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PubMedDate not supplied

[Transfer of the pronator teres tendon to the extensor carp radialis tendon in wrist flexion deformity in cerebral palsy].

The flexion deformity of the wrist in cerebral palsy is quite common, carrying disability to the effective use of the hands. From 1980 to 1990, 36 transferences of the pronator teres to the extensor carpi radialis were reviewed. The authors describe the operative technique by a unique incision, that may be used in cerebral palsy, and conclude that it is a good method for correction of deformity.

Adolescent↗
PubMedDate not supplied

Effect of custom orthotics on plantar pressure distribution in the pronated diabetic foot.

The F-scan system was used to study plantar foot pressure in patients with a pronated foot type. Inshoe measurements were made under the first metatarsal head and medial heel with and without an orthotic in an extra depth shoe. The F-scan system was also used to compare the total contact area under the foot between each patient with and without the orthotic device. Data collected in this study demonstrated a reduced plantar pressure under the first metatarsal head and medial heel in the patients with an orthotic (30-40% reduction). Calculations of the total contact area under the foot revealed an increase in contact area with an orthotic in extra depth shoes (5-10% increase). Pressure-sensitive insoles, which were replaced as needed, provided reproducible measurements of dynamic plantar pressure and contact area through repeated measurements over the 3-month period of this study. Evaluations show that a custom-made foot orthotic can increase total contact area (redistribute force) and is able to reduce plantar pressures. Thus, an orthotic should reduce the risk of ulceration in the diabetic neuropathic foot.

Aged↗
PubMed1994

Clinical use of a syndesmosis screw in stage IV pronation-external rotation ankle fractures.

The purpose of this study was to determine if biomechanical data obtained in studies on cadavers correlates with clinical results in the surgical treatment of stage IV pronation-external rotation (PER-IV) ankle fractures. We surgically treated 20 patients who sustained isolated PER-IV ankle injuries and followed 18 of the patients for an average of 2.5 years. Radiographs were evaluated using previously established methods, and clinical outcome was based on the criteria of Cedell. Eleven patients sustained a PER-IV injury with a medial malleolus fracture; 2 required a syndesmosis screw due to poor medial fixation. Good or excellent results were obtained in 90% of the patients in this group; the poor outcome of 1 patient was due to the development of reflex sympathetic dystrophy. Seven patients had a PER-IV injury with a deltoid ligament tear; because of widening of the syndesmosis, 1 patient required an early operation (within 1 week), and 2 patients required late operations (after 1 month). None of these patients should have required a syndesmosis screw based on biomechanical studies. Good or excellent results were obtained in 71% of the patients in this group. We conclude that the biomechanical data concerning placement of a syndesmosis screw in PER-IV ankle fractures does not correlate with in vivo outcome when a deltoid ligament injury occurs. A screw that stabilizes the distal tibiofibular syndesmosis should probably be placed in patients who sustain PER-IV injuries with deltoid ligament ruptures regardless of the level of the fibula fracture.

Adult↗
PubMed1993

[Pronation from the viewpoint of the transfer of movement between the calcaneus and the tibia].

Excessive foot eversion and abnormal tibial rotation have been associated with knee injuries. Why and whether or not overpronation in athletes leads to overuse injuries at the knee joint, however, is still not understood. It could be that this is related to the mechanical coupling at the ankle joint complex. The purpose of this study was to quantify the movement transferred from calcaneal eversion-inversion into tibial rotation, and vice-versa from tibial rotation into calcaneal eversion-inversion. Fourteen foot-leg specimens were used for investigation. A holding device with six degrees of freedom was constructed which allowed to rotate the calcaneus and to determine the resulting tibial rotation, and vice-versa. The movement transfer between calcaneus and tibia varied substantially, and it was not the same for both input modes. In the case of applied internal tibial rotation no calcaneal eversion was found. Apparently, the movement transfer depends from the individual mechanical coupling at the ankle joint complex. Excessive calcaneal eversion does only result in excessive rotational loading of the knee joint when coupled with a high movement transfer at the ankle joint complex. Finally, the results imply that, during gait, pronation results from ground reaction forces acting on the calcaneus, since internal tibial rotation is not transferred into calcaneal eversion.

Biomechanical Phenomena↗
PubMed2004

Abnormal musculoaponeurotic tunnel in the arm: possible entrapment of the median nerve and brachial artery with high origin of nerve to pronator teres within the tunnel.

Median nerve and brachial artery in the arm are not usually overlapped by any structure. Connective tissue bands and muscular slips draping or enclosing this neurovascular bundle have been reported, however, which may produce clinical symptoms of nerve compression and vascular changes. We report an unusual musculoaponeurotic band that originates as the ligament of Struthers but terminates as the brachiofascialis muscle of Wood and in the process may have entrapped both the median nerve and brachial artery. The nerve to pronator teres originates from the median nerve within this tunnel. On histological examination the nerve was flattened and showed some perineurial thickening. In view of the flexor function of brachialis muscle, this anomalous musculoaponeurotic band may be considered a clinically important entity in the causation of idiopathic neurovasculopathy in the hand.

Brachial Artery↗
PubMed1984

Atypical pronation-eversion ankle joint fractures.

Two cases of pronation-eversion fractures, grade four, are described which were sustained during sports activities. However, in both cases the medial structures of the joint were intact. The trauma mechanism is obscure but may be explained by considering the ankle joint and the subtalar joints as a torsion transmitter as suggested by Inman (1976).

Adult↗
PubMed1992

Anatomic basis of pronator quadratus flap.

The pronator quadratus m. can be raised as a flap on its main anterior interosseous pedicle, whose characteristics are as follows: diameter of the artery 2.1 mm, diameter of the each of both veins 2.4 mm, length of useful pedicle 70-80 mm, after possible intraneural dissection of the nerves to the flexor pollicis longus m.

Forearm↗
PubMed1998

Inhibitory projections from pronator teres to biceps brachii motoneurones in human.

Neural projections from the pronator teres (PT) muscle to biceps brachii (BB) motoneurones were studied in three healthy human subjects using a post-stimulus time histogram method. In 25 BB motor units, electrical stimulation to the PT nerve with intramuscular needle electrodes induced inhibition in nine units (36%), whereas facilitation was produced in 18 units (72%) by stimulation to the median nerve trunk with surface electrodes at the distal end of the intermuscular septum of the arm or in the cubital fossa. Six motor units (24%) received both inhibition (PT nerve stimulation) and facilitation (median nerve trunk stimulation). In the six, the latency of the inhibition was, on average, 1.2 ms longer than that of the facilitation. The stimulation site for the inhibition was, on average, 4.8 cm distal to that for the facilitation. The inhibition was evoked with an intensity well below the motor threshold. These findings suggest that BB motoneurones receive oligosynaptic inhibition of group I afferents from PT in human.

Adult↗
PubMed1998

MR imaging of the major nerves about the elbow: cadaveric study examining the effect of flexion and extension of the elbow and pronation and supination of the forearm.

Magnetic resonance (MR) imaging provides useful information in the evaluation of peripheral nerves. Recent advances in MR imaging allow for detailed depiction of the soft tissue structures of the elbow joint. Three major nerves are present about the elbow. Six cadaveric elbows were imaged to depict the normal anatomy of these nerves and to determine the best plane and position of the elbow for optimal visualization of each nerve. Axial images of the elbow in full extension with the forearm in supination allow identification of all major nerves. Axial images with the elbow in full flexion allow accurate assessment of the cubital tunnel and the ulnar nerve. Axial images of the elbow in full extension with the forearm in pronation are helpful for assessment of the median and radial nerves in the forearm.

Aged↗
PubMed1986

Somatotopic organization of motoneurons innervating the pronators, carpal and digital flexors and forepaw muscles in the dog: a retrograde horseradish peroxidase study.

Central distribution of motor neurons innervating the individual forearm and forepaw muscle through the median and ulnar nerves was studied in the dog using the retrograde horseradish peroxidase (HRP) method. All HRP-labeled cells were seen ipsilaterally in restricted parts within the dorsolateral (DL) and retrodorsolateral nucleus (rDL) of the ventral horn at levels from the cranial tip of C7 to the cranial third of T2. The results showed that motoneurons situated more cranially supply the more proximal muscles and those situated more caudally supply the more distal ones, and that the pronator motoneurons occupy longitudinally the central part of the DL; the carpal flexor motoneurons, the medial part of the DL; the digital flexor motoneurons, the dorsal central part of the DL and the lateral fourth of the rDL; and the forepaw muscle motoneurons, the medial three-fourths of the rDL. These somatotopic arrangements of each motor pool could be correlated with the location and action of the muscles.

Animals↗
PubMed1983

A method for quantification of alternate pronation and supination of forearms.

A method for quantitative evaluation of diadochokinesia test (alternate pronation and supination of forearms) has been developed. Ten parameters that quantify features of movements were established. The method was applied to a group of healthy people and a group of patients with methylmercury poisoning. Significant differences between the two groups were noted in many parameters. To interpret the parameters synthetically, principal component analysis was applied and a scatter diagram on the first two principal components indicated the difference in distribution between the two groups. Among the established parameters, there were six related to regularity. They were combined in a linear form to define a summarized measure for regularity. The measure agreed very well with visual judgment. The obtained results demonstrated the usefulness of the method in daily clinical practices.

Forearm↗
PubMed1989

The pronator quadratus sign: its classification and diagnostic usefulness for injury and inflammation of the wrist.

The clinical value of the pronator quadratus radiological sign was investigated. Fresh undisplaced fractures of the distal radius and acute injuries of the distal radio-ulnar joint showed anterior displacement of the radiolucent shadow in 85% and 88% respectively, but normal subjects no displacement. In rheumatoid arthritis, the presence of synovitis of the wrist joint appeared to be correlated with a blurred shadow at the distal end.

Adolescent↗
PubMed1993

Pronator quadratus free muscle flap for treatment of palmar defects.

Cutaneous flaps are not entirely satisfactory when used for soft tissue defects of the palm, because the skin cover is too mobile. Use of muscle flaps can therefore be advocated for this recipient site. A case is reported where the pronator quadratus muscle has been used as a free muscle flap for coverage of a small defect of the palm.

Adult↗
PubMed1994

A transverse skin incision approach for decompression of pronator teres syndrome.

Pronator teres syndrome is a compressive neuropathy of the median nerve in the proximal part of the forearm and distal part of the arm. The outcome of surgical decompression is occasionally unsatisfactory because of a poor scar. We present the use of a transverse skin incision that allows adequate exploration and decompression distally and proximally, beneath the subcutaneous tissue beyond the volar elbow crease.

Adult↗
PubMed1994

Implantation of the palmar cutaneous branch of the median nerve into the pronator quadratus for treatment of painful neuroma.

A neuroma of the palmar cutaneous branch (PCB) of the median nerve can cause pain in the scar following carpal tunnel release, with secondary decreased wrist range of motion and decreased grip strength. The results of PCB resection and implantation of the PCB into the pronator quadratus muscle are reported in a series of 13 patients. Pain relief was demonstrated before surgery by anesthetic block of the PCB, which did not result in sensory loss in the distribution of the median nerve. Results, at a mean of 19 months after surgery, were excellent (no residual pain, return to previous jobs) in six patients and good (some residual pain, return to a different job, stable or improved grip strength and wrist range of motion) in seven patients.

Adult↗
PubMed2005

Pronator teres is an appropriate donor muscle for restoration of wrist and thumb extension.

OBJECTIVE: To compare the detailed architectural properties of the pronator teres (PT), extensor carpi radialis brevis (ECRB), and extensor pollicis longus (EPL) muscles to evaluate the suitability of PT-to-ECRB and PT-to-EPL surgical procedures. METHODS: Muscle physiologic cross-sectional areas and region-specific muscle fiber lengths were measured in cadaveric PT, ECRB, and EPL muscles (n = 10 muscles of each type). One-way repeated-analyses of variance measures and post hoc t tests with Bonferroni corrections were used for statistical comparisons. RESULTS: The ulnar head of the PT was present in 8 of 10 specimens. The average PT fiber length was similar to that of the ECRB (7.02 +/- 0.49 cm vs 6.17 +/- 0.27 cm) but was significantly longer than that of the EPL (5.44 +/- 0.25 mm). Fiber length in the humeral head of the PT was longer compared with the ulnar head (7.19 +/- 0.52 cm vs 4.14 +/- 0.25 cm). The average physiologic cross-sectional area of the PT was similar to that of the ECRB (3.5 +/- 0.4 cm2 vs 3.3 +/- 0.3 cm2) but was significantly larger than that of the EPL (3.5 +/- 0.4 cm2 vs 1.1 +/- 0.1 cm2). CONCLUSIONS: From an architectural point of view the PT is an excellent donor choice for transfer to the ECRB for restoration of wrist extension or to the EPL for restoration of thumb extension. Because there is fiber length heterogeneity within the PT, however, when the ulnar head is present it may limit the total excursion of the donor muscle. These data suggest that releasing the ulnar head of the PT before transfer may result in larger excursions of this important motor in tendon transfer surgery.

Aged↗