Pronator syndrome is a condition caused by compression of the median nerve in the forearm, rather than at the wrist as seen in carpal tunnel syndrome.
The median nerve passes through several structures in the forearm, and compression can occur at different points along its course. This includes areas around the pronator muscles as well as the lacertus fibrosus (sometimes referred to as lacertus syndrome).
Symptoms are often less clearly defined than carpal tunnel syndrome and may involve aching in the forearm as well as altered sensation in the hand.
Accurate diagnosis is important, as the condition can overlap with other types of nerve compression and requires a different approach to treatment.
Symptoms may include:
Symptoms are often less noticeable at night compared to carpal tunnel syndrome.
Symptoms may include:
Symptoms are often less noticeable at night compared to carpal tunnel syndrome.
Diagnosis is based on clinical assessment, including examination of the forearm and hand.
Assessment focuses on reproducing symptoms with specific movements and identifying the level of nerve compression.
It is important to distinguish pronator syndrome from other conditions such as carpal tunnel syndrome and more focal compression at the lacertus fibrosus.
Nerve studies or imaging may be used in selected cases.
Treatment is usually non-surgical.
Non-surgical treatment may include:
If symptoms persist and a specific point of compression is identified, surgical decompression of the nerve may be considered.
Surgical treatment involves releasing the structures compressing the median nerve in the forearm.
The procedure is tailored to the site of compression and is typically performed as a day-case under local or regional anaesthetic.
Recovery depends on the severity of symptoms and treatment performed.
Recovery typically includes:
Improvement may take time, particularly if symptoms were long-standing.
As with any surgical procedure, there are potential risks, although these are uncommon.
Possible complications include:
Very rarely, a condition known as complex regional pain syndrome (CRPS) can occur, leading to prolonged pain and sensitivity.
You should seek medical advice if you experience persistent forearm pain or altered sensation in the hand, particularly if symptoms are affecting daily activities or not improving.
Assessment is important to distinguish pronator syndrome from other nerve conditions such as carpal tunnel or lacertus syndrome.
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