Many patients with the carpal tunnel syndrome present with nocturnal paresthesia in the digits innervated by the median nerve, but atypical presentations are not uncommon. The combination of neck and wrist pain is a common complaint and the pain may be due to compression of the same nerve at two different levels -a "double crush" syndrome. Distinguishing a single lesion from a double lesion is important for effective treatment of the patients.

This study was done to identify the cases of carpal tunnel syndrome and median double crush syndrome with electroneurophysiological testing the patients with upper extremity complaints and also to assess the bilateral involvement of these syndrome.

We assessed the clinical findings, electroneurophysiological findings and teratment status of the 137 patients with pain and paresthesia is the digits, arm or neck from January 1989 to August 1992. The patients with direct nerve trauma and systemic diseases such as diabetes, hypothyroidism were excluded this time.

The diagnosis was established on the basis of abnormalities of distal median antidromic sensory latency at 14cm longer than 3.8msec, distal median motor latency longer than 4.2msec and needle electromyography of muscles of upper extremity and paracervical muscles.

The results were as follows;

1) Thirty four cases (24.82%) showed no abnormalities in electrophysiolgical testing, 55 cases (40.15%) were diagnosed as carpal tunnel syndrome, 42 cases (30.66%) were cervical radiculopathy, and 6 cases (4.38%) were double crush syndrome.

2) Bilateral involvement was 63.64% in the carpal tunnel group, and 100.0% in the double crush group.

3) The mean distal sensory were 2.90±0.29 msec in the control group, 2.95±0.37msec

in no abnormalities group, 6.08±2.16 msec in the carpal tunnel group, 2.99±0.31 msec in the cervical radculopathy group, and 5.60±2.16 msec in the double crush group.

4) the mean age of patients was 46 (17∼77)years. The proportion of female patients was higher in the carpal tunnel group as 87.27% and 66.67% in the double crush group than that of the cervical radiculopathy group as 11.9%.

5) Distal finger pain was dominant in the carpal tunnel and double crush groups but proximal neck and arm pain was common is the cervical radiculopathy group.

6) Medical and surgical treatment was done in 38.2% in no abnormalities group, 80.0% in the carpal tunnel group, 51.1% in the cervical radiculopathy group, and 100.0% in the double crush group but most of patients received anti-inflammatories.

Keywords :Carpal tunnel syndrome, Cervical radiculopathy, Double crush syndrome