Pronator teres syndrome

Background
  • Pronator teres syndrome is considered to be the least common of the three median nerve entrapment syndromes, the other two of which carpal tunnel syndrome and anterior interosseus nerve syndrome
  • Compression of the nerve occurs at the level of the elbow or at the immediate proximal portion of forearm.
  • Common in the 4th and 5th decades of life
  • Women have higher incidence, as well as those with forearm hypertrophy (athletes)

Clinical Features

Symptoms
  • Primarily will complain of paresthesia overlying the 1st, 2nd, 3rd and lateral portion of the 4th digit
  • Pain to the volar aspect of proximal forearm which may be worse on palpation
  • Typically does not feature nocturnal exacerbation
  • May report decreased grip strength

Physical Examination Findings
  • Symptoms worsened with resisted forearm pronation, resisted elbow flexion
  • Exacerbating examination techniques may produce paresthesias to volar aspect of proximal forearm, which helps distinguish from other median nerve entrapment syndromes
  • May have concomitant medial epicondylitis

Differential Diagnosis

Evaluation
  • Ortho appreciates dedicate elbow films at minimum
    • Usually no gross appreciable pathology
  • Ultrasound and MRI also useful though not required in ED setting

Management
  • Conservative management first indicated and most beneficial in large majority of cases
    • Course of extremity rest and NSAID treatment, 3-6 month management period
  • Referral to orthopaedics
    • Surgical management possible if no response or worsening of symptoms over 3 month period

Disposition

Outpatient

See Also

References
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