So, some your fingers feel numb and tingle all over. Sometimes your hands feels weak, and powerless. Other times, your pain is aggravated by placing your arm in certain positions. What gives? Is it carpal tunnel syndrome? Will it ever get better? More importantly, will you need to have surgery?
These are questions one often asks when trying to figure out hand and wrist pain. Carpal tunnel syndrome (CTS) is a painful disorder that can reduce the activities of daily life (ADL). CTS is a compression of arteries,veins, ligaments, and tendons in the area of the wrist. All of these necessary parts must pass through the carpal tunnel for fully functional hands. When it comes to hand and wrist pain, the first thing that comes to mind is carpal tunnel syndrome. But another lesser-known syndrome that should also come to mind is pronator teres syndrome.
Pronator teres syndrome has many of the same signs and symptoms as carpal tunnel syndrome. Both PTS and CTS compress and affect the median nerve. This median nerve is responsible for innervating the following: forearm flexor group muscles, hand muscles of the thenar eminence and first/second lumbricals, skin of the palm and first three fingers. The distinction between PTS and CTS is in the location of median nerve compression. PTS is a compression at/near the elbow, while CTS is a compression at the wrist. Since the location of squeezing usually affects body parts that are distal to the affected area, the symptomatology is slightly different. This difference aids in the confirmation of diagnosis.
The pronator teres is a muscle that aids in pronation of the wrist. Pronation would be the act of rotating your palms so that the thumbs are pointing towards the body midline, sometimes called “turning your palms down”. PTS sufferers are usually those who perform repeated wrist pronations during their activities, whether it be in sports, hobbies, or work.
Signs and symptoms of pronator teres syndrome can overlap with those of carpal tunnel syndrome. These include: weakness in hand grip strength, numbness/tingling in hands/fingers, numbness/tingling in palmar surface of hand, difficulty pinching together index finger and thumb.
Signs and symptoms that are not usually shared between CTS and PTS, which are more indicative of pronator teres syndrome are: weakness while flexing forearm muscles, fatigue from short-term use of forearm flexors, pain exacerbation during elbow flexion, atrophy of forearm flexor group.
Considering that PTS affects more of the forearm in its presentation, it is a discerning factor in correct diagnosis. Proper analysis of all the patient signs/symptoms by a trained professional is highly recommended. Testing for PTS can be done through an orthopedic exam that includes: Pronator Teres Test, Tinel’s sign, Phalen’s sign, Reverse Phalen’s sign.
Treatment for pronator teres syndrome should begin with focused therapeutic massage, to release spasm of the pronator teres muscle. Massage to supporting muscles that attach to elbow (at olecranon, proximal heads of radius and ulna) are also beneficial. Also, strengthening exercises for both forearm flexors and extensors should be performed regularly to balance opposing muscle groups. Acupuncture can provide significant pain relief, promote blood flow, and accelerate the healing process, naturally. If these modalities do not provide significant relief, other forms of therapy may be necessary. A chiropractor or other family physician may need to analyze for dislocation, trauma, or other abnormality and x-ray the area to locate the nerve impingement. Your doctor may also inject cortisone to reduce inflammation for immediate relief. Not all of these therapies may be necessary, and improvement may be seen with only one or two different treatment therapies. In any case, consultation with a trained professional is always recommended.