Journal of Chiropractic Medicine
Volume 2, Issue 2 , Pages 66-74, Spring 2003

Case report: Myofascial pain syndrome: a double crush-like appearance

  • R. Kevin Pringle, DC

      Affiliations

    • Private Practice of Chiropractic, Houston, TX
    • Corresponding Author InformationSubmit requests for reprints to: Dr. R. Kevin Pringle, 4107 Pinebridge, Spring, TX 77388
  • ,
  • Daniel L. Richardson, PhD

      Affiliations

    • Professor, Department of Chiropractic Practice and Department of Biochemistry, Nutrition, National University of Health Sciences, Lombard, IL
  • ,
  • Robert S. Shiel, PhD

      Affiliations

    • Associate Professor, Department of Diagnosis, National University of Health Sciences, Lombard, IL

Received 6 September 2002

Abstract 

Objective

To discuss the case of a patient with myofascial pain syndrome that appeared similar to double crush syndrome.

Clinical Features

This is a case report of a 45-year old female who presents to the private practice clinic with the same signs and symptoms of carpal tunnel syndrome, 1 year post-carpaltunnel surgery. The history is consistent with injuries that result in double crush syndrome and thoracic outlet syndrome. The patient history includes a motor vehicle accident (MVA) in 1963 that resulted in a prolonged hospital stay and fracture of a cervical vertebral (C4) body. She fractured the olecranon process of the right elbow during a fall in 1970's. She has smoked approximately 1 pack a day for 20 years. Her job involves long periods of sitting at a keyboard and in a car. All of these portions of the patient history are possible factors in the clinical signs and symptoms of double crush syndrome.

Intervention and Outcome

Treatment involved chiropractic manipulation and physical therapy modalities for the elimination of pain and returning the patient's full range of motion in the wrist, elbow, shoulder and cervical spine. After range of motion was restored, a home exercise program was initiated. The home exercise program included a return to past sporting activity and active, resistive (Theraciser band) activities for the elbow and cervical spine. Also a reduction in smoking was initiated as part of the patient's treatment plan.

Conclusion

It is our contention that patients who have electromyographic (EMG) demonstrable carpal tunnel syndrome need a cervical spine workup and a period of conservative care to include skilled manipulation, physical therapy and home exercises before surgery is recommended.

Key Words:  Myofascial Pain Syndrome , Double Crush Syndrome , Manipulation , Botanical Therapies , Somatoform Disorders , Doctor-Patient Relations

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PII: S0899-3467(07)60045-7

doi:10.1016/S0899-3467(07)60045-7

Journal of Chiropractic Medicine
Volume 2, Issue 2 , Pages 66-74, Spring 2003