Pronator Syndrome

Pronator syndrome is compression of the median nerve about the elbow and/or upper forearm. Pronator Syndrome leads to symptoms similar to those of carpal tunnel syndrome, as the same nerve is involved, but is much less common. The two syndromes are therefore often confused. In addition, the two syndromes may occur simultaneously, meaning that the median nerve is compressed in two places at the same time, i.e. a “double crush”.

As opposed to causing numbness of the fingers at night, pronator syndrome often causes numbness with heavy use. It is also associated with pain over the upper forearm.

A nerve study may be helpful to diagnose pronator syndrome, but is not fully accurate, and often misses the diagnosis of pronator syndrome. Even if the nerve study suggests pronator syndrome, the results of the nerve study should be confirmed on a physical examination. If there’s any question of where the median nerve is compressed, in the pronator area or the carpal tunnel, a diagnostic injection into the carpal tunnel can be performed. If the carpal tunnel injection temporarily resolves the symptoms, this implies that the problem is solely due to carpal tunnel syndrome. If the symptoms are helped, but remain present, then another area of compression, such as pronator syndrome, exists.

If pronator syndrome is causing problems, then Pronator Release surgery is very effective. This outpatient surgery can be performed through a small, cosmetic incision hidden in the elbow crease.

Pronator Release

After surgery, no splint is used and there are no formal activity restrictions. This procedure is not very painful, but I recommend taking it easy (avoiding heavy or highly repetitive activities) for 2-4 weeks. The wound should be kept clean and dry for 24 hours, at which point the dressing is removed and showering is allowed. There are no stitches to remove (they’re buried and absorb-able). There’s a piece of tape over the wound. The tape will fall off when it’s ready. The longer it stays on, the nicer the final wound may look. Please don’t submerge the incision under water (like swimming, or putting your hand under water) for 10 days after surgery.

The absorb-able stitches aren’t quite as strong as regular stitches. So don’t do anything too hard or too fast for 2 weeks: If something’s falling, let it hit the ground; don’t reach out to catch it. It’s best to use a sling for 2 weeks while asleep (so you don’t thrash) and when you’re around other people, as others grab your arms more than you’d think. You can remove the sling whenever you’re in a controlled setting, ie. awake and alone, or when sitting and eating, etc. Otherwise, it’s best to wear the sling.