Compression in the palmar region of the wrist that causes occlusion of the neurovascular structures as they pass under the retinaculum.
Normally the result of over use and can be compounded by poor ergonomics and posture and local swelling.
Signs and symptoms:
Pain into the wrist and fingers, and altered sensation into the same region (2 / 3 / 4th digits). Often stiff and sore in the morning, worse with activity and eased with rest. Altered sensation at night while sleeping, and shooting pains are often described as part of the presentation. Patients can also report cervical pain and increased neural tension into the affected upper limb, particularly in the median nerve distribution. Ribs 1 and 2 can also be involved with postural abnormalities and thoracic outlet type contributions are common.
Education regarding the management of local symptoms and improved ergonomics. Manual therapy to address contributing factors and for symptomatic relief. Assessment and treatment of upper limb neural dynamics as indicated. Work site and postural elements addressed through re-education and strengthening is paramount.
A gradual reduction in symptoms over a 6-8 week period with appropriate management and activity modification is typical. Cortisone injections or early specialist review may be prudent.