Title : Usage of corticosteroid injection for treatment of pronator syndrome
Abstract:
Introduction: Pronator syndrome is a compressive neuropathy of the median nerve between the two heads of pronator teres caused by chronic overuse of gripping and pronation. Carpal tunnel syndrome is more common than pronator syndrome and it is important to distinguish between the two. Ultrasound guided perineural hydrodissection injection can be used for diagnosis and treatment. Hydrodissection is a technique that uses fluid to separate nerves from surrounding tissue. This study looked at patients who had pronator injections and pronator releases over the past 5 years.
Methods: Patients included in this study were those diagnosed with pronator syndrome based on symptoms and physical exams from December 2019 to December 2024.Exclusion criteria include patients younger than 18 years old, those lost to follow up, patients who were misdiagnosed, and patients with pronator syndrome who were not treated with an injection or surgery. Patient age, follow up, number of pronator injections, carpal tunnel injection, symptoms before and after injection(s), and symptoms after surgical release were retrospectively analyzed. Carpal tunnel syndrome, history of prior carpal tunnel release, date of steroid injection if provided to the carpal tunnel, and primary or revision carpal tunnel release during the pronator syndrome release were also investigated. Sports medicine providers performed ultrasound guided injections. The most common steroid injection mixture used was 40 mg triamcinolone acetonide and 2 mL of 2% lidocaine. Patients were not immobilized after the injection.
Results: The average age of the 80 patients with pronator syndrome was 46.6 years old. Of the 83 ultrasound guided pronator injections, 25 of which were hydrodissections. The injections consisted of a local anesthetic and a steroid: 76 triamcinolone acetonide, 1 methylprednisolone, and 4 dexamethasone. 8 patients had more than 1 pronator injections performed in the same arm. The average follow up after the injection was 327 days. 20 extremities (24.1%) had no relief of symptoms, 43 (51.8%) had temporary relief of symptoms for an average of 274 days, and 7 (8.43%) patients had resolution of symptoms after the injection for an average of a 251 day follow up. Of the 36 surgical pronator releases, 11 patients had a prior pronator injection.
Discussion: Ultrasound guided pronator injections are an effective way to diagnose and treat patients who have pronator syndrome. 60.23% of the injections provided patients with temporary relief to resolution of symptoms. 13% of injections resulted in pronator releases.
