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Restricting Forearm Rotation After Injury
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Posted on: 04/26/2012
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Turning the hand palm up (called supination) and palm down (pronation) can disrupt a bone fracture or other forearm/wrist injury during the healing process. Placing the arm in some type of immobilizer (e.g., splint or cast) helps hold the arm still and restricts forearm rotations (supination and pronation).
Sometimes it is very important to avoid any amount of forearm rotation. This is especially true when ligaments between the two forearm bones or in the wrist are torn or damaged. Any stress on the ligaments during recovery may disrupt the natural healing.
But the best way to restrict forearm rotation is unknown. For example, does a cast work better to restrict forearm rotation than a splint? If the cast is used, should it be a long arm cast (above the elbow including wrist) or short arm cast (below the elbow)? If a splint is used, which one is advised: short arm splint, sugar tong splint, or long arm splint?
For those who have never heard of a sugar tong splint, it is much like the long arm splint in that it includes (covers) both the elbow and the wrist. The sugar tong splint does allow elbow motion (flexion and extension), which the long arm splints and casts do not allow.
The results of this study from South Korea may help provide some help in answering the question of which immobilizer to use. Healthy adult volunteers (ages 23 to 66) participated. Forearm rotation was measured using a specially designed goniometer (device used to measure joint motion). Measurements of pronation and supination were recorded without a cast or splint. The same measurements were then taken with the arm in each one of the different immobilizers.
Four observations were made:
The long arm cast was able to hold the forearm and prevent rotations better than any other method.
The rest of the immobilizers reduced the amount of forearm rotation by about 60 per cent.
Differences were observed in the amount of rotation between men and women with these different methods of immobilization. Women tended to have more forearm rotation than men when in the short arm cast.
The short arm splint allowed the most amount of forearm rotation (more than half the normal range-of-motion).
The authors advise surgeons to use the long arm cast when forearm rotation must be stopped as much as possible. The long arm cast restrained forearm rotation to less than 10 per cent of normal supination and pronation. The short arm splint should only be used when unrestricted forearm motion is allowed. And the surgeon should keep in mind that women tend to have more forearm motion than men when in the short arm cast.
One final note about this study. The authors pointed out that using normal, healthy adults who have no injuries could be somewhat misleading. Without pain or swelling from an injury, these individuals may have a greater ability to move the forearm. And when they used prefabricated splints that are molded to the person's arm, it's likely they were able to get a better fit than would be possible with someone in pain or who still had swelling.
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References:
Jae Kwang Kim, MD, PhD, et al. Comparison of Forearm Rotation Allowed By Different Types of Upper Extremity Immobilization. In The Journal of Bone and Joint Surgery. March 7, 2012. Vol. 94A. No. 5. Pp. 455-460.
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*Disclaimer:*The information contained herein is compiled from a variety of sources. It may not be complete or timely. It does not cover all diseases, physical conditions, ailments or treatments. The information should NOT be used in place of visit with your healthcare provider, nor should you disregard the advice of your health care provider because of any information you read in this topic. |
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