Students with learning disabilities (LD) often struggle to develop deep, transferable concep tual understanding in mathematics due to cognitive and processing challenges, underscor ing the relevance of instruction grounded in strong teacher pedagogical content knowledge (PCK). This issue is critical given widening post-pandemic achievement gaps and increased expectations for conceptual understanding in inclusive classrooms. Although many studies document effective mathematics interventions for students with LD, relatively few examine howteachers’ PCK functions in these classrooms. In contrast, general education research highlights the importance of PCK for conceptual learning. This manuscript bridges these studies by examining how insights from broader PCK research may inform instruction for students with LD. This manuscript presents a practice-based conceptual synthesis of research on mathematics teachers’ PCK, integrating findings from special education and mathematics intervention literature with classroom vignettes and practitioner examples. The synthesis highlights how core PCK components—content knowledge, understanding of student thinking and misconceptions, and instructional strategies—may support early conceptual understanding in students with LD, emphasizing multiple representations, error analysis, and routines that promote generalization through distributed practice. Implications for practice, professional development, and future research are discussed, offering practice-informed pathways to support inclusive mathematics instruction for students with LD.