WHAT YOU SHOULD KNOW
Pronator syndrome is compression of the median nerve by the forearm muscles. This is the same nerve as in carpal tunnel syndrome. The difference besides location is that with muscular compression of the nerve is an on and off phenomenon occurring with use of the forearm muscles for powerful gripping and especially twisting activities.
MEDICAL HISTORY
Patients complain of a deep ache in the forearm with radiation down towards the wrist and hand. Numbness and tingling can occur in the thumb, index, long, and ring fingers. Patients often feel weak, and symptoms are made worse with forceful gripping and twisting.
EXAMINATION
Compression added over the forearm muscles by the examiner or forceful contraction of the muscles may reproduce pain, numbness, or tingling. The doctor will test the functions of the nerve for strength and feeling ability.
ADDITIONAL TESTS
None are needed. Electrical nerve tests will routinely be normal in this form of muscular nerve compression as opposed to carpal tunnel and cubital tunnel syndromes.
TREATMENT OPTIONS
| NON-OPERATIVE | SURGICAL RELEASE | |
| CONSISTS OF | Stretching and ergonomic training | Eliminating bands in the muscle that trap the nerve |
| FEATURES | Makes the muscle group more elastic with less pressure on nerve | Short incision, outpatient, immediate use for light activities |
| ADVANTAGES | Avoids surgery | Definitive solution to problem |
| DISADVANTAGES | Only works on mild cases | Temporary period of weakness where arm cannot be used for heavy activity |
RECOVERY
Light everyday activities are allowed immediately. Sutures are removed in the office at 2 weeks. Rehabilitation begins soon after surgery with the same stretching exercises done during the non-operative treatment program. Strengthening comes next along with endurance as the patient prepares to return to heavy activities. Powerful use of the arm doesn’t usually occur until several months after surgery as the healing tissues become more mature.
