By Michele S Jang ~

The term “Double Crush” was first described in journals by neurosurgeons and neurologists in the 20th century who found that the etiology of carpal tunnel syndrome involved irritation of the brachial plexus in the thoracic outlet.

The brachial plexus is a network of nerves which originate in your cervical spine and traverse through the thoracic outlet space formed by your neck and shoulder to serve your upper extremity.

Pressure on the thoracic outlet by tightened tissue or poor posture can cause irritation of the brachial plexus.  Forced movement of one’s arm to the outer ranges of motion can cause further irritation of the brachial plexus. The body’s natural response will be to then splint or limit range of motion range in order to prevent further irritation.

If the upper extremity is used in the outer ranges, the distal end of the brachial plexus, namely the Median nerve in the wrist becomes inflamed. The tunnel through which the Median nerve travels, becomes congested and compromised, leading to carpal tunnel syndrome.

The term “Double Crush” refers to the compression of the brachial plexus in two places, proximally as well as distally at the median nerve of your wrist.

Here are some common areas of proximal compression:

• Cervical spine fibrosis and nerve root irritation
• Compression between the middle and anterior scalenes
• Compression of the costo-clavicular joint space
• Tension in the pectoralis minor
• Tightness of the axillary tissue

When treating carpal tunnel syndrome, it is important to determine if a proximal “crush” is also contributing to your pain.  At Spirit Winds Physical Therapy, we utilize specific testing to determine areas of proximal involvement and employ the appropriate treatment to address them.  Exercises to further promote improved nerve glide and education pertaining to movement & postures that contribute to “Double Crush” are explored.

Michele S Jang, PT is a physical therapist who likes to look outside the box. She has been a physical therapist for over 21 years and has extensive training in manual therapy or the use of hands to help rehabilitate the body. Michele has been an instructor both in the United States and abroad. She offers Free Consults on Tuesday afternoons. Michele also has a team of therapists at Spirit Winds who offer an array of expertise on exercise, fall prevention, foot and shoe assessments, body mechanics and proper breathing technique to increase awareness and healing. Mi