Preoperative Electrodiagnostic Study Findings Differ Between Patients With Double-crush Syndrome and Carpal Tunnel Syndrome: A Propensity Matched Analysis

Nicholas B Pohl; Rajkishen Narayanan; Parker L Brush; Yunsoo Lee; Rabia Qureshi; Arun Kanhere; M Lauren Micou; Sebastian I Fras; Ian David Kaye; John J Mangan; Mark F Kurd; Michael J Mehnert; Jose A Canseco; Alan S Hilibrand; Alexander R Vaccaro; Christopher K Kepler; Gregory D Schroeder

doi:10.5435/JAAOS-D-24-00056

Preoperative Electrodiagnostic Study Findings Differ Between Patients With Double-crush Syndrome and Carpal Tunnel Syndrome: A Propensity Matched Analysis

J Am Acad Orthop Surg. 2024 May 8. doi: 10.5435/JAAOS-D-24-00056. Online ahead of print.

Authors

Nicholas B Pohl¹, Rajkishen Narayanan, Parker L Brush, Yunsoo Lee, Rabia Qureshi, Arun Kanhere, M Lauren Micou, Sebastian I Fras, Ian David Kaye, John J Mangan, Mark F Kurd, Michael J Mehnert, Jose A Canseco, Alan S Hilibrand, Alexander R Vaccaro, Christopher K Kepler, Gregory D Schroeder

Affiliation

¹ From the Department of Orthopedic Surgery, Rothman Institute, Thomas Jefferson University, Philadelphia, PA (Pohl, Narayanan, Brush, Lee, Kanhere, Micou, Fras, Kaye, Mangan, Kurd, Canseco, Hilibrand, Vaccaro, Kepler, Schroeder), Department of Orthopedic Surgery and Sports Medicine, Temple University Hospital, Philadelphia, PA (Dr. Qureshi), and the Department of Physical Medicine & Rehabilitation, Rothman Institute, Thomas Jefferson University, Philadelphia, PA (Mehnert).

PMID: 38723279
DOI: 10.5435/JAAOS-D-24-00056

Abstract

Introduction: Double-crush syndrome (DCS) represents a condition that involves peripheral nerve compression in combination with spinal nerve root impingement. The purpose of this study was to compare electrodiagnostic study (EDS) results in patients undergoing carpal tunnel release (CTR) for carpal tunnel syndrome with those undergoing both CTR and anterior cervical diskectomy and fusion for DCS.

Methods: Patients receiving an isolated CTR were compared with those undergoing CTR and anterior cervical diskectomy and fusion within two years of CTR. The latter group was defined as our DCS cohort. Electrodiagnostic study results were collected which included sensory and motor nerve conduction data as well as electromyogram (EMG) findings. All electrodiagnostic studies were done before CTR in both sets of patients.

Results: Fifty-four patients with DCS and 137 CTR-only patients were included. Patients with DCS were found to have decreased sensory onset latency (3.51 vs 4.01; P = 0.015) and peak latency (4.25 vs 5.17; P = 0.004) compared with the CTR-only patients. Patients with DCS had slower wrist motor velocity (30.5 vs 47.7; P = 0.012), decreased elbow motor latency (9.62 vs 10.6; P = 0.015), and faster elbow motor velocity (56.0 vs 49.4; P = 0.031). EMG results showed that patients with DCS were more likely to have positive findings in the biceps (31.9% vs 1.96%; P < 0.001) and triceps (24.4% vs 2.97%; P < 0.001), but not abductor pollicis brevis (APB) (45.7% vs 37.9%; P = 0.459).

Conclusion: We identified changes on EDS between patients with and without DCS. In patients with DCS, sensory nerve studies showed shorter peak and onset latency than in CTR-only patients. Interestingly, DCS and CTR-only patients had different patterns of wrist and elbow motor nerve conduction. Providers observing positive EMG findings proximal to the APB should raise their suspicion for possible cervical radiculopathy and when present with carpal tunnel syndrome-like symptoms, should also consider DCS in their diagnostic differential.