1. Carroll, R.E., Hurst, L.C., “The relationship of thoracic outlet syndrome and carpal tunnel syndrome.” CORR, 1982; 164: 149-150.
2. Frith, R.W., Litchy, W.J., “Electrophysiologic abnormalities of peripheral nerves in patients with cervical radiculopathy.” Muscle & Nerve, 1985; 613.
3. Massey, W.E., Riley, T.L., Pleet, B.A., “Co existing carpal tunnel syndrome and cervical radiculopathy (double crush syndrome.” Southern Med Journal, 1981; 74: 8: 957-959.
The author wanted to point out in a group of 19 patients with co existing carpal tunnel syndrome and cervical radiculopathy predominantly in C6 or C7 that the clinic features of the two syndromes are similar and that when they co exist, one of the problems may over shadow the other, which is otherwise ignored. They suggest that one must consider dual lesions. The patients presented in this study had carefully nerve conduction study and EMGs. There was no discussion of physical findings, surgical treatment, or the results of that treatment. Therefore, this study is of limited value other than an attempt to alert physicians of the overlap and the potential concomitant existence of these problems.
4. Murray-Leslie, C.F., Wright, V., “Carpal tunnel syndrome, humeral epicondylitis, and the cervical spine: a study of clinical and dimensional relations.” BMJ, 1976; 1: 1439-1442.
This was a retrospective look at 43 patients treated surgically for carpal tunnel syndrome and comparing them with 43 controls noting the high prevalence of lateral epicondylitis (33%) in the CTS patients vs. 7% in the control. Blind reading of the cervical spine x-rays on all of the subjects reveal a consistent trend to degenerative cervical spine disease in those people treated for carpal tunnel syndrome than in the control. The lesions were significant in several vertebral levels. Additionally, they had medial humeral epicondylitis in 3 patients (this is usually caused by cubital tunnel syndrome). I also wanted to note that the carpal tunnel group did not differ in body height or weight from the control group. They recorded the possibility that narrowing of the cervical disc might be evidence of degeneration of soft tissues diffusely about throughout the body, such as a common extensor origin at the elbow resulting in epicondylalgia.
5. Osterman, L.A., “The Double Crush Syndrome.” OCNA, 1988; 19:1:147-155.
Dr. Osterman in this timely, well thought out study, though retrospective pointed out the high frequency of multiple nerve entrapment problems within the same patient and the possibility of overlap of these problems. He queried that this was related to multi-level entrapment of the nerves throughout its course, i.e. from neck, brachial plexus, and down to more localized spots that carpal or cubital tunnel respectively. This data clearly shows better response to nerve decompression at the carpal tunnel in patients with isolated carpal tunnel syndrome, then those with multiple involvement such as cervical spondylosis with carpal tunnel syndrome, etc. These findings are consistent with what we see in the day-to-day treatment of patients who present with these problems. The more difficult one is having multiple comorbidities frequently related the nervous or musculoskeletal systems. No attempt was made to confirm or prove actual multiple level involvement of a particular nerve root.
6. Upton, A.R.M., McComas, A.J., “The double crush in nerve entrapment syndromes.” The Lancet, August 18,1973: 359-362.
The classic introducing the concept of double crush.
7. Yu, J., Bendler, E.M., Mentari, A. “ Neurological disorders associated with carpal tunnel syndrome.” Electromyogr Clin Neurophysiol, 1979; 19, 27-32.