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CC BY-NC-ND 4.0 · Revista Iberoamericana de Cirugía de la Mano 2018; 46(01): 069-083
DOI: 10.1055/s-0038-1645874
Update Article | Artículo de Actualización
Thieme Revinter Publicações Ltda Rio de Janeiro, Brazil

Biología del transporte axonal y síndrome de doble compresión

Biology of the Axon Transportation and Double Crush Syndrome
R. S. Rosales
1   Unidad de Cirugía de La Mano y Microcirugía, GECOT, La Laguna, Tenerife, España
,
A. Sánchez Díez de la Lastra
1   Unidad de Cirugía de La Mano y Microcirugía, GECOT, La Laguna, Tenerife, España
,
L. Méndez Hernández
2   Servicio Neurofisiología Hospital Universitario, Santa Cruz de Tenerife, España
,
A. Dorta Fernández
1   Unidad de Cirugía de La Mano y Microcirugía, GECOT, La Laguna, Tenerife, España
› Author Affiliations
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Publication History

26 March 2018

27 March 2018

Publication Date:
11 May 2018 (online)

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Resumen

Después de más de 40 años desde la descripción del Síndrome de Doble Compresión por Upton y McComas en el Lancet, sigue siendo un tema debatido que ha llevado a algunos cirujanos de mano a dudar de su existencia. La evidencia científica demuestra que la alteración del transporte axonal es el mecanismo más plausible en la fisiopatología de ese síndrome de compresión nerviosa. Se ha demostrado que una cuidadosa exploración clínica junto a un buen estudio neurofisiológico bien dirigido incrementa la eficiencia diagnóstica en términos de pacientes correctamente diagnosticados en el SDC. La liberación del Ligamento Transverso del Carpo está indicada en determinados pacientes que cumplen unos criterios de inclusión y exclusión específicos. Los resultados demuestran que la liberación del canal carpiano en esa población diana específica, es capaz de mejorar la gravedad de los síntomas de manera similar a la población afecta de Síndrome del Túnel Carpiano y de manera casi similar, a nivel de la Discapacidad de MMSS. Sólo instrumentos genéricos, como el SF-36, han sido capaces de detectar la diferencia a nivel de ciertas dimensiones de la Salud en relación a la Calidad de Vida entre los resultados del tratamiento en SDC y STC.

Abstract

The Double Crush Syndrome (DCS) described by Upton and McComas more than 40 years ago is still a debated issue in nerve compression disorders. The purpose of this review paper was to present the biological bases of the axonal transportation related to the physio-pathology of the DCS and to describe the clinical examination, diagnosis, and the outcomes in the treatment. Scientific evidence stands that impaired axonal transport is the most likely mechanism in producing the DCS. A careful clinical examination combined with a well-directed electrophysiological test increase the efficiency in the diagnosis. Surgical release of the Carpal ligament in DCS is indicated in patients who follow specific inclusion and exclusion criteria and the outcomes is similar to the Carpal Tunnel Syndrome (CTS) population in terms of improvement of symptoms related to the distal nerve compression, and almost similar in terms of Upper extremity Disability. However, Quality of Life Outcomes Instruments, as SF-36, detect differences between the outcomes in CTS and DCS.

Palabras-Clave

neuropatía - síndrome de túnel carpiano - síndrome de doble compresión - radioculopatía - transporte axonal

Keywords

neuropathy - carpal tunnel syndrome - double crush syndrome - radiculopathy - axonal transport
 

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