Briggs Matthew S, Rethman Katherine K, Lopez Matthew T
OSU Sports Medicine, Sports Physical Therapy Residency, Columbus, OH, USA.
OSU Sports Medicine, Clinical Outcomes Research Coordinator Program, Columbus, OH, USA.
Int J Sports Phys Ther. 2018 Apr;13(2):255-268.
Differentiating between cervical nerve root and peripheral nerve injuries can be challenging. A phenomenon known as double crush syndrome may increase the susceptibility to injury and symptoms at other locations along the course of the nerve. The purpose of this case report is to describe the physical therapy differential diagnosis and management of a cyclist with upper extremity pain, weakness, and paresthesia.
The subject was referred to physical therapy with a diagnosis of cervical disc disease. His chief complaints were chronic neck and right shoulder pain as well as a recent onset of right hand numbness and weakness following 100-mile bike ride one month prior. Diagnostic imaging revealed multi-level degenerative changes of the cervical spine. Initial electromyography and nerve conduction studies (EMG/NCS) indicated right ulnar neuropathy at the elbow. The ultimate incorporation of ulnar nerve mobilizations in various positions immediately decreased symptoms. In light of the subject's improvement after ulnar nerve mobilizations, imaging findings, and EMG/NCS findings, the subject's presentation was consistent with a double crush syndrome with C8 nerve root compression and distal ulnar nerve compression at the elbow.
The subject demonstrated full resolution of all symptoms, 0% disability on the Neck Disability Index, 8.3% disability of the Disabilities of the Arm, Shoulder, and Hand questionnaire, normal EMG/NCV findings, and unrestricted return to work and endurance cycling at three months and maintained at one year. He did not require hand surgery.
This case report highlights the importance of continual clinical re-examination and re-assessment with ancillary diagnostic testing, especially if chosen interventions are not eliciting desired responses. The identification of key risk factors, such as occupation and recreational activities is imperative in achieving the most efficacious clinical treatment. In this case, the recognition of a double crush syndrome assisted in optimizing the physical therapy plan of care and the subject ultimately achieving full recovery.
Level 4.
区分颈神经根损伤和周围神经损伤可能具有挑战性。一种被称为双重压迫综合征的现象可能会增加神经走行过程中其他部位受伤和出现症状的易感性。本病例报告的目的是描述一名上肢疼痛、无力和感觉异常的自行车运动员的物理治疗鉴别诊断及管理。
该患者因诊断为颈椎间盘疾病而被转诊至物理治疗科。他的主要诉求是慢性颈部和右肩疼痛，以及在一个月前进行100英里自行车骑行后近期出现的右手麻木和无力。诊断性影像学检查显示颈椎存在多节段退变改变。初始肌电图和神经传导研究（EMG/NCS）表明右侧肘部尺神经病变。最终在不同位置进行尺神经松动术立即减轻了症状。鉴于患者在尺神经松动术后症状改善、影像学检查结果以及EMG/NCS检查结果，该患者的表现符合双重压迫综合征，伴有C8神经根受压和肘部远端尺神经受压。
该患者所有症状完全消失，颈部残疾指数评分为0%残疾，手臂、肩部和手部功能障碍问卷评分为8.3%残疾，EMG/NCV检查结果正常，三个月时恢复工作和耐力骑行不受限制，并在一年时保持这种状态。他无需进行手部手术。
本病例报告强调了持续进行临床重新检查以及借助辅助诊断测试进行重新评估的重要性，特别是在所选干预措施未引发预期反应时。识别关键风险因素，如职业和娱乐活动，对于实现最有效的临床治疗至关重要。在本病例中，双重压迫综合征的识别有助于优化物理治疗护理计划，患者最终实现了完全康复。
4级。
