A physical therapist is examining a patient who presents with symptoms consistent with pronator syndrome. Which of the following findings would MOST likely be observed during the examination?

Option 1- Weakness of the wrist extensors
Option 2- Sensory loss over the dorsal aspect of the hand
Option 3- Weakness of the finger flexors
Option 4- Pain over the lateral elbow

Transcript

Welcome back to the Scorebuilders' Question and Answer Podcast! This podcast provides members of the Scorebuilders' team with the opportunity to explore challenging multiple-choice examination questions with students actively preparing for the licensing examination.

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A physical therapist is examining a patient who presents with symptoms consistent with pronator syndrome. Which of the following findings would MOST likely be observed during the examination?

Option 1- Weakness of the wrist extensors
Option 2- Sensory loss over the dorsal aspect of the hand
Option 3- Weakness of the finger flexors
Option 4- Pain over the lateral elbow

Pronator Syndrome
Pronator syndrome is a proximal median nerve entrapment that occurs when the nerve is compressed at or near the elbow. It typically occurs when the median nerve is entrapped by the pronator teres. However, there are other structures in that area that can compress the nerve and cause a similar clinical presentation. All of these conditions are termed pronator syndrome due to the similarity in presentation.

The key to this question is knowing two things - which nerve is involved in pronator syndrome, and what does that nerve supply? If you can answer both of those questions, the correct answer becomes clear. 

Let's explore each of the options:

Option 1 - Weakness of the wrist extensors

Weakness of the wrist extensors would not be expected with pronator syndrome because the wrist extensors are innervated by the radial nerve, not the median nerve. The median nerve innervates the pronator muscles and many of the wrist and finger flexor muscles. We can eliminate this option

Option 2 - Sensory loss over the dorsal aspect of the hand

Sensory loss over the dorsal aspect of the hand would not be expected because the dorsal surface of the hand is primarily innervated by the radial and ulnar nerves, not the median nerve. Sensory loss in pronator syndrome would more likely affect the palmar surface of the hand, thumb, index finger, middle finger, and lateral half of the ring finger. Wrong side of the hand for the median nerve.

Option 3 - Weakness of the finger flexors

Pronator syndrome would likely result in weakness of the finger flexors. The median nerve innervates many of the wrist and finger flexor muscles, including the flexor digitorum superficialis, lateral portion of the flexor digitorum profundus, flexor carpi radialis, and palmaris longus. Because pronator syndrome is a proximal median nerve entrapment, occurring at or near the elbow, the compression affects the nerve before it has a chance to branch off to supply the forearm flexor muscles. This means all of those muscles are potentially affected, including the finger flexors. 

Option 4 - Pain over the lateral elbow

Pronator syndrome would likely result in pain in the anterior forearm, lateral hand, and palmar aspect of the lateral digits. Pain over the lateral elbow is more characteristic of lateral epicondylitis or a compressive neuropathy of the radial nerve such as radial tunnel syndrome.
When we follow the median nerve from the elbow distally and consider what it supplies along the way, weakness of the finger flexors is the finding that fits perfectly with a proximal median nerve entrapment.

The correct answer is Option 3.

Let's explore the all student data:
10% of students selected Option 1 - Weakness of the wrist extensors
15% of students selected Option 2 - Sensory loss over the dorsal aspect of the hand
50% of students selected Option 3 - Weakness of the finger flexors - the correct response
25% of students selected Option 4 - Pain over the lateral elbow

System Classification
This question is a Neuromuscular and Nervous Systems question which represents approximately 24% of all exam items.

Content Outline Classification
This question is a Foundations for Evaluation, Differential Diagnosis, and Prognosis question which represents approximately 33% of all exam items.

Level Classification
This question is a Level 1 question since the question requires students to possess basic foundational academic knowledge. Remediation of Level 1 questions occurs through academic review of entry-level content using textbooks, review books, Basecamp, and flash cards.