Elbow Position Affects Distal Radioulnar Joint Kinematics

Purpose Previous in vivo and in vitro studies of forearm supination-pronation suggest that distal radioulnar joint kinematics may be affected by elbow flexion. The primary hypotheses tested by this study were that, in vivo, ulnar variance changes with elbow flexion and forearm rotation, and the arc of forearm rotation changes in relationship to elbow flexion. Methods Changes in radioulnar kinematics during forearm supination-pronation and elbow flexion (0 degrees to 90 degrees) were studied in 5 uninjured subjects using computed tomography, dual-orthogonal fluoroscopy, and 3-dimensionat modeling. Analysis of variance and post-hoc testing was performed. Results Proximal translation of the radius was greatest with the elbow flexed to 90 degrees with the arm in midpronation. With the arm in midpronation, the translation of the radius was significantly greater at 0 degrees versus 45 degrees of elbow flexion (0.82 +/- 0.59 mm vs 0.65 +/- 0.80 mm, F: 4.49, post hoc: 0.055; p = .05) and significantly smaller at 45 degrees versus 90 degrees of elbow flexion (0.65 +/- 0.80 mm vs 0.97 +/- 0.35 mm, F: 4.49, post hoc: 0.048; p = .05). Proximal translation of the radius in midpronation was significantly greater than when. the forearm was in a supinated position when the elbow was at 0 degrees or 90 degrees flexion (F: 14.90, post hoc: <0.01; p <.01, F: 19.11, post hoc: <0.01, p <.01). The arc of forearm rotation was significantly decreased at 0 degrees compared with 900 of elbow flexion (129.3 degrees +/- 22.2 degrees vs 152.8 degrees +/- 14.4 degrees, F: 3.29, post hoc: 0.79; p = .09). The center of rotation shifted volarly and ulnarly with increasing elbow extension. Conclusions Elbow position affects the kinematics of the distal radioulnar joint. The kinematics of the distal radioulnar joint are primarily affected by forearm rotation and secondarily by elbow flexion. These findings have clinical relevance to our understanding of ulnar impaction, and how elbow position affects the proximal-distal translation of the radius. These findings have implications for the treatment of ulna impaction, radiographic evaluation of the distal ulna, and future biomechanical studies. (J Hand Surg 2009;34A:126.1-1268. (C) 2009 Published by Elsevier Inc. on behalf of the American Society for Surgery of the Hand.)