Symptom Improvement in a Patient With Chronic Pronator Teres Syndrome Treated With Ultrasound-Guided Hydrodissection and Manual Therapy: A Case Report

Pronator teres syndrome (PTS) is an uncommon neuropathy caused by compression of the median nerve at the proximal forearm, resulting in paresthesia and pain in the radial digits. Although conservative management is typically the preferred initial approach, chronic and refractory cases often require multimodal treatment strategies. A 55-year-old female truck driver presented with a five-year history of persistent bilateral numbness and pain radiating from the palms to the distal phalanges. Physical examination revealed positive pronator compression and bilateral upper limb neurodynamic tests, with a numerical rating scale (NRS) score of 8/10. Palpation during ultrasound imaging demonstrated localized tenderness and radiating pain around the pronator teres and median nerve. Cervical pathology and carpal tunnel syndrome were excluded. The patient underwent ultrasound-guided hydrodissection of the median nerve at the pronator teres level every two weeks, combined with manual mobilization and a prescribed home-based exercise program. Symptomatic relief was achieved after the first session, and after four treatment sessions over two months, the NRS score improved from 8/10 to 3/10. Functional recovery was achieved, and the patient successfully maintained symptom control through continued adherence to the home-based exercise program. This report highlights the potential effectiveness of a multimodal strategy for addressing chronic PTS. Ultrasound-guided hydrodissection may improve mobility of the median nerve by reducing perineural restrictions, while manual mobilization and gliding exercises are likely to provide complementary therapeutic effects. Given the chronicity of the patient's condition, the early and sustained response underscores the potential utility of combining these techniques in refractory cases. Ultrasound-guided hydrodissection, when combined with manual therapy and a structured home-based exercise program, may represent a minimally invasive and effective management option for chronic pronator teres syndrome that is unresponsive to conservative care.