Houston Methodist. Leading Medicine

Hand FAQ


I'm more than a little distressed by the news I got today. According to the surgeon I just saw, my forearm aching is an "illness" not a disease. I got the impression that this illness is mental, not physical. I was told to go home, use ice or heat, take ibuprofen and wait three months to see if it goes away. What kind of medical advice is that? He didn't say see a shrink but I think it was on his mind.


You may be suffering from a condition referred to some as pronator syndrome. Pronator syndrome is a nerve entrapment (pressure on the median nerve in the forearm). The nerve can get pinched between two other soft tissue structures such as muscles, tendons, ligaments, or fascia (connective tissue). Besides forearm aching, it can also cause numbness of the thumb and index finger. Not everyone believes such a condition really exists. That's because there are no tests that truly diagnose the problem. Pressure on the nerve is just as likely to reproduce the symptoms as not. Likewise with the other clinical tests at the surgeon's disposal. X-rays, MRIs, CT scans, and ultrasound images show nothing out of the ordinary. Electrodiagnostic tests normally used to test nerve lesions are normal nine times out of 10. That leaves some experts wondering if this is truly a disease or more likely an illness. In fact, because women in their 40s are the ones most likely to be seen with this condition, the notion that this might be hormonal, emotional, or psychologic has been raised. And because surgery to decompress the nerve isn't successful, there is a belief that what we are facing here isn't a disease, but rather an illness. When surgery does relieve the problem, it could be a placebo effect. So determining disease (true pathologic anatomy or physiology) from illness (physical symptoms caused by emotional or psychologic distress) can't be cleared up by successful treatment. Your surgeon's advice is actually very good. Conservative care is the first line of treatment for this condition whether it is called "aching forearm" or "pronator syndrome." Heat or cold along with pain relievers is the recommended approach for this problem. Exercises prescribed by a hand therapist may help stretch the nerve. Manual therapy (a type of hands on approach) to release fibrous tissue around the nerve may help. Any postural effects will be addressed. The therapist may conduct a review of your home and/or office work areas for possible contributing or aggravating factors. In the opinion of hand experts, surgery is only recommended rarely and then only after at least six months of nonoperative care first. Other supportive measures may include splinting, acupuncture, or pain medications. Steven Presciutti, MD, and Craig M. Rodner, MD. Pronator Syndrome. In The Journal of Hand Surgery. May 2011. Vol. 36A. No. 5. Pp. 907-909.

*Disclaimer:* The information contained herein is compiled from a variety of sources. It may not be complete or timely. It does not cover all diseases, physical conditions, ailments or treatments. The information should NOT be used in place of visit with your healthcare provider, nor should you disregard the advice of your health care provider because of any information you read in this topic.
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