnosis in carpal tunnel syndrome diagnosis, an analysis of the literature. Eur J Radiol 2008;67(1):146-52. https://doi.org/10.1016/j.ejrad.2007.06.017
25. Andreisek G, Crook DW, Burg D, Marincek B, Weishaupt D. Peripheral neuropathies of the median, radial, and ulnar nerves: MR imaging features. RadioGraphics 2006;26(5):1267-87. https://doi.org/10.1148/rg.265055712
26. Osterman AL. The double crush syndrome. Orthop Clin North Am 1988;19(1):147-55. PMID: 3275922
27. Mujadzic M, Papanicolaou G, Young H, Tsai TM. Simultaneous surgical release of ipsilateral pronator teres and carpal tunnel syndromes. Plast Reconstr Surg 2007;119(7):2141-7. https://doi.org/10.1097/01.prs.0000260703.56453.06
28. Olehnik WK, Manske PR, Szerzinski J. Median nerve compression in the proximal forearm. J Hand Surg Am 1994;19(1):121-6. https://doi.org/10.1016/0363-5023(94)90235-6
29. Hartz CR, Linscheid RL, Gramse RR, Daube JR. The pronator teres syndrome: compressive neuropathy of the median nerve. J Bone Joint Surg Am 1981;63(6):885-90. https://doi.org/10.2106/00004623-198163060-00004
30. Luangjarmekorn P, Tsai TM, Honsawek S, Kitidumrongsook P. Role of pronator release in revision carpal tunnel surgery. SICOT J 2016;2:9. https://doi.org/10.1051/sicotj/2016006
31. Hsiao C-W, Shih J-T, Hung S-T. Concurrent carpal tunnel syndrome and pronator syndrome: A retrospective study of 21 cases. Orthop Traumatol Surg Res 2017;103(1):101-103. doi:10.1016/j.otsr.2016.10.009
32. Morgan G, Wilbourn AJ. Cervical radiculopathy and coexisting distal entrapment neuropathies: double-crush syndromes? Neurology 1998;50(1):78-83. https://doi.org/10.1212/wnl.50.1.78
2. Zancolli ER, Zancolli EP, Perrotto CJ. New mini-invasive decompression for pronator teres syndrome. J Hand Surg Am 2012;37(8):1706-10. https://doi.org/10.1016/j.jhsa.2012.05.033
3. Nemoto K, Matsumoto N, Tazaki K, Horiuchi Y, Uchinishi K, Mori Y. An experimental study on the “double crush” hypothesis. J Hand Surg Am 1987;12(4):552-9. https://doi.org/10.1016/s0363-5023(87)80207-1
4. Dellon AL, Mackinnon SE. Chronic nerve compression model for the double crush hypothesis. Ann Plast Surg 1991;26(3):259-64. https://doi.org/10.1097/00000637-199103000-00008
5. Wilbourn AJ, Gilliatt RW. Double-crush syndrome: a critical analysis. Neurology 1997;49(1):21-9. https://doi.org/10.1212/wnl.49.1.21
6. Dorwart BB. Carpal tunnel syndrome: a review. Semin Arthritis Rheum 1984;14(2):134-40. https://doi.org/10.1016/0049-0172(84)90003-9
7. Bednarik J, Kadanka Z, Vohánka S. Median nerve mononeuropathy in spondylotic cervical myelopathy: double crush syndrome? J Neurol 1999;246(7):544-51. https://doi.org/10.1007/s004150050401
8. Baba H, Maezawa Y, Uchida K, Furusawa N, Wada M, Imura S, et al. Cervical myeloradiculopathy with entrapment neuropathy: a study based on the double-crush concept. Spinal Cord 1998;36(6):399-404. https://doi.org/10.1038/sj.sc.3100539
9. Schmid AB, Coppieters MW. The double crush syndrome revisited--a Delphi study to reveal current expert views on mechanisms underlying dual nerve disorders. Man Ther 2011;16(6):557-62. https://doi.org/10.1016/j.math.2011.05.005
10. Cohen BH, Gaspar MP, Daniels AH, Akelman E, Kane PM. Multifocal neuropathy: expanding the scope of double crush syndrome. J Hand Surg Am 2016;41(12):1171-5. https://doi.org/10.1016/j.jhsa.2016.09.009
11. Naam NH. First commentary on "Multifocal Neuropathy: Expanding the Scope of Double Crush Syndrome". J Hand Surg Am 2016;41(12):1176. https://doi.org/10.1016/j.jhsa.2016.09.010
12. Curtin C. Second commentary on "Multifocal Neuropathy: Expanding the Scope of Double Crush Syndrome". J Hand Surg Am. 2016;41(12):1177. https://doi.org/10.1016/j.jhsa.2016.09.011
13. Martin CH, Seiler JG, Lesesne JS. The cutaneous innervation of the palm: an anatomic study of the ulnar and median nerves. J Hand Surg Am 1996;21(4):634-8. https://doi.org/10.1016/S0363-5023(96)80017-7
14. Preston DC, Shapiro BE. Median neuropathy at the wrist. En: Preston DC, Shapiro BE. Electromyography and neuromuscular disorders. 3rd ed. Cleveland, OH: Elsevier; 2013.
15. American Academy of Orthopaedic Surgeons Work Group Panel. Clinical guidelines on diagnosis of carpal tunnel syndrome. 2007. Disponible en: www.aaos.org/research/guidelines/CTS_guideline.pdf.
16. Hagert E. Clinical diagnosis and wide-awake surgical treatment of proximal median nerve entrapment at the elbow: a prospective study. Hand (N Y) 2013;8(1):41-6. https://doi.org/10.1007/s11552-012-9483-4
17. Rehak DC. Pronator syndrome. Clin Sports Med 2001;20(3):531-40. https://doi.org/10.1016/S0278-5919(05)70267-2
18. Rodner CM, Tinsley BA, O´Malley MP. Pronator syndrome and anterior interosseous nerve syndrome. J Am Acad Orthop Surg 2013;21(5):268-75. https://doi.org/10.5435/JAAOS-21-05-268
19. Rydevik B, Lundborg G. Permeability of intraneural microvessels and perineurium following acute, graded experimental nerve compression. Scand J Plast Reconstr Surg 1977;11(3):179-87. https://doi.org/10.3109/02844317709025516
20. Dahlin LB, Lundborg G. The neurone and its response to peripheral nerve compression. J Hand Surg Br 1990;15(1):5-10. https://doi.org/10.1016/0266-7681(90)90040-b
21. Lo SF, Chou LW, Meng NH, Chen FF, Juan TT, Ho WC, et al. Clinical characteristics and electrodiagnostic features in patients with carpal tunnel syndrome, double crush syndrome, and cervical radiculopathy. Rheumatol Int 2012;32(5):1257-63. https://doi.org/10.1007/s00296-010-1746-1
22. Akyuz M, Yalcin E, Selcuk B, Onder B, Ozçakar L. Electromyography and ultrasonography in the diagnosis of a rare double-crush ulnar nerve injury. Arch Phys Med Rehabil 2011;92(11):1914-6. https://doi.org/10.1016/j.apmr.2011.05.007
23. Liotta G, Granata G, Librante A, di Pasquale A, Caliandro P, Martinoli C, et al. Atypical double nerve lesion after humeral fracture: diagnosis by ultrasound. Muscle Nerve 2010;41(2):287-8. https://doi.org/10.1002/mus.21580
24. Seror P. Sonography and electrodiagnosis in carpal tunnel syndrome diagnosis, an analysis of the literature. Eur J Radiol 2008;67(1):146-52. https://doi.org/10.1016/j.ejrad.2007.06.017
25. Andreisek G, Crook DW, Burg D, Marincek B, Weishaupt D. Peripheral neuropathies of the median, radial, and ulnar nerves: MR imaging features. RadioGraphics 2006;26(5):1267-87. https://doi.org/10.1148/rg.265055712
26. Osterman AL. The double crush syndrome. Orthop Clin North Am 1988;19(1):147-55. PMID: 3275922
27. Mujadzic M, Papanicolaou G, Young H, Tsai TM. Simultaneous surgical release of ipsilateral pronator teres and carpal tunnel syndromes. Plast Reconstr Surg 2007;119(7):2141-7. https://doi.org/10.1097/01.prs.0000260703.56453.06
28. Olehnik WK, Manske PR, Szerzinski J. Median nerve compression in the proximal forearm. J Hand Surg Am 1994;19(1):121-6. https://doi.org/10.1016/0363-5023(94)90235-6
29. Hartz CR, Linscheid RL, Gramse RR, Daube JR. The pronator teres syndrome: compressive neuropathy of the median nerve. J Bone Joint Surg Am 1981;63(6):885-90. https://doi.org/10.2106/00004623-198163060-00004
30. Luangjarmekorn P, Tsai TM, Honsawek S, Kitidumrongsook P. Role of pronator release in revision carpal tunnel surgery. SICOT J 2016;2:9. https://doi.org/10.1051/sicotj/2016006
31. Hsiao C-W, Shih J-T, Hung S-T. Concurrent carpal tunnel syndrome and pronator syndrome: A retrospective study of 21 cases. Orthop Traumatol Surg Res 2017;103(1):101-103. doi:10.1016/j.otsr.2016.10.009
32. Morgan G, Wilbourn AJ. Cervical radiculopathy and coexisting distal entrapment neuropathies: double-crush syndromes? Neurology 1998;50(1):78-83. https://doi.org/10.1212/wnl.50.1.78