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Posted on 09-01-2016

Double- Crush Syndrome

Most people with carpal tunnel syndrome think they have a primary problem in the wrist.  While the wrist and hand may be the site of most of your symptoms, the cause can lie elsewhere.  When the vertebrae in your neck are slightly twisted, or if there is a disk injury present, this can narrow the tunnels in your neck where nerves pass through.  When this occurs and there is also a problem with compression at the wrist, it is called double-crush syndrome.  Double meaning the nerves are pinched at two locations.

Double-crush syndrome is not uncommonly seen in clinical practice.  It was first described by Upton and McComas and published in Lancet in 1973.  They found 81/115 cases of carpal tunnel syndrome where there was associated cervical radiculopathy (symptoms radiating from the neck) as well. 

Because carpal tunnel syndrome, arm, and hand pain can have more than one area of pressure creating the symptoms, a thorough neck examination needs to be done.  Otherwise, a misdiagnosis can be given and lead to inappropriate treatment because the cause is not being addressed.

Conservative care can be helpful in the case of double-crush syndrome, as identification of each entrapment site is of great importance.  In a case report in Journal of Manipulative Physiological Therapeutics by Mariano et al., chiropractic management was found to be helpful in the treatment of double-crush syndrome.  The patient had both cervical radiculopathy and carpal tunnel syndrome documented by needle EMG exam.  The patient was treated with chiropractic adjustments, adjunctive physiotherapy and wrist splints with good results.

It has been my experience to frequently encounter a double-crush syndrome associated with post whiplash injuries and those who perform repetitive actions with their arms and hands.  A common problem with prolonged computer use.  Point tenderness in the muscles of the neck and shoulders, and around the elbow area, along with hands falling asleep at night or a loss of grip strength, are all sings of double-crush syndrome.  It has also been my experience, as well as Mariano et al., that double-crush syndrome can and does respond to chiropractic management that includes: spine and upper extremity adjustments, specific muscle release techniques (massage), postural awareness training and exercises along with specific stretches done on a regular interval during the day.  I call this the “30/30 rule”: a 30 second break is done every 30 minutes.

In order to identify if you or someone you know suffers from Double-Crush Syndrome, we are offering an opportunity for a Free, NO Charge/NO Obligation Consultation to find out if our comprehensive program may be right for you.

-Dr. Daniel Lehoux, D.C.

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