Rerouting of the biceps brachii for paralytic supination contracture of the forearm in tetraplegia due to trauma.

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.