Answers to Questions about Chiropractic:
What Is "Double Crush Syndrome?"

Samuel Homola, D.C.

Question

I went to see a chiropractor after suffering from very mild and intermittent carpal tunnel syndrome. Neck x-rays revealed that I had a worn disc between my 5th and 6th cervical vertebrae and my condition was diagnosed as "double crush syndrome." My chiropractor informed me that "we can do something about it" but it would require 40 appointments. Is it possible for a chiropractor to know from the outset how many appointments a patient will need?

When I asked the chiropractor whether he would be writing to my general practitioner about these findings, he replied "No, it's not necessary." Why would this be? Is this standard procedure?

Answer

True carpal tunnel syndrome stems from impingement or irritation of the median nerve in the wrist, usually affecting the thumb and first finger. Since some fibers of the median nerve are derived from the 6th and 7th cervical nerves, it's possible for the symptoms of carpal tunnel syndrome to be confused with nerve symptoms originating in the neck. When there is compression of the median nerve in the wrist as well as compression of the 6th or 7th cervical nerve in the neck, the overlapping symptoms are called "double crush syndrome," and require attention to both the wrist and the neck. A neurologist can determine whether the symptoms are originating in the wrist, the neck, or both, by using nerve conduction studies and needle electromyography to locate sites of damage and nerve root compression. Your chiropractor should be willing to send your records to a neurologist for a definitive diagnosis. If your neck is not at fault, it should be left alone.

Assuming that chiropractic treatment is appropriate, it is not possible to predict in advance how many sessions would be needed. Treatment should be discontinued when symptoms disappear or get worse. The chiropractor's reluctance to share information with your family doctor is improper.

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Dr. Homola is a second-generation chiropractor who has dedicated himself to defining the proper limits on chiropractic and to educating consumers and professionals about the field. His 1963 book Bonesetting, Chiropractic, and Cultism supported the appropriate use of spinal manipulation but renounced chiropractic dogma. His 1999 book Inside Chiropractic: A Patient's Guide provides an incisive look at chiropractic's history, benefits, and shortcomings. Now retired after 43 years of practice, he lives in Panama City, Florida.

This page was posted on July 18, 2002.