September 2026

Two Things Can Be True

Besides “well, that depends,” my second favorite attorney phrase is “two things can be true.”

That came to mind at the OTLA convention, where I had several curbside conversations with attorneys between sessions. The questions were practical, specific, and exactly the kind that benefit from physician input early in a case.

One attorney described a client with a cyst compressing the cervical spinal cord. Surgery was delayed, and the client was left with permanent numbness and tingling in the hand. The other side’s position: this is just carpal tunnel syndrome.

But those two explanations are not interchangeable, and they are not mutually exclusive. Compression in the cervical spine can produce hand numbness and tingling that looks a lot like carpal tunnel, and spinal cord compression is a recognized mimic of it.  A nerve already irritated at the neck can also become more vulnerable to compression at the wrist, a concept known as double crush syndrome.

In a situation like that, nerve conduction studies and electromyography can help sort out where the symptoms are actually coming from: the spine, the median nerve at the wrist, or both.  That distinction drives causation, treatment, and how permanency is framed.

This is one of the practical advantages of working with a physician consultant early. Instead of waiting until the medical questions surface at deposition, you can get a clear read on what the records support, what additional workup would help, and how to evaluate competing explanations before positions harden.

 If a case on your desk raises a question like this, I am always happy to talk through it.

 P.S. If there is a topic you would like me to cover in a future newsletter, or you have feedback on this one, I would appreciate it. Please email me at info@pnwmdlegal.com.