Quantification of Pronator Quadratus Contribution to Isometric Pronation Torque of the Forearm

Purpose The contribution of the pronator quadratus (PQ) muscle in generation of pronation torque has not been determined. The purpose of this study was to investigate pronation torque in healthy volunteers before and after temporary paralysis of the PQ with lidocame, under electromyographic guidance. Methods A custom apparatus was designed to allow isometric testing of pronation torque at 5 positions of rotation: 90 degrees of supination, 45 degrees of supination, neutral, 45 degrees of pronation, and 80 degrees of pronation. After validation of the apparatus, 17 (9 male, 8 female) right-hand-dominant volunteers were recruited. They were tested at all 5 positions in random order and then had their PQ muscles paralyzed with lidocaine. Repeat testing was performed in the same random order 30 minutes after injection. Three unblinded subjects underwent testing after injection of saline instead of lidocaine to determine effect of fluid volume alone on PQ function. Results The validation trial demonstrated reproducibility of the testing apparatus. After paralysis of PQ with lidocaine, pronation torque decreased by an average 21% (range, 16.7% to 23.2%) at all positions compared with preinjection testing. All were statistically significant except at 80 degrees of pronation. The subjects who underwent injection of saline showed no evidence of decrease in pronation torque. Conclusions This study demonstrated a significant decrease in pronation torque with controlled elimination of PQ function. Open reduction and internal fixation of distal radius fractures damages the PQ and may result in a pronation torque deficit. Pronation torque measurement may help in postoperative outcome analysis of surgical procedures using the volar approach to the distal radius. (J Hand Surg 2009;34A: 16.12-1617. Copyright (c) 2009 by the American Sociery for Surgery of the Hand. All rights reserved.)