A) Assessment & Differential Diagnosis Assessment Plan: 1. Subjective Examination: -Onset/Chronicity: Confirm timeline (2 months) and pattern of symptoms (transient vs constant). -Aggravating/Easing Factors: Clarify specifics of night pain and activities (e.g., gripping, typing, or repetitive wrist movements). -Impact: Investigate the effect of symptoms on daily function (teaching, ADLs, sleep). -PMHx: Previous neck, shoulder, or wrist injuries; diabetes, thyroid dysfunction (common comorbidities in CTS). 2. Objective Examination: -Cervical Spine: -Active/Passive ROM (focus on rotation, extension, lateral flexion for foraminal narrowing). -Spurlings Test: To reproduce radicular symptoms. -Neural Tension Testing (e.g., ULTT Median Nerve Bias). Wrist/Hand: -Carpel Tunnel Special Test: To assess carpal tunnel syndrome (CTS). -Palpation: Ganglion cyst size/location and tenderness at wrist. -Manual muscle testing: Assess grip strength and finger abduction (median nerve function). -Sensory testing: Dermatomes (C7 vs median nerve distribution). Differential Diagnosis: - Double Crush Syndrome (Cx foraminal narrowing + CTS). - CTS is supported by ultrasound findings and nocturnal symptoms. - Cervical radiculopathy is supported by CT findings at C6/7, affecting the C7 dermatome (middle finger). - possible ganglion cyst on both and just causing irritation??? - Thoracic Outlet Syndrome?? Last 2 are a long shot tbh treatment: - Cervical mobilizations (grade I-II) to reduce foraminal narrowing irritability. - Wrist mobilizations (carpal glides). - IASTM release of forearm flexors to reduce tension on the carpal tunnel. Rebooking - x1 weekly for 3-4 weeks - Then taper to fortnightly for another 4-6 weeks - Then transition to monthly checkups if needed

@Rulan Albarouki Why I think it’s Double Crush Syndrome is because the client has evidence of both CTS (ultrasound findings, nocturnal symptoms) and C7 radiculopathy (CT scan showing foraminal narrowing). Bilateral symptoms make DCS likely, as proximal nerve irritation (C7) can increase sensitivity to distal compression (carpal tunnel). CTS vs Cervical Radiculopathy? CTS is more likely because: 1. Classic nocturnal symptoms (worse at night, relieved by splinting). 2. Ultrasound findings of thickened median nerves confirm local compression. 3. Bilateral presentation is typical in repetitive-use injuries like hers. Cervical radiculopathy is less likely because: 1. Imaging shows left-sided narrowing but cant explain bilateral symptoms. 2. No consistent link to neck movements aggravating her symptoms.

it could be 2 answers: Bicep tendon: The long head of the biceps tendon runs through the bicipital groove at the front of the shoulder. During an overhand punch, the shoulder is placed into a combination of flexion, abduction, and external rotation, which can stress the biceps tendon. Repeated forceful motions or poor control during the punch can cause irritation or inflammation of the bicep tendon. Pain at the front of the shoulder, particularly during activities like lifting the hand to the head or pressing, most likely suggests tendon issues OR Supra/Subacromial Bursa Why? The supraspinatus tendon passes under the acromion, the positioning of an overhand right punch can compress the supra tendon and/or the subacromial bursa. You also mentioned hand behind back issues that’s why I’m thinking it would be subacromial issue but if I was to pick one maybe the bicep tendon

Great share. I do wet cupping and have found immense benefit using it for clients. Again like all modalities, it’s no miracle, but creates a window of opportunity to then get stronger by doing the rehab etc.

Great explanation 🙌🏻🙌🏻