Massage therapy · Kitchener–WaterlooPronator Teres Syndrome

Symptoms of this syndrome are quite similar to those of carpal tunnel syndrome. They include numbness or tingling in the thumb, index finger, middle finger and the thumb-side half of the ring finger (Binsaleem, 2025). There is often an aching pain in the forearm, and tenderness when pressing on the upper forearm over the pronator teres muscle, which is located just below the elbow crease on the inside of your elbow (Balcerzak et al., 2022). Strength may also be reduced in the thumb and first fingers, as well as when turning the forearm or bending the wrist.

This condition is overshadowed by the more common carpal tunnel syndrome, and it is often misdiagnosed as carpal tunnel syndrome (Balcerzak et al., 2022). It is a rare condition and is more common in people who do repetitive forearm and wrist movements (Binsaleem, 2025). The median nerve can be squeezed where it passes between the two parts (heads) of the pronator teres muscle, or under the bicipital aponeurosis, a band of tissue from the biceps tendon (Binsaleem, 2025).

Pronator Teres Syndrome Anatomy

How to Treat Pronator Teres Syndrome

Treatments you may want to discuss with your family doctor or nurse practitioner

Tips

• Pronator teres syndrome is more common in women, mostly in their 40s and 50s (Binsaleem, 2025).
• Jobs that involve constant forearm movement, such as carpentry, tend to increase the chance of developing this condition (Binsaleem, 2025).
• Less commonly, a tumour or other structures in the forearm can press on the median nerve (Balcerzak et al., 2022).

Pronator teres syndrome happens when the median nerve gets squeezed as it passes through the muscles just below the inside of your elbow. My aim is to take pressure off the nerve, help it slide freely again, and change the day-to-day habits that keep irritating it.

Which path we take depends on your symptoms

• If you have aching, tingling or numbness that comes and goes, without weakness, and it's steady or improving, I can usually treat you directly.
• If your hand or forearm is getting weaker, the numbness is constant or spreading, or your symptoms keep getting worse, see your family doctor or nurse practitioner first so other causes, such as carpal tunnel syndrome, can be checked. Once they've looked at it, I provide supportive care alongside their plan, and after any surgery I need your surgeon's okay before hands-on treatment.

I start by assessing your neck, shoulder, elbow, forearm and wrist, with a neuro screen (sensation, reflexes and strength) and tests that help show where along the arm the nerve is being irritated. Hand symptoms can start further up the arm, so I check along the whole route of the nerve.

Hands-On Treatment

• Massage, trigger point and myofascial work for the forearm and upper arm, staying off direct pressure on the nerve
• Gentle mobilisation of the elbow and wrist
• Work on the neck, shoulder and upper back where they're adding to the problem
• Warm applications in the clinic to ease tight muscles

Exercise and Habits

• Gentle nerve glides, taken only to the first hint of tingling, which should fade as soon as you ease off
• Pain-free forearm stretches and, later, strengthening for the forearm and grip
• A look at your posture, computer set-up and the repetitive forearm movements in your work or hobbies
• A home programme to do between visits

1. Binsaleem, S. (2025) 'Median nerve entrapment neuropathy: a review on the pronator syndrome', JSES Reviews, Reports, and Techniques, 5(1), pp. 70–78. doi: 10.1016/j.xrrt.2024.10.001. Available at: https://pmc.ncbi.nlm.nih.gov/articles/PMC11764074/ (Accessed: 7 October 2026).
2. Balcerzak, A.A., Ruzik, K., Tubbs, R.S. et al. (2022) 'How to differentiate pronator syndrome from carpal tunnel syndrome: a comprehensive clinical comparison', Diagnostics, 12(10), 2433. doi: 10.3390/diagnostics12102433. Available at: https://pmc.ncbi.nlm.nih.gov/articles/PMC9600501/ (Accessed: 7 October 2026).