The motor branch of the median nerve to pronator teres is the first muscular branch given off below the elbow, arising before the nerve passes between the two heads of pronator teres. It innervates both the humeral and ulnar heads of pronator teres, providing the primary forearm pronator supply.
The pronator teres branch is spared in anterior interosseous nerve syndrome (AINS) and in carpal tunnel syndrome, helping to localise these distal median nerve lesions. Its preservation in high median nerve palsy from elbow-level injury but loss in proximal lesions helps map the injury level. The branch is at risk during pronator teres release for pronator syndrome.
Denervation of the pronator teres branch indicates a median nerve injury proximal to the elbow, distinguishing it from AINS (which spares pronator teres) and carpal tunnel syndrome.
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