United Brachial Plexus Network, Inc.

This is not a surgery where you lose one function to gain another. My daughter is 6 years old now and she had this surgery almost 3 years ago when she was age 3. She didn't lose her supination to gain pronation. She maintains both movements. I agree that it was a very easy surgery. I wanted to clarify because someone stated that you lose one function to gain another and this simply isn't true.

"Will my child gain more than they lose?" That's the million dollar question on all these secondary surgeries!

It truly depends what sort of range the child has. If they have full 180 degrees rotation but the baseline is just "off" then no, they will not lose anything by a rotational osteotomy which just adjusts that range, since they have more than is functional in one direction already.

BUT if a child doesn't have the full range of motion (which is more typically the case due to contractures forming by weakness in the first place) by shifting their functional range you run a very real and probable risk that they will lose function on one end to gain function on the other. That's just the nature of the beast!

Kate

we had the osteotomy done to be in a neutral position to aid in supination, thus to have a better "starting point"

Hi,
This is a subject that my husband and I have not decided on either. We saw Dr. Nath and he recommended the forearm osteotomy with Davino, but we are also afraid of what will happen if we do it and if we don't do it. We do therapy, we have a strap that helps slightly with the suppination. At this point we are waiting for a while to see how she does with the things we are trying.

Hi, would you e-mail me and give me some more details on who did the surgery and details.
mgjazz@yahoo.com

Thanks,
Michele

That last post was for Blakesmom97.
Thanks

Great comments.. I can add one detail. You can get a splint made to simulate what you would lose from the surgery. I have spent 3 days now with one of those. Since I have only 60 degress of rotation from neutral to mostly supination, it's a big difference to shift that to the other side (more pronation). I'm glad nobody made this decision for me. (I am now 36... nobody suggested anything like this when I was 20.)

The biggest problem is one the therapist pointed out: you need to be in supination to flex your elbow fully, and if you can't do that you can't bring your hand to your mouth.

There are also risks, which the surgeon (Hodgson) went through one by one. For instance, I already have ossification, and the surgery brings a small risk of accelerating that and locking up the forearm bones (result: no rotation.)

Like Kate said, do you stand to gain more than you lose?

Erik, I just wanted to thank you for your comments! I never thought about not being able to get my hand to my mouth if I lose supination. Ah more for me to think about now! I was supposed to have a tendon transfer with my last surgery almost 4 weeks ago but after thinking on it my dr chose not to do that part of the surgery because it might compromise my shoulder. So I will need on more surgery to get pronation but havent officially picked which one yet.

Thanks again for your comments!!!
Amy 20 years old ROBPI from MN

Hi Amy,

I've been reading your posts for details. Thanks very much. It sounds like you have passive ROM but not active? For the tendon transfer to work.

I have a bony problem - adult radius bone is completely straight, no curve at all, so no pronation, stops at neutral. Forearm osteotomy would put some curve in it. I think I will ask more questions about the muscle arrangements.

It was the physical therapist making the splint that explained what position the forearm bones are in when you put hand to mouth. After looking at my right arm (uninjured...relatively) I think it's only in special cases that it matters. But in my left arm the radius in neutral gets in the way and reduces passive flexion by 20 degrees. (If I had more active shoulder rotation it wouldn't be such a big deal.)

So far, the main supination activity on my list seems to be holding books open. On the pronation side are: more fingers for typing, and picking up Lego, small objects, etc. Actually, the splint *helps* me do a bunch of things already. I joked that I might just settle for a good splint and skip the surgery.

Hi Erik,
You are very right, I do have great passive ROM every where but cant seem to get my active motion to kick in. My doctor was thinking about taking the flexor digitorum superficialis tendon to my ring finger (the tendon that bends the middle joint) and transfering that to the pronator teres muscle in the forearm. he is now second guessing himself thinking that my biceps might be too strong for that procedure to work. He would rather reroute the biceps but then I lose supination past neutral.

I do have a strap to wear for pronation and it works gret but I can only wear it for 20 or so minutes at a time and I think I would like a more permanent "fix" so to speak. so now I am back to deciding which is the best surgery for me and where I can make the most gains and least losses. I guess I can ask on Tuesday when I go see my doc for my post op appt. Pretty soon to talk more surgery but financially, I think I need to have my other surgery before the end of the year if my shoulder is recovered enough.
I will keep you updated!

In your situation, I think I would opt for the splint as long as its not getting in the way all the time. I would like to just use my splint as well but becoming an occupational therapist I dont know that the patients would be as confident in my skills if I were wearing a splint all the time. Or the other problem would be if I need it for more than 20 minutes, my hand gets too cold to function after that time so I have to take it off.
I havent seen any therapists wear splints at work so I am not sure if it would be any affect at all, probably not but I dont know. I am just a bit worried, becoming an OT is going to be hard work for me, but its what I really want to do!

Keep me updated on your choice as well, splint or surgery?
Talk to you later,
Hugs,
Amy 20 years old ROBPI from MN