Compressions du nerf médian dans la région du coude et de la partie proximale de l’avant-bras. À propos d’une série de 35 cas consécutifs

Abstract

Median nerve entrapment at the elbow and the proximal forearm represents 7 to 10 % of median nerve mononeuropathies. Literature distinguishes two distinct syndromes: the pronator syndrome and the anterior interosseous nerve syndrome. We report a retrospective series of 35 cases of proximal compression of the median nerve, including a previous study of 13 cases assessed in 2001. Thirty-four patients were operated on between 1994 and 2011. The series included 15 men and 19 women with a mean age of 57years. Subjective complaints were the main reason of consulting with or without a deficit. All but one benefited from a preoperative electrical study. Neurography showed abnormalities in 18 cases and myography in 30 cases. At least one site of compression was found at surgery. Thirty-one cases, including nine of the 13 cases previously evaluated in 2001, were assessed with a mean follow-up of 69months. Twenty-height considered them improved and all but one were objectively improved by surgery. The nine cases evaluated in 2001 had better results in 2011. Through this series and an exhaustive literature review, we concluded that there are no preoperative criteria that can differentiate a pronator teres syndrome from an anterior interosseous nerve syndrome. If no improvement occurs, surgical treatment should be proposed, one must then assess all potential sites of nerve entrapment. Patients must be informed that improvement can take several years.