Double Crush Phenomenon
Pain resulting from compromise of neural structures (neuropathic pain) is common in various regions of the body and is often thought to be associated with excessive tension or compression on a nerve leading to ischemia (loss of blood flow). One of the most familiar syndromes associated with neuropathic pain is carpal tunnel syndrome (CTS). In this case, the median nerve is thought to be compromised at the carpal tunnel of the wrist.
What many people are not told is that there is a concept referred to a the double crush phenomenon where it is believed that when a nerve is compromised in one area along it’s path, then it is more likely to demonstrate symptoms somewhere else. In the example of CTS and the median nerve there are numerous areas where the median nerve could run into problems including the neck, inter-scalene triangle, near the first rib, under pectoralis minor, under the pronator trees muscle and at the carpal tunnel. When these areas are addressed, through conservative care, the carpal tunnel symptoms (usually found in the hand) often clear up. So, before rushing into surgery or allowing someone else to do so for neuropathic pain, make sure they are examined by a practitioner who can check the entire nerve’s path. All too often we see patients who have surgeries like a carpal tunnel release and are found to be no different than individuals who only underwent conservative care at long-term follow-ups.