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Pronator teres syndrome, a challenging differential diagnosis of median nerve compression– case report

International Physical Medicine & Rehabilitation Journal
André Ribeiro,1 Daniela Alves Filipe Ermida,1 Sofia Moreira,1 Sandra Assunção,1 Bruno Mendes,2 Luís Gil Andrade,1 Jorge Lains,1,3

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Median entrapment neuropathies viewed as a common finding in clinical practice hold several challenging differentials diagnoses when the site of compression is proximal to the carpal tunnel, requiring a reliable understanding of the anatomy involved in this nerve path,and possible sites of compression.
The pronator teres syndrome, most seen in women around the age of 40/50 years old, can manifest by pain in the proximal anterior aspect of the forearm, usually when alternating between pronation and supination of this segment, with or without resistance and can mimic the typical distal symptoms of carpal tunnel syndrome.
This case report describes the path taken by a patient, initially exhibiting mild paresthesia of the hand and first three fingers in 2018, bilaterally, whose complaints were attributed to the misdiagnosis of carpal tunnel syndrome for about 3 years. He underwent several conservative treatments and left carpal decompression surgery without resolution. He also had several visits to the hospital and was accompanied by different specialties including Neurology, Rheumatology, and Orthopaedics. In 2021 he was referred by Orthopaedics to a Physiatry consult, where after a methodical physical exam and complementary diagnostic exams, the pronator syndrome was diagnosed.


pronator teres muscle, electromyography, median nerve compression, diagnosis