Orthopedics Book


Median Nerve Injury at the Elbow

Aka: Median Nerve Injury at the Elbow, Pronator Syndrome
  1. See Also
    1. Peripheral Nerve Injury
  2. Pathophysiology
    1. Forearm compression of the Median Nerve via the pronator teres muscle
  3. Differential Diagnosis
    1. Carpal Tunnel Syndrome
  4. Symptoms
    1. Forearm discomfort and ache
    2. Provoked with elbow extension
    3. Paresthesias in the thumb, index and middle finger
  5. Signs
    1. Sensory loss over thenar eminence (not present in Carpal Tunnel Syndrome)
    2. Tinel sign absent (contrast with Carpal Tunnel Syndrome)
    3. Phalen maneuver (contrast with Carpal Tunnel Syndrome)
    4. Normal Forearm sensation
    5. Sensation in fingers may also be normal
  6. Management
    1. Modify activity
    2. Consider steroid injection
    3. Consider brief Splinting with elbow at 90 degrees (risk of loss of elbow range of motion)
  7. Course
    1. Anticipate 3-6 month course with therapy
  8. References
    1. Neal (2010) Am Fam Physician 81(2): 147-55 [PubMed]

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