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Pronator Teres Syndrome Cheat Sheet (DRAFT) by

Pronator Teres, Rx, Hx, PE

This is a draft cheat sheet. It is a work in progress and is not finished yet.

Pronator Teres

- Compre­ssion of median nerve by pronator teres
- Median nerve innervates most of the flexor muscles of the forearm and hand
- Sensation to volar forearm and first 3 and a half digits

Path

- Median nerve passes through cubital fossa at forearm
- Passes beneath bicipital aponeu­rosis and arch of the FDS
- Passes between superf­icial and deep heads of the pronator teres

Causes

- Prolon­ged­/re­pet­itive forearm pronation and finger flexion (gripping with palm down)
- More common in dominant arm
- Usually in fifth decade
- Four times more common in women
- Diabetes, alcoholism or hypoth­yro­idism increases risk

Hx

- Aching discomfort in volar forearm
- Parest­hesia in first three and a half digits
- Can present similar to CTS (noctural pain usually absent and symptoms increase in repeti­tiv­e/r­esisted forearm supina­tio­n/p­ron­ation in PTS)

PE

- TTP over pronator teres, medial epicondyle
- +ve Tinel sign (proximal anterior forearm)
- -ve Phalan­s/T­inels at carpal tunnel
- +ve Pronator Teres test
- Weakness of FPL, FDP, Pronator Quad - grip
- Assess for Cx radicu­lopathy - weakness of wrist extensors and triceps
- Assess for other areas of entrapment (see below)

Sites of entrapment

Ligament of Struthers - Anatomical variant (1%)
Ligament attaches from suprac­ondylar process to the medial episco­ndyle
Palpate distal humerus (5cm proximal to medial epicon­dyle)
Thickened bicipital aponeu­rosis - Occurs in resisted elbow flexion (120-130 degrees) with the forearm in maximal supination
Thickened proximal edge of the arch of the FDS - Resisted flexion of middle finger
AINS Anterior intero­sseous nerve - branch of the median nerve gets entrapped purely motor unable to do "­ok" sign

DDx

- Double crush
- Cx arthro­pathy
- Cx disc
- Brachial plexus neuritis
- TOS
- CTS
- Cubital tunnel entrapment

Imaging

Above image shows suprac­ondylar process on x-ray
- X-ray if suprac­ondylar process , deformity, f#, neoplasm
- MRI - tumours, cysts, osseous spurs, anatomical varients
- US

Management

- Rest
- Nerve gliding exercises
- Avoid repeti­tiv­e/f­orceful gripping
- Splint if severe for two weeks
- Night splint
- Cryoth­erapy over pronator teres
- US (15 mins 1MHz, 1 watt 25% duty cycle) and elec stim
- Stretching and myofascial release of hypertonic pronator teres and wrist flexors
- Sx if failure to respond to conser­vative care within 4 months