Summary Pronator Syndrome is a compressive neuropathy of the median nerve at the level of the elbow. Diagnosis is made clinically with pain at the proximal volar forearm, sensory changes over the palmar cutaneous branch, and positive Tinel's over the proximal volar forearm. Treatment involves a prolonged nonoperative course, and rarely, surgical decompression. Epidemiology Incidence rare login to view 1 more bullet Demographics female > male common in 5th decade Risk factors associated with well-developed forearm muscles (e.g. weight lifters) Etiology Pathoanatomy 5 potential sites of entrapment include login to view 9 more bullets Associated conditions commonly associated with medial epicondylitis Presentation Symptoms paresthesias in thumb, index, middle finger and radial half of ring finger as seen in carpal tunnel syndrome login to view 1 more bullet should have characteristics differentiating from carpal tunnel syndrome (CTS) login to view 4 more bullets Physical exam provocative tests are specific for different sites of entrapment login to view 4 more bullets possible coexisting medial epicondylitis Imaging Radiographs recommended views login to view 1 more bullet findings login to view 1 more bullet Studies EMG and NCV may be helpful if positive but are usually inconclusive may exclude other sites of nerve compression or identify double-crush syndrome Differential AIN compressive neuropathy Carpal tunnel syndrome Pronator teres strain Treatment Nonoperative rest, splinting, and NSAIDS for 3-6 months login to view 4 more bullets Operative surgical decompression of median nerve login to view 7 more bullets