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Several studies have shown that S1P plays a crucial role in tissue fibrosis [21] regulating different aspects, including the permeability of the vascular barrier, the recruitment of inflammatory cells, and the proliferation and differentiation of myofibroblasts, through the transactivation of the TGF-β signalling pathway [22]

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• Numbness limited to the hand • No neck pain • Symptoms worse at night • Positive wrist compression tests • Symptoms improve when shaking the hand • Neck stiffness or pain • Pain radiating from shoulder into arm • Weakness above the elbow • Symptoms triggered by neck movement • Shoulder blade discomfort Sometimes both conditions can occur simultaneously