Bone & Joint Expert Care

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Pronator syndrome

What is pronator syndrome?

Pronator syndrome is a nerve disorder in the elbow and upper arm that causes pain, hand weakness and loss of feeling, often in the thumb and first three fingers. It involves compression of the median nerve in the forearm by muscles or ligament-like tissues. It may greatly decrease athletic performance in sports that require strong hand or wrist action.

How does pronator syndrome occur?

Pressure affects the median nerve at the forearm. It is caused by swollen, inflamed or scarred tissue ligament-like tissue or between muscles of the forearm. A virus may cause inflammation of the nerve.

What increases risk?

  • Sports or occupations that require repetitive and strenuous forearm and wrist movements (tennis, squash, racquetball, carpentry), particularly rotation of the wrist and hand
  • Sports that require strenuous or repetitive forearm movement (tennis, racquetball, golf)
  • Poor physical conditioning (strength and flexibility)
  • Inadequate warm-up before practice or play
  • Diabetes mellitus
  • Hypothyroidism (underactive thyroid gland)

What are the symptoms or pronator syndrome?

  • Tingling, numbness or burning in part of the hand or fingers that may awaken you at night
  • Sharp pains that may shoot from the elbow to the wrist and hand, especially at night
  • Morning stiffness or cramping of the hand
  • Thumb weakness, particularly when bending the thumb; frequent dropping of objects; and inability to make a fist
  • Shiny, dry skin on the hand
  • Easy forearm fatigue and activity related forearm discomfort that may radiate up into the arm
  • Reduced performance in sports requiring strong grip

How is pronator syndrome treated?

Non-operative treatment: Initial treatment consists of rest from the offending activity and medications and ice to help reduce inflammation. Discomfort often improves by shaking your hand or dangling your arm. Stretching and strengthening exercises of the muscles of the forearm and elbow are important. Referral to a physical therapist or an athletic trainer may be necessary for treatment.

Operative treatment

Surgery may be necessary to free the pinched nerve. Surgery may be performed on an outpatient basis (you go home the same day), or you may be admitted for overnight stay. Surgery provides almost complete relief in most patients.

What are the complications of treatment?

Possible complications of non-operative treatment include:

  • Persistent symptoms
  • There is no evidence that ongoing compression will lead to permanent injury in most cases

Possible complications of operative treatment include:

  • Surgical complications not specifically associated with the forearm, such as pain, bleeding (uncommon), infection (<1%), nerve injury (uncommon), stiffness, problems with anesthesia, and inability to return to previous level of pre-injury activity-level. 
  • Complications specific to surgical treatment of this condition include ongoing pain, nerve irritation and/or compression, and possible inability to return to previous level of activity. 

When can you return to your sport/activity?

This condition is usually curable with appropriate treatment, and sometimes it heals spontaneously. Occasionally, surgery is necessary. Surgery is usually needed if muscle wasting (atrophy) or nerve changes have developed.

How can pronator syndrome be prevented?

  • Appropriately warm up and stretch before practice or competition
  • Maintain appropriate conditioning:
    • Wrist, forearm, and elbow flexibility
    • Muscle strength and endurance
    • Cardiovascular fitness
  • Ensure proper equipment fit
  • Use proper technique and have a coach correct improper technique