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Pronator teres rerouting in children with cerebral palsy
1Fort Worth Affiliated Orthopaedic Residency Program, Fort Worth, TX 76104, USA. rebunata@earthlink.net
Insights
Pronator teres rerouting surgery significantly improved forearm supination and positioning in children with cerebral palsy, enhancing their ability to grasp objects. This surgical intervention addresses uncontrolled pronation, a common challenge in affected children.
Area of Science:
- Pediatric Orthopedics
- Neurology
- Rehabilitation Medicine
Background:
- Children with cerebral palsy often exhibit uncontrolled forearm pronation during hand use.
- This hypertonic positioning is frequently linked to dystonia rather than spasticity.
- Severe pronation (≥25 degrees) impedes essential functions like grasping a cup.
Purpose of the Study:
- To evaluate the effectiveness of pronator teres rerouting (PTR) surgery.
- To assess improvements in active forearm motion and positioning during functional tasks.
- To analyze the impact of PTR on children with cerebral palsy experiencing dynamic forearm pronation.
Main Methods:
- Thirty-one pediatric patients with cerebral palsy underwent pronator teres rerouting.
- Pre- and post-operative assessments included active/passive range of motion and dynamic forearm positioning.
- Performance in five functional tasks related to forearm rotation was evaluated.
- Study design: Therapeutic, Level IV evidence.
Main Results:
- Average follow-up was 39 months.
- Active supination increased by an average of 65 degrees.
- Dynamic forearm positioning improved from an average of 26 degrees pronation to 7 degrees pronation.
- 30 out of 31 patients could grasp a cup post-surgery; 9 showed slight overcorrection.
Conclusions:
- Pronator teres rerouting effectively enhances active supination and dynamic forearm positioning in children with cerebral palsy.
- The surgical technique may lead to slight overcorrection in some cases, suggesting a dystonic component to positioning disorders.
- Adjusting surgical tension is recommended for children with significant dynamic hypertonia to prevent overcorrection.
Purpose:
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.
Methods:
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.
Results:
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.
Conclusions:
Pronator teres rerouting improves both active supination and dynamic forearm positioning in children with cerebral palsy. The use of the technique described in the literature resulted in slight overcorrection of forearm positioning in the nine children. This finding is consistent with the concept that positioning disorders are at least partly dystonic rather than spastic. It is recommended that the transfer be tensioned more loosely in children who have excessive dynamic hypertonia.
Type Of Study/Level Of Evidence:
Therapeutic, Level IV.
