Pronator teres syndrome: Difference between revisions
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==Background== | ==Background== | ||
[[File:Nerves of the left upper extremity.gif |thumb|Nerves of the left upper extremity showing the median nerve at the elbow (area of nerve copression).]] | |||
*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]] | *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. | *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 | *Common in the 4th and 5th decades of life | ||
*Women have higher incidence, as well as those with forearm hypertrophy (athletes) | *Women have higher incidence, as well as those with forearm hypertrophy (athletes) | ||
==Clinical Features== | ==Clinical Features== | ||
===Symptoms=== | ===Symptoms=== | ||
Revision as of 13:34, 5 February 2022
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
- Medial epicondylitis
- Carpal tunnel syndrome
- Anterior interosseus nerve syndrome
- Thoracic outlet syndrome
- Brachial plexus neuritis
Upper extremity peripheral nerve syndromes
Median Nerve Syndromes
Ulnar Nerve Syndromes
Radial Nerve Syndromes
- Radial neuropathy at the spiral groove (ie. "Saturday night palsy")
- Posterior interosseous neuropathy
Proximal Neuropathies
- Suprascapular neuropathy
- Long thoracic neuropathy
- Axillary neuropathy
- Spinal accessory neuropathy
- Musculocutaneous neuropathy
Other
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