pronater teres syndrome and physical therapy management

1. PRONATER TERES SYNDROM
DR.AHMAD MERAJUL HASAN INAM(MPT ORTHO)

2. First described by Henrik Seyffarth(1951) it was originally caused by a
compression of Median nerve between the 2 heads of pronater teres or by
the FDS muscle in the forearm.
Since Seyfarth original description PT syndrome has been expanded to
encompass compression of median nerve at the ligament of struthers ,
bicipital apponeurosis, pronater teres and the arch of the FDS.(joshpt)

4. ETIOLOGY
Quick repetitive grasping pronation movement (may cause PT
muscle hypertrophy and entrapment of median nerve).
Local trauma /compression /undergoing anticoagulant therapy/renal
dialysis.
Occupation like- carpentry, mechanics.
In sports like-rackate ,rowing and weight lifting.

5. CLINICAL PRESENTATION
Typically complains of pain in the proximal volar aspect of the
forearm.
Tingling or numbness and parasthesia in the palm thumb and 3
fingers but not in little finger.
Patient describe decreased grip or pinch strength or generallise
weakness as well as loss of fine motor skill
Tenderness present while pressing the PT muscle(tinnel sign can
be present )

6. Physical Therapy Assessment
Subjective Findings-
Onset-
Gradual due to overuse or for no known reason
Age-20-40 Years of age
Duration-
history of several months of recurrent symptoms
Frequency-
Recurrent with overuse
one long episode with the history of no known cause

7. Area of symptoms-
Sensory-lateral side of the hand and lateral 3
and half fingers.
Motor-Anterior forearm and hand
Type of Symptoms-
Paraesthesia
Decrease Muscles Strength

8. OBJECTIVE ASSESSMENT-
Observation-
Later stage wasting of the anterior forearm and
hand
AROM-
Full ROM,symptom may present at the end ROM
if held for prolong period
PROM-
Full ROM without any symptom

9. Resisted Movement-
◦ Later weakness on pronation, flexion of wrist,
opposition of thumb, flexion of second and third
finger
Palpation-

10. SPECIALTEST
Pronator teres compression test--The test is performed by placing
pressure over the pronator muscle in both upper extremities.
A positive test is indicated by reproduction of paresthesia in the
lateral 3 and half digits in 30 seconds or less, while the uninvolved
limb remains asymptomatic.

11. DIFFRENTIAL DIAGNOSIS

12. IMAGING STUDIES
x ray rarely diagnostic in PT syndrome
Minimum literature exists regarding the diagnostic utility of MRI.
MRI can be helpful if there is concern for extrinsic causes of
compression such as a tumor or hematoma.
Ultrasound.
Eletrodiagnostic studies –
EMG and NCS are often negative or inconclusive in cases of PT
syndrome.
If NCS are positive they may show decreased conduction
velocities from the elbow to the wrist.

13. PHYSIOTHERAPY MANAGEMENT
With conservative treatment, 50 % of patient with PT syndrome have
been reported to recover in 4 months.
MODALITIES-
Modalities for PT syndrome does not exist but research on the use of
the modalities of other nerve pathology which may be relevent to
treatment of PT syndrome.
ULTRASOUND –
frequency -1.0 MHz/ intensity - 1.0W/cm2 , duty cycle-25% with 15
minutes duration.
10 session 5 time/ week for 2 weeks) followed by 10 additional
sessions (twice a week for 5 weeks).

14. ELECTRICAL STIMULATION-
Help to reduce pain and promote healing
IONTOPHORASIS –
It is helpful to reduce inflammation which may be primary
cause of nerve compression.

15. MANUALTHERAPY
MAYOFACIAL RELEAS-
Release of pronater teres muscle followed by hotpack to
volar aspect of the forearm.
NERVE GLIDDING –
If the nerve compression exists , the clinician must consider
whether the increased stressed imparted to the nerve in an
attempt to moblize it is clinically beneficial.
MASSAGE TECHNIQUE-
Massage techniques accompanied by streches of the forearm
musculature could help to reduce the symptoms.

16. THERAPUTIC EXERCISES
PRONATER TERES STRECH –
Streching the PT muscle will help the lengthen this muscle
and prevent muscle tightness associated with PT syndrome.
Hold the strech 20- 30 seconds take a short break and repeat
the process 5 times.
FLEXOR STRECH-
Extend the arm and wrist and with the help of apposite hand
to pull the finger downward gentelly hold 20-30sec.

17. PRONATER TERES STRECH

18. STANDING PALM STRECH -
stand an arms length away from the wall with your feet
spread slightly apart, extend your arm at a 90 deg angle from
your body.
Press the wall with your palm with fingers pointed upward.
 SUPINATER STRENGTH TRAINING-
strengthen this muscle to help relieve pronator syndrome
pain(15 time repetition).

19. STANDING CURL AND PRESS-
with 2 weight you can gentelly exercise the muscle in your
shoulders arm and hands this will help to increase the
strength and mobility (repeat 10 time/ session).

20. STANDING PALM STRECH

21. SUPINATER STRENGTH TRAINING

22. STANDING CURLAND PRESS

23. SPECIALTECHNIQUES
Dry needling
Kinasio-taping

25. HOME ADVICE
Patient education
Explain do’ and dont’s
Explain the prognosis
Self myofacial release

27. initial stages avoid combining movements of pushing and
pulling