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Pronator Teres Syndrome
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Contents
Other Names
- Pronator Syndrome
Background
- Involves entrapment of the Median Nerve between the humeral head and ulnar head of the Pronator Teres
- Relatively rare condition, easily missed
- Sometimes mistaken for Carpal Tunnel Syndrome[1]
Pathophysiology
- Entrapment most commonly occurs[2]
- 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
- Fractures
- Dislocations
- Instability & Degenerative
- Tendinopathies & Ligaments
- Neuropathies
- Pediatric Considerations
- Distal Radial Epiphysitis (Gymnast's Wrist)
- Torus Fracture
- Arthropathies
- Cartilage
- Vascular
- Other
Differential Diagnosis Forearm Pain
- Fractures
- Pediatric Specific Fractures
- Dislocations & Instability
- Soft Tissue Trauma
- Tendinopathies
- Neuropathies
- Pediatric Considerations
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
- Weakness of Flexor Pollicis Longus, Abductor Pollicis Brevis is not uncommon
- Wasting of median nerve muscles a late finding
- Pronator teres is spared of weakness
- Sensory loss can occur and mimic carpal tunnel syndrome
- Special Tests
- Pronator Teres Syndrome Test: Patient pronates forearm, extends elbow against resistance
- Resisted Elbow Flexion And Forearm Supination Test: patient flexes elbow, supinates forearm against resistance
- Resisted Elbow Extension And Forearm Pronation Test: Patient extends elbow, pronates forearm against resistance
- Tinels Test: Tapping over proximal edge of pronator teres
- Phalens Test: Positive in 50% of cases[3]
Evaluation
Radiographs
- Standard Radiographs Wrist
- 3 view radiographs useful for ruling out other pathology
- No role in diagnosis pronator teres syndrome
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[4]
MRI
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[5]
- 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
- Sports Medicine Review Wrist Pain: https://www.sportsmedreview.com/by-joint/wrist/
References
- ↑ 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.
- ↑ 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.
- ↑ 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.
- ↑ 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.
- ↑ 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:
13 October 2022 21:54:53
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