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Pronator Syndrome

What is Pronator Syndrome?

Pronator syndrome is a constellation of symptoms caused by the entrapment of the median nerve at the elbow. The median nerve is one of the three nerves which supply sensory and motor function to the upper extremity. It runs the length of the arm beginning in the axilla, and its branches end in the fingers. In Pronator Syndrome, compression of the nerve occurs at the elbow. Entrapment of the median nerve can also occur at the wrist, causing Carpal Tunnel Syndrome, or at the forearm, causing Anterior Interosseous Nerve Syndrome.


What causes Pronator Syndrome?

Entrapment and compression of the median nerve results from swelling and inflammation of the structures surrounding the median nerve as it passes through the elbow. Risk factors for the development of Pronator Syndrome include hypothyroidism, diabetes, and activities which require pronation of the forearm, which is the act of rotating the forearm from a palms up to palms down position.


What are the symptoms of Pronator Syndrome?

Pronator syndrome typically causes an aching pain in the forearm. The hand muscles are weakened, and grip and fine motor movements may be affected. Numbness and tingling may occur in the thumb and index finger.


How is Pronator Syndrome Diagnosed?

In addition to a careful history, the physical exam often points to the diagnosis of pronator syndrome. Several maneuvers performed by the clinician during the physical exam will elucidate the exact cause of pronator syndrome. For example, if symptoms are reproduced when the elbow is flexed to 120 degrees against resistance, this is strongly correlated with median nerve compression by a structure known as the ligament of Struthers. Similarly, the clinician may attempt to compress the medial nerve at the elbow by pressing on it. If numbness and tingling is reproduced within 30 seconds, it is strongly suggestive of pronator syndrome.

An X ray of the elbow will be taken to rule out any bony abnormality which may be causing symptoms. Occasionally, MRI will be needed to obtain more detail about the soft tissues affecting the median nerve. Nerve conduction studies and electromyography are performed to confirm the diagnosis.


How is Pronator Syndrome Treated?

Non-Surgical

The vast majority of patients with pronator syndrome respond well to conservative treatment. Three to six months of rest from the offending activity, splinting, and use of NSAIDs to decrease inflammation under the watchful eye of a hand specialist may be all that is needed for symptoms to resolve.

Surgical

If motor deficits such as weakness or paralysis are noted on the physical exam, or if the patient does not respond to conservative methods, surgery may be needed to treat pronator syndrome. Surgery is aimed at decompressing the nerve at the exact area of entrapment. Postoperatively, a long arm splint is placed. Eight to ten days later, the splint is removed, sutures are removed, and the patient is transitioned to a removable splint. The splint is worn at night and during the day as tolerated for a minimum of two weeks. Physical therapy is prescribed and typically lasts two months.


How can Dr. Knight help your pronator syndrome?

Dr. Knight knows that pronator syndrome can be difficult to diagnose. With his years of experience in the treatment of peripheral nerve problems, he will take a careful history and perform a detailed examination to confirm the diagnosis. He will then begin conservative treatment. If necessary through minimally invasive techniques, he may need to relieve pressure on the nerve. No matter what the treatment needed Dr. Knight will return you to your active pain free lifestyle as quickly as possible.


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