Double Crush Syndrome or Carpal Tunnel?

As mentioned in previous blogs, nerve compression can cause a number of different symptoms. Pins and needles, numbness, burning, weakness, pain and lack of sensation are all very typical descriptors for this type of condition. In the case of nerve compression (or a “pinched nerve” as many refer to it) there are various treatment options. Prior to determining the best treatment though, it is important to decipher the actual site of nerve compression. A treatment won’t be successful if it isn’t directed at the correct location!

Sites of Nerve Compression

Many patients present to our clinic with nerve compression in the wrist. This is often called carpal tunnel syndrome. The symptoms are similar to what was listed above (numbness, tingling and pain) but the discomfort is primarily located in the wrist and hand. Yet numbness, tingling and pain can also occur in the hand because of nerve compression higher up in the arm. Nerve compression can occur in the elbow, shoulder or neck for example. Common diagnoses for nerve compression conditions include carpal tunnel syndrome, lateral stenosis, cervical disc herniation and thoracic outlet syndrome. Interestingly, we’re not necessarily restricted to having just one location of entrapment. For some patients, they can have two sites of injury at the same time. This is often referred to as double crush syndrome.

Double Crush Syndrome Symptoms

Patients with double crush syndrome can experience a variety of symptoms. In addition to numbness, tingling, pins and needles and pain in the upper limb, a person can also experience headaches and neck pain (if the neck is involved). The patient with double crush syndrome can also display a variety of clinical signs, such as a slouched posture with a forward head. As mentioned, double crush syndrome involves two compression sites. An example of this could be a patient with carpal tunnel syndrome as well as having joint degeneration in the neck (which is also irritating and compressing the nerve). This can prove difficult for the practitioner to detect and diagnose.

Forward Head Posture

Forward Head Posture


In the above example, if the patient was simply diagnosed with carpal tunnel syndrome and compression in the neck was not discovered, it is unlikely that treatment solely directed at the wrist would be completely effective. Likewise, it would be unlikely for treatment in the neck to eliminate all the symptoms given the compression at the wrist. Therefore, it is paramount for the practitioner to thoroughly examine a patient and determine the areas of nerve compression. Logically, treatment should be targeted at the various sites of nerve compression.

Active Release Technique

One treatment option that our clinic uses for double crush syndrome is active release technique. Our active release practitioners have taken a specific active release nerve entrapment course, which focuses on the treatment of conditions like double crush syndrome. Adjunctive treatment options for double crush syndrome include spinal adjustments, joint mobilizations, exercise and postural advice to name a few. As with most conditions that present to our clinic, the best choice of treatment depends on a variety of factors specific to each individual patient. These can include severity of pain, previous treatments and patient preference for a given treatment option.

Double Crush Syndrome in the Literature

Interestingly, there is much still to be learned about double crush syndrome. There is controversy in the literature as to the physiological mechanism of two nerve compressions as well as the mere existence of the condition itself. Perhaps it can be said that as we wait for more information to be published, a prudent practitioner will assume the possibility of more than one nerve compression site. From this, examination and treatment should be tailored accordingly.

Do you think you have double crush syndrome?

Give us a call, we can help!



Huisstede BM et al. Carpal tunnel syndrome part 1 – effectiveness of nonsurgical treatments – a systematic review. Archives of Physical Medicine & Rehabilitation 2010; 91: 981-1004.

Miedany YE, Ashour S, Youssef S, Mehanna A, Meky FA. Clinical diagnosis of carpal tunnel syndrome: old tests-new concepts. Joint Bone Spine 2008; 75: 451-457.

Schmid AB, Coppeiters MW. Double crush syndrome – a Delphi study. Manual Therapy 2011; 16: 557-562.