Clinical features and surgical treatment of combination of pronator teres syndrome and carpal tunnel syndrome

Authors

  • Iurii L. Chyrka Medical centre «Spinex», Vinnytsia, Neurosurgical Department, Yushchenko Vinnytsia Regional Neurological Hospital Regional, Vinnytsia, Ukraine https://orcid.org/0000-0002-3050-3499
  • Oleksandr S. Lemeshov Medical centre «Spinex», Vinnytsia, Neurosurgical Department, Yushchenko Vinnytsia Regional Neurological Hospital Regional, Vinnytsia, Ukraine https://orcid.org/0000-0002-9210-8830

DOI:

https://doi.org/10.25305/unj.276981

Keywords:

pronator teres syndrome, carpal tunnel syndrome, neuropathy, median nerve

Abstract

Objective: To determine the effectiveness of surgical interventions aimed at decompression of the median nerve (MN) in the carpal tunnel and pronator teres canal, in combination with carpal tunnel syndrome (CTS) and pronator teres syndrome (PTS).

Materials and methods: The results of surgical treatment of patients with a combination of CTS and PTS were analyzed, a total of 20 observations. The analysis of the results was evaluated according to: the Boston Questionnaire (BCTQ), namely, symptoms severity scale - SSS (minimum 1 point, maximum 5 points) and functional severity scale - FSS (minimum 1 point, maximum 5 points), the Bishop Score, visual analogue scale (VAS).

Results: All operated patients (100%) experienced a significant regression of the main manifestations of the disease on the first day after the operation. Paresthesia in the fingers of the hand decreased, the sensitivity in the MN dermatome improved significantly, and sleep improved. The average indicators after surgery on symptoms severity scale (SSS) were 1.3 points, on functional severity scale (FSS) - 1.4 points, visual analogue scale - 2 points. The assessment of treatment results according to the Bishop Score in the postoperative period, that is, at the time of discharge (3 days after surgery), was an average of 10 points.

Conclusions: Decompression of the MN in the area of the carpal tunnel and pronator teres is an effective method of treatment for the combination of CTS and PTS. A positive effect in the form of a regression of pain syndrome, sensitivity disorders and an increase in strength in the hand is observed already in the early postoperative period. Scores on BCTQ and VAS improve by more than 50%.

References

1. Mackinnon SЕ. Nerve Surgery. New York: Thieme, 2015.

2. Atroshi I, Gummesson C, Johnsson R, Ornstein E, Ranstam J, Rosén I. Prevalence of carpal tunnel syndrome in a general population. JAMA. 1999 Jul 14;282(2):153-8. [CrossRef] [PubMed]

3. Hartz CR, Linscheid RL, Gramse RR, Daube JR. The pronator teres syndrome: compressive neuropathy of the median nerve. J Bone Joint Surg Am. 1981 Jul;63(6):885-90. [PubMed]

4. Afshar A. Pronator Syndrome Due to Schwannoma. J Hand Microsurg. 2015 Jun;7(1):119-22. [CrossRef] [PubMed] [PubMed Central]

5. Farrell HF. Pain and the pronator teres syndrome. Bull Hosp Joint Dis. 1976 Apr;37(1):59-62. [PubMed]

6. Asheghan M, Hollisaz MT, Aghdam AS, Khatibiaghda A. The Prevalence of Pronator Teres among Patients with Carpal Tunnel Syndrome: Cross-sectional Study. Int J Biomed Sci. 2016 Sep;12(3):89-94. [PubMed] [PubMed Central]

7. Dididze M, Tafti D, Sherman AL. Pronator Teres Syndrome. 2022 Sep 7. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan–. [PubMed]

8. Fernández-de-Las-Peñas C, López-de-Celis C, Rodríguez-Sanz J, Hidalgo-García C, Donelly JM, Cedeño-Bermúdez SA, Pérez-Bellmunt A. Safety of Dry Needling of the Pronator Teres Muscle in Cadavers: A Potential Treatment for Pronator Syndrome. Pain Med. 2022 May 30;23(6):1158-1161. [CrossRef] [PubMed]

9. Créteur V, Madani A, Sattari A, Bianchi S. Sonography of the Pronator Teres: Normal and Pathologic Appearances. J Ultrasound Med. 2017 Dec;36(12):2585-2597. [CrossRef] [PubMed]

10. Gainor BJ. The pronator compression test revisited. A forgotten physical sign. Orthop Rev. 1990 Oct;19(10):888-92. [PubMed]

11. Spinner M, Linscheid RL. Nerve entrapment syndromes. In Morrey BF, ed. The elbow and its disorders. 2nd ed. Philadelphia: WB Saunders, 1993:1993:813-882

12. Kane PM, Daniels AH, Akelman E. Double Crush Syndrome. J Am Acad Orthop Surg. 2015 Sep;23(9):558-62. [CrossRef] [PubMed]

13. Freedman M, Helber G, Pothast J, Shahwan TG, Simon J, Sher L. Electrodiagnostic evaluation of compressive nerve injuries of the upper extremities. Orthop Clin North Am. 2012 Oct;43(4):409-16. [CrossRef] [PubMed]

14. Koo JT, Szabo RM. Compression neuropathies of the median nerve. Journal of the American Society for Surgery of the Hand. 2004 Aug 1;4(3):156-75. [CrossRef]

Published

2023-06-29

How to Cite

Chyrka, I. L., & Lemeshov, O. S. (2023). Clinical features and surgical treatment of combination of pronator teres syndrome and carpal tunnel syndrome. Ukrainian Neurosurgical Journal, 29(2), 43–48. https://doi.org/10.25305/unj.276981

Issue

Section

Original articles