All Double Crush Syndrome patients were assessed via VAS, BCTQ & Nerve conduction study before and after the treatment program.

The patients were classified randomly into two groups, the control group received a standard physical therapy program of nerve glide, hand strengthening exercise and mobilization and the study group they received a cervical mobilization in addition to the standard physical therapy program for 12 sessions.

Inclusion Criteria:

• Thirty female patients diagnosed as Double Crush Syndrome based on the clinical diagnostic criteria of the American Academy of Neurology, (American Academy of Neurology 2019).
• Patient ages ranged from 25 to 35 years old. Patient who reported pain, hyperesthesia, and/or paresthesia at the course of median nerve distribution and upper limb.
• A Nerve Conduction Study (NCS) evidence of peripheral entrapment of median nerve at level of carpal bone "Carpal tunnel Syndrome" with a fractionated sensory nerve conduction velocity for the median nerve across the wrist of 40 m/s or less and with sensory peak latency > 3.6 ms and recordable and with motor distal latency >4.4 ms and less than 6.5ms.

Exclusion Criteria:

• Patients had Systemic disease causes double Crush Syndrome as rheumatoid arthritis (RA), thyroid disease, Diabetes mellitus (DM), Pregnant women, Patients with concomitant neurological disease as peripheral neuropathy, Patients with history of wrist surgery, fracture, or carpal tunnel injection in the last two weeks before the study, Patients who have wasting of the thenar muscles, Patients with previous surgery for CTS.
• Patients with complete conduction block on EDX or previous regular exposure to hand-held vibrating tools, Patients with Nerve Conduction Study with motor distal latency > 6.5 ms.