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. 2025 Jan;17(1):96-103.
doi: 10.1177/17585732241239031. Epub 2024 Mar 22.

The pronator contracture syndrome: A new entity in supination restriction

Tim Philips  1 , Joris Duerinckx  1   2 , Laurens Van Melkebeke  1 , Roger van Riet  3   4   5 , Pieter Caekebeke  1   2   3
Affiliations

The pronator contracture syndrome: A new entity in supination restriction

Tim Philips et al. Shoulder Elbow. 2025 Jan.

Abstract

Forearm rotation is essential for daily activities and functional dexterity, involving both pronation and supination. Forearm rotation limitations can result from various pathologies, often linked to trauma, structural changes in radio-ulnar joints, and interosseous membrane alterations. Soft tissue contracture, such as post-burn scarring or specific neurological conditions, can also restrict forearm rotation. We present two cases of painless restricted passive and active supination, devoid of bony, neurovascular, soft tissue, or congenital abnormalities. We describe a surgical technique to improve forearm rotation in these patients.

Keywords: contracture; deficit; forearm; limitation; rotation; stiffness; supination.

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Conflict of interest statement

The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Figures

Figure 1.
Figure 1.
Preoperative image of pronatation, neutral, and supination (Courtesy of ORF foundation).
Figure 2.
Figure 2.
The incision is made 8 cm from the radial head centered over the insertion of the pronator teres muscle (Courtesy of ORF foundation).
Figure 3.
Figure 3.
The incision is 4 cm in length centered over the insertion of the pronator teres muscle (Courtesy of ORF foundation).
Figure 4.
Figure 4.
The radial artery, superficial sensory branch of the radial nerve, and the brachioradial muscle are retracted radialy and the flexor carpi radialis muscle ulnarly (Courtesy of ORF foundation).
Figure 5.
Figure 5.
The pronator teres tendon is identified (Courtesy of ORF foundation).
Figure 6.
Figure 6.
The tenotomy is performed proximal of the musculotendinous junction to preserve muscle function (Courtesy of ORF foundation).
Figure 7.
Figure 7.
Image of the tenotomy with the superficial sensory branch of the radial nerve on the radial side (Courtesy of ORF foundation).
Figure 8.
Figure 8.
Post-operative image at 3 months. Note the scar at the anterior side of the forearm (Courtesy of ORF foundation).
Figure 9.
Figure 9.
Post-operative image at 3 years (Courtesy of ORF foundation).
See this image and copyright information in PMC

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