Flexor-Pronator Strain

A flexor-pronator strain of the elbow is a common source of pain in the elbows of pitchers. The pain is

Flexor-pronator origin
The flexor-pronator muscle are a source of medial elbow pain in throwing athletes. Note the location of the flexor-pronator origin (orange arrow).
located on the medial side of the elbow (the inside of the elbow closest to the body). There are many causes of pain on the medial side of the elbow in pitchers and other throwing and overhead athletes, such as medial epicondylitis (“golfer’s elbow), ulnar neuritis or ulnar nerve compression, and ulnar collateral ligament injury. Therefore diagnosis of this injury can be difficult.

A flexor-pronator strain can either result from an acute event or can develop as a result of overuse. A pitcher who has an acute flexor-pronator strain will remember a specific throw where he felt sharp pain on the medial side of the elbow. His pain will usually be located just past the bony prominence on the inside of the elbow. He often will have pain flexing the wrist or pronating the forearm.

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Evaluation by a sports medicine physician is important soon after the injury to try to determine the correct diagnosis quickly. X-rays are usually normal with this injury. In high-level athletes an MRI is often ordered to ensure that the pain is not coming from an underlying injury to the ulnar collateral ligament, also known as the Tommy John injury. Most of the time, a flexor-pronator strain is treated with rest from pitching for several weeks to give the tendons time to heal. Ice and physical therapy can also be helpful to decrease the athlete’s symptoms. As the pain improves, the pitcher will be started on a long toss program prior to returning to full pitching.

7 Responses to Flexor-Pronator Strain

  1. Injury while hitting in wiffle tournament. Am54 years young. MRI results arrived thus morning – see doc next week. Diagnosis is complete rupture of the pronator teres at the medial epicondyle. I like golf and wish to continue an active lifestyle. Generally speaking, what are the options for this type of issue?

    • Depending on the extent of the injury, the tendon can be repaired to bone surgically, or the surgeon may elect to allow it to heal without surgery.

  2. My son is 18 & plays college baseball. His primary position is shortstop. In highschool he was also a pitcher. He had started feeling pain in his throwing elbow and was diagnosed with a strain in his ucl. He was put on a PT program and rest. That was back in June. After still not feeling 100% his. College coach sent him to a surgeon where a second MRI showed no change or additional damage. He felt something in his elbow the other day while throwing and the surgeon said it was his floor pronator. Surgery not necessary. My question after rambling on is would PRP be a viable option and would you recommend it. Thx

    • PRP has been used for partial UCL injuries. I haven’t seen data on its use for flexor pronator injuries. There is generally little downside other than the cost and it might not work.

  3. I just started throwing with my kid after hurting my arm 20 years ago. Could never throw again after pitching years of tennis ball stick ball and finally 21 innings in 2 days did it. For a while I couldn’t shoot a basketball and roll it off the fingers, but could always still throw a football. The pain is right at this point on the elbow, right on the inside at the bone, like in that picture. I would think after 5 or 10 years btwn throws it would not come back on the first harder throw. Does this sound like the same injury or something else? Would love to throw again with my kids. Thanks

    • It could be, but it is hard to say without examining you. If it isn’t getting better, you might consider seeing a doctor.

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