The Journal of Bone and Joint Surgery, Vol 76, Issue 3 398-402, Copyright © 1994 by Journal of Bone and Joint Surgery, Inc
Rerouting of the biceps brachii for paralytic supination contracture of the forearm in tetraplegia due to trauma
H Gellman, D Kan, RL Waters and A Nicosa
Department of Orthopaedic Surgery, University of Southern California, Los Angeles 90033.
Six tetraplegic patients (eight forearms) who had a supination contracture
were evaluated after lengthening and rerouting of the biceps brachii.
Preoperatively, the mean range of supination and pronation of the forearm
was 85 and 14 degrees, respectively. Pronation increased a mean of 75
degrees without affecting the strength of flexion or the flexion-extension
arc of motion of the elbow. The forearms that had a satisfactory result had
a mean active range of supination of 69 degrees, while those that had a
poor result had no active supination. The mean duration of follow-up was
twenty-seven months (range, twelve to seventy-two months). The result was
considered satisfactory for six limbs and unsatisfactory for two.
Functional gains were made in the patients' ability to feed and groom
themselves, in their ability to tend to personal hygiene, and in writing
and typing skills when the dominant extremity was treated. The results were
less predictable for the non-dominant extremity. The maximum gain in the
range of motion occurred at three months and the maximum functional gain,
by six months.