Pronator teres syndrome: Difference between revisions
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==Background== | ==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]] | [[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]] | |||
*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=== | ||
*Primarily will complain of | *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 | *Pain to the volar aspect of proximal forearm which may be worse on palpation | ||
*Typically does not feature nocturnal exacerbation | *Typically does not feature nocturnal exacerbation | ||
*May report decreased grip strength | *May report decreased grip strength | ||
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===Physical Examination Findings=== | ===Physical Examination Findings=== | ||
*Symptoms worsened with resisted forearm pronation, resisted elbow flexion | *Symptoms worsened with resisted forearm pronation, resisted elbow flexion | ||
*Exacerbating examination techniques may produce | *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 | *May have concomitant medial epicondylitis | ||
==Differential Diagnosis== | ==Differential Diagnosis== | ||
*[[Thoracic outlet syndrome]] | *[[Thoracic outlet syndrome]] | ||
{{Elbow DDX}} | |||
{{Upper extremity peripheral nerve syndromes}} | |||
==Evaluation== | ==Evaluation== | ||
*Ortho appreciates dedicate elbow films at minimum | *Ortho appreciates dedicate elbow films at minimum | ||
**Usually no gross appreciable pathology | **Usually no gross appreciable pathology | ||
*Ultrasound and MRI also useful though not required in ED setting | *[[Ultrasound]] and [[MRI]] also useful though not required in ED setting | ||
==Management== | ==Management== | ||
*Conservative management first indicated and most beneficial in large majority of cases | *Conservative management first indicated and most beneficial in large majority of cases | ||
**Course of extremity rest and NSAID treatment, 3-6 month management period | **Course of extremity rest and [[NSAID]] treatment, 3-6 month management period | ||
*Referral to orthopaedics | *Referral to orthopaedics | ||
**Surgical management possible if no response or worsening of symptoms over 3 month period | **Surgical management possible if no response or worsening of symptoms over 3 month period | ||
==Disposition== | ==Disposition== | ||
Outpatient | *Outpatient | ||
==See Also== | ==See Also== | ||
*[[Peripheral nerve syndromes]] | |||
==References== | ==References== | ||
Latest revision as of 14:12, 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
Elbow Diagnoses
Radiograph-Positive
- Distal humerus fracture
- Radial head fracture
- Capitellum fracture
- Olecranon fracture
- Elbow dislocation
Radiograph-Negative
- Biceps tendon rupture/dislocation
- Lateral epicondylitis
- Medial epicondylitis
- Olecranon bursitis (nonseptic)
- Pronator teres syndrome
- Septic bursitis
Pediatric
- Nursemaid's elbow
- Supracondylar fracture
- Lateral epicondyle fracture
- Medial epicondyle fracture
- Olecranon fracture
- Radial head fracture
- Salter-Harris fractures
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