Get PT First

A recent interaction with a past patient resulted in the patient getting PT first and a desirable outcome. Without PT intervention first, the outcome for the patient may have been far different. The patient initially went to his primary MD complaining of tingling into his thumb and first two fingers with no mechanism of injury. He was relatively sedentary over the winter and came back to the area and started playing golf. His primary MD thought this might be carpal tunnel syndrome and offered some nerve dulling medication and a wrist splint.

When wearing the splint he reported feeling better. Without the splint, he was not getting any better. His doctor recommended an orthopedic specialist MD, but the patient couldn’t be seen for several weeks. When initially the patient asked for a PT referral, his doctor refused.

How to Get PT

He shared this experience/interaction with me and asked for advice on how to get his doctor to write a PT referral. His primary doctor finally agreed.  

His primary doctor was correct that his symptoms were consistent with carpal tunnel syndrome, but an important piece to the puzzle was missing. Why would an older Medicare-age male suddenly develop carpal tunnel syndrome? The answer came when you listen to the patient. He was playing a fair amount of golf, which requires lots of neck motion. He was golfing for the first time in almost a year.

What PT’s Do

All patients when they present with hand and arm symptoms are screened by Physical Therapists to rule out symptoms that may be coming from the neck. So, upon special testing of the neck, called the quadrant or Spurling test, it revealed that when the neck was placed in the test position, it recreated the familiar pain down the arm and into the patient’s thumb and first two fingers. Special testing at the wrist also demonstrated a diagnosis of carpal tunnel syndrome.

So, which is it? The answer is both!

It is called double crush syndrome and it was determined that with the primary focus of treatment of the neck, his symptoms gradually were eliminated and he was able to wean off the meds and brace. The patient asked since he was essentially fully without pain and symptoms if he should see the specialist. My answer would normally be no,but since he was still struggling with another orthopedic problem, I suggested that he keep the appointment.

So, when asked at a follow-up appointment how his visit went, he stated he was able to get his other orthopedic problem addressed. He said he was given a steroid shot. The patient also shared that he told the doctor that PT was really helpful and the symptoms in his arm and hand disappeared with PT treatment. He was told that with carpal tunnel syndrome, the MD typically will not refer to rehab because it doesn’t help.

So, a couple of thoughts. What would have happened if the patient did not get referred to PT? What if he didn’t push for a PT referral? Would his symptoms have worsened over the three weeks he would have waited for the specialist to see him? Would the specialist have picked up that he had a double crush syndrome? Would it have resulted in unnecessary and expensive testing and treatment? Would it have resulted in surgery?

The next time you are not sure what to do, think PT first. Physical therapists train to treat orthopedic problems all over the body and have a broad area of expertise in many areas to help you avoid unnecessary and expensive treatment interventions.

Looking for a PT to evaluate your pains or issues, contact a highly skilled therapist at Freedom Physical Therapy Services.


Jeffrey Verhagen is the Clinical Operations Administrator for Freedom Physical Therapy Services. He is a manual therapist who graduated from the University of Wisconsin – Madison in 1990 with a Bachelor of Science in Physical Therapy.