Abstract
The double crush syndrome is described as an increased risk of distal nerve injury after a more proximal injury. This was a case series of two patients who developed Complex Regional Pain Syndrome under circumstances when a double crush phenomenon could have occurred. Both initially had spinal stenosis and subsequent spinal surgery. Both later had crush injuries to a unilateral lower extremity, which progressed to CRPS. There is no documented correlation between double crush syndrome and CRPS; however, these cases raise awareness about a heightened propensity for CRPS in such patients, which will lead to earlier, accurate diagnosis and treatment.
Highlights
The double crush syndrome (DCS) was proposed in 1973 by physicians Upton and McComas [1]. They described the potential susceptibility of a distal nerve segment to injury in the setting of a more proximal lesion: “neural function is impaired because single axons, having been compressed in one region, become especially susceptible to damage at another site [1].”
Neither had symptoms of Complex Regional Pain Syndrome (CRPS) until an injury to the foot resulted in subsequent presentation of symptoms
There certainly are factors which are consistent in the literature between the two syndromes
Summary
The double crush syndrome (DCS) was proposed in 1973 by physicians Upton and McComas [1] They described the potential susceptibility of a distal nerve segment to injury in the setting of a more proximal lesion: “neural function is impaired because single axons, having been compressed in one region, become especially susceptible to damage at another site [1].”. Multiple studies have implicated varied mechanisms contributing to the initial insult These have included pathological, anatomic, or metabolic origins [2]-[7]. Studies of the physiologic mechanism have been completed following the initial insult They have implicated both morphological and biochemical changes in the biogenesis of pain [8]. In the two cases to be presented in this article, there was an initial mechanism of insult to the spinal cord, followed by crush injury to a distant part of the body, along the same peripheral nerve pathway as the first insult. Both patients have reviewed this article and written consent stating that this report may be published has been provided
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