Median nerve compression in the proximal forearm

Abstract

Thirty-nine limbs in 36 patients underwent surgical decompression of the median nerve in the proximal forearm. Seventeen patients with 19 limbs had prior ipsilateral carpal tunnel releases, and 24 had workers' compensation claims related to heavy labor or repetitive tasks. The most common presenting complaints were paresthesias/numbness in the distribution of the median nerve and pain in the forearm or hand. The most common physical finding was a positive pronator compression test, followed by median nerve hypesthesia. Elbow to wrist nerve conduction tests were obtained in 37 of 39 limbs and were abnormal in 12. Intraoperatively, the nerve was compressed at the flexor digitorum superficialis tendon in 22 limbs, pronator teres in 13 limbs, and both in 4 limbs. Postoperatively, 30 limbs had complete or partial relief of symptoms; in a sub-group of 19 limbs that had a prior failed carpal tunnel release, 14 had complete or partial relief. Although there was a trend toward better results in patients with normal preoperative nerve conduction tests and intraoperative compression at the flexor digitorum superficialis, the difference was not significant.