Posttraumatic rotation deficit of the forearm, including synostosis

Prono-supination takes place over the full length of the forearm, the whole forearm thus being one single joint. Any change to the configuration of the proximal (PRUJ) or distal (DRUJ) radioulnar joints or to the forearm diaphyses and the connecting interosseous membrane (IOM) can result in loss of forearm rotation by either mechanical interference and/or by pain induction. Capsule retraction and scar formation in the soft tissues of the forearm can make early posttraumatic limitations progressively worse. Soft tissue contracture may even be the sole cause of loss of forearm rotation as e.g. in burn victims or certain neurologic conditions. Preservation of forearm rotation should be a prime concern at all times during the care of injuries to the elbow, forearm and wrist. Judicious positioning in case of immobilization, early assisted active motion (‘place and hold’) and intermittent alternating endpoint splinting are basic elements of rehabilitation (Fig. 1). The minimum functional range lies between 50 to 72 degrees supination and 40 to 55 degrees pronation, deficits of the latter being more easily compensated by shoulder movement.