Abstract
The syndromes treated in this chapter are the carpal tunnel syndrome (without surgery or after surgery) and less frequent injuries like compression at the level of the arcade of Struthers, the lacertus fibrosus, between the two fascicles of the pronator teres, or under the flexor digiti superficialis.
Rehabilitation of the entrapment syndromes of the median nerve without surgery only concerns the early stages of the nerve compression; more advanced stages require surgery. Its goal is to improve the tissue glidings around the nerve and the sensitivity of the damaged areas and to maintain the trophicity of the concerned muscles in advanced cases.
After surgery, the fight against perineural fibrosis is an important element of the treatment that must of course be adapted to the type of surgery.
Concerning the carpal tunnel, even if the prognosis is usually good without rehabilitation, deficits can appear due to biomechanical elements caused by the surgery:
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Palmar displacement of the flexor tendons by “bowstring” effect, transferring the constraints on the A1 pulley. This phenomenon can lead to a trigger finger after carpal tunnel surgery.
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Loss of the proximal fixation point of the thenar and hypothenar muscles, possibly causing a loss of strength.
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Possible hypertrophic healing of the flexor retinaculum, causing pillar pain and perineural fibrosis.
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Relative relaxation of the thenar muscle, which can decompensate a rhizarthrosis that already existed but wasn’t causing pain.
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Mesplié, G., Léger, O. (2015). Entrapment Syndromes of the Median Nerve. In: Hand and Wrist Rehabilitation. Springer, Cham. https://doi.org/10.1007/978-3-319-16318-5_13
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