Pronator Syndrome

Overview

(AIN Syndrome)

Patients who present with pronator syndrome have pain over the pronator teres with inability to flex the thumb and index finger at the last joint.  This is accompanied by numbness tingling and paresthesias in the thumb through ring fingers that generally wakes patients up at night. It can occur concomitantly with carpal tunnel syndrome.

Dr. Anup Patel Advantage

Dr. Anup Patel performs decompression of nerve compressions including some of the rarest syndromes encountered in the upper extremity. Trained by Dr. David T.W. Chiu, a pioneer and leader in microsurgery and nerve disorders, and Dr. John Persing, a pioneer and leader in neurosurgery, Dr. Patel often employs microsurgical techniques with precise dissection to relieve pressure on the nerves.

Dr. Chiu and Dr. Patel were recognized on the Tonight Show for their work in treating the peripheral nerve compression of Jimmy Fallon. Dr. Patel routinely treats patients from around the world suffering from nerve issues causing pain, sensory disturbances, and motor function loss.

Dr. Patel utilizes loupe magnification to identify the median nerve in the forearm and free it from all compressive structures including the following ligament of Struthers, bicipital aponeurosis (lacertus fibrosus), pronator teres, and the FDS arch.  He uses vessel loops to identify the nerve and protected while releasing it from the structures aforementioned.  The nerve is dissected free from all of the structures often using microsurgical instruments.

Symptoms

  • Pain and ache over the top part (volar) of the forearm
  • Motor weakness manifested by inability to flex the thumb and index finger


Causes

  • Compression of the anterior interosseous nerve (a branch of the median nerve) in the forearm


Treatment: Non-Surgical

  • NSAIDs
  • Activity modification
  • Steroidal medication


Treatment: Surgical

  • Release of the compressive structures of the posterior interosseous nerve in the forearm

Patient 1

32 year old truck driver male who presents with moderate numbness, tingling and paresthesias in the right median nerve distribution accompanied by significnat motor weakness in thumb and index finger flexion.

Electrodiagnostic studies demonstrate pronator syndrome with carpal tunnel syndrome. Patient undergoes median nerve decompression at the carpal tunnel and forearm levels regaining full sensation and full range of motion in 3 months.

Patient 2

63 year old male accountant with severe numbness, tingling and paresthesias in the left median nerve distribution accompanied by profound motor weakness in thumb and index finger flexion. Electrodiagnostic studies demonstrate pronator syndrome with carpal tunnel syndrome.

Patient undergoes median nerve decompression at the carpal tunnel and forearm levels regaining full sensation and full range of motion in 5 months. The videos demonstrate our technique including precise dissection to minimize post-operative scarring of the nerve.

Patient 3

80 year old male who is an avid golfer presents with numbness, tingling and paresthesias in the left median nerve distribution accompanied by profound motor weakness in thumb and index finger flexion.

Electrodiagnostic studies demonstrate pronator syndrome with carpal tunnel syndrome. Patient undergoes median nerve decompression at the carpal tunnel and forearm levels regaining full sensation and full range of motion in 8 months.

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Dr. Anup Patel

Dr. Anup Patel is a board-certified plastic and reconstructive surgeon trained in aesthetic, hand/upper extremity and reconstructive surgery. He completed his plastic and reconstructive surgery training at the premier Yale University followed by a hand and microsurgery fellowship at the New York University Institute of Reconstructive Plastic Surgery and Mount Sinai Department of Orthopedics. Dr. Patel received his MD and MBA from the Yale University School of Medicine and Yale University School of Management, respectively. He graduated as the valedictorian of his class at the University of Florida majoring in economics, biochemistry and molecular genetics and valedictorian of his high-school class at Lake Highland.

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