Compression neuropathy of the median nerve in the forearm, also known as pronator syndrome, typically presents with pain in the forearm +/- paresthesia/pain in the median nerve territory. The anterior interosseous nerve can be involved with a mononeuritis. While this usually resolves without surgery, occasionally will require this approach for reconstruction or release. Related anatomical structures include the lacertus fibrosus, deep head of pronator teres, arch of flexor digitorum superficialis, and fascia in the distal arm. Release of the median nerve in the forearm addresses these structures and decompresses the nerve in this area. This release is also a method for exposing the median nerve for reconstructive options. This patient presented with median nerve neuropathy in the forearm and hand. In addition to this forearm release, a carpal tunnel release was performed. This video portrays the median nerve decompression in the forearm. For acquiring adequate proximal exposure, a distal step-lengthening of the superficial head of pronator teres is performed. While surgical anatomy can differ from patient to patient, this patient had several tendinous fasciae as well as the deep head of pronator teres.
A lazy-S incision is made over the proximal forearm.
- Presciutti S, Rodner CM. Pronator syndrome. J Hand Surg Am. 2011 May;36(5):907-9; quiz 909. doi: 10.1016/j.jhsa.2011.02.014. Review. PMID: 21527144.
- Dang AC, Rodner CM. Unusual compression neuropathies of the forearm, part II: median nerve. J Hand Surg Am. 2009 Dec;34(10):1915-20. PMID: 19969200.
- Colbert SH, Mackinnon SE. Nerve compressions in the upper extremity. Mo Med. 2008 Nov-Dec;105(6):527-35. Review. PMID: 19052017.
- Lee MJ, LaStayo PC. Pronator syndrome and other nerve compressions that mimic carpal tunnel syndrome. J Orthop Sports Phys Ther. 2004 Oct;34(10):601-9. Review. PMID: 15552706.
- Mackinnon SE. Pathophysiology of nerve compression. Hand Clin. 2002 May;18(2):231-41. Review. PMID: 12371026.
Disclosure: No authors have a financial interest in any of the products, devices, or drugs mentioned in this production or publication.