Round pronator syndrome
Infringement of the nerves of the upper extremities is a common cause of pain and temporary disability. In the life of a modern person there are a lot of repetitive movements – during the day we work at the computer, in the evening we relax, use phones and so on – this is what is considered the main reason for the development of these problems. The same applies to people engaged in manual labor – various tunnel syndromes not only worry office workers. Many people, faced with such problems, turn to massage therapists.
If a client comes to you with complaints of pain in the upper limb, the first thing you need to do is to precisely determine the essence of the problem in order to understand whether massage will help in this case or whether it is better to refer the client to another specialist. In some cases, one disease can exactly repeat the symptoms of another – it is necessary to conduct a thorough differential diagnosis. If you make the wrong diagnosis, you will not be able to develop a competent and effective treatment strategy.
Symptoms of the round pronator syndrome can be completely identical to the symptoms of carpal tunnel syndrome, since in both cases there is an infringement of the median nerve. That is why this syndrome is often misdiagnosed, since carpal tunnel syndrome is a more common disease.
With round pronator syndrome, the median nerve is compressed by the muscle of the same name (round pronator), sometimes this disease is simply called pronator syndrome. In addition, sometimes the term “round pronator syndrome” is mistakenly used to name a symptom complex that develops when the median nerve is impaired by other structures of the elbow, for example, the Strazer ligament or the aponeurosis of the biceps of the shoulder.
The median nerve in the elbow extends between the two heads of the muscle called the round pronator. It is in this place that this nerve can be impaired due to muscle hypertonicity or the formation of scar tissue (fibrous changes in muscle tissue), which will compress the nerve. Sometimes the infringement of the median nerve occurs due to a variety of anatomical abnormalities – for example, this nerve can go deeper than both heads of the pronator. In this case, the nerve can be squeezed between the muscle itself and the ulna.
The main reason for the development of round pronator syndrome is the repetitive movements that cause overstrain of this muscle. As we have already said, not only office workers suffer from it, constantly typing at the computer – this syndrome can develop in those who work a lot with a hammer or other hand tools, even those who regularly clean the fish with a knife – when doing all these actions the round pronator is actively involved in the work. Overexertion of this muscle can lead to nerve infringement, which causes typical neurological symptoms (pain, tingling, numbness) in the front of the forearm and other areas innervated by the median nerve.
Women suffer from this syndrome more often than men, but the reasons for this gender distribution are not yet fully understood.
Most of the symptoms appear distal to the place where the nerve was pinched. Paresthesia, aching or stitching pain in the forearm, as well as pain in the arm and hand in the innervated areas of the median nerve are sure signs of round pronator syndrome, which should not be confused with symptoms of carpal tunnel syndrome.
Of course, the symptoms of these two diseases are similar, and in both cases the median nerve is impaired, but they also have differences. So, for example, with round pronator syndrome, the pain intensifies with repeated bending of the arm at the elbow, and the severity of symptoms increases both in the forearm and in the hand. With carpal tunnel syndrome, symptoms are more pronounced with various movements in the wrist and pain is not felt so much in the forearm. In both cases, atrophy of the muscles of the elevation of the thumb is possible, since they are innervated by the branches of the median nerve.
There are several other ways to distinguish round pronator syndrome from carpal tunnel syndrome. With carpal tunnel syndrome, clients often complain that pain disturbs them at night, and with round pronator syndrome, during the day. During sleep, the wrist is often in a bent position for a long time, which is why the symptoms of the tunnel syndrome are more pronounced – in this position, the carpal tunnel narrows and presses on the median nerve. Since flexion of the wrist does not affect the round pronator in any way, the pain during compression of the median nerve by this muscle in this position does not increase.
Also in practice, I often use manual testing of a round pronator. I ask the client to stand straight and bend his arm at the elbow at an angle of 90 degrees. Then I grab the client’s elbow with one palm (for stabilization), and with the other I take the client’s palm as if I want to shake his hand. The client is trying to hold his hand in this position, and at this time I am trying to supine the client’s forearm.