Pronator Teres Syndrome

Pronator teres syndrome is a condition where the median nerve in your forearm gets squeezed as it passes through a muscle called pronator teres. This squeezing can cause symptoms like pain, numbness, and weakness in your forearm, hand, and fingers, especially the thumb and index finger. Although it's not very common, it can happen if you do a lot of repetitive movements with your forearm or if you've had an injury.
If not treated, the condition can get worse, leading to long-lasting pain, muscle loss, and trouble using your hand and arm.

Treatments for Pronator Teres Syndrome

The overall treatment goal for pronator teres syndrome is to relieve compression and irritation of the median nerve in order to alleviate symptoms and restore normal function. Treatment typically begins conservatively with rest, activity modification, bracing, anti-inflammatory medications, and physical therapy. If conservative measures fail to improve symptoms after a few months, then surgery may be considered.

Non-Surgical Treatments

Physical Therapy

Physical therapy focuses on exercises and techniques to improve strength, flexibility, and range of motion. Therapists work to alleviate symptoms by targeting specific muscles and nerves, aiming to reduce pressure on affected nerves and enhance overall function.

Medication

Over-the-counter or prescribed medications such as nonsteroidal anti-inflammatory drugs (NSAIDs), corticosteroids, or pain relievers might be used to manage pain, inflammation, and discomfort associated with nerve compression. In some cases, neuropathic medications may be prescribed to manage nerve-related pain.

Splinting or Bracing

Wearing braces or splints can help alleviate pressure on nerves by keeping the affected area in a proper position, reducing strain and allowing for healing. For instance, wrist splints are often used in carpal tunnel syndrome to keep the wrist in a neutral position, relieving pressure on the median nerve.

Steroid Injections

Corticosteroid injections can help reduce inflammation and alleviate symptoms by targeting specific areas of nerve compression. These injections are often used to help diagnose certain types of nerve entrapment by providing temporary relief.

Surgical Treatments

Pronator Teres Muscle Release

Pronator teres muscle release involves surgically cutting or releasing the pronator teres muscle and other areas of compression on the median nerve.

Median Nerve Decompression Surgery

Median nerve decompression involves surgically removing structures other than the pronator teres muscle that may be decompressing the nerve to create more space for the nerve.

Tendon Transfer Surgery

Typically performed in combination with a pronator teres muscle release or median nerve decompression, this procedure involves taking a nearby healthy tendon, detaching it from its original attachment point, and transferring it to a new location to restore lost function.

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The Center for Hand and Upper Extremity is a highly specialized practice comprised of some of the most experienced nerve and tendon surgeons in the world. Our advanced out-patient surgery centers are led by renowned orthopedic, plastic, and reconstructive surgeons who specialize exclusively in hand and upper limb disorders and perform hundreds of nerve procedures every year. We utilize the latest microsurgical techniques and advanced imaging technology to precisely locate and treat nerve compressions. Our standard of surgical care has no equal when it comes to restoring confidence, independence, and comfort.

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When to Seek Medical Attention

Pronator teres syndrome or median nerve compression symptoms often develop gradually over time. However, it's generally recommended to seek medical attention if you experience persistent numbness, tingling, weakness or pain in the forearm, wrist or hand. Signs like clumsiness, dropping objects or difficulty with fine motor tasks can indicate nerve compression. Severe or progressive symptoms, or symptoms that interfere with your normal activities, sleep or quality of life are also reasons to see a doctor promptly. Getting an accurate diagnosis and appropriate treatment from a specialist like an orthopedist or neurologist can help prevent nerve damage and preserve function. Don't try to ignore or self-treat hand and arm symptoms for too long before getting evaluated. Early intervention provides the best outcome.

Frequently Asked Questions

What causes pronator teres syndrome?

It is often caused by repetitive forearm motions that irritate the median nerve as it passes between the two heads of the pronator teres muscle. Sports like racquetball, tennis, volleyball can increase risk. Anatomical variations or injuries can also compress the nerve.

What are the risk factors?

Repetitive forceful forearm rotation, occupational tasks like assembly work or painting, being female, having a shallow antecubital fossa, past fracture or injury to the forearm/elbow area.

How is it diagnosed?

Physical exam showing tenderness over the pronator teres muscle, numbness in median nerve distribution, sometimes atrophy of thenar muscles. Nerve conduction studies help confirm. MRI or ultrasound sometimes used. Often, diagnostic injections are utilized to help confirm the diagnosis.

What is the long-term prognosis after treatment?

With appropriate treatment, many patients see significant improvement in symptoms and regain good function. Symptoms may recur if activities that irritate the nerve resume intensely. Nerve damage can become permanent without treatment.

How can I prevent it from recurring after surgery?

Avoid repetitive forearm twisting motions, improve ergonomics at work, take frequent stretches and breaks, strength training, and use an elbow pad to protect the area during activities.

What is the recovery time after surgery?

A short period of immobilization may be used, but often you are using your extremity the day after surgery. Hand therapy for 6-12 weeks may be prescribed to improve motion and strength. Most patients recover well over 3-6 months.

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