Before any treatment can occur it is very important to get a thorough physical exam combined with a careful history of symptoms and physical health in order to get a correct diagnosis and therefore the correct treatment. Making a diagnosis can not be based on the symptoms alone. Included in the physical exam is “ruling out” all the other causes of hand/wrist pain and numbness. Very commonly we see patients who have “double crush” syndrome. Double crush is a condition where the nerve is compressed in the wrist but also somewhere else along its pathway such as the neck or shoulder. Therefore in all cases, the neck, shoulder and elbow should be carefully screened. In these cases if only the wrist was treated, complete recovery would not be possible.