Sindrome compressiva del nervo mediano al muscolo pronatore rotondo

Abstract

The pronator teres syndrome is a rare compression neuropathy of the median nerve. In the antecubital region the nerve lies between the two heads of the pronator teres muscle. Many structures compress the nerve at this level: Struther’s ligament, bicipital aponeurosis, pronator teres, flexor digitorum superficialis, the accessory head of flexor pollicis longus and vascular structures. The distinctive physical findings are tenderness of the proximal part of pronator teres, worsened by resisted pronation of the forearm and flexion of the elbow, and numbness involving the middle and index fingers and the thumb. Electrodiagnostic studies can be very helpful but entirely normal findings cannot exclude the diagnosis. Patients with pronator syndrome should be managed first with nonoperative treatment. Patients who do not respond to such therapy are candidate to surgical decompression and neurolysis of the median nerve.