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What is Pronator Teres Syndrome?

Pronator Teres Syndrome is a compression neuropathy of the median nerve in the forearm. This is an uncommon condition compared to the more common nerve compression disorder at the wrist  Carpal Tunnel Syndrome.

Characteristics and Clinical Presentation of Pronator Teres Syndrome

Compression of the upper forearm median nerve can cause pain, tingling, weakness or numbness in the forearm and distal median nerve distribution in the hand, including the muscles to the thumb and sensation to the thumb, index, middle, and ring fingers.

Patients also commonly report tenderness over the proximal median nerve, which may be aggravated by resisted pronation of the forearm.

Symptoms of pronator teres syndrome include:

  • Aching or pain in the upper volar forearm.
  • Tenderness over the actual pronator teres muscle.
  • Weakness in the forearm or hand.
  • Numbness and tingling in the palm, thumb, middle or index finger.
  • Typically not having pain or discomfort at night, rather with use.

Causes of Pronator Teres Syndrome

The most common cause of Pronator Teres Syndrome involves entrapment of the median nerve between the two heads of the pronator teres muscle. Compression of the nerve from the arch of the flexor digitorum superficialis can also be a contributing factor.

Thickening of the bicipital aponeurosis, located in the cubital fossa of the elbow, may also contribute to Pronator Teres Syndrome. This compression can cause an aching pain in the forearm, lower upper arm, and hand weakness. Numbness and tingling in the palm, thumb, and index and middle fingers have also been observed.

Getting a Diagnosis for Pronator Teres Syndrome

Pronator Teres Syndrome may be confused with Carpal Tunnel Syndrome. Both conditions are affecting the median nerve in the arm. In Pronator Teres Syndrome, the median nerve is compressed at the pronator muscle usually below the elbow, which may cause forearm ache.

A test involving resisted pronation may help diagnose this condition. The physician will hold the patient’s hand in a handshaking position and place their other hand on the patient’s elbow for support.

The physician will then attempt to supinate, or turn their wrist palm-side up, and extend the elbow. while the patient attempts to resist the motion. With Pronator Teres Syndrome, this may elicit a pain response.

Treatment Options for Pronator Teres Syndrome

Your surgeon will usually attempt to treat Pronator Teres Syndrome non-surgically. This includes anti-inflammatory medications and rest in addition to rehab.

Conservative Treatments

Non-surgical intervention has the possibility of treating the affected region. Identifying a movement of ADL may lead to a cause and treatment. For this reason, conservative treatments are preferred by Drs. Mark and Jason Pruzansky whenever possible. These treatments include:

  • Anti-inflammatory medications (NSAIDs) to relieve inflammation and pain.
  • Brief use of a splint to support the elbow.
  • Resting and modalities to the affected area.
  • Physical therapy and stretching.

Surgical Treatments

In the event that surgical intervention is entertained due to lack of progress, an MRI may be considered to identify a benign lesion compressing the nerve.

Decompressing the entrapped nerve may be needed in stubborn cases.  Postoperatively, patients typically receive an arm splint. 8-10 days later, the patient usually transitions to a removable splint to be worn at night.

Preventing Pronator Teres Syndrome

Pronator Teres Syndrome may be aggravated or caused by forceful repetitive movements in the forearm. These symptoms can be caused by overuse, pressure, excessive exercise, trauma, tumors, scar tissue, and the growth of fibrous bands in the pronator muscle. Knowing which is involved leads to a treatment plan.

Prognosis for Pronator Teres Syndrome

Prognosis for prospective patients is usually favorable, with many post-operative patients reporting that they became pain-free or had a great reduction of their symptoms. Recovery usually includes physical therapy to maximize mobility, strength, and function.

If You Believe You Have Pronator Teres Syndrome Contact HandSport Surgery Institute

Please contact us to schedule an appointment with our talented team. People experiencing Pronator Teres Syndrome should be evaluated to try and prevent further nerve damage and mobility issues.

If you believe you may have this syndrome, it’s important to be evaluated by a highly skilled hand surgeon. Call Drs. Mark and Jason Pruzansky at 212-249-8700 to schedule an appointment, obtain an accurate diagnosis, and start to restore comfort to your forearm and hand.

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