Anatomical approach to the pronator teres.
A pronator teres (PT) tendon transfer is used to treat patients with multiple pathologies, including radial nerve palsy, cerebral palsy, and tetraplegia. Identification of the tendon at time of surgery may involve a random search for its insertion site along the radius. Efficient location of the PT is essential to expedite the procedure and limit unnecessary tissue dissection. This paper describes a succinct method of identifying the tendon using a systematic and anatomic approach. The radial sensory nerve is identified at its exit point from beneath the brachioradialis (BR) muscle. The fascia surrounding the BR muscle and tendon is incised, and the radial artery is visualized. The radial sensory nerve is traced in a proximal direction under the BR muscle. The BR is retracted medially and the ECRL laterally. The PT tendon and insertion site are found just proximal to the emergence site of the radial sensory nerve from the BR. This method of identification of the PT insertion saves tourniquet time and avoids unnecessary dissection.
Kozin
Scott H
SH
Department of Orthopaedic Surgery, Temple University; Shriners Hospital for Children, Philadelphia, Pennsylvania, U.S.A. skozin@shrinenet.org
Hines
Brent
B