Diagnosis and Treatment of Wrist Pain
The pronator quadratus (PQ) is the prime mover of forearm pronation in all positions of elbow flexion and extension. Although the PQ has been detailed in anatomy texts, little attention has been paid to this muscle's function or potentially related pain syndromes.
This case report documents a PQ myofascial pain syndrome alleviated with trigger-point therapy. A 15-year-old male presented with progressively worsening left wrist pain of 16 months' duration. Previous unsuccessful treatment included a wrist splint and various forms of physiotherapy (stretches, ultrasound, ice, laser and TENS); X-ray, MRI and arthrographic studies were negative.
Following examination, treatment featured trigger-point therapy of the PQ muscle belly and interferential current (IFC) for nine visits over a three-week period, after which time the patient was asymptomatic.
Included in the text is a list of criteria for diagnosing active myofascial trigger-points and differential diagnoses, including upper extremity compression syndromes, such as anterior interosseous nerve entrapment syndrome, carpal tunnel syndrome and pronator teres syndrome.
The author recommends that clinicians pay close attention to patients presenting with forearm and wrist pain, and differentiate between compression syndromes and myofascial trigger points, to accurately diagnose and treat this condition.
Annis RS. Pronator quadratus - a forgotten muscle: a case report. Journal of the Canadian Chiropractic Association