Arm and hand pain causes: Supinator, pronator and brachioradialis muscles

by Christina Abbott on March 11, 2010

This is part of a series on the causes of arm and hand pain. To see the general list, go back to the checklist of causes.

The supinator and both pronator muscles are located right in the forearm. They cause pain locally and down into the wrist and thumb. The brachioradialis is a longer muscle but has a referred pain pattern similar to the supinator and a similar function.

supinatorcombThe supinator muscle (in red to the left here) is known mostly for causing “tennis elbow” and lateral epicondylitis, or pain in the outer part of the elbow. It nestles deep around the bones of the joint, wrapping around the radius bone of the forearm on the thumb side, attaching below to the ulna bone near your elbow. It’s job is to turn your arm so your palm faces upward. Local pain can be felt both with movement and at rest. Referred pain from Trigger Points is felt in the elbow, but also down into the base of the thumb and the back side of the web between the thumb and index finger.

brachioradialisThe brachioradialis attaches between the upper arm bone (humerus) and the head of the radius bone at the thumb side of the wrist. The reason I include it here is that it causes pain in the outside of the elbow like epicondylitis and performs the same motion of twisting the arm as the supinator, like opening doors with a doorknob. Referred pain also goes down into the base of the thumb and the back of the web between the thumb and index finger.

pronator-teres-combThe pronator teres turns the palm downward, opposite to the supinator, and attaches between the inner elbow and the middle of the radius bone of the forearm. The pain it causes from Trigger Points is in the inner fleshy part of the forearm and down into the wrist and base of the thumb. The pronator quadratus spans the space between the ulna and radius at the wrist and has the same action as the pronator teres. It occupies a similar position to the carpal ligament that forms the top of the carpal tunnel. It’s Trigger Points are not recorded, but local pain would be at the wrist, more toward the base of the thumb.

{ 6 comments… read them below or add one }

Eric February 13, 2014 at 4:05 pm

how would i go about reducing pain caused by this?
i have had an injured brachialis muscle that protrudes when i raise my arm up by bending at my elbow, and it causes pain especially when lifting objects.
my thumb is in pain as well and i have been in physiotherapy for months but the muscle simply wont heal at all.
will i need surgery to fix this?

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Christina Abbott February 13, 2014 at 7:10 pm

Ouch! It sounds as if you have ruptured a tendon. Without seeing it, I would think you need a surgical repair to restore the function of the muscle. When a tendon ruptures fully the muscle has nothing to pull on so it just rolls up into a ball. Has your PT checked into this with an MRI or a doctor’s evaluation?

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Eric February 24, 2014 at 4:12 am

i have had an ultrasound of the muscle but they said it looked fine, even though bending my arm up at the elbow causes a visible slight protrusion of the muscle.

would an mri see something else?

i also experience a lot of pain when moving my thumb, such as using it to push touch screen buttons, and it causes a pain in my wrist (palm side) where my thumb tendon meets my wrist.

i have tried small weight strength exercises, barbell curls that i read strengthen the muscle, it seems to help a bit so far but the pain at the base of my thumb tendon bothers me the most.

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Melissa April 7, 2014 at 5:29 pm

My daughter is the pitcher for her fastpitch softball team and has experienced pain in the inner elbow when she pitches. After pitching 4 games in 2 days she had pain and bruising around her outer elbow. She was told her supinator muscle was damaged. She says she has no pain when throwing overhand only when pitching? Is this normal? Possible? Her coaches are questioning her and making her feel like she’s faking her injury? Her doctor said the elbow bruising was from muscle bleeding due to micro tears of the muscle. Bruising only lasted around 3 days before being completely gone.

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Christina Abbott April 8, 2014 at 12:11 pm

Hi, Pain in the inner elbow (medial epicondylitis when it continues) is usually caused by tension on the tendons of the flexor muscles that would be gripping the ball. The difference between pain throwing overhand and underhand could be explained by supinator stress since that muscle turns the palm up as when throwing underhand. Bruising without having experienced impact trauma there would be consistent with more than just micro tears. Micro tears are what cause epicondylitis on either side of the elbow, usually accompanied by pain and often swelling, but not bruising. Her coaches may need more education on soft tissue, tendon and joint injury. Stretching before and after playing is crucial for prevention of future injury. Look for stretching instructions in my blog and try them. The ones that hurt are the ones she needs to do. Be sure to hold the stretches for only 2 seconds and repeat several times. Ice after playing to reduce inflammation.Temporarily you might use a compression band below the elbow to reduce the stress on the tendons, but a band should not be used except when needed because it reduces the flow of blood which is so necessary for keeping the tissues healthy. Hope that helps answer your questions. Christina

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Melissa April 8, 2014 at 6:14 pm

Thank you! Yes you answered everything. I appreciate it!

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