United Brachial Plexus Network, Inc.

I am again thinking about pronation vs supination. I am able to supinate but unable to pronate, watching my OT during some observation hours I think she was using pronation way more often that supination. Just a note for those that do not know already, I am currently in college to become an occupational therapist. I am able to apply in the fall. But I am getting concerned that unless I have the ability to pronate my future career as an OT will be extremely complicated.
So I am thinking about an osteotomy that would give me pronation. Problem being, I would lose supination past neutral. Any one done this, would you recommend it? Pros/Cons? Any help would be really great!!!
Thank so much!
Amy 19 ROBPI from MN

It always seems like it comes down to the question of which function would I like to lose. Hmmmm. Dustin's arm is in the pronate and he cannot supinate beyond neutral. But, since the arm is not functional it's hard to determine which would be more useful. Since his hand is in this position he can type and tie his shoes, cut meat. But, what would he be able to do if it was supinated, hard to determine. I know you are a very determined young lady. I believe you will be able to do what you set your mind to. Maybe you could have someone play injured party for you and you could practice some manuvers on them as you are. That may help you determine what you will have to compensate, and what you may have difficulty with. It is a tough decision but that may give you a little more insight. You may be able to use your other hand in the position where you need to use a pronated hold or manuver. I would try playing around with it for a while it may help. Well, how's that for an answer that doesn't say anything, lol.
It's kind of the decision Dustin has to make if he decides to go with a muscle transfer, do you lose tricep or gracilis. Same question just different muscle.
Sue

Hi Amy,

I can't supponate, I barely get to neutral actively and that's if I force it, unless my arm is resting on something/agaisnt something. I need pronation way more in what I do daily (and being in nursing is very manual, so you know what I mean).

I like the suggestion of getting people (friends) to play injured and you try stuff, see what works/what doesn't, what you are missing... have you asked your OT her opinion? She would give you valuable insight.

Talk to you soon! Miss chatting with you!

Marieke (31, LOBPI)

Do you want to be a hand therapist? I am unsure as to why to would need to be able to pronate otherwise. In fact, did you ask you OT if you would need to pronate to work in hands?
I'm just asking these questions because I have observed hands in earlier clinicals(I am in OT school) and from my perspective you can just demonstrate positions you want to get your patient to perform with your non affected. However I'm not a CHT so I may be wrong.
I cannot pronate with my ROBPI. I just started my level 2 fielwork at a hospital 2 weeks ago(40 hours a week, 3 months) and I have not found my inability to pronate to be an issue at all. Like you, I have supination but no pronation.
Becky

Thanks for the replies! I havent asked my OT yet what she thinks. I haven't narrowed down what I want to do yt but I am very interested in the hand. I think I would love to do hand therapy but then I really haven't observed much else just yet.

Some of the stuff I was observing I kept asking if it had to be done on both sides and my OT kept saying that yes it was important to do both sides at the same time. This was mainly shoulder related.

I am just thinking about this as a possibility because if I decide this is what I want it will have to be done this spring. Otherwise I will be too old(aged out of the Shriners system and unable to afford surgery elsewhere) or it would be during school and I really can't miss classes the further I get in school.

Becky, would you mind sharing more about your clinicals with me and your observations? You can email me if you like hope16_05@hotmail.com

I really appreciate any advice everyone has to offer. It will help me make the best decision for me!
Thanks again,
Amy 19 ROBPI from MN

Amy, I met a young woman this week who had an osteotomy and the range that she got from it was a real surprise for me. What I learned is that it's not just about moving a bone and that's what you get, but you'll change how the muscles are being used. I knew this from previous discussions, but seeing the result for this young woman was eye opening. It corrected multi-dimensional issues. Her physician also said that one of the reasons it will give her good results was that she had already stopped growing, so nothing would change the result. So my advice is to ask and ask again. Also, I know you go to the shriner's system but you may want to ask Dr. Kozin (philly shriners) about this also because he's a hand specialist.
-francine

Dr. Kozin is the one who had suggested this for me orriginally. I had been talking to him the summer of 2005 and sent him med records, then we arranged to meet at Camp in DC. I had been talking to him about overhead range but after reviewing my records he thought that because of previous surgery that was not an option. And then he suggested an osteotomy. At the time I told him I didnt want it, but now I am thinking about it.

I already see a hand specialist and I only have to travel 4 and a half hours to see him. He also works at Mayo and we get along great so I think I will probably stick with my same dr. But thanks for the suggestion!
Amy 19 ROBPI from MN