Simultaneous surgical release of ipsilateral pronator teres and carpal tunnel syndromes

Because of overlapping symptoms, carpal tunnel syndrome is sometimes diagnosed and a more proximal site of compression may be missed. Incomplete relief following carpal tunnel surgery may be caused by the failure to identify the second site of compression.

A retrospective review was performed on 61 patients who were diagnosed as having both carpal tunnel syndrome and pronator teres syndrome of the ipsilateral median nerve. Besides precise medical history and physical evaluation, nerve conduction velocity studies and electromyography were performed. All patients but two had ipsilateral endoscopic carpal tunnel release and pronator teres release. Results after surgery were clinically assessed and evaluated as follows: complete relief, partial relief, or no relief.

Postoperative evaluation resulted in 39 of 61 patients (64 percent) experiencing complete relief. Thirteen patients (21 percent) had partial relief. Eight of these patients were secondarily diagnosed with more proximal compression. Five of them had thoracic outlet compression syndrome, and three of them had cervical radiculopathy. For five patients, no specific reason was found for experiencing only partial relief. Nine patients (15 percent) had no significant relief. Among those patients, four were diagnosed with thoracic outlet compression syndrome and two with cervical radiculopathy; for three patients, the authors found no specific reason for failure.

The main benefit of using this protocol in this selected group of patients is to shorten total morbidity time and to avoid exposure of the patient to two operations instead of one.