A concise, evidence-based guide for people experiencing aching forearms, tingling fingers or reduced grip caused by Pronator Teres Syndrome. Learn why it happens, how it is diagnosed, and the safest ways to get better.
What is pronator syndrome?
Pronator syndrome, also called Pronator Teres Syndrome (PTS), is a compressive neuropathy (pressure injury) of the median nerve in the upper forearm. The nerve is most often squeezed where it passes between the two heads of the pronator teres muscle, just below the elbow. As a result, patients may notice aching in the forearm, tingling in the thumb, index or middle fingers and occasional hand weakness.
Who is at risk?
• People in their 40s–50s, especially females
• Manual workers, musicians, racket-sport and weight-training enthusiasts
• Anyone performing repetitive twisting or gripping without adequate rest
• Individuals with diabetes or an under-active thyroid gland (hypothyroidism)
Why does the nerve get trapped?
Common compression points include:
• Between the two heads of the pronator teres muscle – most frequent site
• Thickened lacertus fibrosus (bicipital aponeurosis)
• Fibrous arch of flexor digitorum superficialis (FDS)
• Rare bony variants such as a supracondylar process or a fibrous ligament of Struthers
Strong forearm muscles, repetitive pronation (palm-down rotation) and forceful grip raise the pressure around these structures, irritating the nerve.
Typical symptoms
• Deep, dull ache in the front of the forearm, sometimes radiating up the arm
• Tingling, numbness or burning in the thumb, index, middle and half of the ring finger
• Numbness in the fleshy base of the thumb (thenar eminence) – this feature is spared in Carpal Tunnel Syndrome and helps doctors tell the two apart
• Thumb weakness, loss of pinch strength and tendency to drop objects
• Forearm fatigue or cramp during sport or keyboard work
Night-time waking is less common than in Carpal Tunnel Syndrome.
Diagnosis in clinic
A specialist will:
• Take a full history of tasks that trigger pain
• Press over the pronator teres for 30 seconds (Pronator Compression Test) – reproduction of tingling is positive
• Test resistance to forearm pronation with the elbow partly bent – pain suggests compression
• Check strength of the thumb-bending muscle (flexor pollicis longus) and index-finger flexor
• Rule out Carpal Tunnel Syndrome using Phalen’s or Durkan’s wrist tests
Electromyography (EMG) and nerve-conduction studies may be arranged to exclude other sites of entrapment, though results are often normal in isolated pronator syndrome. An X-ray checks for rare bony spurs.
Conservative (non-surgical) treatment – first 3–6 months
Rest and activity change
• Limit repetitive gripping, heavy lifting and prolonged pronation–supination cycles
• Take frequent micro-breaks; vary hand position whenever possible
Elbow brace
• A soft brace holding the elbow at 90° and the forearm neutral can be worn for two to four weeks to calm inflammation.
Medication
• Short courses of ibuprofen or naproxen reduce pain and swelling (take with food).
• A guided perineural injection with 5 % dextrose may ease persistent symptoms.
Physiotherapy
• Stretching: gentle pronator teres and forearm flexor stretches twice daily
• Nerve flossing (neural glides): controlled arm and wrist movements that encourage the median nerve to slide freely
• Strengthening: low-weight hammer curls and supinator exercises rebuild endurance
• Myofascial release and kinesio-taping support local healing
Work-station review
• Split keyboards, vertical mice and proper chair height help desk users stay neutral.
Expected progress
Most patients notice meaningful relief within eight weeks when exercises are practised regularly and aggravating activities are limited.
Surgical options
If disabling pain or measurable weakness persists beyond three to six months, or if tests show significant nerve impairment, surgery may be offered. The aim is to release every likely point of compression.
00000Approaches:
• Wide open decompression – explores pronator teres, lacertus fibrosus and FDS arch in one incision; success 70-90 % but leaves a longer scar
• Limited release – targets only the tightest structure; smaller wound but risk of incomplete relief
• Endoscopic (keyhole) release – specialist centres only; minimal tissue disruption, faster scar healing
Recovery: light hand use after two weeks; gradual strengthening from six weeks; full sports clearance usually by three to six months.
Potential complications (rare)
• Incomplete release or scar tissue causing recurrent symptoms
• Injury to skin-sensory branches or small blood vessels (vasa nervorum)
• Infection or elbow stiffness – reduced by early finger and shoulder motion
Living well during recovery
• Apply a cold gel pack for 10 minutes after activity
• Keep the elbow supported on cushions when reading or using a phone
• Maintain general fitness: brisk walking increases blood flow to healing nerves
• Discuss blood-sugar or thyroid optimisation with a GP if relevant
CLINICAL PEARLS / KEY POINTS
• Pronator syndrome is rarer than Carpal Tunnel Syndrome; palm numbness helps distinguish it.
• Median nerve entrapment often responds to simple load-management and targeted stretching.
• Strong ergonomic habits prevent recurrence once pain settles.
• EMG tests can be normal – the diagnosis is chiefly clinical.
• Double crush (combined elbow and wrist compression) must be excluded.
PATIENT FAQs
What exactly is the median nerve?
It is one of the main nerves supplying feeling to the thumb, index and middle fingers and power to several forearm and thumb muscles.
Could pronator syndrome and Carpal Tunnel Syndrome occur together?
Yes. When two sites compress the same nerve it is called double crush syndrome. Both areas may need treatment for complete relief.
Why does my palm tingle when the problem is near my elbow?
The palmar cutaneous branch leaves the median nerve above the wrist, so compression higher up can irritate that branch and give palm numbness.
Do I need a scan?
Most patients do not. Your clinician decides case-by-case; X-rays exclude unusual bone spurs, while ultrasound or MRI are reserved for unclear cases.
How long should I try exercises before considering surgery?
A dedicated programme for at least 12 weeks is advised unless severe weakness or progressive numbness develops earlier.
Is full recovery likely?
Yes. With early diagnosis and proper management, long-term complications are uncommon and most people return to sport or work without restriction.
CALL-TO-ACTION
For personalised assessment or a second opinion, phone The Arm Doc on 020 3384 5588, email Info@TheArmDoc.co.ukor visit www.TheArmDoc.co.uk. Exercise videos and printable nerve-glide sheets are available online.
EVIDENCE & GUIDELINES
• National Institute for Health and Care Excellence (NICE) Guideline CG176: Neuropathic Pain Management, 2023
• British Orthopaedic Association Standards for Trauma (BOAST): Nerve Entrapment Syndromes, 2024
• Latest systematic reviews in Journal of Hand Surgery (European Volume) 2025
• Patient outcomes audited using Quick-DASH scoring and reviewed annually
DISCLAIMER
This leaflet provides general information for adult patients. It does not replace individual medical advice. Diagnosis and treatment decisions should always be made in consultation with a qualified healthcare professional. In emergencies or sudden worsening of symptoms, seek immediate medical attention.