One-80° Pronosupinator FAQs

Multi-award winning One-80° Pronosupinator

The One-80° Pronouspinator is used to treat stiffness of either supination and/or pronation.  Please read the FAQ below for answers to common questions. If you don’t find your question here, please feel free to email us on info@upperlimbco.com

How effective are mobilisation orthoses?

The average gain for people with stiffness is 40-50⁰ with similar mobilisation orthoses.

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.

Mobilisation orthoses work despite:
– Therapy plateau
– Hard end-feel
– Chronic stiffness
– Malunion
– Injury severity

Please 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 One-80° Pronosupinator dynamically holds your patient’s forearm in firm supination or pronation. Your patient can briefly rotate out of position, but will be pulled firmly back into a stretched position when they relax. 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 in my clinic that will fit most patients?

Yes. The One-80° 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 arms, supination and/or pronation. The forearm length is adjustable, meaning it will fit a large 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 One-80° Pronosupinator is not like the neoprene anti-pronation orthoses available, or a lot of Van Lede splints (wrist splint + elbow splint velcroed together in rotation). We guarantee the One-80° 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 One-80° Pronosupinator (ie they can pronate approximately 60 degrees from a dynamically supinating position or vice versa), they can wear the One-80° Pronosupinator while doing tasks at work or home. Some even wear it whilst sleeping (be sure to assess for skin / neurovascular suitability 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 mobilisation/stretching orthoses fail. To be effective, orthoses must be fitted so they hold the patient at end-of-range in either supination or pronation. So when you apply an orthosis, 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 are not at end-of-range. In the case of the One-80° 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 One-80° 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 perform general function. Many people wear them whilst working. It is difficult to perform tasks that require fine control.

How long should someone wear it?

The typical wear time is 4 hours per day (this is total and can be spread across the day or night).  But the recommended wear-time may vary from person to person.  Some people may benefit from wearing it for longer each day and some may improve with shorter wear times.

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.