Pronator Teres Syndrome
Pronator Teres Syndrome is an entrapment neuropathy of the median nerve, where it passes between the two heads of the Pronator Teres muscle. This muscle attaches to the lower humerus, as well as the inner ulna bone. It is between these two heads, that the Median nerve can become entrapped.
Symptoms of Pronator Teres Syndrome
- Tingling or numbness in the palm, thumb and three fingers (excluding the little, pinky finger!)
- Aching sensation in the forearm.
- Pain may be increased with resisted pronation (turning the palm over to face down).
- Pain may also increase with wrist flexion (pointing the hand and fingers towards the underside of the forearm).
- Tenderness when feeling the pronator teres muscle.
- Decreased strength in the thumb and three fingers.
- Decreased strength in pronating the forearm and flexing the wrist.
Symptoms of pronator syndrome can be very similar to carpal tunnel syndrome and so it is important to distinguish between them. With carpal tunnel syndrome there will be no weakness or pain with turning the palm down (pronation) and the Pronator Teres muscle is not tender to touch. Cases of carpal tunnel syndrome also do not cause neural symptoms such as numbness or tingling in the palm of the hand. In CTS this is isolated to the actual thumb and fingers.
Causes
Pronator syndrome usually occurs after prolonged or repetitive forearm pronation (turning the palm of the hand to face downwards), accompanied by forced flexion of the fingers. In simple terms, forceful grasping with the hand and twisting at the wrist. These kind of movements are common in manual occupations such as carpentry and mechanics. In sports, racket sports, rowing and weight lifting are the most common culprits. The reasons this causes compression is due to an increase in muscle bulk of the pronator teres muscle.
Pronator Teres Syndrome may also occur as a result of a trauma to the forearm, bony abnormalities, tumors or restrictive bands of fibrous tissue and scar tissue. Interestingly, it is four times more common in females than males!
Treatment
- Rest from activities which may be contributing to the condition.
- Apply ice to ease pain and swelling.
- A doctor may prescribe pain killers or anti-inflammatory medications such as ibuprofen.
- A sports injury specialist may use electrotherapy treatments such as ultrasound or laser.
- Sports massage may be helpful to reduce muscular tension.
- Pronator muscle stretches may be helpful.
- Acupuncture may be effective in releasing muscular tension.
- A nerve block or corticosteroid injection may be used if symptoms do not improve.
- Surgery is very occasionally used to release tight or abnormal structures.
