Pronosupinator FAQs

Pronosupinator

The Pronouspinator is usually used to treat stiffness of either supination and/or pronation. There are other good and bad options on the market and custom made.  Please read the FAQ below for answers to your questions. If you don’t find it here, please feel free to email us on upperlimbco@gmail.com

Efficacy

The average gain for people with stiffness is 40-50⁰ # with similar splints.

Dynamic splints (such as Lee, Von Kersberg & Lastayo’s) and strong static progressive splints (such as the JAS Pro/Sup) have been shown to be efficacious in the stiffest of patients, even when therapy fails.

This is despite:

Therapy plateau

Hard end-feel

Chronic stiffness

Malunion

Injury severity

# refer to peer reviewed articles for evidence.

When is it indicated for use?

For stiffness, loss of movement in supination and/or pronation

For pain at end-of-range supination and/or pronation associated with stiffness

After wrist, forearm or elbow traumas (eg. Distal radius fractures, ulnar fractures, elbow fractures, significant soft tissue injury)

Contraindications:

Unstable wrist, elbow or forearm (eg current subluxation or dislocation)

Non-united fractures

Heterotopic ossification

Synostosis

Neurovascular conditions must be monitored closely by a health professional.

How does it work?

The Pronosupinator dynamically holds your patient in firm supination or pronation. Your patient can briefly rotate out of position, but will be pulled back firmly. They are able to flex and extend their elbow freely regardless of rotation. This allows your patient to be stretched most of the time, be able to undertake intermittent function, while getting the total end-range-time they need to elongate soft tissues. This is the best way of stretching soft tissues and improving rotation and is supported by evidence.

Can I have one waiting which will fit most patients?

Yes. The Pronosupinator is designed in a way that the standard size will be suitable for most of your patients, including the next patient walking through your door with stiffness. Each splint will fit left or right, supination and/or pronation, with room for adjustment for a range of people.

What are sizing options?

We have paediatric (6 years and up), standard (adolescent and adult) and large (adolescent and adult with BMI >30). The standard and large will fit most adults height-wise, from 150cm to 187cm and 155 to 190 cm respectively. If your patient’s BMI is under 30, the standard will fit, over 30, a large is required.

Will it achieve a stretch?

Yes. The Pronosupinator is not like the TAP splint (neoprene anti-pronation splint), or a lot of Van Lede splints (wrist splint + elbow splint velcroed together in rotation). We guarantee the Pronouspinator will be able to hold the patient at their end-of-range regardless of how stiff they are.

Because the elbow is free to flex and extend and the wearer can briefly dynamically rotate against the Pronosupinator (ie they can pronate approximately 60 degrees from a dynamically supinating position or vice versa), they can wear the Pronosupinator while doing tasks at work or home. Some even wear it whilst sleeping (with the obvious skin / neurovascular checks first). As such, they can achieve 4 hours of stretch per day without too much difficulty.

How do I know if it’s stretching or not?

This is where many splints applied to stretch fail. They have to be fitted so they hold the person at end-of-range in either supination or pronation. At that point, you should test that the patient is held as far in supination or pronation as they can go. To do this, first, apply the splint; second, attempt to passively stretch them further into the direction of stretch (either supinated or pronated). If they can easily move further, they’re not at end-of-range. In the case of the Pronosupinator, if this occurs, adjust the splint – we guarantee it will hold your patient at end-of-range.

If you can push your patient past the position the splint holds them in – it won’t work.

Where does it stretch?

The Pronosupinator pulls through the DRUJ, not the carpus nor the thumb. As such all forces are transmitted between the elbow and the DRUJ.

Can I use my hand while wearing it?

Yes. The patient can rotate out of supination or pronation and flex and extend the elbow. This allows them to pick up things or do general functions. Many people wear them whilst working. It is difficult to do tasks which require fine control.

What are alternatives?

A JAS Pro/Sup splint, Progress Plus splint or custom made Colello work well. If you can get a Van Lede splint to hold at end-of-range (often it won’t on a stiff patient) and convince your patient to wear it for 4 hours or more per day, it may improve their ROM, but unlikely to the same extent. A neoprene TAP splint is not indicated and will not hold a stiff patient at end-of-range. Whatever you apply, must be tested to hold them as far as they can be held passively. If it doesn’t, it will yield suboptimal results.

Evidence

Lee, M. J., & LaStayo, P. C. (2003). A Supination Splint Worn Distal to the Elbow: A Radiographic, Electromyographic, and Retrospective Report. Journal of Hand Therapy16(3), 190-198.

Lucado, A. M., Li, Z., Russell, G. B., Papadonikolakis, A., & Ruch, D.S. (2008). Changes in impairment and function after static progressive splinting for stiffness after distal radius fracture. Journal of Hand Therapy21(4), 319-325.

McGrath, M. S., Ulrich, S. D., Bonutti, P. M., Marker, D. R., Johanssen, H. R., & Mont, M. A. (2009). Static progressive splinting for restoration of rotational motion of the forearm. Journal of Hand Therapy22(1), 3-9.

Parent-Weiss, N. M., & King, J. C. (2006). Static progressive forearm rotation contracture management orthosis design: a study of 28 patients. JPO: Journal of Prosthetics and Orthotics18(3), 63-67.

Shah, M. A., Lopez, J. K., Escalante, A. S., & Green, D. P. (2002). Dynamic splinting of forearm rotational contracture after distal radius fracture. The Journal of hand surgery27(3), 456-463.