Pronator Syndrome Research Articles

The Prevalence of Pronator Teres Syndrome among Male and Female with Type II Diabetes Mellitus

Background: Pronator Teres Syndrome (PTS) is a condition characterized by the entrapment of the median nerve at the elbow, often resulting in pain, numbness, and weakness in the forearm and hand. While the relationship between diabetes mellitus and peripheral neuropathies is well-established, the prevalence of PTS in individuals with Type II Diabetes Mellitus and its correlation with gender remains underexplored. Objective: The study aimed to determine the prevalence of PTS among patients with Type II Diabetes Mellitus and to investigate the potential correlation between PTS and gender. Methods: This cross-sectional study included 100 participants (50 males and 50 females) with Type II Diabetes Mellitus, recruited from a tertiary care facility in Sindh over a six-month period. Participants were subjected to the resisted pronation/supination test to diagnose PTS. Data were analyzed using SPSS version 25, with the Chi-square test applied to examine the correlation between PTS prevalence and gender. A p-value ≤ 0.05 was considered statistically significant. Results: Of the 100 participants, 45 tested positive for PTS, with a slightly higher prevalence among females (24) compared to males (21). However, the statistical analysis revealed no significant correlation between PTS prevalence and gender (p-value = 0.546). The age distribution of participants showed a broad range, with the highest frequency in the 40 to 45 years and more than 60 years age groups, each constituting 22% of the sample. Conclusion: The study concludes that there is no significant correlation between the prevalence of PTS and gender among patients with Type II Diabetes Mellitus. These findings suggest that PTS affects males and females with Type II Diabetes Mellitus equally, indicating that gender does not play a discernible role in the prevalence of PTS within this population.

Accessory head of flexor carpi radialis and abnormal course of the median nerve in the forearm

Background: The median nerve anatomy and its clinical presentation are crucial for surgeons to consider avoiding iatrogenic injury and performing effective surgical interventions. Case Description: An atypical presentation of median nerve anatomy proximal to the carpal tunnel was found during cadaveric dissection. The median nerve was located deep to a uniquely double-headed flexor carpi radialis and curved medially around the tendons of the forearm to enter the carpal tunnel superficially. Conclusion: The atypical presentation of median nerve anatomy can assist surgeons in adverse event reduction during surgeries such as carpal tunnel and pronator teres syndrome releases.

Pronator Syndrome and other Nerve Compressions that Mimic Carpal Tunnel Syndrome a Case Report and Literature Review

The resolution of small to intermediate-sized anomalies affecting the craniofacial region can pose a formidable problem Proximal neuropathy of the median nerve (MN) is a relatively rare condition, accounting for approximately 1% of all compressive neuropathies affecting the upper limb. The existing body of literature documents two distinct clinical presentations, which are based upon the location of entrapment. These presentations are commonly referred to as pronator teres (PT) syndrome and anterior interosseous nerve (AIN) syndrome. Pronator teres syndrome, also known as median nerve compression in the upper forearm, manifests as a constellation of clinical manifestations and indications. Carpal tunnel syndrome is a dynamic condition that is commonly characterized by the compression of the median nerve within the carpal tunnel. Although relatively uncommon when compared to carpal tunnel syndrome, pronator syndrome and anterior interosseous nerve syndrome are conditions involving compression of the proximal median nerve. These conditions may be considered as potential diagnoses when a patient with carpal tunnel syndrome does not show improvement following conservative or surgical treatment. The process of differential diagnosis primarily relies on the evaluation of symptoms, the analysis of paresthesia patterns, and the identification of distinct patterns of muscle weakness. Initial management of all patients should primarily involve nonsurgical treatment modalities. However, it has been demonstrated through empirical evidence that surgical intervention may produce favorable outcomes. Many surgical methodologies have been established, with the majority of outcome data derived from retrospective case series. A full comprehension of the anatomical structure of the median nerve, possible points of compression, and distinctive clinical manifestations of carpal tunnel syndrome (CTS) is imperative for physicians in order to correctly identify and successfully manage their patients.

Effectiveness of ultrasound-guided perineural hydro-dissection with 5% dextrose for pronator teres syndrome: a case series

Pronator teres syndrome (PTS) is s a proximal compressive neuropathy of the median nerve at the elbow level by the pronator teres muscle leading to pain and numbness in the area of the nerve distribution. Conservative treatment may be effective in 50-70% of cases with extremity rest and non-steroidal anti-inflammatory drugs, corticosteroids, and surgical decompression. Dextrose perineural hydro-dissection under ultrasound guidance is an interventional therapeutic option in cases of peripheral neuropathy due to nerve entrapment. This is a serial case study investigating the efficacy of dextrose perineural hydro-dissection for long-term pain relief in PTS. A numeric rating scale (NRS) and Quick-DASH (Quick-Disability of the Arm, Shoulder and Hand) were used to evaluate pre- and post-treatment states with ultrasound-guided 5% dextrose hydro-dissection therapy. All patients experienced satisfactory resolution on evaluation twelve months after treatment. In long-term evaluation, dextrose perineural hydro-dissection exhibits good clinical and functional outcomes for patients with PTS.
 Abbreviations: CTS - carpal tunnel syndrome; HD - hydro-dissection; NRS - numeric rating scale; PTS - Pronator teres syndrome; Quick-DASH - Quick-Disability of the Arm, Shoulder and Hand
 Key words: Pronator Syndrome; Pain; Perineural Hydro-Dissection; Median Neuropathy
 Citation: Tua Siahaan YM. Effectiveness of ultrasound-guided perineural hydro-dissection with 5% dextrose for pronator teres syndrome: a case series. Anaesth. pain intensive care 2023;27(5):607−613; DOI:
 10.35975/apic.v27i5.2318
 Received: July 11, 2023; Reviewed: August 27, 2023; Accepted: August 27, 2023

Clinical features and surgical treatment of combination of pronator teres syndrome and carpal tunnel syndrome

Objective: To determine the effectiveness of surgical interventions aimed at decompression of the median nerve (MN) in the carpal tunnel and pronator teres canal, in combination with carpal tunnel syndrome (CTS) and pronator teres syndrome (PTS). Materials and methods: The results of surgical treatment of patients with a combination of CTS and PTS were analyzed, a total of 20 observations. The analysis of the results was evaluated according to: the Boston Questionnaire (BCTQ), namely, symptoms severity scale - SSS (minimum 1 point, maximum 5 points) and functional severity scale - FSS (minimum 1 point, maximum 5 points), the Bishop Score, visual analogue scale (VAS). Results: All operated patients (100%) experienced a significant regression of the main manifestations of the disease on the first day after the operation. Paresthesia in the fingers of the hand decreased, the sensitivity in the MN dermatome improved significantly, and sleep improved. The average indicators after surgery on symptoms severity scale (SSS) were 1.3 points, on functional severity scale (FSS) - 1.4 points, visual analogue scale - 2 points. The assessment of treatment results according to the Bishop Score in the postoperative period, that is, at the time of discharge (3 days after surgery), was an average of 10 points. Conclusions: Decompression of the MN in the area of the carpal tunnel and pronator teres is an effective method of treatment for the combination of CTS and PTS. A positive effect in the form of a regression of pain syndrome, sensitivity disorders and an increase in strength in the hand is observed already in the early postoperative period. Scores on BCTQ and VAS improve by more than 50%.

Radial Tunnel Syndrome: Review and Best Evidence.

Radial tunnel syndrome (RTS) is caused by compression of the posterior interosseous nerve and consists of a constellation of symptoms that have previously been characterized as aspects of other disease processes, as opposed to a distinct diagnosis. First described in the mid-20th century as "radial pronator syndrome," knowledge regarding the anatomy and presentation of RTS has advanced markedly over the past several decades. However, there remains notable controversy and ongoing research regarding diagnostic imaging, nonsurgical treatment options, and indications for surgical intervention. In this review, we will discuss the anatomic considerations of RTS, relevant physical examination findings, potential diagnostic modalities, and outcomes of several treatment options.

Value of High-Frequency Ultrasound in the Diagnosis of Pronator Teres Syndrome

Objective To investigate the clinical value of high-frequency ultrasound in the diagnosis of pronator teres syndrome (PTS). Methods The high-frequency ultrasound was employed to examine and measure the median nerve of the pronator teres muscle in 30 patients with PTS and 30 healthy volunteers (control group).The long-axis diameter (LA),short-axis diameter (SA) and cross-sectional area (CSA) of the median nerve were measured.The receiver operating characteristic curve of the median nerve ultrasonic measurement results was established,and the area under the curve (AUC) was calculated.The diagnostic efficiency of each index for PTS was compared with the surgical results as a reference. Results The PTS group showed larger LA[(5.02±0.50) mm vs.(3.89±0.41) mm;t=4.38,P=0.013],SA[(2.55±0.46) mm vs.(1.70±0.41) mm;t=5.19,P=0.009],and CSA[(11.13±3.72) mm2 vs.(6.88±2.68) mm2;t=8.42,P=0.008] of the median nerve than the control group.The AUC of CSA,SA,and LA was 94.3% (95%CI=0.912-0.972,Z=3.586,P=0.001),77.7% (95%CI=0.734-0.815,Z=2.855, P=0.006),and 78.8% (95%CI=0.752-0.821,Z=3.091,P=0.004),respectively.With 8.63 mm2 as the cutoff value,the sensitivity and specificity of CSA in diagnosing PTS were 93.3% and 90.0%,respectively. Conclusion High-frequency ultrasound is a practical method for diagnosing PTS,and the CSA of median nerve has a high diagnostic value.

Lacertus Syndrome: an Outcome Analysis After Lacertus Release

The lacertus fibrosus or bicipital aponeurosis is a sheet of ligamentous tissue just distal to the elbow joint and can be a compression point for the median nerve. Essentially, lacertus syndrome is a subset of pronator syndrome and an uncommon diagnosis by itself. Surgical release of the lacertus consists of a small 2-cm incision that can be performed under local anesthesia. This study aimed to evaluate the outcome of lacertus release in resolving median nerve symptoms. This retrospective study was performed at Prince Court Medical Centre, Kuala Lumpur, Malaysia, from January 2020 until June 2021. Ninety-three patients who presented with numbness of fingers, hand, or upper limb; forearm pain; and muscle weakness. They were diagnosed with lacertus syndrome on the basis of local tenderness at the lacertus fibrosus with either weakness of flexor pollicis longus and flexor digitorum profundus of the index finger or paresthesia over the thenar eminence. The patients underwent 3 months of hand therapy, and those with no symptom improvement were offered lacertus release performed by a single surgeon. The surgical technique consists of a surgical incision starting from a point 2 cm distally and 2 cm radially to the medial epicondyle. The incision projects 2 cm distally in an oblique fashion toward the radial styloid. A wide-awake local anesthesia no tourniquet (WALANT) technqiue was utilized and 20 mL of local anesthesic was injected subcutaneously around this region at least 20 minutes before the surgery. Careful dissection was made subcutaneously, and the lacertus fibrosus was identified as a thickened, shiny white structure and released. The Quick Disabilities of the Arm, Shoulder, and Hand (QuickDASH) score, grip strength, and pinch strength were tested before and after surgery. At 6 months after surgery, the QuickDASH score was again assessed with a WALANT satisfactory questionnaire. A total of 93 patients were included in the study. The mean age of the patients was 38.7 years, and most were women (77.4%). The mean operating time was 70 minutes. The mean preoperative QuickDASH score was 53, which significantly reduced immediately after surgery to 7.8 (P < .001) and remained low at 6 months after surgery (10.6). The mean grip strength showed a significant increase from a preoperative mean of 16 kg to a postoperative mean of 24 kg (P < .001). Pinch strength also significantly increased from a preoperative mean of 9 kg to 13 kg after surgery (P < .001). Lacertus syndrome remains an underdiagnosed disease that can be treated efficiently with a directed minimal surgical incision under wide-awake local anesthesia. Lacertus release appears to significantly reduce pain and numbness with markedly improved hand grip and pinch strength. The corresponding QuickDASH scores also improved significantly after surgery. This study is vital to our understanding of proximal median nerve entrapment and to accurately diagnose it. Therapeutic III.

Early and delayed surgical management of the pronator teres syndrome. Selective reinnervation of the anterior interosseous nerve aimed to restore pinch grip among patients with late clinical presentation

Background. The incidence of pronator teres syndrome (PTS) is low. The misdiagnosis leads to delay in surgical treatment and irreversible changes not only within the median nerve (MN) itself, but within the sensory and muscular apparatus as well.Objective: to compare the outcomes of early and delayed surgical management of PTS; to compare the restoration of the pinch grip (PG) after decompression and reinnervation (nerve transfer, NT) of the anterior interosseous nerve (AIN) vs. decompression of MN alone in late terms of the disease (PTS).Materials and Methods. Six patients with verified PTS were included into the study. Three patients with the history of the disease (HoD) less than 3 mos. received surgical decompression (SD) of MN under standartized methodology alone. Another three patients with the HoD more than 3 mos. received SD of MN, with two of them received simultaneous NT of the branches of the radial or MN to AIN. In all patients sensory and motor deficit (function of "extrinsic"and "intrinsic"muscles), intensity of the neuropathic pain, both pre- and post-surgery have been evaluated according to MRC Scale and VAS, respectively. An ability to reproduce PG, or “OK” sign, with help of the thumb (flexor pollicis longus muscle – FPL) and index finger (deep flexor muscle – FDP2) were evaluated.Results. All patients showed complete relief of the neuropathic pain (VAS0) regardless of the terms of the disease. Three patients with HoD less than 3 mos. showed good recovery of FPL, FDP2 (M4-5) – all patients were able to reproduce "OK" sign. One patient with HoD more than 3 mos. after SD of MN alone showed no recovery of FPL, FDP2 (M0-1). Another two patients with the HoD more than 3 mos. showed good recovery of FPL and FDP2 (M3-4) after NT to AIN. No patient with HoD more than 3 mos. was able to reproduce "OK" sign.Conclusions. Early decompression of MN in PTS cases results in complete relief of the sensory and motor neurologic deficit; late decompression of MN in PTS cases does not lead to relief of the sensory deficit within NCP autonomous area, while the prognosis of the recovery of the median nerve innervated “extrinsic” and “intrinsic” muscles is rather unfavorable; In case of late PTS presentation, NT to AIN allows restoring only a single component ("extrinsics") of the motor functions of the hand which are required for the succesfull reproduction of the pinch grip; In case of late PTS presentation, poor recovery of OP should be expected, hence the succesfull reproduction of the pinch grip due to the thumb hyperadduction would be impossible; carefull interpretation of the clinical, radiological and electophysiological data on the pre-surgical stage could potentially help avoiding the misdiagnosis and improve the outcomes of the surgical treatment in all cases of a single or multilevel MN entrapment.

Muscle Activity Characteristics of the Pronator Teres during Throwing in Baseball Pitchers: A Pilot Study.

The pronator teres muscle is a major dynamic stabilizer of elbow valgus stress during throwing. This study aims to investigate pronator teres muscle activation during breaking ball pitching in baseball pitchers. Twelve male college baseball players with more than eight years of baseball experience were included in this study. A wireless surface electromyography (EMG) system was used to measure the activation of the forearm muscles and record EMG data during fastball and curveball pitching. Peak pronator teres muscle activation during curveball pitching was greater than that during fastball pitching (p = 0.03). There was no difference in the muscle activation of the other forearm muscles (p > 0.05). These results indicate that increased muscle activity in the pronator teres may contribute to stiffness and induce pronator teres syndrome or medial elbow injuries related to the overuse of the pronator teres, especially during curveball pitching. Controlling curveball throws contributes to player coaching and conditioning for the prevention of elbow joint disorders and pronator teres syndrome.

Morphometric Parameters of the Fibrous Arch of Flexor Digitorum Superficialis: A Cross-sectional Cadaveric Study in the Indian Population

Introduction: The Flexor Digitorum Superficialis arch (FDS arch) serves as a connection between the humero-ulnar and radial heads of the FDS muscle. This arch can potentially compress the median nerve, leading to the development of pronator syndrome. Aim: To describe the morphometric parameters of the FDS arch in the Indian population. Materials and Methods: A two-year cross-sectional cadaveric study was conducted at the Department of Anatomy, Christian Medical College, Vellore, India, from December 2018 to November 2020. Thirty-four forearms from 17 adult cadavers (8 male and 9 female) were included in the study after excluding those with forearm deformities caused by trauma, congenital malformations, or scars. Measurements were taken for the distance from the medial epicondyle to the apex of the FDS arch and the thickness of the arch. The type of FDS arch (tendinous or muscular, distinct or indistinct) was also observed. Descriptive statistics, including means, standard deviations, and range, were calculated using STATA/IC 16.0. Results: Among the specimens, the FDS arch was tendinous in 20 (58.8%) and muscular in 14 (41.2%) cases. The mean distance from the medial epicondyle to the apex of the FDS arch was 65.8±12.8 mm, and the mean thickness was 0.80±0.43 mm. A distinct arch was observed in 25 (73.53%) specimens, while an indistinct arch was found in 9 (26.47%) specimens. Conclusion: The findings of this study contributed valuable insights for surgical interventions aimed at decompressing the median nerve entrapment in the proximal forearm.

How to Differentiate Pronator Syndrome from Carpal Tunnel Syndrome: A Comprehensive Clinical Comparison.

The diagnostic process that allows pronator syndrome to be differentiated reliably from carpal tunnel syndrome remains a challenge for clinicians, as evidenced by the most common cause of pronator syndrome misdiagnosis: carpal tunnel syndrome. Pronator syndrome can be caused by compression of the median nerve as it passes through the anatomical structures of the forearm, while carpal tunnel syndrome refers to one particular topographic area within which compression occurs, the carpal tunnel. The present narrative review is a complex clinical comparison of the two syndromes with their anatomical backgrounds involving topographical relationships, morphology, clinical picture, differential diagnosis, and therapeutic options. It discusses the most frequently used diagnostic techniques and their correct interpretations. Its main goal is to provide an up-to-date picture of the current understanding of the disease processes and their etiologies, to establish an appropriate diagnosis, and introduce relevant treatment benefiting the patient.

Proximal Median Nerve Compression in the Differential Diagnosis of Carpal Tunnel Syndrome.

Carpal tunnel syndrome (CTS) is the most common median nerve compression neuropathy. Its symptoms and clinical presentation are well known. However, symptoms at median nerve distribution can also be caused by a proximal problem. Pronator syndrome (PS) and anterior interosseous nerve syndrome (AINS) with their typical characteristics have been thought to explain proximal median nerve problems. Still, the literature on proximal median nerve compressions (PMNCs) is conflicting, making this classic split too simple. This review clarifies that PMNCs should be understood as a spectrum of mild to severe nerve lesions along a branching median nerve, thus causing variable symptoms. Clear objective findings are not always present, and therefore, diagnosis should be based on a more thorough understanding of anatomy and clinical testing. Treatment should be planned according to each patient’s individual situation. To emphasize the complexity of causes and symptoms, PMNC should be named proximal median nerve syndrome.

Percutaneous Ultrasound-Guided Release of the Lacertus Fibrosus for Median Nerve Entrapment at the Elbow.

The aim of this technical note is to present a microinvasive percutaneous ultrasound-guided release of the lacertus fibrosus of the biceps brachii for pronator syndrome, i.e., entrapment of the median nerve at the elbow. Fifteen consecutive patients were included. Patients showed isolated pronator syndrome including pain plus reduced strength of specific median nerve innervated muscles. The release was performed in a non-operating interventional room under wide-awake local anesthesia no tourniquet (WALANT). It was conducted superficial to the pronator teres with in-plane ultrasound guidance. The recovery of strength was first assessed peroperatively, and then systematic visits at postoperative weeks 1 and 4 included assessments of both strength and pain. Procedures were comfortably completed with no immediate surgical or anesthetic complication. Muscle strength returned immediately and persisted at postoperative visits. Visual analog scores for pain reduced from 6.2 to 2.5 and 0.6 at weeks 1 and 4, respectively. All working patients were able to perform in their professional activities at week 1. The millimetric skin incision healed with no hypertrophic scar tissue. A small hematoma occurred at week 1 and resorbed spontaneously. No other delayed complication was observed. The procedure appeared effective with improved invasiveness compared to existing techniques. Real-time monitoring with ultrasound may improve the safety. The technique could be regarded as a new ultrasound-guided alternative to surgery. Performed superficial to the pronator teres muscle under WALANT anesthesia, the microinvasive percutaneous ultrasound-guided release of the lacertus fibrosus may be an effective treatment of pronator syndrome.

Is Carpal Tunnel Release an Effective Treatment for Patients with Suspected Concurrent Carpal Tunnel and Pronator Syndrome?

Background: Some patients with a confirmed diagnosis of carpal tunnel syndrome (CTS) on clinical examination and electrodiagnostic testing (EDX) may also have one or more clinical features of pronator syndrome (PS). However, the EDX is negative for PS. We label these patients as suspected concurrent carpal tunnel and pronator syndrome (CCPS). We suspect that this is a presentation of reverse double crush syndrome that occurs when a symptomatic distal compression neuropathy converts an asymptomatic proximal compression into a symptomatic one. We believe both compressions can be relieved by decompressing the median nerve only at the wrist. The aim of our study is to determine whether carpal tunnel release (CTR) is an effective treatment for patients suffering from CCPS. Methods: This is a prospective, cohort study of the outcomes of CTR in two matched groups with 37 patients in each group. Group A included patients with suspected CCPS and group B included patients with isolated CTS. All patients were evaluated pre-operatively and 1 year after surgery using the Boston Carpal Tunnel Questionnaire (BCTQ). At one year, patients were also assessed for residual symptoms and positive provocative tests. Results: A significant improvement in the symptom and functional severity scales (SSS and FSS) of the BCTQ was noted in both groups. The degree of improvement in SSS was similar in both groups; however, group A showed a greater improvement in FSS. This could be attributed to higher pre-operative values in some items of FSS in group A. No patients in either group had residual symptoms severe enough to necessitate further treatment. Conclusion: The outcomes of CTR are similar in patients with isolated CTS and suspected CCPS and a CTR may be sufficient to address symptoms of CTS and PS in patients with CCPS. Level of Evidence: Level II (Therapeutic).

Median Nerve Passing below the Ulnar Head of Pronator Teres in Cadavers of a Medical College in Western Nepal: A Descriptive Cross-sectional Study.

Median nerve passes between two heads of pronator teres muscle while passing through the elbow. Detailed knowledge of these variations in the course of Median Nerve in relation to pronator teres and its neighboring structure is required for diagnosis of pronator syndrome. The aim of the study is to find out the proportion of Median Nerve passing below the ulnar head of pronator teres in cadavers of a medical college in Western Nepal. A descriptive cross-sectional study was carried out at the Department of Anatomy in a medical college of Nepal from 20th July 2021 to 2nd September 2021 after ethical clearance from the same institution (Reference number: UCMS/IRC/079/21). Variations in the course of the median nerve while passing through pronator teres were observed, recorded and photographed. Convenience sampling method was used. Data were analyzed using Microsoft Excel 2016. Point estimate at 95% Confidence Interval was calculated along with frequency and percentage. Out of 54 prosected specimens of upper limbs, 4 (7.40%) (0.418-14.38 at 95% Confidence Interval) Median Nerve passed below the ulnar head of pronator teres muscle and in 50 (92.60%) specimens Median Nerve passed between two heads of pronator teres. Our study shows that the median nerve passed below the ulnar head of pronator teres muscle is higher as compared to other studies done in similar settings. Thus, knowledge of variations in the course of Median Nerve in elbow has immense importance in the academic and clinical arena.

Outcome of Surgical Treated Isolated Pronator Teres Syndromes-A Retrospective Cohort Study and Complete Review of the Literature.

Purpose: This study aims to elucidate the occurrence of postoperative carpal tunnel syndrome (CTS), the functional outcome of patients with primary pronator teres syndrome (PTS), and review complete literature regarding this topic. Material and Methods: A retrospective chart review was conducted in patients with PTS at a single center. In all patients, a numeric Visual Analog Scale (VAS) score, Pinch-Test, Jamar hand dynamometer test (JAMAR), and the Disabilities of the Arm Shoulder and Hand (DASH) score were analyzed preoperatively and at final follow-up to assess outcome. Additionally, a complete review of the literature was performed, including all data dealing with pronator teres syndrome. Results: Ten female and two male patients were included with a mean age of 49 years. Significant improvement in DASH and numeric VAS was detected at latest postoperative follow-up. In three patients, clinical signs of CTS pathology were detected during the follow-up period. One patient needed to be treated surgically, and in the other two patients, a conservative management was possible. In one patient (8%), a PTS recurrence was detected. All patients presented satisfied at latest follow-up. Conclusion: In one-fourth of our patients, a CTS occurred during the follow-up period. Therefore, focusing on double-crush syndrome in unclear or mixed symptoms is necessary to avoid multiple operations. Furthermore, it seems that assessment with NCV is not enough for diagnosing PTS; therefore, further research is needed to clarify this problem.

Safety of Dry Needling of the Pronator Teres Muscle in Cadavers: A Potential Treatment for Pronator Syndrome.

Entrapment of the median nerve at the pronator teres muscle can contribute to symptoms in the forearm and wrist. The pronator teres is also involved in patterns of spasticity observed in people who had suffered a stroke. Research on treatment efficacy with dry needling is scarce. To determine if a solid filiform needle safely penetrates the pronator teres muscle during the clinical application of dry needling. A cadaveric descriptive study. Needle insertion of the pronator teres was conducted in ten cryopreserved forearms with a 30 ×0.32 mm filiform needle. With the forearm supinated, the needle was inserted 3 cm distal to the mid-point between the biceps tendon insertion and the medial epicondyle. The needle was advanced in a cranial and medial direction to a depth clinically judged to be in the pronator teres muscle. Safety was assessed by measuring the distance from the needle to the surrounding neurovascular bundles. Accurate needle penetration of the pronator teres was observed in 100% of the specimens (mean needle penetration: 16.7 ± 4.3 mm, 95% confidence interval [CI] 13.6 to 19.7 mm). No neurovascular bundles were pierced in any of the specimen's forearms. The distances from the tip of the needle to the surrounding neurovascular bundles were 16.4 ± 3.9 mm (95% CI 13.6 to 19.2 mm) to the ulnar nerve (A), 9.0 ± 2.2 mm (95% CI 7.3 to 19.5 mm) to the median nerve (B), and 12.8 ± 4.0 mm (95% CI 10.0 to 15.7 mm) to brachial artery (C). The results from this cadaveric study support the assumption that needling of the pronator teres using described anatomical landmarks can be accurately and safely conducted by an experienced clinician.

Compression Neuropathies of the Upper Extremity: A Review

Compressive neuropathies of the forearm are common and involve structures innervated by the median, ulnar, and radial nerves. A thorough patient history, occupational history, and physical examination can aid diagnosis. Electromyography, X-ray, and Magnetic Resonance Imaging may prove useful in select syndromes. Generally, first line therapy of all compressive neuropathies consists of activity modification, rest, splinting, and non-steroidal anti-inflammatory drugs. Many patients experience improvement with conservative measures. For those lacking adequate response, steroid injections may improve symptoms. Surgical release is the last line therapy and has varied outcomes depending on the compression. Carpal Tunnel syndrome (CTS) is the most common, followed by ulnar tunnel syndrome. Open and endoscopic CTS release appear to have similar outcomes. Endoscopic release appears to incur decreased cost baring a low rate of complications, although this is debated in the literature. Additional syndromes of median nerve compression include pronator syndrome (PS), anterior interosseous syndrome, and ligament of Struthers syndrome. Ulnar nerve compressive neuropathies include cubital tunnel syndrome and Guyon’s canal. Radial nerve compressive neuropathies include radial tunnel syndrome and Wartenberg’s syndrome. The goal of this review is to provide all clinicians with guidance on diagnosis and treatment of commonly encountered compressive neuropathies of the forearm.

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

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.