Patients › Elbow

Pronator and AIN Release

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Updated Aug 2026

Why this operation has been suggested¶

Dr Kieran Hirpara, an upper-limb surgeon at Mater Private Hospital Rockhampton, starts with the least invasive options that suit your condition. This operation releases tight bands or tissue pressing on one of the nerves in your forearm, the median nerve or one of its branches. It is offered when the nerve has been squeezed for a long time and simpler treatment has not helped enough.

For pronator syndrome, we usually begin with rest, avoiding the activities that flare your symptoms, and anti-inflammatory medicine. This works for 50 to 70% of people. Surgery is considered when symptoms have lasted more than 6 months despite this care. For anterior interosseous nerve syndrome, surgery is considered after at least 12 months with no return of muscle strength.

The aim of the operation is to take pressure off the nerve. That should ease the aching in your forearm and help you use your hand and fingers with more confidence.

Before the operation¶

You will need some imaging before surgery, such as an X-ray, MRI or ultrasound scan. These help plan the operation.

On the day, stop eating and drinking 7 hours before your operation time. We ask for 7 hours rather than 6 so you can be brought forward if the theatre list runs early. Your surgeon will tell you which medicines to stop and when. Bring a list of everything you take, including tablets, drops and creams. Arrange for someone to drive you home afterwards. Wear loose, comfortable clothing. If you have other medical conditions, you may need blood tests or a review with the anaesthetist (the doctor who gives your anaesthetic). Most people need neither.

On the day¶

You arrive at the hospital's surgical admissions unit. Staff check you in and prepare you for theatre. You meet the anaesthetist, the doctor who gives your anaesthetic. This operation is done under general anaesthetic. A regional nerve block is sometimes added for post-operative pain relief; the anaesthetist will discuss this with you on the day.

You are then taken into the operating theatre, where the operation is performed. Afterwards you wake up in the recovery area. Nurses watch over you while the anaesthetic wears off. Once you are stable, you either go to the ward or go home, depending on the procedure and your recovery.

What the operation involves¶

The operation is called a nerve release. Your surgeon makes a cut on the palm side of your forearm, near your elbow. Through this cut, they find the nerve that is being squeezed and free it from the tight bands of muscle and tissue pressing on it. There are a few spots along the nerve where this pressure can build up, so each one is checked and released.

Where possible, this is done through a small cut using a thin camera to guide the work. This keyhole approach causes less damage to the surrounding tissue than a larger, more open operation. Some cases need a deeper, more open release instead, depending on which part of the nerve is affected and how much scar tissue has formed. If long-standing scar tissue is found, it may be removed as part of the same operation.

Once the nerve is free, the cut is closed with stitches and covered with a dressing. You will go home the same day.

The aim throughout is simple: give the nerve room, so it is no longer squeezed at the spots that have been causing your symptoms.

After the operation¶

You will wake up in the recovery area with nurses nearby. They will keep you comfortable and give you pain relief if you need it. Your forearm will be wrapped in a light dressing, and you can move your fingers gently soon after you wake up. You will not need a sling or a brace for this operation. Most people are up and walking within a few hours. Someone should stay with you for the first 24 hours after you get home. Keep the dressing clean and dry until your surgeon tells you it can come off. Your team will tell you whether you go home the same day or stay one night in hospital.

Recovery¶

In the first few days your forearm will be sore and a little swollen. This settles gradually. Keeping your hand raised on a pillow when resting helps, and simple pain relief eases the discomfort. You can move your fingers gently from the start, and this gentle movement is encouraged.

You will keep the dressing clean and dry until your surgeon takes it off. Hand therapy after surgery is with Ruby Doolan at Extend Rehabilitation. Ruby will guide your exercises and make any splint you need. The exercises are gentle at first and build up as the nerve settles. You can do most things at home, such as dressing, eating and light tasks, as long as they do not hurt.

As the pressure on the nerve eases, you should notice the aching fade and your grip feel steadier. Some people feel a difference within days. For others, strength and feeling return slowly over a longer stretch. Once you can grip and use your hand without pain, you can return to your usual activities. Driving is allowed once you are out of any splint, can hold the wheel with both hands and react in an emergency stop, and are off strong pain medication. Our guide to driving after upper-limb surgery has more detail.

Everyone heals at their own pace. Your timeline may differ, and your surgeon and therapist will guide you along the way.

What can go wrong¶

Most patients do well, but problems can occasionally happen. Your surgeon and the team monitor you closely to spot any issue early.

This operation is sometimes done through a deeper, more open release rather than a small keyhole cut. That means more work under the skin, so the early days can feel a bit tougher than you might expect. If your pain seems out of step with what you were told to expect, or simple painkillers are not touching it, call the clinic.

The aim of the operation is to give the nerve room. In a small number of people the pressure is not fully relieved, or the nerve was being squeezed somewhere other than the spots that were released. If your aching and weakness carry on much as before once things have settled, bring it up at your next review. Further tests can check whether the nerve is still under pressure elsewhere.

Some people who have this operation feel the result did not match what they hoped for. The aching may ease only partly, or strength and feeling may not return the way you expected. This does not always mean something went wrong at surgery. If your recovery feels slower or smaller than you expected, say so at your review. Your surgeon can talk through what you are noticing and what else might help.

The complications table on this page lists typical rates if you want the specifics.

When to call us¶

Call us if you have a fever, or the wound becomes more red, swollen or starts to leak fluid. Call us if your pain suddenly gets much worse, or simple painkillers are not touching it. Go to emergency if you have calf swelling or pain, or shortness of breath. Go to emergency if you lose feeling in your hand or fingers, or you cannot move your arm, wrist or fingers the way you could before.

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