Next Article in Journal
Clinical and Radiological Predictors for Early Hematoma Expansion After Spontaneous Intracerebral Hemorrhage: A Retrospective Study
Previous Article in Journal
Pulmonary Embolism After Acute Ischaemic Stroke (PEARL-AIS): Global Prevalence, Risk Factors, Outcomes, and Evidence Grading from a Meta-Analysis
 
 
Font Type:
Arial Georgia Verdana
Font Size:
Aa Aa Aa
Line Spacing:
Column Width:
Background:
Case Report

The Diagnostic Pitfalls in the Pronator Teres Syndrome—A Case Report

by
Wiktoria Rałowska-Gmoch
1,
Marcin Hajzyk
2,
Tomasz Matyskieła
3,
Beata Łabuz-Roszak
1 and
Edyta Dziadkowiak
4,*
1
Department of Neurology, St. Jadwiga Provincial Specialist Hospital, Institute of Medical Sciences, University of Opole, pl. Kopernika 11a, 45-040 Opole, Poland
2
Orthopedic Children Department, Hospital Complex in Chorzów, Truchana 7, 41-500 Chorzów, Poland
3
Department of Neurology, Neurosurgery University of Warmia and Mazury, ul. Warszawska 30, 10-082 Olsztyn, Poland
4
Clinical Department of Neurology, University Centre of Neurology and Neurosurgery, Faculty of Medicine, Wroclaw Medical University, Borowska 213, 50-556 Wroclaw, Poland
*
Author to whom correspondence should be addressed.
Neurol. Int. 2025, 17(10), 169; https://doi.org/10.3390/neurolint17100169 (registering DOI)
Submission received: 29 September 2025 / Revised: 5 October 2025 / Accepted: 7 October 2025 / Published: 12 October 2025
(This article belongs to the Section Pain Research)

Abstract

Pronator teres syndrome is a rare proximal median neuropathy caused by compression of the median nerve at various points. It is a rare condition, and many times it is mistaken for carpal tunnel syndrome. There are many authors who refer to the pronator syndrome as a compression of the median nerve at several potential sites of entrapment in the region of the antecubital fossa, more proximal compression at the Ligament of Strutters, and more distally, including lacerus fibrosus within the pronator teres muscle and the anterior interosseous nerve. The diagnostic difficulties in a patient with severe right forearm pain during elbow flexion and pronation are presented. Routine test results, including MRI of the right elbow joint, nerve conduction study of the brachial plexus and ulnar nerve, and electromyographic study of the muscles of the right upper extremity, were normal. Ultrasonography showed an enlarged pronator teres muscle. The patient underwent surgical removal of the lacertus fibrosus. All symptoms resolved.

1. Introduction

Pronator teres syndrome (PTS) is a proximal median neuropathy caused by compression of the median nerve at various points within the anatomical structures of the elbow and forearm. It is a rare condition, and many times it is mistaken for carpal tunnel syndrome (CTS). There are many authors who refer to the pronator teres syndrome as a compression of the median nerve at several potential sites of entrapment in the region of the antecubital fossa, more proximal compression at the ligament of Struthers, and more distally, including lacertus fibrosus within the pronator teres muscle [1,2,3,4,5]. Others describe PTS as a compression of the median nerve by only the pronator teres muscle (PT) in the forearm [1].
Among the causes of PTS are repetitive gripping or forearm pronation movements (e.g., prolonged hammering, scooping food, dishwashing, playing tennis). These movements can lead to muscle hypertrophy in the antecubital fossa and result in median nerve damage, especially in individuals with additional fibrous bands [1]. In the scientific literature, PTS has also been described as resulting from local trauma, compression with schwannoma, anticoagulation therapy, and dialysis [1,5].
Clinical symptoms depend on the location and cause of the lesion. Pain and discomfort usually occur at the site of nerve entrapment [1,3,5,6,7,8,9]. In proximal median neuropathy, sensory loss affects the thenar eminence, thumb, index, middle, and lateral ring fingers, while in carpal tunnel syndrome (CTS), the thenar eminence is spared [3,4,5]. Struthers syndrome, a rare compressive neuropathy, should be considered in the differential diagnosis. Here, the median nerve or brachial artery is compressed by the ligament of Struthers and the humeral supracondylar process, causing hand pain, numbness, weakness, or ischemic forearm pain during resisted elbow flexion [8,9,10,11,12,13]. Differentiating pronator teres syndrome (PTS) from CTS, anterior interosseous nerve syndrome (AINS), cervical radiculopathy, and thoracic outlet syndrome is essential. PTS occurs with CTS in 6–11.5% of cases [12]. Lacertus fibrosus syndrome involves median nerve compression below the bicipital aponeurosis, just distal to the elbow. It is associated with repetitive forearm movements and presents mainly as reduced hand strength and endurance [14].
One of the easiest provocative tests for PTS is: pronator teres resistant pronation or activation of the sublimity bridge of the flexor digitorum superficialis (FDS) by resisted flexion of the long finger when other fingers are held in extension, or activation of the lacertus fibrosus with resisted flexion of the elbow with forearm in supination. One can provoke PTS symptoms by compression of the nerve between the two heads of the pronator teres muscle during resisted forearm pronation in the extended elbow (Figure 1) [2,15,16,17,18,19]. The Tinel’s sign at the proximal forearm, and a positive Phalen test over the pronator teres muscle can be present in 50% of cases [1].
Electrodiagnostic studies are very important to localize the lesion as a result of trauma or compression, and neuromuscular ultrasound is a complementary test. Very often, the routine tests are normal or nonspecific [11,12,13,20,21]. Electromyography (EMG) abnormalities are most commonly observed in the flexor pollicis longus (FPL) and flexor digitorum profundus (FDP) to digits 2 and 3, less frequently in the flexor digitorum superficialis (FDS) and abductor pollicis brevis (APB) [1,13,20,21,22]. EMG should assess median-innervated muscles both proximal and distal to the carpal tunnel to differentiate PTS from CTS, radiculopathy, or AINS. Additionally, at least two non-median C8–T1 and one non-median C6–C8 muscles should be examined to exclude brachial plexopathy or radiculopathy [1,2,8,23].
Ultrasonography has an important role in diagnosing PTS and other upper limb neuropathies. It is a useful tool for the examination of PT and dynamic changes in the morphology of the median nerve. Magnetic resonance imaging may show a hyperintense signal change secondary to denervation edema of the anterior forearm muscles [10,11,13,20,21,24,25].
The goal of pronator teres syndrome treatment is to relieve median nerve compression and restore function. Conservative management—rest, immobilization, physical therapy, and braces—aims to reduce nerve pressure and improve strength, flexibility, and motion. If symptoms persist after 3–6 months, surgical treatment may be considered [12,16,22,25,26,27,28].
Surgical management involves identifying and protecting the medial and lateral antebrachial cutaneous nerves, followed by forearm incision, median nerve exploration, and decompression by releasing the pronator teres and other compressive structures, including the ligament of Struthers, lacertus fibrosus, and the FDS fibrous arch [22,29,30]. All tendinous portions of the pronator teres must be released during a single-stage procedure. Decompression at multiple sites is still considered one operation [1,29,30,31].
The prognosis of pronator syndrome depends on the timing of diagnosis, severity of nerve compression, and effectiveness of treatment interventions. In initial appropriate therapy, the degree of nerve entrapment has an influence on treatment results [20,22,29,30,31,32,33].
The aim of this study was to present a comprehensive clinical overview of a patient diagnosed with pronator teres syndrome, with particular focus on the underlying anatomical factors, diagnostic challenges, and therapeutic management. The authors provide a detailed discussion of the differential diagnosis, highlighting the potential for misdiagnosis with other neuropathies of the upper limb. Accurate identification of the syndrome allowed for the implementation of surgical intervention, which resulted in complete resolution of the patient’s symptoms and significant functional recovery. This case underscores the importance of careful anatomical and clinical evaluation in the management of peripheral nerve entrapment syndromes.

2. Case Report

A 34-year-old man was referred to our clinic because of strong pain in the right forearm during flexion of the elbow, pronation movements, pain around the pronator teres palpation, and sensory disturbances involving the entire palm of his right dominant hand. The initial symptoms included mild symptoms in the middle finger. Retrospectively assessed using the 2-point Visual Analog Scale (VAS) for pain. The symptoms persisted for over one year. He was working as a carpenter, and because of the pain, he could not work and avoided activities that required repeated pronosupination movements. His symptoms progressively intensified due to his activities and occupation. He was very healthy, and he did not have any significant medical or surgical history.
The medical examination reveals pain in the forearm region aggravated by resisted pronation of the forearm and flexion of the elbow. Pain intensity was assessed as 9 points on the VAS. The pronator compression test was positive around PT, while the Carpal Tunnel Test, like the Tinel, Phalen test, showed negative. The Adson test was normal.
On physical examination, thenar muscle atrophy was found in the right hand, and the index and middle finger flexion strength was 4/5 Medical Research Council Scale, the thumb abduction strength was 4/5, and the ring and little finger flexion strength was 5/5. Hypoesthesia was found in the median nerve territory. The deep tendon reflexes were normal, and the patient was able to make an “OK sign”.
Autoimmunological and metabolic tests were normal. Borelioza, Human Immunodeficiency Virus (HIV), Venereal Disease Research Laboratory (VDRL), and Creatine Kinase (CK) tests were normal. Cervical ribs were not visible on X-ray, and Doppler ultrasound of the neck and upper limb vessels revealed no pathology. In the Magnetic Resonance (MR) scan of the right elbow and adjacent muscles, there was no discernible pathology. An MR scan of the neck and cervical spine was normal. The routine nerve conduction study revealed only prolonged sensory median latency (Figure 2). All other nerves of the brachial plexus with ulnar inching were normal; additional tests excluded CTS. Normal conduction parameters were obtained for the anterior interosseous nerve. Nerve conduction studies also did not provide evidence of thoracic outlet syndrome. Extensive EMG of the affected limb was normal.
Despite consultation with several medical professionals, a final diagnosis could not be determined.
He was treated with injections of steroids and physical therapy, but there were no improvements. The patient was treated with anti-inflammatory drugs and Gabapentin 1200 mg/d, Pregabalin 600 mg/d without improvement. Ultrasound-guided hydrodissection around the median nerve with corticosteroid injection also did not reduce the symptoms.
He was also rehabilitated using physiotherapy, kinesiotherapy, therapeutic exercises, and manual techniques that aid in stretching and releasing the compressed nerve. A full rehabilitation protocol was made, but there were no significant improvements.
Muscle ultrasound showed the enlarged pronator teres. The patient underwent the orthopedic consultation and then the removal of the lacertus fibrosus. The approach was a most uncommon skin incision, but it was still a modification of Henry‘s surgical instruction. The approach was S-shaped and approximately 10 cm. Cutaneous nerve branches of the lateral brachial and medial antebrachial cutaneous nerve were identified and atraumatically mobilized.
The easiest way to find the medial nerve was to look for the proximal part in the elbow flexion crease. The lacertus fibrosus was cut. After that step, the existence of Struher’s ligament and supracondylar process could be seen. The radial artery lay radial to the nerve and had to be protected throughout the procedure. The medial nerve was adherent to the pronator teres muscle. The muscle mass was protected, and the dissection proceeded to the distal part of the superficial arcade. The tendinous portion of the pronator teres was released. It was critical for all tendinous portions of the pronator teres that potentially compressed the nerve to be released in one step (Figure 3).
Two weeks after surgery, the patient was getting better, and the tingling sensations were much improved. One month later, the Tinel sign was negative. Motor power of the first and third fingers had improved to 5 in the Medical Research Scale. His complaints significantly lessened, as depicted by VAS. Shortly thereafter, he came back to his occupation and lived a normal life free of pain.
At the neurological follow-up visit six months after surgical treatment, clinical improvement was maintained, and the patient reported no recurrence of symptoms. He remained professionally active.

3. Summary

Pronator teres syndrome is a rare condition that is more common in women and people who perform repetitive forearm and wrist movements. Usually, it is difficult to diagnose because it can mimic other, more common conditions, such as CTS. Clinical diagnosis is based on diagnostic and imaging studies. This case report showed us to never give up, even when the diagnostic tests are nearly normal, but clinical features are dominant during patient examination. Physical therapy is a mainstay treatment for PTSD, as well as anti-inflammatory drug therapy and corticosteroid injections, which should be required for at least 6 weeks before any surgical interventions.
The management of pronator teres syndrome is challenging and requires consideration of various therapeutic options. The literature increasingly emphasizes the importance of ultrasound-guided hydrodissection when conservative measures fail to improve symptoms [16,34,35,36]. Shojaie et al. described their experience in treating pronator teres syndrome in a healthy young badminton player using ultrasound-guided median nerve hydrodissection. Following the initial session, the patient reported a 50% reduction in VAS score and improved capacity to lift weights. A second session was administered four weeks later. At the three-month follow-up, the VAS score had declined to 1/10, and ultrasonographic assessment demonstrated a normal median nerve with a negative sonographic Tinel sign, and the patient returned to professional badminton pain-free [34].
Particular attention should be given to delayed onset muscle soreness (DOMS). DOMS is well recognized after unaccustomed or resisted exercises of large muscles, but is often overlooked in the intrinsic and extrinsic muscles of the hand. DOMS reflects exercise-induced muscle damage (EIMD). According to Tedeschi, recognizing this phenomenon can improve exercise prescription, enhance recovery, and prevent setbacks in rehabilitation [37]. Also, Szajkowski et al. emphasize that after DOMS, foam rolling and percussive massage accelerate the restoration of muscle tone, decrease stiffness, and improve elasticity relative to passive rest, but offer no extra benefit for pain reduction [38]. However, the current literature does not support a clear advantage of foam rolling or stick massage in improving indirect markers of muscle damage (soreness, range of motion, swelling, and maximal voluntary isometric contraction) compared to no intervention in healthy individuals. Methodological heterogeneity and the limited number of high-quality studies make it difficult to draw definitive conclusions [37,38,39,40].

4. Conclusions

Pronator teres syndrome describes the signs and symptoms that result from compression of the median nerve by the pronator teres muscle in the forearm. The clinical presentation is different from its more common distal counterpart, carpal tunnel syndrome. Therefore, it is very important to correctly diagnose the pronator teres syndrome and provide appropriate treatment.

Author Contributions

W.R.-G. conceptualized and wrote the manuscript, M.H. wrote the manuscript, T.M. wrote the manuscript, B.Ł.-R. reviewed the manuscript, E.D. conceptualized and wrote the manuscript, and reviewed the manuscript. All authors have read and agreed to the published version of the manuscript.

Funding

Supported by the University of Opole, No P-2025-008.

Informed Consent Statement

Informed consent was obtained from all subjects involved in the study. The diagnostic procedures were conducted in accordance with the principles outlined in the Helsinki Declaration (1975, revised in 2013). Resolution No. KB 314/2024, issued on 18 April 2024, by the Bioethics Committee of Wrocław Medical University.

Data Availability Statement

The data presented in this study are available upon request from the corresponding author. The data are not publicly available.

Acknowledgments

We gratefully acknowledge the work of Paweł Skrzydło for creating and preparing Figure 1.

Conflicts of Interest

The authors declare no conflicts of interest.

Abbreviations

AINS Anterior Interosseous Nerve Syndrome
APB Abductor Pollicis Brevis
CTS Carpal Tunnel Syndrome
DOMS Delayed Onset Muscle Soreness
EIMD Exercise-Induced Muscle Damage
EMG Electromyography
FDS Flexor Digitorum Superficialis
FDP Flexor Digitorum Profundus
FPL Flexor Pollicis Longus
PT Pronator Teres Muscle
PTS Pronator Teres Syndrome
VAS Visual Analog Scale

References

  1. Dididze, M.; Tafti, D.; Sherman, A.L. Pronator Teres Syndrome. In StatPearls; StatPearls Publishing: Treasure Island, FL, USA, 2025. [Google Scholar] [PubMed]
  2. Shapiro, B.E.; Preston, D.C. Entrapment and compressive neuropathies. Med. Clin. North. Am. 2009, 93, 285–315. [Google Scholar] [CrossRef]
  3. Rodner, C.M.; Tinsley, B.A.; O’Malley, M.P. Pronator syndrome and anterior interosseous nerve syndrome. J. Am. Acad. Orthop. Surg. 2013, 21, 268–275. [Google Scholar] [CrossRef]
  4. Olewnik, Ł.; 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, 299–306. [Google Scholar] [CrossRef] [PubMed]
  5. Soubeyrand, M.; Melhem, R.; Protais, M.; Artuso, M.; Crézé, M. Anatomy of the median nerve and its clinical applications. Hand Surg. Rehabil. 2020, 39, 2–18. [Google Scholar] [CrossRef] [PubMed]
  6. Kowalska, B.; Sudoł-Szopińska, I. Ultrasound assessment on selected peripheral nerve pathologies. Part I: Entrapment neuropathies of the upper limb—Excluding carpal tunnel syndrome. J. Ultrason. 2012, 12, 307–318. [Google Scholar] [CrossRef] [PubMed]
  7. Asheghan, M.; Hollisaz, M.T.; Aghdam, A.S.; Khatibiaghda, A. The Prevalence of Pronator Teres among Patients with Carpal Tunnel Syndrome: Cross-sectional Study. Int. J. Biomed. Sci. 2016, 12, 89–94. [Google Scholar] [CrossRef]
  8. Shon, H.C.; Park, J.K.; Kim, D.S.; Kang, S.W.; Kim, K.J.; Hong, S.H. Supracondylar process syndrome: Two cases of median nerve neuropathy due to compression by the ligament of Struthers. J. Pain. Res. 2018, 11, 803–807. [Google Scholar] [CrossRef]
  9. Afshar, A. Pronator Syndrome Due to Schwannoma. J. Hand Microsurg. 2015, 7, 119–122. [Google Scholar] [CrossRef]
  10. de Ruiter, G.C.W.; Wesstein, M.; Kurvers, A. Median Nerve Compression by the Ligament of Struthers: Clinical Image. World Neurosurg. 2025, 198, 124003. [Google Scholar] [CrossRef]
  11. Takahashi, V.S.; Dos Santos, T.R.; Duarte, M.L. Pronator Teres Syndrome—Case Report with Imaging Tests Diagnosis. Prague Med. Rep. 2025, 126, 42–45. [Google Scholar] [CrossRef] [PubMed]
  12. Bridgeman, C.; Naidu, S.; Kothari, M.J. Clinical and electrophysiological presentation of pronator syndrome. Electromyogr. Clin. Neurophysiol. 2007, 47, 89–92. [Google Scholar] [PubMed]
  13. Bair, M.R.; Gross, M.T.; Cooke, J.R.; Hill, C.H. Differential Diagnosis and Intervention of Proximal Median Nerve Entrapment: A Resident’s Case Problem. J. Orthop. Sports Phys. Ther. 2016, 46, 800–808. [Google Scholar] [CrossRef] [PubMed]
  14. Gupta, P.; Gupta, D.; Shrivastav, S. Lacertus Fibrosus Syndrome: A Case Report. Cureus 2023, 15, e47158. [Google Scholar] [CrossRef]
  15. Rajaram-Gilkes, M.; Fung, K.; Kiniale, C.; Adams, W. Bilateral Variations of Pronator Teres in the Upper Limb. Cureus 2024, 16, e66996. [Google Scholar] [CrossRef]
  16. Binsaleem, S. Median nerve entrapment neuropathy: A review on the pronator syndrome. JSES Rev. Rep. Tech. 2024, 5, 70–78. [Google Scholar] [CrossRef] [PubMed]
  17. Balcerzak, A.A.; Ruzik, K.; Tubbs, R.S.; Konschake, M.; Podgórski, M.; Borowski, A.; Drobniewski, M.; Olewnik, Ł. How to Differentiate Pronator Syndrome from Carpal Tunnel Syndrome: A Comprehensive Clinical Comparison. Diagnostics 2022, 12, 2433. [Google Scholar] [CrossRef]
  18. Werner, C.O.; Rosén, I.; Thorngren, K.G. Clinical and Neurophysiologic Characteristics of the Pronator Syndrome. Clin. Orthop. Relat. Res. 1985, 197, 231–236. [Google Scholar] [CrossRef]
  19. Hartz, C.R.; Linscheid, R.L.; Gramse, R.R.; Daube, J.R. The Pronator Teres Syndrome: Compressive Neuropathy of the Median Nerve. J. Bone Jt. Surg. Am. 1981, 63, 885–890. [Google Scholar] [CrossRef]
  20. Shields, L.B.E.; Iyer, V.G.; Zhang, Y.P.; Shields, C.B. Proximal median nerve neuropathy: Electrodiagnostic and ultrasound findings in 62 patients. Front. Neurol. 2024, 15, 1468813. [Google Scholar] [CrossRef]
  21. Chang, K.V.; Wu, W.T.; Hsu, P.C.; Yang, Y.C.; Özçakar, L. Ultrasonography in Pronator Teres Syndrome: Dynamic Examination and Guided Hydrodissection. Pain. Med. 2022, 23, 219–220. [Google Scholar] [CrossRef]
  22. Sayer, G.; Gunsoy, Z.; Golgelioglu, F.; Bayrakcioglu, O.F.; Kizkapan, T.B.; Ozboluk, S.; Dinc, M.; Oguzkaya, S. The Role of Palmar Cutaneous Branch Release in Enhancing Surgical Outcomes for Severe Carpal Tunnel Syndrome. J. Clin. Med. 2025, 14, 2196. [Google Scholar] [CrossRef]
  23. Shafshak, T.S.; el-Hinawy, Y.M. The anterior interosseous nerve latency in the diagnosis of severe carpal tunnel syndrome with unobtainable median nerve distal conduction. Arch. Phys. Med. Rehabil. 1995, 76, 471–475. [Google Scholar] [CrossRef]
  24. Créteur, V.; Madani, A.; Sattari, A.; Bianchi, S. Sonography of the Pronator Teres: Normal and Pathologic Appearances. J. Ultrasound Med. 2017, 36, 2585–2597. [Google Scholar] [CrossRef]
  25. Gurses, I.A.; Altinel, L.; Gayretli, O.; Akgul, T.; Uzun, I.; Dikici, F. Morphology and morphometry of the ulnar head of the pronator teres muscle in relation to median nerve compression at the proximal forearm. Orthop. Traumatol. Surg. Res. 2016, 102, 1005–1008. [Google Scholar] [CrossRef] [PubMed]
  26. Hsiao, C.W.; Shih, J.T.; Hung, S.T. Concurrent carpal tunnel syndrome and pronator syndrome: A retrospective study of 21 cases. Orthop Traumatol Surg Res. 2017, 103, 101–103. [Google Scholar] [CrossRef]
  27. Moura, F.S.E.; Agarwal, A. A rare and severe case of pronator teres syndrome. J. Surg. Case Rep. 2020, 2020, rjaa397. [Google Scholar] [CrossRef]
  28. Lee, H.J.; Kim, I.; Hong, J.T.; Kim, M.S. Early surgical treatment of pronator teres syndrome. J. Korean Neurosurg. Soc. 2014, 55, 296–299. [Google Scholar] [CrossRef] [PubMed]
  29. Lee, M.J.; LaStayo, P.C. Pronator syndrome and other nerve compressions that mimic carpal tunnel syndrome. J. Orthop. Sports Phys. Ther. 2004, 34, 601–609. [Google Scholar] [CrossRef]
  30. Binder, H.; Zadra, A.; Popp, D.; Komjati, M.; Tiefenboeck, T.M. Outcome of Surgical Treated Isolated Pronator Teres Syndromes-A Retrospective Cohort Study and Complete Review of the Literature. Int. J. Env. Res. Public. Health. 2021, 19, 80. [Google Scholar] [CrossRef]
  31. Carter, G.T.; Weiss, M.D. Diagnosis and Treatment of Work-Related Proximal Median and Radial Nerve Entrapment. Phys. Med. Rehabil. Clin. N. Am. 2015, 26, 539–549. [Google Scholar] [CrossRef] [PubMed]
  32. Strohl, A.B.; Zelouf, D.S. Ulnar Tunnel Syndrome, Radial Tunnel Syndrome, Anterior Interosseous Nerve Syndrome, and Pronator Syndrome. J Am Acad Orthop Surg. 2017, 25, e1–e10. [Google Scholar] [CrossRef]
  33. Mogedano-Cruz, S.; González-de-la-Flor, Á.; Rodríguez-Anadón, C.; Bohn, L.; Villafañe, J.; Romero-Morales, C. Predicting median nerve depth from anthropometric features: A tool for safer invasive procedures. PLoS ONE 2025, 20, e0330383. [Google Scholar] [CrossRef]
  34. Shojaie, P.; Botchu, R.; Iyengar, K.; Drakonaki, E.; Sharma, G.K. Ultrasound-guided median nerve hydrodissection of pronator teres syndrome: A case report and a literature review. J. Ultrason. 2023, 23, e165–e169. [Google Scholar] [CrossRef] [PubMed]
  35. Donati, D.; Boccolari, P.; Tedeschi, R. Manual Therapy vs. Surgery: Which Is Best for Carpal Tunnel Syndrome Relief? Life 2024, 14, 1286. [Google Scholar] [CrossRef] [PubMed]
  36. Delzell, P.B.; Patel, M. Ultrasound-Guided Perineural Injection for Pronator Syndrome Caused by Median Nerve Entrapment. J. Ultrasound Med. 2020, 39, 1023–1029. [Google Scholar] [CrossRef]
  37. Tedeschi, R. The forgotten DOMS: Recognising delayed muscle soreness in hand rehabilitation. Br. J. Sports Med. 2025, 59, 1120–1121. [Google Scholar] [CrossRef]
  38. Szajkowski, S.; Pasek, J.; Cieślar, G. Foam Rolling or Percussive Massage for Muscle Recovery: Insights into Delayed-Onset Muscle Soreness (DOMS). J. Funct. Morphol. Kinesiol. 2025, 10, 249. [Google Scholar] [CrossRef]
  39. Medeiros, F.; Martins, W.; Behm, D.; Ribeiro, D.; Marinho, E.; Santos, W.; Viana, R.B. Acute effects of foam roller or stick massage on indirect markers from exercise-induced muscle damage in healthy individuals: A systematic review and meta-analysis. J. Bodyw. Mov. Ther. 2023, 35, 273–283. [Google Scholar] [CrossRef] [PubMed]
  40. Santos, I.S.; Dibai-Filho, A.V.; Dos Santos, P.G.; Júnior, J.D.A.; de Oliveira, D.D.; Rocha, D.S.; Fidelis-de-Paula-Gomes, C.A. Effects of foam roller on pain intensity in individuals with chronic and acute musculoskeletal pain: A systematic review of randomized trials. BMC Musculoskelet. Disord. 2024, 25, 172. [Google Scholar] [CrossRef]
Figure 1. Schematic illustration of the provocative test for pronator teres syndrome: (A)—Neutral position without compression of the median nerve; blue dot—absence of symptoms. (B)—Forearm pronation results in compression of the median nerve and the onset of symptoms; red dot—elicitation of symptoms.
Figure 1. Schematic illustration of the provocative test for pronator teres syndrome: (A)—Neutral position without compression of the median nerve; blue dot—absence of symptoms. (B)—Forearm pronation results in compression of the median nerve and the onset of symptoms; red dot—elicitation of symptoms.
Neurolint 17 00169 g001
Figure 2. Prolonged latency of the sensory nerve action potential of the median nerve; normal value: 3.20 ms.
Figure 2. Prolonged latency of the sensory nerve action potential of the median nerve; normal value: 3.20 ms.
Neurolint 17 00169 g002
Figure 3. Surgical incision-“lazy S “volar incision for proximal median nerve decompression is made 3 cm distal to the medial epicondyle over the pronator muscle.
Figure 3. Surgical incision-“lazy S “volar incision for proximal median nerve decompression is made 3 cm distal to the medial epicondyle over the pronator muscle.
Neurolint 17 00169 g003
Disclaimer/Publisher’s Note: The statements, opinions and data contained in all publications are solely those of the individual author(s) and contributor(s) and not of MDPI and/or the editor(s). MDPI and/or the editor(s) disclaim responsibility for any injury to people or property resulting from any ideas, methods, instructions or products referred to in the content.

Share and Cite

MDPI and ACS Style

Rałowska-Gmoch, W.; Hajzyk, M.; Matyskieła, T.; Łabuz-Roszak, B.; Dziadkowiak, E. The Diagnostic Pitfalls in the Pronator Teres Syndrome—A Case Report. Neurol. Int. 2025, 17, 169. https://doi.org/10.3390/neurolint17100169

AMA Style

Rałowska-Gmoch W, Hajzyk M, Matyskieła T, Łabuz-Roszak B, Dziadkowiak E. The Diagnostic Pitfalls in the Pronator Teres Syndrome—A Case Report. Neurology International. 2025; 17(10):169. https://doi.org/10.3390/neurolint17100169

Chicago/Turabian Style

Rałowska-Gmoch, Wiktoria, Marcin Hajzyk, Tomasz Matyskieła, Beata Łabuz-Roszak, and Edyta Dziadkowiak. 2025. "The Diagnostic Pitfalls in the Pronator Teres Syndrome—A Case Report" Neurology International 17, no. 10: 169. https://doi.org/10.3390/neurolint17100169

APA Style

Rałowska-Gmoch, W., Hajzyk, M., Matyskieła, T., Łabuz-Roszak, B., & Dziadkowiak, E. (2025). The Diagnostic Pitfalls in the Pronator Teres Syndrome—A Case Report. Neurology International, 17(10), 169. https://doi.org/10.3390/neurolint17100169

Article Metrics

Article metric data becomes available approximately 24 hours after publication online.
Back to TopTop