Definition
Forearm pain caused by compression of median nerve
Sites of Compression
Pronator Teres
- commonest site
- hypertrophied / excess fascia
Ligament of Struthers
- remnant third head Coracobrachialis
- runs from supracondylar spur to medial epicondyle
- median nerve & brachial artery may be deep to it
Bicipital Aponeurosis
- lacertus Fibrosis
- from medial border of biceps to subcutaneous ulna border
- may be thickened
Arch of FDS
- runs from humeroulnar Head (origin CFO & Sublime tubercle medial coronoid)
- inserts anterior oblique line on radius
- accessory muscle slips and anomalous origins of FDS
History
Pain in anteromedial EJ / volar aspect of distal arm
- worse with repetitive pronation / supination eg tennis, tools
May have
- intermittent / nocturnal parasthesia
- some weakness
Examination
Tenderness at site of compression
- proximal flexors
Pain with resisted pronation elbow in flexion / PT
Other provocations test
- Ligament of Struthers - resisted flexion of elbow at 135°
- Bicipital aponeurosis - resisted supination flexed elbow
- Arch of FDS - resisted flexion of FDS of MF
NCS
Aim
- confirm location
- exclude CTS
Findings
- delayed conduction velocity across elbow 30%
- EMG abnormalities of PT or FCR
X-ray
Spur
- seen with ligament of struthers
MRI
May help identify site of compression / ligament of struthers
Management
Non-operative Management
NSAIDS
Avoid aggravating activities
RICE
Operative Management
Technique
Medial incision
- divide bicipital aponeurosis
- release pronator teres
- release FDS
- +/- ligament of struthers if present