Pronator Teres

Median Nerve, Lateral Cord, Anterior Division, Upper and Middle Trunk, C6, C7. 

This muscle has two heads of origins (a) from the medial epi-condyle of the humems and (b) the coronoid process of the ulna. The median nerve enters the forearm between these two heads. 

Two fingerbreadths distal to the midpoint of a line connecting the medial epicondyle (ME) and biceps tendon (BT). 

If the needle electrode is inserted too deeply it will be in the flexor pollicis longus if inserted too ulnarly it will be in the flexor carpi radialis. 

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Flexor pronator (medial) group Supplied by the median and ulnar nerves, this group comprises of the pronator teres, flexor carpi radialis, palmaris longus, flexor carpi ulnaris, and the flexor digito-rum superficialis. 

During supination, the interosseous membrane between the radius and ulna becomes taut. Supination is produced by contraction of the supinator and biceps muscles pronation involves the pronator quadratus and pronator teres. The pronators are less powerful than the supinators. 

He was treated with a variety of osteopathic techniques. The cervical spine was treated with muscle energy and normal motion was restored. The first rib was treated with facilitated positional release. The pronator teres and the wrist were treated with counterstrain. The wrist was treated with articulatory techniques. 

This case is a good example of multiple impingement syndromes. Besides the obvious carpal tunnel, A.M. had some additional impingement of the median nerve as it passes by the pronator teres. The tension in the soft tissues at the thoracic inlet impinged the nerves of the brachial plexus as they passed through the costoclavicular space. It is important to remember that when there is a fall on the rigid arm, the force is transmitted all the way to the neck. In A.M. s case,... 

Struthers , which joins the anomalous bony process and the medial epicondyle. Clinically, this condition typically affects young sportsmen as a result of intense muscular activity in the elbow and forearm and may start with pain and numbness in the first three fingers and weakness of forearm muscles innervated by the median nerve (Sener et al. 1998). US can demonstrate the relationship of the median nerve with the anomalous bone and ligament. Although not yet reported in the radiological literature, displacement of the nerve by these structures may represent an indicator of entrapment. Therapy includes excision of the ligament of Struthers and ablation of the supracondylar process. The brachial artery can also be compressed by an anomalous insertion of the pronator teres muscle into the supracondylar process (Talha et al. 1987). 

The anterior group of muscles and tendons includes the biceps brachii and the brachialis that lie in the cubital region between the brachioradialis muscle laterally and the pronator teres muscle medially. The biceps brachii muscle is located superficial to the brachialis and has a long distal tendon that is not surrounded by muscle, making it more susceptible... 

The medial compartment includes the pronator teres and the superficial flexor muscles of the wrist and hand that arise from the medial epicondyle as the common flexor tendon . The pronator teres is the most superficial and anterior of the medial muscles. It has two proximal attachments one (humeral head) immediately proximal to the medial epicondyle and the common flexor tendon, the other (ulnar... 

The superficial layer of volar muscles consists of the flexor digitorum superficialis, the pronator teres, the palmaris longus, the flexor carpi radialis and the flexor carpi ulnaris (Fig. 9.2b,c). These muscles take their origin from a strong common tendon which arises from the medial epicondyle (see Chapter 8). The flexor digitorum superficialis, the largest muscle of the superficial layer, consists of three heads - humeral, ulnar and radial - which join at the proximal forearm and continue distally in four distal tendons that insert into the middle phalanx of the... 

The major nerves and vessels of the forearm are located within or traverse the volar compartment (Fig. 9.3). The median nerve enters the volar compartment passing between the superficial and deep heads of the pronator teres muscle. It then crosses the ulnar artery and proceeds toward depth to pass... 

If inserted too laterally it will be in the pronator teres, and if inserted too medially it will be in the palmaris longus. 

Figure 105. Common sites of median nerve entrapment. A, supracondylar B, pronator teres C, carpal trmnel.

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