Degenerative disc disease of the spine is the natural consequence of aging. It will, therefore, be present, at least radiographically, in most of the patients in whom we treat carpal tunnel syndrome. It is incumbent upon us as clinicians, to ensure that we make every effort to thoroughly examine each patient to ascertain which patients have a true and isolated carpal tunnel syndrome and which patients have a double crush component. Developing the habit of beginning our history and physical examination at the level of the neck is the most critical step in ensuring that we make the correct diagnosis.