Pronator Teres Syndrome Among Other Compressive Neuropathies of the Upper Limb. A Case Report

Keywords: Nerve, median, pronator, neuropathy, syndrome, teres

Abstract

Pronator teres syndrome (PTS) is a condition involving entrapment of the median nerve as it passes between the muscular bellies of the pronator teres muscle. It is a rare condition, often misdiagnosed as other compressive neuropathies of the upper limb. We present a rare case of PTS associated with ulnar nerve compression at the elbow and median nerve compression at the wrist. Electrophysiological studies revealed entrapment of the median nerve at the wrist and ulnar neuropathy at the elbow. Dynamic ultrasound of the forearm confirmed morphological changes in the median nerve as it traversed the pronator teres muscle. The patient showed significant improvement following corticosteroid treatment, rehabilitation, and functional readaptation techniques. Conclusions: PTS should be considered in patients presenting with sensory disturbances in the forearm and wrist. Differentiating it from other compressive neuropathies is critical, as early diagnosis enables the implementation of conservative therapeutic measures to prevent progression to structural nerve damage.

Downloads

Download data is not yet available.

Metrics

Metrics Loading ...

Author Biography

Íñigo Úbeda Pérez de Heredia, Traumatology Service, Clínica Beiman Sevilla, Sevilla, Spain
Traumatology Service, Clínica Beiman Sevilla, Sevilla, Spain

References

Paulsen F, Waschke J. Sobotta. Cuaderno de tablas. Músculos, articulaciones y nervios. 3.ª ed. UK: Elsevier

Limited; 2019, p. 52-63

Olewnik L, Podgórski M, Polguj M, Wysiadecki G, Topol M. Anatomical variations of the pronator teres muscle in a Central European population and its clinical significance. Anat Sci Int 2018;93(2):299-306.

https://doi.org/10.1007/s12565-017-0413-y

Sharma N, Pandit R, Subedi S. Median nerve passing below the ulnar head of pronator teres in cadavers of a

Medical College in Western Nepal: A descriptive cross-sectional study. JNMA J Nepal Med Assoc 2022;60(245):31-

https://doi.org/10.31729/jnma.7230

Dididze M, Tafti D, Sherman Al. Pronator teres syndrome. StatPearls [Internet]. Treasure Island (FL): StatPearls

Publishing; 2023. Disponible en: https://www.ncbi.nlm.nih.gov/books/NBK526090/

Özdemir A, Acar MA, Güleç A, Durgut F, Cebeci H. Clinical, radiological, and electrodiagnostic diagnosis of

pronator syndrome concurrent with carpal tunnel syndrome. J Hand Surg Am 2020;45(12):1141-7.

https://doi.org/10.1016/j.jhsa.2020.06.006

Balcerzak AA, Ruzik K, Tubbs RS, Konschake M, Podgórski M, Borowski A, et al. How to differentiate

pronator syndrome from carpal tunnel syndrome: A comprehensive clinical comparison. Diagnostics (Basel)

;12(10):2433. https://doi.org/10.3390/diagnostics12102433

Zancolli ER, Zancolli EP, Perrotto CJ. New miniinvasive decompression for pronator teres síndrome. J Hand Surg Am 2012;37(8):1706-10. https://doi.org/10.1016/j.jhsa.2012.05.033

Adler J, Moriatis J. Proximal median nerve compression: Pronator syndrome. Hand Surg J 2020;45(12):1157-65.

https://doi.org/10.1016/j.jhsa.2020.07.006

Moura FSE, Agarwal A. A rare and severe case of pronator teres syndrome. J Surg Case Rep 2020;2020(10):397.

https://doi.org/10.1093/jscr/rjaa397

Chang KV, Wu WT, Hsu PC, Yang YC, Ozcakar L. Ultrasonography in pronator teres syndrome: Dynamic

examination and guided hydrodissection. Pain Med 2022;23(1):227-8. https://doi.org/10.1093/pm/pnab143

Fernández-de-Las-Peñas C, López-de-Celis C, Rodríguez-Sanz J, et al. Safety of dry needling of the pronator teres muscle in cadavers: A potential treatment for pronator syndrome. Pain Med 2022;23(6):1158-61.

https://doi.org/10.1093/pm/pnab274

Sánchez Saba JE, Civit JF, Ramírez Vargas P, Melibosky Ramos F, Villavicencio Achurra A, Román Veas J, et al.

Síndromes compresivos del nervio mediano. Revisión y actualización de la bibliografía. Rev Asoc Argent Ortop

Traumatol 2023;88(4):451-6. https://doi.org/10.15417/issn.1852-7434.2023.88.4.1734

Rodner CM, Tinsley BA, O’Malley MP. Pronator syndrome and anterior interosseous nerve syndrome. J Am Acad Orthop Surg 2013;21(5):268-75. https://doi.org/10.5435/JAAOS-21-05-268

Montemayor MG, Rodríguez J, Valencia H. Neuropatías por atrapamiento. Formación Médica Continuada en

Atención Primaria 2008;15(1):10-20. https://doi.org/10.1016/S1134-2072(08)70726-6

Créteur V, Madani A, Sattari A, Bianchi S. Sonography of the pronator teres: Normal and pathologic appearances. J Ultrasound Med 2017;36(12):2585-97. https://doi.org/10.1002/jum.14306

Toyat S, Chong W, Kandiah S, Lakshen P, Zulkifli E, Kamil M, et al. A rare case of pronator teres syndrome &

accompanying anterior interosseous nerve syndrome. Malaysian Orthop J 2018;12.

https://doi.org/10.1093/jscr/rjaa397

Published
2024-12-26
How to Cite
Úbeda Pérez de Heredia, Íñigo. (2024). Pronator Teres Syndrome Among Other Compressive Neuropathies of the Upper Limb. A Case Report. Revista De La Asociación Argentina De Ortopedia Y Traumatología, 89(6), 632-636. https://doi.org/10.15417/issn.1852-7434.2024.89.6.1872
Section
Case Presentations