J Korean Neurosurg Soc.  2014 May;55(5):296-299. 10.3340/jkns.2014.55.5.296.

Early Surgical Treatment of Pronator Teres Syndrome

• Lee HJ
• Kim I
• Hong JT
• Kim MS

• KMID: 2018039
• DOI: http://doi.org/10.3340/jkns.2014.55.5.296

Abstract

We report a rare case of pronator teres syndrome in a young female patient. She reported that her right hand grip had weakened and development of tingling sensation in the first-third fingers two months previous. Thenar muscle atrophy was prominent, and hypoesthesia was also examined on median nerve territory. The pronation test and Tinel sign on the proximal forearm were positive. Severe pinch grip power weakness and production of a weak "OK" sign were also noted. Routine electromyography and nerve conduction velocity showed incomplete median neuropathy above the elbow level with severe axonal loss. Surgical treatment was performed because spontaneous recovery was not seen one month later.

Keyword

Pronator teres syndrome; Pronation test; Thenar muscle atrophy; Tinel sign

MeSH Terms

Axons
Elbow
Electromyography
Female
Fingers
Forearm
Hand
Hand Strength
Humans
Hypesthesia
Median Nerve
Median Neuropathy
Muscular Atrophy
Neural Conduction
Pronation
Sensation

Figure

• 

  Fig. 1 Right thenar muscle atrophy (arrow).

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  Fig. 2 A positive Tinel sign and pronation test are observed on the volar aspect of the proximal forearm.

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  Fig. 3 Axial T2-weighted magnetic resonance imaging depicts increased signal intensity in the pronator teres, flexor carpi radialis, flexor digitorum superficialis, and palmaris longus (arrow).

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  Fig. 4 A 10-cm classical "lazy-S" shaped skin incision is made from 3 cm distal to the medial epicondyle over the flexor/pronator muscles.

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  Fig. 5 The thickened and tight superficial fascia of the pronator teres (asterisk) compresses the median nerve. After the median nerve was released, a thin, grayish, discolored median nerve (arrowhead) is observed.

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