Purpose
This is a retrospective observational study that assessed the prevalence of positive
diagnostic imaging and electrodiagnostic (EDX) findings in patients diagnosed with
pronator syndrome (PS), who previously had a carpal tunnel syndrome (CTS) surgery.
The other purpose of our study was to determine how often PS occurred and was missed
in patients treated surgically for CTS.
Methods
The files of 180 patients who underwent CTS surgery were reviewed retrospectively.
We assessed all patients for a diagnosis of PS. We accepted the clinical findings
and patient history as the reference standard for the diagnosis of PS. Anteroposterior
and lateral radiographs of the elbow, bilateral upper limb magnetic resonance imaging
(MRI) studies, and bilateral dynamic forearm ultrasound (US) were performed on patients
with clinical symptoms and physical examinations that indicated PS. Bilateral upper
limb EDX was also performed for these patients. One patient refused additional tests.
Results
A total of 174 extremities in 146 patients were included in the study. Pronator syndrome
was diagnosed by 2 hand surgeons in 22 extremities (19 patients) through a clinical
evaluation that included a history and physical examination. Diagnostic testing was
positive for findings of PS in 24% of extremities (5 of 21) tested by EDX, in 57%
of extremities (12 of 21) tested by US, and 5% of extremities (1 of 21) tested by
MRI. There was no lower humeral spur that could cause median nerve compression on
any plain radiographs.
Conclusions
With clinical evaluation as the reference standard, EDX, US, and MRI are not helpful
in making a diagnosis of PS concurrent with CTS.
Type of study/level of evidence
Diagnostic IV.
Key words
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References
- Primary myoses in the M. pronator teres as cause of lesion of the N. medianus (the pronator syndrome).Acta Psychiatr Neurol Scand Suppl. 1951; 74: 251-254
- Concurrent carpal tunnel syndrome and pronator syndrome: a retrospective study of 21 cases.Orthop Traumatol Surg Res. 2017; 103: 101-103
- High median nerve entrapments. An obscure cause of upper-extremity pain.Hand Clin. 1996; 12: 691-703
- Pronator syndrome.Clin Sports Med. 2001; 20: 531-540
- Nerve compression syndromes at the elbow.Orthop Trauma. 2016; 30: 355-362
- Median nerve entrapment syndrome in the proximal forearm.J Hand Surg Am. 1979; 4: 48-51
- The pronator teres syndrome: compressive neuropathy of the median nerve.J Bone Joint Surg Am. 1981; 63: 885-890
- Pronator syndrome.J Hand Surg Am. 2011; 36: 907-909
- Proximal median nerve compression.Hand Clin. 1992; 8: 307-315
- Simultaneous surgical release of ipsilateral pronator teres and carpal tunnel syndromes.Plast Reconstr Surg. 2007; 119: 2141-2147
- The prevalence of pronator teres among patients with carpal tunnel syndrome: cross-sectional study.Int J Biomed Sci. 2016; 12: 89-93
- Subclinical pronator syndrome in patients with carpal tunnel syndrome: an electrophysiological study.Egypt Rheumatol. 2015; 37: 197-202
- Double crush syndrome.J Am Acad Orthop Surg. 2015; 23: 558-562
- Clinical diagnosis and wide-awake surgical treatment of proximal median nerve entrapment at the elbow: a prospective study.Hand (N Y). 2013; 8: 41-46
- Lacertus syndrome.in: Lalonde D. Wide Awake Hand Surgery. 1st ed. Thieme, New York2016: 141-145
- Needle electromyography: basic concepts.in: Handbook of Clinical Neurology. Vol. 160. Elsevier, Philadelphia, PA2019: 243-256
- Needle electromyography: basic concepts and patterns of abnormalities.Neurol Clin. 2012; 30: 429-456
- Proximal median neuropathies: electromyographic and clinical correlation.Muscle Nerve. 1992; 15: 390-395
- Ultrasound assessment on selected peripheral nerve pathologies. Part I: entrapment neuropathies of the upper limb–excluding carpal tunnel syndrome.J Ultrason. 2012; 12: 307-318
- Ultrasonography for diagnosing carpal tunnel syndrome: a meta-analysis of diagnostic test accuracy.Ultrasound Med Biol. 2012; 38: 1121-1128
- Predictors of carpal tunnel syndrome: accuracy of gray-scale and color Doppler sonography.AJR Am J Roentgenol. 2006; 186: 1240-1245
- Neuromuscular ultrasound in common entrapment neuropathies.Muscle Nerve. 2013; 48: 696-704
- Peripheral neuropathies of the median, radial, and ulnar nerves: MR imaging features.Radiographics. 2006; 26: 1267-1287
- MR imaging of the nerves of the upper extremity: elbow to wrist.Magn Reson Imaging Clin. 2015; 23: 469-478
- Peripheral MR neurography: approach to interpretation.Neuroimaging Clin. 2014; 24: 79-89
- The pronator compression test revisited. A forgotten physical sign.Orthop Rev. 1990; 19: 888-892
- Nerve entrapment syndromes.Elb its Disord. 1993; 2: 813-832
- The pronator syndrome. An evaluation of dynamic maneuvers for improving electrodiagnostic sensitivity.Am J Phys Med Rehabil. 1991; 70: 274-277
- Magnetic resonance imaging of the elbow: a structured approach.Sports Health. 2013; 5: 34-49
Article info
Publication history
Published online: July 22, 2020
Accepted:
June 3,
2020
Received:
May 17,
2019
Footnotes
No benefits in any form have been received or will be received related directly or indirectly to the subject of this article.
Identification
Copyright
© 2020 by the American Society for Surgery of the Hand. All rights reserved.
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- ErratumJournal of Hand SurgeryVol. 46Issue 4
- PreviewIn the article by Özdemir et al in the December 2020 issue of The Journal of Hand Surgery (“Clinical, Radiological, and Electrodiagnostic Diagnosis of Pronator Syndrome Concurrent With Carpal Tunnel Syndrome”, Vol. 45, No. 12, p. 1141-1147), the Figure 1 legend was incorrect. It should have read "FIGURE 1: A Median nerve. US examination in pronation with a relaxed pronator teres (PT). B Median nerve. US examination in supination with a contracted PT. The reduction of diameter at the median nerve is visible." The authors regret this error.
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