15/08/2023
💎Pronator Teres Syndrome:
Pronator Teres Syndrome (PTS) is a compression of the median nerve at the elbow.
🌿Causes of Pronator Teres Syndrome:
The most common cause is impingement of the median nerve between the two heads of the pronator teres muscle. Other causes are the compression of the nerve from the fibrous arch of the flexor superficialis muscle and the thickening of the bicipital aponeurosis.
Impingement and compression of the median nerve resulting swelling and inflammation of the structures situated around the median nerve as it passes through the elbow region.
☘☘Symptoms:☘☘
Pain on the proximal volar forearm
The sensation is present over the distribution of the palmar cutaneous branch of the median nerve (palm of hand)
Symptoms arise 4 to 5 cm proximal to carpal tunnel
In this condition have no night symptoms
🍁🍁Electrodiagnosis test:🍁🍁
NCV:
The Conduction velocity of the median nerve in the proximal forearm may be affected but the distal latency and sensory nerve action potential at the wrist are normal.
MRI:
It shows denervation and atrophy of the affected muscles, by this report the evaluation of pronator teres syndrome is unclear. In the MRI shows the detail of the soft tissue affecting the median nerve.
X- Ray:
An x-ray of the elbow will be taken to confirm any bony abnormality which may be causing symptoms.
🔵🔵Special Test🔵🔵
The Pronator Compression Test: Placing pressure over the pronator muscle in both upper extremities. A positive test is indicated by reproduction of tingling and numbness in the first 3 1⁄2 digits within 30 seconds.
⭕Therapeutic Exercises:::
➕Median Nerve flossing Exercise:
Sit on the table and reach the affected arm out to the side, and bring with your shoulder, the hand facing the floor.Flex the hand and pull the fingers up toward the ceiling.Bend the arm and bring the hand toward the shoulders.Repeat it 5 times
➕. Pronators Stretching:
Standing with the back facing the door.
Raise your to arm backward (shoulder extension) as much as possible, and keep the elbow straight.Grasping the doorframe with your thumb pointing down.Rotate the arm externally.
➕Myofascial Release:
First Keep the elbow bend, palm facing up. Put the thumb over the affected forearm, near the elbowRotate the palm facing down, so that palpate the pronator teres muscle be
After the palpation of the tender point, press for 5 seconds without triggering any symptoms like tingling or numbness sensation.
Rotate your forearm repeatedly. (turning your palm up and down) this movement repeats 10 times while the thumb is still on the belly point.
➕Standing palm press (Flexor and Extensors muscles stretching):
The forearm muscles and hand muscles will be stretched along with the nerves in the arm.
Stand affected side of the body facing the wall side. the feet should be slightly apart.
Press that hand into the wall, while keeping the torso upright position and the arm should be straight.Fingers should be pointed up.
Pull shoulder or body back and hold the stretch for five deep breaths.Change finger’s position is pointed downward without hunching the shoulder and another position will be the same.Hold the stretch for five deep breaths.
➕ Standing curl Exercise:
First, stabilize the pelvis and torso and it helps to work all the muscles in the shoulders and arms.Rotating movements of the arms improve muscle strength and movement in the forearm.
Stand with legs and shoulder-width apart, hold the dumbbell in one hand which hands facing toward the legs.Curl or flex the arms to the shoulders and rotate the hands that face the shoulders.Rotate the arms and hands so that the knuckles are facing toward the body. then back to starting position.
Repeat this movement 10 times.
➕ Massage Techniques:
Massage techniques can help to decrease tension in the pronator teres muscle so that decreases compression on the median nerve. Called “releasing” the pronator teres.
These techniques performed by a trained professional can lengthen the muscle.
The practitioner performs contact inhibition and drained the tension which areas are tight.
This technique helps to work stubborn tension out of the muscle and relieves compression of the underlying nerve.
➕Kinesio Taping:
Attach the tape over the outside of the mid forearm, then stretch it diagonally to the inside of the forearm.Apply the Kinesio tape over the pinky side of the wrist and stretch it towards the inside of the elbow.This tape is applied for 2 or 3 days and then it removes.
➕. Dry needling:
The dry needling technique is used to reduce pain, reduce activation of resting muscle and reduce muscular tension.
In this technique used different size needles and apply them to the pain area.
➕. Patient Education:
During conservative treatment, patients should be advised to minimize their related activities that involve frequently forearm pronation movement.
These activities include:
•Hammering.
•Ladling food.
•washing dishes.
•Playing table-tennis.
•Pouring drinks, activity performed by waitresses.
•Carry the books frequently performed by librarians.
•Twisting the clothes.
🔺Orthotic intervention🔺
It is essential to stop overusing the affected arm for repetitive grasping and forceful forearm rotation. Therefore, an elbow orthosis (brace) can be helpful to rest the elbow in bending, and forearm in mid rotation (neutral) position. It should be worn all the time for at least 2 to 4 weeks.
🔻Ergonomic adjustment🔻
For heavy computer users, you should consider using an ergonomic split keyboard and vertical mouse, which greatly reduce full pronation of your forearm when tying and mousing
