Dextrose hydrodissection with ultrasound-guided as optional therapy in pronator teres syndrome: A case report

Yusak Mangara,Tua Siahaan

doi:10.31579/2690-8808/078

Abstract

Pronator teres syndrome (PTS) is a rare peripheral neuropathy of the proximal median nerve that occurs due to compression of the pronator teres muscle or its surrounding anatomical structures. Treatment options in cases of pronator syndrome include conservative therapy (oral, physical, intervention) to surgical therapy. Dextrose hydrodissection with ultrasound guided is an interventional therapy option in cases of peripheral neuropathy. This study presented a case of 50 year old female with chronic pronator teres syndrome who received ultrasound-guided 5% dextrose hydrodissection therapy and experienced satisfactory resolution within 6 months of post injection evaluation.

Highlights

Pronator teres syndrome (PTS) or pronator syndrome is a syndrome of irritation of the proximal median nerve that occurs due to compression of the pronator teres muscle or the surrounding anatomical structures. [1][2][3][4] Pronator syndrome is included in a variety of cases of peripheral neuropathy of the median nerve that rarely occurs compared to the others, such as carpal tunnel syndrome (CTS) and anterior interosseous nerve syndrome (AINS)
This is in line with other studies, which reported that the distribution of cases of median compression was dominated by CTS (88.2%) in the distal part followed by the proximal part (PTS and AINS) of 11.8%. [3][5] PTS generally occurs in the fifth decade with female dominance. [3]
The clinical manifestation of PTS is pain in the anterior aspect of the forearm that is triggered by repetitive activities such as pronation or supination of the forearm and flexion of the fingers associated with occupation and habits. [3][6] This repetition results in hypertrophy of the muscles and the narrowing of the tunnel, where median nerve passes, leading to compression that will trigger neural inflammation leading to demyelination and perineural fibrosis. [2][3][6] Other symptoms found in PTS are paresthesia or numbness of the fingers 1,2,3 and lateral aspect of the 4th finger and numbness of palm according to the branching of the median nerve

Summary

Introduction

Pronator teres syndrome (PTS) or pronator syndrome is a syndrome of irritation of the proximal median nerve that occurs due to compression of the pronator teres muscle or the surrounding anatomical structures. [1][2][3][4] Pronator syndrome is included in a variety of cases of peripheral neuropathy of the median nerve that rarely occurs compared to the others, such as carpal tunnel syndrome (CTS) and anterior interosseous nerve syndrome (AINS). [2] In one study, the prevalence of pronator teres syndrome was mentioned in only 5% of all cases of median nerve neuropathy. Hydrodissection therapy is an injection technique that involves injecting fluid (hydro) to release the nerve clamp (dissection) due to adhesions or obstruction of the surrounding tissue With ultrasound guidance, this technique is considered safe and effective, especially in cases of nerve clamping, including PTS. With the patient's consent, a long-axis perineural ultrasound-guided injection of the median nerve with 5% dextrose is performed periodically (2x, 2 week intervals) by a certified neurologist. This procedure begins with positioning patient’s elbow being extended). The clinician uses a high-frequency linear transducer with a long-axis approach and points the needle from distal to proximal to perform hydrodissection This needle placement aims to inject dextrose around the median nerve. The NRS and Quick-DASH assessment after 3 months showed good results with NRS 0 and Quick-DASH of 8.25%

Discussion

Findings

Conclusion