Median Nerve Release in the Forearm 1 Mackinnon SE1 Yee A1 April 22, 2013Disclosure: No authors have a financial interest in any of the products, devices, or drugs mentioned in this production or publication.Compression neuropathy of the median nerve in the forearm, also known as pronator syndrome, typically presents with pain in the forearm +/- paresthesia/pain in the median nerve territory. The anterior interosseous nerve can be involved with a mononeuritis. While this usually resolves without surgery, occasionally will require this approach for reconstruction or release. Related anatomical structures include the lacertus fibrosus, deep head of pronator teres, arch of flexor digitorum superficialis, and fascia in the distal arm. Release of the median nerve in the forearm addresses these structures and decompresses the nerve in this area. This release is also a method for exposing the median nerve for reconstructive options. This patient presented with median nerve neuropathy in the forearm and hand. In addition to this forearm release, a carpal tunnel release was performed. This video portrays the median nerve decompression in the forearm. For acquiring adequate proximal exposure, a distal step-lengthening of the superficial head of pronator teres is performed. While surgical anatomy can differ from patient to patient, this patient had several tendinous fasciae as well as the deep head of pronator teres.Keywords: pronator syndromemedian nervestep-lengtheningcompression neuropathynerve decompression You must login to view the full article and extended video on this page. Standard Edition Table of Contents- Slow down- Frustration00:00:00 - Introduction00:00:15 - Orientation00:00:25 - Incision and Distal Exposure00:00:58 - Identifying the Medial Antebrachial Cutaneous Nerve Branches00:01:20 - Exposure between Plane of Brachioradialis and Flexor Carpi Radialis00:01:38 - Identifying the Radial Artery and Superficial Branch of Radial Nerve00:01:50 - Identifying the Tendon of the Superficial Head of Pronator Teres00:02:01 - Step-lengthening the Tendon of the Superficial Head of Pronator Teres00:03:00 - Proximal Exposure00:03:23 - Identifying the Radial Artery00:03:40 - Identifying the Median Nerve00:04:23 - Identifying / Releasing a Tendinous Fascia of the Deep Head of Pronator Teres00:04:53 - Identifying / Releasing a Secondary Tendinous Fascia of the Deep Head of Pronator Teres00:05:46 - Identifying / Releasing the Deep Head of Pronator Teres00:06:34 - Identifying the Branches of the Median Nerve00:06:42 - Identifying / Releasing the Arch of Flexor Digitorum Superficialis00:07:04 - Visualization of the Median Nerve Following Release You must login to view the full article and extended video on this page. 4 Comments philip mathew 5th January 2017 clear and succinct thank you Log in to Reply | Andrew Yee 6th January 2017 Philip, thank you for the comment. Log in to Reply | Neil Harness 20th November 2017 Do you repair the step cut in the pronator teres at the end of the case? Neil Harness Log in to Reply | Andrew Yee 20th November 2017 Neil, the step-lengthening of the pronator teres does not need to be repaired. Log in to Reply | Leave a Comment Cancel replyYou must be logged in to post a comment.