Endoscopic Proximal Median Nerve Decompression: An Alternative Treatment for Pronator Syndrome

Proximal forearm median nerve compressive neuropathy, termed as pronator syndrome, is difficult to diagnose and often overlooked. Its symptoms include vague proximal volar forearm pain that may be associated with paresthesia and numbness in the median nerve distribution. Weakness is typically not present. The treatment of pronator syndrome is largely nonsurgical, consisting of activity modification, anti-inflammatory medication, corticosteroid injections, stretching, and periods of splinting. Surgery is indicated when conservative therapy fails; however, there is no consensus on the treatment approach or technique. Most decompressions are performed using an open technique through a variety of incisions. Recently, endoscopic approaches have drawn an interest. This article describes a technique for endoscopic proximal median nerve decompression that enables the complete decompression of the median nerve in the distal aspect of the arm and proximal aspect of the forearm through a small incision, potentially minimizing surgical morbidity and reducing healing time.