People easily adapt to this weakness without conscious effort or self-awareness, by using 1) the next muscles down, which are innervated by a different nerve, or 2) using ligaments to give resistance, pinching laterally against the index finger or against the side of the end of the thumb, or 3) by what is called "tenodesis," which in this case is extension of the wrist joint, which tightens the muscles on the palm side of the hand. These adaptations on a moment-to-moment basis do not cause problems, but over time in loose-jointed patients, such as many women and people with collagen disorders such as Ehlers Danlos Syndrome, the adaptations can cause soft tissue failures that can become painful, particularly at the base of the thumb and in the proximal forearm (i.e., "Tennis Elbow" in a non-tennis player). Causes
The most common cause is entrapment of the median nerve between the two heads of the pronator teres muscle. Other causes are compression of the nerve from the fibrous arch of the flexor superficialis, or the thickening of the bicipital aponeurosis.⁠

Anatomy
The median nerve passes through the cubital fossa and passes between the two heads of pronator teres muscle into the forearm. It then runs between flexor digitorum superficialis and flexor digitorum profundus muscles and enters the hand through the carpal tunnel.It innervates most of the flexor muscles in the forearm and hand.
Its sensory component supplies the skin of the palm, thumb, index and middle finger as well as half the ring finger, and, importantly and often forgotten, the bones of the wrist. In the proximal forearm it gives rise to the anterior interosseous nerve which innervates the flexor of the thumb (FPL), the flexor digitorum profundus of the index finger (FDP IF), and the pronator quadratus, and terminates in a sensory branch to the bones of the wrist, i.e., the carpal tunnel. Compression of the proximal median nerve results in weakness of these three muscles, and can cause aching pain in the wrist on the basis of the sensory nerve to the carpal bones. Diagnosis
The most common chief complaint is intermittent pain in the wrist, associated with sustained pronation, frequently misinterpreted by patients and providers as "tendonitis." This is usually accompanied by the perception of "hand weakness," and "dropping things." The characteristic physical finding is tenderness over the proximal median nerve, with ensuing numbness in the hand in less than a minute, and/or numbness in the hand with resisted pronation of the forearm in less than a minute.The flexor pollicis longus and FDP of the index finger are weak, leading to impairment of pinching firmly.