Do I have a Carpal Tunnel or Pronator Teres Syndrome?

Harmonize Body Works
Jun 11
4 min read

Feeling pain and discomfort in your wrist when you hold the full kettle, picking up your full grocery bags, while using the mouse, or driving?

There are many possible reasons for wrist pain such as arthritis, sprain, ganglion cyst, or tendinitis. Then when there are nerve related symptoms, such as numbness, sharp shooting pain, a lot of us rule it out as the carpal tunnel syndrome (CTS), because that’s what we heard about the most, but you should know there are other possibilities that has similar symptoms such as pronator teres syndrome (PTS).

CTS vs PTS

CTS, Carpal Tunnel Syndrome and PTS, Pronator Teres Syndrome are both median nerve related syndrome, but the location and how it effects the nerve is slightly different. CTS is an entrapment of median nerve in the wrist itself, and PTS is a compression neuropathy at the elbow level, by the muscle call pronator teres.

The cause of PTS is the forearm muscle; pronator teres, compresses the median nerve and symptoms are very similar to CTS such as;

Aching pain in the forearm
Tingling in the thumb and index finger
Numbness in the hand
Weakness in the thumb and index finger

You wouldn’t notice but I will say pronator teres is one of the muscles that we use the most in our daily life because the action of this muscle is to make the palm of our hand to rotate inwards. So if you think anatomically, the neutral position of the hand is that palm face forward, but most of the tasks require for the palm to face inward/behind.

Which means you're in this position way more than you think! Such as pouring water out of the kettle, turning stirring wheel, typing keyboards, using mouse, gardening, doing dishes, etc. The list just goes on and on!

So why does it come so sudden? You might feel it’s sudden but probably you repetitively use it more than you think, and then one day you used it more in the garden which it will aggravate the pronator teres and become inflame, increase adhesion, form trigger points and starts to irritated median nerve.

The cause of CTS is the non-extendable osteo-fibrous wall, the ‘tunnel’, becomes pressurize, and entraps the nerve along with tendons that makes the fingers to flex. The common symptoms of CTS are;

Pain, numbness, and paresthesia
Sensory changes and paresthesia along with median nerve distribution in the hand
With further progression: night pain, hand weakness, decreased fine motor coordination, decreased grip strength, reduced wrist mobility

How do I know if I have PTS or CTS?

There are quite similar but they have slightly different symptoms such as PTS could have pain in forearm where CTS doesn’t, and also CTS symptoms are gradual at the beginning. But it’s always good to see Physiotherapist, hand therapist, or experienced Remedial massage therapist to run some test to differentiate what you’ve got and treat it before it becomes worse.

Massage therapist's Tips for PTS

For PTS, releasing pronator teres muscle can help a lot with reducing the pain and nerve symptoms. Also, if your work or life style effects the muscle then it’s best to support the muscle to prevent further aggravation, such as taping and support wear.

Self-Massage pronator teres: First, rest the forearm on the table with slight elbow flexion and palm face the ceiling. Get your other hand thumb to the inner elbow, then grab the forearm in the fold level. Have the thumb 45 degree and come down about 2cm. You’ll feel the thick tendon, might be sensitive here, massage gently along and across that tendon. Another way is you can pin the tendon and stretch the wrist by extending; bend the wrist downwards.

Taping for PTS: In same position as massaging, the palm facing the ceiling, slightly extended wrist and flexed elbow. The forearm should be dry and clean. We need 1 tape just enough to go across the forearm 45 degree. For myself, roughly 5-7cm but we’ll be stretching the tape. Start with the inner elbow point, lay the one point of the tape then peel the middle to stretch over 45-degree angle, about 50-70% stretch. Lay down the middle part of the tape, then the last bit lay down without stretch. Rub the tape to stick better. You can leave the tape on for 3-5 days, depends on how quick it peels off.

Other Treatments and therapy

Rest is very important for both CTS and PTS, especially in flare ups, that you stop aggravate the nerve and the tissue.
Changing ergonomic settings to improve the wrist movements

PTS:

Taping to prevent the pronation movement which aggravates symptoms
Anti-inflammatory medication/applications

CTS:

Oral steroid, injection
Surgical release of the ligament of carpal tunnel

Physiotherapy and remedial massage therapist will go very well with PTS, as remedial massage can help reducing pronator teres muscle inflammation and trigger points, surrounding adhesions, and at HBW our therapist can apply dry needle for this case as well. Along with correct strengthening exercise for arm, hand will help to reduce over use of the pronator teres.