We saw seven patients with an idiopathic progressive loss of rotation of
the forearm, occurring primarily during adolescence and manifested
principally by a gradual loss of supination. There were secondary
developmental abnormalities of the radial head and of the ulna (distal
bowing) in four patients. Six surgical procedures were performed on five of
the seven patients, consisting of combinations of sectioning of the
quadrate ligament, release of the interosseous membrane, and ostecotomy and
compression-plate fixation of the distal end of the ulna. There was
functional improvement in four patients. Release of the quadrate ligament
provided the greatest improvement, but that release alone was of minimum
value. We concluded that a contracted quadrate ligament may be an important
deterrent to supination of the forearm, but distortion of the radial head,
curvature of the ulna, and contracted soft tissues in the interosseus space
and distal radio-ulnar joint also are contributory factors.