Pronator Teres Syndrome Among Other Compressive Neuropathies of the Upper Limb. A Case Report
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Published:
Dec 26, 2024
Keywords:
Nerve, median, pronator, neuropathy, syndrome, teres
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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.
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.
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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
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Case Presentations
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References
1. Paulsen F, Waschke J. Sobotta. Cuaderno de tablas. Músculos, articulaciones y nervios. 3.ª ed. UK: Elsevier
Limited; 2019, p. 52-63
2. 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
3. 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-
4. https://doi.org/10.31729/jnma.7230
4. 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/
5. 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
6. 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)
2022;12(10):2433. https://doi.org/10.3390/diagnostics12102433
7. 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
8. 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
9. 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
10. 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
11. 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
12. 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
13. 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
14. 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
15. 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
16. 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
Limited; 2019, p. 52-63
2. 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
3. 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-
4. https://doi.org/10.31729/jnma.7230
4. 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/
5. 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
6. 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)
2022;12(10):2433. https://doi.org/10.3390/diagnostics12102433
7. 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
8. 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
9. 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
10. 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
11. 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
12. 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
13. 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
14. 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
15. 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
16. 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