Pronator Teres Syndrome

What is Pronator Teres Syndrome?

Pronator Teres Syndrome (PTS) is rare neuropathy, resultant of this pain development in the forearm. The identified nerve compression is responsible for Pronator Teres Syndrome is median nerve proximal present in the forearm.

Pronator Teres Syndrome is a type of median nerve entrapment syndromes. Anterior interosseous nerve syndrome and carpal tunnel syndrome are other two types of median nerve entrapment syndromes.

Pronator Teres Syndrome is not same as Carpal Tunnel Syndrome (CTS), as PTS develops due to compression of median nerve at the elbow, whereas nerve compression at the wrist caused CTS. The numbness in the forearm is a classic feature of Pronator Teres Syndrome, which is not present in Carpal Tunnel Syndrome.

Symptoms

Pronator Teres Syndrome has following symptoms:

• Front (volar) side of Proximal lower arm has pain due to damage of the associated soft tissue
• Tingling, pricking, tickling, numbness in the forearm and that extends to first three fingers of the affected hand
• The other hand also develops weakness
• Unexplained weakness of the grip
• Palpation increase the intensity of pain
• Nocturnal exacerbation of the numbness of the forearm
• Light tapping over the affected nerve elicits a feeling of tingling or “pins and needles” symptoms or provides positive Tinel’s sign.
• During the physical examination of the affected hand, the examination maneuvers trigger the symptoms.

If anybody has complete Pronator Teres Syndrome, along with anterior interosseous nerve, the involved muscles are the pronator teres, flexor carpi radialis, palmaris longus, flexor digitorum superficialis.

Test

Pronator Teres Syndrome Test is performed for differentiating Pronator Teres Syndrome from Carpal Tunnel Syndrome, as pain and sensory symptoms are overlaps in both the cases.

Different types of movement like forearm pronation, elbow flexion forearm supination resist can indicate the site of the median nerve compression.

Medial nerve compression at the elbow can lead to numbness in association with pain and the symptoms distributed at the distal median nerve can cause weakness in the flexor pollicus longus muscle and flexor digitorum profundus muscle of the first finger and the pronator quadratus muscle.

The other findings associated with physical findings are a generation of warmth over the pronator teres muscle and pain spread over forearm.

Abduction movement of the thumb become weak. pincer muscles impairment, the altered sensation is also felt at the first three fingers and palm.

For physical examination, the patient is ordered to stand with 90-degree flexion position of the elbow. For stabilize the patient’s hand positioning, clinician placed his/her one hand on elbow and also grasps the patient’s hand in a handshake position with the other hand.

Clinician instructs patient to keep the elbow in relaxing position, instead of firming the position. Then clinician extends the elbow of the patient and that trigger the pain discomfort, which indicates median nerve compression and provide the possibility of the PTS.

Some radiographic tests are performed to obtain detail features of the Pronator Teres Syndrome. The included tests are Ultrasound and MRI, which also detect the underlying cause of the Pronator Teres Syndrome.

The possible different underlying causes are tumor progression on a primary nerve or nerve sheath, osseous spurs, ganglion cysts, variable anatomical features etc. MRI can help to detect the affected nerve.

Treatment

Pronator Teres Syndrome is a treatable condition. A variety of treatment approaches are available, but the applied method depends upon the severity of the patient condition.

The most primary therapeutic approach to treat Pronator Teres Syndrome is taking rest and non-steroidal -anti-inflammatory drugs prescribed as SOS (whenever necessary). Almost 50 to 70 percent Pronator Teres Syndrome patients get relieved from the symptoms.

If the pain is not subsided by non-steroidal -anti-inflammatory drugs, then corticosteroids are prescribed.

If the above mentioned classic therapies are failed to provide relief from the symptoms, then surgical decompression process is applied for recovery of space-occupying lesions. In this process 90 percent success rate is achievable.

Physical therapy

The following Physical therapy is applied for rehabilitation.

Massage Techniques

Specific massage method is applied to release the pronator teres muscle and this will assist to lessen the median nerve compression. This process is called “releasing” pronator teres. In this technique, trained massage therapist massage the affected forearm to lengthen the muscle.

Contact inhibitory technique is also applied for draining the tension and post-isometric relaxation.The massage therapy also helps to eradicate the obstinate the muscular tension and also released compression on the underlying nerve.

Pronator Teres Stretch

Stretching with a proper way is another helpful method for rehabilitation. gentle stretching of the affected arm with regular interval throughout the day decrease the hypertonicity and improves muscle length.

Stretching technique is usually concentrate on stretching the frontal part of the arm in the elbow and forearm area provides benefits in Pronator Teres Syndrome.