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Selected Instructional Course Lecture   |    
Median and Radial Nerve Compression About the Elbow
Peter Tsai, MD1; David R. Steinberg, MD2
1 Department of Orthopaedic Surgery, University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA 19104
2 Penn Orthopaedic Institute, 1 Cupp Pavilion, Presbyterian Medical Center, 39th & Market Streets, Philadelphia, PA 19104. E-mail address: david.steinberg@uphs.upenn.edu
View Disclosures and Other Information
Printed with permission of the American Academy of Orthopaedic Surgeons. This article, as well as other lectures presented at the Academy's Annual Meeting, will be available in March 2008 in Instructional Course Lectures, Volume 57. The complete volume can be ordered online at www.aaos.org, or by calling 800-626-6726 (8 a.m.-5 p.m., Central time).
Disclosure: The authors did not receive any outside funding or grants in support of their research for or preparation of this work. Neither they nor a member of their immediate families received payments or other benefits or a commitment or agreement to provide such benefits from a commercial entity. No commercial entity paid or directed, or agreed to pay or direct, any benefits to any research fund, foundation, division, center, clinical practice, or other charitable or nonprofit organization with which the authors, or a member of their immediate families, are affiliated or associated.
An Instructional Course Lecture, American Academy of Orthopaedic Surgeons

The Journal of Bone and Joint Surgery, Inc.
J Bone Joint Surg Am, 2008 Feb 01;90(2):420-428
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Look for this and other related articles in Instructional Course Lectures, Volume 57, which will be published by the American Academy of Orthopaedic Surgeons in March 2008:"Compression of the Ulnar Nerve at the Elbow: Cubital Tunnel Syndrome," by Harris Gellman, MDCubital tunnel syndrome is the most well-recognized compression/traction neuropathy occurring around the elbow. Compression of the median and radial nerves about the elbow and forearm are less often encountered yet must be understood by any physician who treats upper extremity pathology.
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    Accreditation Statement
    These activities have been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint sponsorship of the American Academy of Orthopaedic Surgeons and The Journal of Bone and Joint Surgery, Inc. The American Academy of Orthopaedic Surgeons is accredited by the ACCME to provide continuing medical education for physicians.
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    David Ring, M.D., Ph.D
    Posted on February 11, 2008
    Untestable illness concepts
    Massachusetts General Hospital, Boston, MA

    To The Editor:

    Pronator syndrome and radial tunnel syndrome are illness constructs that defy scientific investigation. Since there is no reproducible objective test or observation that defines the diagnosis, there is no way to perform experiments and test hypotheses regarding these illnesses. They are not verifiable or falsifiable. I understand that the term pseudoscientific has a very negative connotation, but in the strict meaning of this word (which can be boiled down to “something that is based on a scientific rationale, but is untestable”), these diagnoses are indeed pseudoscientific.

    Consequently, I was disappointed to see an authoritative “Instructional Course Lecture” in the most prestigious journal in orthopaedics that failed to draw these important distinctions between discrete, objective testable conditions such as carpal tunnel syndrome and posterior interosseous nerve palsy, and more mysterious and untestable illness concepts such as radial tunnel syndrome and pronator syndrome. The best evidence that proponents of these illness concepts can offer is “my patients get better”. In my humble opinion, a concerning proportion of surgeons find it frighteningly easy to ignore the power of the human mind to heal as captured in the placebo, or meaning effect. I would accept symptom improvement after surgery as supportive of the value of an untestable illness concept, but only if the surgery was demonstrated to be substantially more effective than sham surgery in a prospective randomized double blind controlled trial. My deceivable human mind requires it.

    No matter one’s opinion about pronator syndrome and radial tunnel syndrome, it must be acknowledged that the scientific basis of these illness constructs is an order of magnitude below discrete, testable conditions such as carpal tunnel syndrome and posterior interosseous nerve syndrome. I hope that all future book chapters and authoritative reviews will help puzzled doctors, like me, by acknowledging this fact.

    The author did not receive any outside funding or grants in support of his research for or preparation of this work. Neither he nor a member of his immediate family received payments or other benefits or a commitment or agreement to provide such benefits from a commercial entity. No commercial entity paid or directed, or agreed to pay or direct, any benefits to any research fund, foundation, division, center, clinical practice, or other charitable or nonprofit organization with which the author, or a member of his immediate family, is affiliated or associated .

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