Surgical management of forearm pronation

Active volitional supination enhances upper limb function. In the spastic forearm with pronation deformity, careful preoperative assessment of muscle function is necessary to design a treatment plan to improve supination. Concomitant procedures performed for flexion contractures have to be taken into consideration. The release of the forearm, wrist, and fingers from a contracted pronated position may unmask active supination or may make the need for a tendon transfer with supinatory activity obvious.