Sonography of the Pronator Teres: Normal and Pathologic Appearances

Abstract

The pronator teres muscle is rarely examined during a routine sonographic examination of the elbow joint. Nevertheless, it can be affected by a variety of conditions, including trauma and tumors, and can be implicated in compression of the median nerve. This pictorial essay first illustrates the anatomy and biomechanics of the pronator teres. Then we present the sonographic technique for examination, normal sonographic appearance, and anatomic variations of the pronator teres and adjacent structures as well as sonography of their main disorders. Normal and pathologic sonographic appearances are correlated with magnetic resonance imaging and radiographic results.

Dextrose hydrodissection with ultrasound-guided as optional therapy in pronator teres syndrome: A case report

“…[2][6] If symptoms persist for more than 6 months with adequate conservative therapy, surgical therapy may be recommended as a last resort. [1][2] [3] In this case, the patient had chronic severe pain and paresthesia affecting activity with NRS 9 and Quick-DASH 49.5%. In addition, a history of oral NSAID medications and lifestyle modifications has been performed but has not shown satisfactory results.…”

“…Pronator teres syndrome (PTS) or pronator syndrome is a syndrome of irritation of the proximal median nerve that occurs due to compression of the pronator teres muscle or the surrounding anatomical structures. [1][2][3] [4] Pronator syndrome is included in a variety of cases of peripheral neuropathy of the median nerve that rarely occurs compared to the others, such as carpal tunnel syndrome (CTS) and anterior interosseous nerve syndrome (AINS). [2] In one study, the prevalence of pronator teres syndrome was mentioned in only 5% of all cases of median nerve neuropathy.…”

Review Article “Spotlight on Ultrasonography in the Diagnosis of Peripheral Nerve Disease: The Evidence to Date”

“…In addition, ultrasound can localise a proximal median nerve injury and may help establish a cause, such as entrapment by the ligament of Struther’s, 49 pronator teres muscle, 50 or an accessory palmaris longus muscle, 51 as well as vascular pathology 52 and iatrogenic injury. 53 …”

“…47 Ultrasound is useful to assess persistent symptoms post-surgical carpal tunnel release, where it can detect a compressive post-operative scar, a residual anatomical constriction point suggesting incomplete release or an alternative cause for neuropathy. 48 In addition, ultrasound can localise a proximal median nerve injury and may help establish a cause, such as entrapment by the ligament of Struther's, 49 pronator teres muscle, 50 or an accessory palmaris longus muscle, 51 as well as vascular pathology 52 and iatrogenic injury. 53…”

Ultrasonographic evaluation of the median nerve: normal and variant anatomy and appearance

“… Transverse sonography over the proximal humeral head of pronator teres muscle depicting median nerve (white arrow) running deep between humeral head of pronator muscle (PTHH) and brachial anterior muscle (BA), with nerve located distally to brachial artery (black arrow) ( 17 ) …”