Nerve Entrapment Syndromes

may present with well-defi ned symptoms of ulnar nerve compression at the elbow; electrical studies, however, may have normal results in the ulnar nerve but reveal changes of carpal tunnel syndrome (which may be either subclinical or less symptomatic to the patient). Post-traumatic thickening of the brachial fascia in the distal arm can produce a simultaneous median and lateral antebrachial nerve compression. When more than one nerve is suspected in the neural compression process, a more proximal lesion such as the brachial plexus, must be ruled out as the site of the pathologic process. 2. A nerve can be compressed at more than one level; that is, a “double crush” lesion may exist. This most commonly occurs at the neck and the wrist but can also occur at other locations such as the thoracic outlet and the cubital tunnel. 3. Two separate neurologic processes may coexist. For example, a patient who is wheelchair-bound from a syrinx may develop hand atrophy, which represents new bilateral ulnar nerve compression rather than progression of the syrinx. Thus, on occasion, it is necessary to direct one’s conservative or surgical attention to two nerves, two sites on one nerve, or even two neurologic conditions to address the patient’s presenting symptoms and new neurologic fi ndings.