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Pronator Teres Syndrome

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Other Names

  • Pronator Syndrome

Background


General

Course of the median nerve at the elbow[2]
  • Entrapment most commonly occurs[3]
    • Between humeral head and ulnar head of the Pronator Teres muscle
    • Can also occur at lacertus fibroseus (biceps aponeurosis) or under sublimis bridge
    • Other etiologies: local trauma, compression with schwanomma
  • Involves hypertrophied pronator-flexor mass

Risk Factors

  • Gender: Male > female
  • Sports with repetitive forceful gripping or pronation
    • Throwing
    • Tennis
    • Archery
    • Arm Wrestling
    • Weight Lifting
    • Rowers
  • Occupations
    • Repetitive forearm pronation and supination
    • hammering, ladling food, cleaning dishes

Differential Diagnosis

Differential Diagnosis Wrist Pain

Differential Diagnosis Forearm Pain

Other Considerations


Clinical Features

History

  • Patients will report volar wrist pain
  • Often aggravated by pronation, elbow flexion
  • Report of parasthesias, numbness, tingling

Physical Exam: Physical Exam Wrist

Special Tests


Evaluation

Radiographs

EMG/NCS

  • Gold standard for diagnosis
  • EMG abnormalities can be seen in FPL, FDP, FDS, APB sparing PT

Ultrasound

  • Cross sectional area of median nerve between humeral and ulnar heads of PT correlates with severity and duration of symptoms[5]

MRI

  • Needs to be updated

Classification

  • N/A

Management

Nonoperative

  • First line for all cases, most cases will resolve with conservative measures
  • Avoidance of provocative activities
  • Protection from external compression
  • Night splint to prevent elbow flexion
  • Physical Therapy
  • Corticosteroid Injection at point of compression
  • Medications including NSAIDS

Operative

  • Indications:
    • Failure of conservative measures
    • Objective findings of weakness
    • Motor atrophy
    • Abnormal EMG/NCS
  • Procedure:
    • Release of pronator teres muscle and other compressive structures

Return to Play

  • Prognosis is generally favorable
  • For occupation-related disease
    • Most patients return to light duty at 3 weeks, full duty at 6 weeks[6]
    • Surgical cases have a longer recovery, up to 12 weeks at the discretion of the surgeon
  • For athletes, there are no clear guidelines
    • Typically, they can continue to play unless they develop prominent sensor or motor deficits

Complications


See Also

Internal

External


References

  1. Asheghan M, Hollisaz MT, Aghdam AS, Khatibiaghda A. The Prevalence of Pronator Teres among Patients with Carpal Tunnel Syndrome: Cross-sectional Study. Int J Biomed Sci. 2016 Sep;12(3):89-94.
  2. Löppönen, Pekka, Sina Hulkkonen, and Jorma Ryhänen. "Proximal median nerve compression in the differential diagnosis of carpal tunnel syndrome." Journal of clinical medicine 11.14 (2022): 3988.
  3. Olewnik Ł, Podgórski M, Polguj M, Wysiadecki G, Topol M. Anatomical variations of the pronator teres muscle in a Central European population and its clinical significance. Anat Sci Int. 2018 Mar;93(2):299-306.
  4. Hartz CR, Linscheid RL, Gramse RR, Daube JR. The pronator teres syndrome: compressive neuropathy of the median nerve. J Bone Joint Surg Am. 1981 Jul;63(6):885-90.
  5. Asheghan M, Hollisaz MT, Aghdam AS, Khatibiaghda A. The Prevalence of Pronator Teres among Patients with Carpal Tunnel Syndrome: Cross-sectional Study. Int J Biomed Sci. 2016 Sep;12(3):89-94.
  6. Carter GT, Weiss MD. Diagnosis and Treatment of Work-Related Proximal Median and Radial Nerve Entrapment. Phys Med Rehabil Clin N Am. 2015 Aug;26(3):539-49.
Created by:
John Kiel on 14 June 2019 08:37:49
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Last edited:
1 December 2023 21:05:03
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