Doble compresión del nervio mediano en el brazo. Revisión crítica de la bibliografía. [Double compression syndrome of the median nerve in the arm]

Contenido principal del artículo

Ignacio Rellán
Mariana Bendersky
Ezequiel Ernesto Zaidenberg
Agustín Guillermo Donndorff
Gerardo Luis Gallucci
Pablo De Carli
Jorge Guillermo Boretto

Resumen

La compresión mecánica de un nervio periférico en dos sitios diferentes a lo largo de su trayecto se define como síndrome de doble compresión. Esta enfermedad se basa en la  teoría de la mayor susceptibilidad que tendría un nervio a nivel distal cuando este también se encuentra comprimido, en forma asintomática, a nivel proximal, debido a una alteración en el flujo axonal. Si bien la descompresión del túnel carpiano es una cirugía con resultados previsibles, hay pacientes operados por síndrome de túnel carpiano que no mejoran después de una cirugía, como cabría esperar. Si se excluye de este análisis a las comorbilidades, como diabetes, casos avanzados con atrofia muscular o descompresiones insuficientes, muchos de estos fracasos terapéuticos podrían estar fundamentados por el escaso diagnóstico de un segundo sitio de compresión concomitante. No obstante, existe gran controversia alrededor del síndrome de doble compresión que involucran no solo a su existencia, sino también a su incidencia y fisiopatología. El objetivo de esta publicación es presentar una revisión bibliográfica crítica del síndrome de doble compresión centrada en el compromiso del nervio mediano tanto en la muñeca como en el codo. AbstractThe mechanical compression of a peripheral nerve at two different sites is defined as double compression syndrome. This concept is based on the theory of the higher susceptibility that a nerve would present at a distal level when it is also compressed asymptomatically at a more proximal site. While carpal tunnel release is a surgery with predictable results, there are patients undergoing carpal tunnel decompression who do not have the expected improvement after surgery. Excluding from this analysis comorbidities such as diabetes, advanced cases with thenar atrophy, or incomplete decompressions, many of these therapeutic failures could be explained on the sub diagnosis of a second concomitant compression site. Despite this, there exists a big controversy around the double compression syndrome involving not only its existence but also its incidence and pathophysiology. Our objective is to perform a critical literature review of the double compression syndrome focused on the entrapment of the median nerve in the wrist and elbow.

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Rellán, I., Bendersky, M., Zaidenberg, E. E., Donndorff, A. G., Gallucci, G. L., De Carli, P., & Boretto, J. G. (2019). Doble compresión del nervio mediano en el brazo. Revisión crítica de la bibliografía. [Double compression syndrome of the median nerve in the arm]. Revista De La Asociación Argentina De Ortopedia Y Traumatología, 84(4), 427-433. https://doi.org/10.15417/issn.1852-7434.2019.84.4.937
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Biografía del autor/a

Ignacio Rellán, Hospital Italiano de Buenos Aires, CABA, Argentina

Médico especialista en Cirugía de Miembro Superior en el Hospital Italiano de Buenos Aires, CABA, Argentina

Mariana Bendersky, Hospital Italiano de Buenos Aires, Argentina

Médica especializada en Neurologia Pediatrica en el Hospital Italiano de Buenos Aires, Argentina

Ezequiel Ernesto Zaidenberg, Hospital Italiano de Buenos Aires, Argentina

Médico traumatólogo especialista en Mano del Hospital Italiano de Buenos Aires, Argentina

Agustín Guillermo Donndorff, Hospital Italiano de Buenos Aires, Argentina

Médico traumatólogo especialista en Mano del Hospital Italiano de Buenos Aires, Argentina

Gerardo Luis Gallucci, Hospital Italiano de Buenos Aires, Argentina

Médico de planta del Servicio de Ortopedia y Traumatología del Hospital Italiano de Buenos Aires,  Argentina.

Pablo De Carli, Hospital Italiano de Buenos Aires, CABA, Argentina

Jefe de Servicio de Ortopedia y Traumatología en el  Hospital Italiano de Buenos Aires, CABA, Argentina

Jorge Guillermo Boretto, Hospital Italiano de Buenos Aires, CABA, Argentina

Médico de planta del Hospital Italiano de Buenos Aires, CABA, Argentina

Citas

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