The pronator compression test revisited. A forgotten physical sign

Area of Science:

• Neurology
• Orthopedic Surgery
• Clinical Diagnostics

Background:

• Median nerve entrapment, specifically pronator syndrome, presents diagnostic challenges.
• Previous carpal tunnel release or double crush syndrome complicates diagnosis in over 50% of cases.
• Electromyographic results were often inconclusive in identifying pronator syndrome.

Purpose of the Study:

• To evaluate the diagnostic utility of pronator compression testing for median nerve entrapment.
• To assess the efficacy of surgical decompression for pronator syndrome.
• To determine the reliability of clinical signs in diagnosing pronator syndrome.

Main Methods:

• Prospective study of 10 patients with suspected pronator syndrome.
• Manual compression of the median nerve at the pronator muscle site.
• Assessment of preoperative paresthesia duration, Tinel's sign, and electromyographic results.
• Evaluation of surgical decompression outcomes.

Main Results:

• All 10 patients developed hand paresthesias within 30 seconds of pronator compression.
• Eight patients had a positive Tinel's sign at the impingement site.
• Only one patient showed a positive electromyographic result.
• Surgical decompression resulted in good or excellent outcomes for 9 out of 10 patients.

Conclusions:

• Pronator compression testing is a valuable and dependable clinical sign for diagnosing pronator syndrome.
• Early diagnosis and surgical intervention lead to favorable outcomes.
• Clinical examination remains crucial despite potential diagnostic challenges from prior surgeries or coexisting conditions.