The San Francisco Giants right hand pitcher Mark Melancon has stated he is day-to-day and will undergo surgery for pronator syndrome if his symptoms persist or at the end of the season.

What is pronator syndrome?
Pronator syndrome is a diagnosis that some doctors believe exists and others do not. The syndrome is troublesome forearm pain that is fairly diffuse and activity-related. Numbness is not one of the symptoms. The proposed pathophysiology is a compressive neuropathy in the front of the elbow or in the upper part of the forearm.

How do you diagnose pronator syndrome?
One of the sources of debate is that pronator syndrome cannot be confirmed by an objective test such as electrodiagnostic testing. The examination is normal except for imprecise and subjective things like tenderness and slight weakness resisting substantial force. Press reports indicate that Mark Melancon’s diagnosis of pronator syndrome was suggested by MRI findings, but there is no evidence that MRI can accurately and reliably diagnose pronator syndrome.

Why do some doctors use the diagnosis of pronator syndrome and others do not?
Non-specific, activity-related forearm pain is very common. For surgeons that believe in pronator syndrome, the “proof” is that patients feel better and thank them after surgery. However, people can be very resilient after surgery; even pretend or sham surgery. People can feel better and do more not because the surgery addressed an important problem, but because it gave them confidence and energy that allowed them to adapt. In research, we call this the placebo effect.

How could we determine if pronator syndrome is a useful diagnosis?
They only way to know if pronator syndrome is a useful diagnosis would be to compare real surgery and sham surgery and make sure the patient and evaluators had no way of knowing which one they got. Until we have a few such studies, people that have surgery for pronator syndrome are putting faith in what may be a social construction (a diagnosis that exists only because we behave as if it exists) and exposing themselves to the potential harm of surgery unnecessarily.

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References: Rodner, C.M., B.A. Tinsley, and M.P. O’Malley, Pronator syndrome and anterior interosseous nerve syndrome. J Am Acad Orthop Surg, 2013. 21(5): p. 268-75.