Assessment:

In my opinion, these are the symptoms of Pronator Teres Syndrome, the major symptoms of this
can be very similar to carpal tunnel syndrome and include: Tingling or numbness in the palm,
thumb and three fingers but not the little pinky finger. There will be an aching sensation in the
forearm and tenderness when feeling or pressing in on the pronator teres muscle in the arm.

Management Plan:

 An effective conservative management strategy includes rest, modalities and nerve

gliding exercise.
 Perhaps the most important aspect of treatment is the avoidance of repetitive forceful
gripping.
 A discussion of workstation ergonomics and specifically avoiding repetitive tasks is
essential.
 Activity modification may be necessary and in severe cases, an elbow splint may be used
to maintain 90 degrees of flexion with the forearm in mid-rotation. This splint would be
worn for approximately two weeks and would be taken off for range of motion activities.
 Ice packs or ice massage directly over the pronator teres muscle may provide benefit. The
use of ultrasound and electrical stimulation has shown benefit for the treatment of other
nerve pathologies, and their use may be beneficial in the treatment of pronator syndrome.
 Fifteen minutes of pulsed ultrasound daily has been shown to help more distal sources of
median nerve compression. The suggested settings are frequency – 1 MHz; intensity – 1
watt/cm squared; duty cycle – 25%.
 Good clinical judgement is required to assess the point at which the benefits of soft tissue
mobilization outweigh the risks of symptom exacerbation.
 When the symptoms are no longer acute, stretching and myofascial release of
hypertonic pronator teres and wrist flexor muscles is appropriate.
 Stretching should be performed prior to nerve mobilization.
 Median nerve mobilization is performed with the cervical spine in contralateral lateral
flexion, and rotation while moving the forearm from a flexed-supinated position into an
extended-pronated position. Nerve mobilization should not proceed past the point of
symptom provocation or exacerbation.