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Introduction:

The Pronator Teres Syndrome is a dynamic compression; symptoms appear on the median territory during daily activities that maintain pronation in time. It is usually associated to a distal compression of the median nerve at the carpal tunnel. Observations made in spastic patients while releasing the aponeurosis of the flexor-pronator muscles, showed that deep to the muscular mass the median nerve can be identified. Based on them a new mini open approach was designed, similar in invasiveness to the one used at the carpal tunnel. It allows the release of the structures that compress the median nerve in the proximal forearm.

Material and Methods:

Since November 1999, we have operated on 44 cases (40 patients). 35 females and 5 males. Mean age was 54 years old. All patients had associated a CTS. Twenty-seven cases had simple CTS (numbness only at night), and 17 had complex CTS (permanent numbness). An elbow AP view X-ray was taken to rule out supracondylar process. EMG was done in all cases. Patients were evaluated with three clinical tests for PTS: Compression test, Forearm resisted test and middle finger flexor superficialis test. All patients were operated by the same surgeon with this new mini invasive technique. Follow-up was lost in 3 patients

Results:

None had supracondylar process in the X-ray. EMG was possitive in 3 patients (6,8%). Preoperative test were positive as follows: Compression test: 68%, Forearm resisted test: 80 % and middle finger flexor superficialis test: 43%.

After surgery all but 3 patients (93%) had no more symptoms related to PTS in the first postoperative visit at 6 days. Two of the 3 patients with persistent symptoms had the same numbness on the median nerve territory (partial recovery). These patients were on the complex CTS associated group. One patient had disappearance of night symptoms after carpal tunnel release but because of persistence of daytime symptoms due to pronation activities and positive tests, the PTS was liberated in a second procedure, recovering completely.

Conclusion:

All patients with PTS syndrome had a CTS associated. In the same surgical procedure these two pathologies can be approached with a minimal invasive technique. With the release of compressive structures under a mini-invasive approach all but three patients (93%) had no more median nerve symptoms.