Double Crush Syndrome and Upper Cervical Chiropractic Treatment

by Son PMR(Physical medicine & Rehabilitation ) & Chiropractic Clinic in Seoul

Patient Case Study

 Mr. A, a 40-year-old office worker, had been experiencing persistent neck stiffness and pain for several months. Initially, he assumed it was simple muscle tension, but over time, he began to notice tingling and numbness in his hands. The symptoms worsened when he worked on a computer for long hours, and he also experienced swelling and stiffness in his hands upon waking in the morning.

After visiting a hospital, Mr. A was diagnosed with Double Crush Syndrome, a condition where both cervical nerve compression (cervical disc issues) and carpal tunnel syndrome (median nerve compression at the wrist) occur simultaneously.

What is Double Crush Syndrome?

Double Crush Syndrome is a condition where a nerve is compressed at two or more points along its pathway, leading to symptoms.

✔ Cervical nerve compression disrupts nerve conduction, making the median nerve at the wrist more susceptible to compression.

✔ Carpal tunnel syndrome occurs when the median nerve is compressed at the wrist, leading to tingling and sensory disturbances.

Thus, when cervical disc compression and carpal tunnel syndrome coexist, treating only one area may not be sufficient for full symptom relief.

Causes of Double Crush Syndrome

✅ Upper cervical misalignment (C1, C2 issues) → Leads to impaired nerve function and increased neural compression

✅ Cervical nerve compression (cervical disc herniation, stenosis, straight neck, etc.) → Nerve dysfunction at the neck weakens peripheral nerve resilience

✅ Carpal tunnel syndrome → Median nerve compression at the wrist

✅ Increased use of computers and smartphones → Prolonged use raises the risk of nerve compression

✅ Poor posture (forward head posture, shoulder tension) → Increases strain on the cervical spine and wrists

✅ Chronic conditions (diabetes, thyroid disorders, etc.) → Leads to overall nerve dysfunction

Key Symptoms of Double Crush Syndrome

✔ Neck pain and stiffness → Worsens when extending the neck backward or holding certain postures

✔ Hand tingling and sensory disturbances → Fingers feel numb or have reduced sensation

✔ Weakness in the wrist and fingers → Difficulty gripping small objects or maintaining a firm grip

✔ Increased nighttime symptoms → Tingling hands may cause sleep disturbances

✔ Posture-related symptom aggravation → Symptoms worsen when the neck is extended or held in a fixed position

Diagnosis of Double Crush Syndrome

🔹 Physical examination → Identifying nerve compression at the wrist and elbow

🔹 Cervical spine imaging (MRI, X-ray, etc.) → Assessing cervical nerve compression

🔹 Nerve conduction study (NCS) and electromyography (EMG) → Evaluating nerve damage

🔹 Postural and alignment assessment → Checking for misalignment in the upper cervical spine (C1, C2) and spinal structure

Treatment Options for Double Crush Syndrome

1) Upper Cervical Chiropractic Care

When the C1 and C2 vertebrae are misaligned, nerve function is impaired.

✔ Chiropractic adjustments can restore proper cervical alignment, improving nerve conduction and promoting peripheral nerve recovery.

✔ Correcting cervical alignment reduces nerve compression in the neck, wrist, and arm, alleviating symptoms.

2) Injection Therapy and IMS for Nerve Recovery

✅ Ultrasound-Guided Nerve Injection (Increased Precision & Safety)

  • Using ultrasound imaging, injections can accurately target compressed nerves.

  • Effective for cervical nerve compression, carpal tunnel syndrome, and cubital tunnel syndrome.

  • Reduces inflammation and swelling around the nerves, alleviating compression.

✅ Blind Nerve Injection Therapy (Fast Procedure)

  • Experienced physicians use palpation techniques to locate nerves and administer injections.

  • Quick and effective for cervical radiculopathy (cervical disc herniation, stenosis) and peripheral nerve entrapment syndromes.

✅ IMS (Intramuscular Stimulation) Therapy

  • Relaxes overactive muscles, improving blood circulation and nerve function.

  • Beneficial when tight neck and shoulder muscles contribute to nerve compression.

  • Relieves soft tissue tension in the wrist, elbow, and shoulder to reduce peripheral nerve compression.

✅ Peripheral Nerve Injections

  • Direct treatment for carpal tunnel syndrome and cubital tunnel syndrome.

  • Helps improve symptoms of hand tingling and sensory disturbances.

3) Nerve Mobilization Exercises & Rehabilitation Therapy

🔹 Median nerve stretching (for carpal tunnel syndrome patients)

🔹 Ulnar nerve stretching (for cubital tunnel syndrome patients)

🔹 Cervical nerve stretching

4) Lifestyle Modifications & Supportive Devices

✅ Managing computer and smartphone use → Adjusting workstation ergonomics, using wrist supports

✅ Wrist splints → Helps prevent and alleviate carpal tunnel syndrome symptoms

✅ Proper pillow usage → Maintains optimal neck alignment to reduce nerve compression

5) Considering Surgical Treatment When Necessary

If conservative treatments (chiropractic care, injections, IMS, and exercises) fail to provide sufficient relief, nerve decompression surgery may be necessary.

However, surgery is a last resort, as most patients experience symptom improvement through non-surgical treatments.

Key Takeaways for Treating Double Crush Syndrome

✔ Double Crush Syndrome involves nerve compression at multiple sites, making it ineffective to treat only one location.

✔ A comprehensive approach combining upper cervical chiropractic care, nerve mobilization exercises, ultrasound and blind injections, and IMS therapy is most effective.

If you experience persistent neck pain and hand tingling like Mr. A, it may not just be carpal tunnel syndrome—it could be Double Crush Syndrome.

For ongoing nerve compression issues, a precise evaluation and customized treatment plan are essential. We are here to help you relieve nerve compression and improve your quality of life!

👍Consultation and Appointment Information

Son PMR & Chiropractic Clinic( 2nd floor, 229-1 Gucheonmyun-Ro, Gangdongu, Seoul, South Korea) 

by  Dr Son MD & DC 
Contact: 02-482-8875 in Seoul( +82-2-482-8875)

chson@daum.net

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