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A Question of Ethics
Recently, after I had finished teaching a class on ethics, I  read a blog post on the AAAOM
website regarding "gainful employment." The published information made me reflect on what I had just discussed with the students — the acupuncturists' ethical responsibility to the patient, the profession and the public.

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By Ben Benjamin, PhD

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Pronator Teres Injuries: Treatment Options

Anatomy

The pronator teres is larger than the supinator muscle and responsible for pronating the forearm (turning the hand palm-down). It has a small, deep head, originating from the coronoid process of the ulna, and a larger, more superficial head originating from the medial supracondylar ridge and the medial epicondyle.

Pronator Teres Injuries: Treatment Options - Copyright – Stock Photo / Register Mark Pronator Teres Anatomy At the medial epicondyle, it shares a common tendon with the flexor carpi radialis and flexor carpi ulnaris. The muscle inserts on the middle of the lateral surface of the radius, just distal to the insertion of the supinator. The pronator teres can be injured through repetitive use of a screwdriver or other hand tools. Pronation is used to loosen screws with the right hand, and to tighten them with the left. It can also be strained through racket sports, particularly in overhead motions and trying to put a spin on the ball.

Pronator Teres Injuries: Treatment Options - Copyright – Stock Photo / Register Mark Resisted Pronation Assessment Tests

To assess for this injury use resisted pronation. Face the client, then have the person bend their elbow at 90 degrees, with the thumb facing the ceiling. Now lace your fingers together and grasp the distal forearm right above the wrist. Ask the client to rotate their palm toward the floor, while you simultaneously apply an equal and opposite force to prevent any movement from occurring. This test stresses the pronator teres and will cause pain at the medial elbow if that structure is injured and on the flexor surface of the forearm if the injury is in the muscle belly or the attachment to the radius.

 

Pronator Teres Injuries: Treatment Options - Copyright – Stock Photo / Register Mark Friction of the Pronator Teres Radial Attachment Treatment

Friction Therapy

The pronator teres can be injured in the common flexor tendon at the medial epicondyle. We covered the treatment for this injury site in the golfer's elbow article (Massage Today, February, 2016). Another potential injury site is the muscle's insertion onto the middle of the lateral surface of the radius, just distal to the insertion of the supinator.

To treat this attachment, place your fingers on the radius, slightly anterior (toward the flexor side of the radius), in the middle third of the forearm. Next, place your thumb on the ulna as a counter pressure, and then move your fingers in a superior-to-interior direction to perform the friction.

Once the client is feeling a bit better have them begin a series of pronation exercises with a one-sided weight.  The closer the hand is to the weights the easier the exercise will be to perform. As the client gets stronger they should grip the bar further and further from the weight. The client should start with three sets of 10 reps, starting at one pound and build up to 8 or 10.

Pronator Teres Injuries: Treatment Options - Copyright – Stock Photo / Register Mark
Pronator Teres Exercise

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