Pronator teres rerouting in children with cerebral palsy

The Journal of Hand Surgery
Robert E Bunata

Abstract

The forearm in children with cerebral palsy often assumes uncontrolled dynamic positioning in pronation when the hand is put into use. This hypertonic positioning seems to be an expression of dystonia rather than spasticity. This article reports the effect of pronator teres rerouting (PTR) using the technique of tendon Z-lengthening and repair on active motion and on forearm positioning during use. Thirty-one patients who had pronator teres rerouting were observed before and after surgery for active and passive forearm range of motion, changes in dynamic forearm positioning, and the performance of 5 functional tasks related to forearm rotation. The primary indication for surgery was pronation positioning of 25 degrees or greater because that positioning precludes grasping a glass or cup of water. The follow-up period averaged 39 months. The average active supination increased 65 degrees, and the average dynamic positioning changed from 26 degrees pronation to 7 degrees pronation. Thirty of the 31 patients gained the ability to hold a cup of water in the involved hand. Nine children positioned the hand in supination during grasp. Pronator teres rerouting improves both active supination and dynamic forearm positioning in children...Continue Reading

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Citations

Jun 28, 2014·The Journal of Hand Surgery·Robert Bunata, Kurt Icenogle
Apr 6, 2011·The Journal of Hand Surgery·Robert Bunata
Mar 21, 2007·Journal of Electromyography and Kinesiology : Official Journal of the International Society of Electrophysiological Kinesiology·Mark J C Smeulders, Michiel Kreulen
May 11, 2007·Developmental Medicine and Child Neurology·Judith C van MunsterMijna Hadders-Algra
Oct 9, 2009·Developmental Medicine and Child Neurology·Rose GilmoreRoslyn Boyd
Mar 17, 2012·Clinical Neurology and Neurosurgery·Justin M BrownGeoffrey L Sheean
May 2, 2014·Frontiers in Neurology·Carlyne ArnouldJean-Louis Thonnard
Aug 23, 2016·The Journal of Hand Surgery·Scott Oishi, Lesley Butler
Apr 25, 2012·The Journal of Hand Surgery, European Volume·T OzkanZ Y Hosbay
Jul 15, 2015·Journal of Orthopaedic Surgery and Research·Goran ČobeljićHenry Dushan Atkinson
Jul 31, 2014·Journal of Pediatric Orthopedics·Jimmy J T HoKen N Kuo
Jul 17, 2010·Journal of Pediatric Orthopedics. Part B·Konstantinos N MalizosNikolaos S Rigopoulos
Jun 20, 2019·Disability and Rehabilitation·Marko B HasiukOleh O Kachmar
May 2, 2009·The Journal of Bone and Joint Surgery. British Volume·A AmraniZ F El Alami
Apr 8, 2020·Indian Journal of Orthopaedics·Maximillian MifsudRachel Buckingham
Oct 1, 2021·BMC Musculoskeletal Disorders·Shi-Li DingHai-Fei Shi

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