Clinical Decision-Making in a Patient with Cervical Radiculopathy and Cubital Tunnel Syndrome: Double Crush Syndrome

Background and Purpose: Double crush syndrome (DCS) is pathology involving the association between proximal and distal nerve lesions. It is often difficult to diagnose due to the variety of possible sources of tissue involvement and, therefore, is difficult to treat effectively. The purpose of this case report is to describe the physical therapy diagnosis and treatment of an older adult with DCS consisting of cervical radiculopathy (CR) and cubital tunnel syndrome (CuTS). Case Description: 74-year-old female with a diagnosis of CR was referred to physical therapy. The physical examination confirmed this diagnosis. Due to the patient not responding well to initial treatment, the PT decided to perform additional special tests, the results of which indicated possible L CuTS. A DCS, consisting of L CuTS as well as C7 CR was then confirmed by EMG/NCS results. Intervention: The patient’s treatment consisted of manual therapy, cervical strengthening, neurodynamic mobilizations, patient education, activity modification, and a home exercise program. Outcomes: The patient attained all of her therapy goals and was able to return to full participation of her normal activities without the limitation of pain. Discussion: This report highlights the successes and difficulties regarding the PT diagnosis and treatment of a patient presenting with DCS. Based on this case report, utilization of nerve mobilization tests are suggested to differentiate the likelihood of peripheral nerve involvement versus CR. Further research regarding the diagnosis of DCS and the conservative treatment of its potential components, especially CuTS, would be beneficial in improving the outcomes and the overall healthcare experience of patients with this diagnosis