AANEM Connect

As a more junior neuromuscular colleague (having completed fellowship in 2025), I would really appreciate some assistance from the wider neuromuscular community. I have a 68 year old patient who has clinical features of bilateral ulnar nerve compression: atrophy of ADM and FDI bilaterally, with sensory loss in the bilateral ulnar nerve distribution, not extending into the forearm. Her job involves a signficiant degree of manual labour. NCS bilaterally: unobtainable ulnar SNAPs (antidromic), low ampltiude ulnar motor responses at the ADM and FDI, with some temporal dispersion in the BE and AE responses. No conduction block or focal slowing across the elbow. Median motor responses and median F-responses normal. Median and radial SNAPs normal. EMG of FDI showed fibrillation potentials and chronic neurogenic change. FPL and EIP, triceps and deltoid were all normal. Ulnar innervated FDPs were clinically not weak and normal on EMG. MRI of her C-spine shows "Bilateral moderate to severe foraminal stenosis at C7/T1 and foraminal perineural cysts, dynamic impingement of the C8 roots is suspected". I asked for imaging of the right arm and the following is reported "possibility of cubital tunnel pathology should be considered as there is a prominent osteophyte arising along the medial aspect of the elbow joint, impinging with into the cubital tunnel and displacing the ulnar nerve. There is mild thickening of the ulnar nerve with increased signal seen along the course of the proximal ulnar nerve, extending up to the level of the flexor carpi ulnaris heads". 

The surgeon is considering an ACDF, but I am wondering, based on the clinical and EMG findings, and now the MRI of the one arm, whether these findings can be explained by peripheral pathology alone (bearing in mind she has an almost identical presentation on the other side), or whether she may have a double crush syndrome. What more can I do to try and tease the two out? Any input would be much appreciated.