Do you have a painful forearm or weird sensations in your thumb and pointer finger? Maybe
your forearm, wrist, and elbow have been aching. A quick online search for symptoms yields
dozens of results for painful hand, wrist, and elbow conditions, making fact-finding very confusing.
Your pain and discomfort may partially match common wrist complaints like carpal tunnel
syndrome, hand tendonitis, elbow pain, and other related conditions, or your symptoms don’t
seem to fit any single situation — making it hard to tell what exactly is going on!
One lesser-known condition that causes finger tendon and forearm discomfort is called
pronator teres syndrome, and this culprit for finger, hand, wrist, and forearm pain lies close to
the elbow. Pronator teres syndrome can imitate other conditions; however, it is discernable.
But what exactly is pronator teres syndrome, and how can you tell pronator teres syndrome
from other related wrist and hand conditions?
(Picture from Google Images)
What is pronator teres syndrome?
The elbow is a structure connecting bones, ligaments, connective tissues, the elbow joint,
several muscles, bursa (fluid-filled sacs designed to absorb forces), and nerves. Repetitive or
excessive movement causes injury, pain, inflammation and damage to these structures.1
With this syndrome, a specific muscle is the victim: the pronator teres!2
Excessive or repetitive movement can have many causes: carpentry, assembly line work,
basketball, plumbing, weightlifting, mechanic work, or any repetitive movement that causes the
wrist to bend and the forearm to go palm-down. These excessive movements contribute to
stress and strain on the pronator teres. This muscle lives in the upper forearm and has two ends
or heads. When it becomes swollen or inflamed, it can affect other structures nearby, such as
the median nerve of the forearm and wrist.2 Additionally, the median nerve can also be
compressed by a local ligament coming off the bicep muscle: the lacertus fibrosis.
The median nerve is one of three nerves that supply our upper extremity. This nerve begins in
the upper arms and extends into the wrist and fingers. When the pronator teres muscle
compresses this nerve, it creates aching in the forearm and wrist, possible muscle weakness,
and changes in sensation to the thumb and index finger.3
Pronator teres syndrome is like carpal tunnel syndrome, defined as compression of the median
nerve at the wrist.3,4 However, pronator teres syndrome affects both the hand and the forearm,
whereas carpal tunnel syndrome largely affects the wrist and hand only. Common signs that the
median nerve is being entrapped at the elbow include the following3,4:
- Aching discomfort in the forearm and tenderness on palpating (pressing) into the pronator teres muscle
- Tingling sensation in the forearm, palm, and/or fingers (including the thumb)
- Numbness in the forearm, hand, and/or fingers (including the thumb)
- Pain and discomfort in the forearm, hand, and/or fingers (including the thumb)
- Muscle weakness in the forearm, wrist, and/or fingers (including the thumb)
With pronator teres syndrome, there may not be a history of trauma or injury associated with
symptoms. Instead, the symptoms may come on gradually and worsen over time.3,4
Who gets pronator teres syndrome?
Several factors can put people at higher risk of developing pronator teres syndrome.4 These
- People employed in occupations that increase the bulk of the pronator teres muscle such as mechanics, plumbers, and athletes in weightlifting or racket sports
- People with a history of trauma to the elbow resulting in restrictive bands of scar tissue or fibrous tissue in the forearm
The typical age of onset is in the fifth decade (40-49), and the condition is more common in women
than men. Patients with metabolic disorders like diabetes, alcoholism, or hypothyroidism are
predisposed to this condition.5
How do I know if I have pronator teres syndrome?
Symptoms of pronator teres include aching pain and discomfort on the volar (front) side of the
forearm with sensory disturbances along the thumb, pointer finger, and even the palm of the
hand. The pain may span the lower arm. You may notice discomfort when turning your wrist to
go palm-down (pronation), or this maneuver may make your pain and changes in sensation
worse.2,3,4 If you are experiencing any of these symptoms, reach out to our Woodbury chiropractic team today to learn more about our treatment approaches.
Is pronator teres syndrome the same thing as carpal tunnel syndrome?
Not really. Although the symptoms may be similar, the causes are very different and require
different treatment approaches. Compression of the median nerve causes carpal tunnel
syndrome by inflamed tendons where the wrist meets the hand; pronator teres syndrome is
compression of the median nerve near the elbow due to hypertonic (tight) muscles, muscle
adhesions, and/or the presence of scar tissue or fibrous tissue that compress the nerve.2,3
Pronator teres syndrome treatment in Woodbury, MN
At MN Spine and Sport, our chiropractors in Woodbury, MN, have many treatment options! For mild to moderate cases of pronator teres syndrome, conservative treatments like chiropractic care and rehabilitation are the first line of defense to attempt resolve of the condition. These non-surgical methods may include one or more of the following:
- Manual therapy
- Rest from the inciting activity (this is really important and always overlooked!)
- Anti-inflammatory pain medications or other anti-inflammatory treatments, like PEMF or laser
- Forearm splinting to prevent rotating
- Targeted exercises and rehabilitation
Severe cases may require a minimally invasive surgical intervention to relieve the pressure on
the median nerve. Thankfully, most cases don’t need it and can be treated conservatively!!
- Chumbley EM, O’Connor FG, Nirschl RP. Evaluation of overuse elbow injuries. Am Fam Physician. 2000
- Plancher KD, Peterson RK, Steichen JB. Compressive neuropathies and tendinopathies in the athletic
elbow and wrist. Clin Sports Med. 1996 Apr;15(2):331-71.
- Posner MA. Compressive neuropathies of the median and radial nerves at the elbow. Clin Sports Med.
- Howard FM. Compression neuropathies in the anterior forearm. Hand Clin. 1986;2:737-745.
- Tetro AM, Pichora DR. High median nerve entrapments. An obscure cause of upper-extremity pain.
Hand Clin. 1996;12:691-703.
- Dididze M, Tafti D, Sherman Al. Pronator Teres Syndrome. [Updated 2021 Aug 3]. In: StatPearls
[Internet]. Treasure Island (FL): StatPearls Publishing; 2021 Jan-. Available from: