Elbow Position Affects Distal Radioulnar Joint Kinematics

PurposePrevious 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.MethodsChanges in radioulnar kinematics during forearm supination–pronation and elbow flexion (0° to 90°) were studied in 5 uninjured subjects using computed tomography, dual-orthogonal fluoroscopy, and 3-dimensional modeling. Analysis of variance and post-hoc testing was performed.ResultsProximal translation of the radius was greatest with the elbow flexed to 90° with the arm in midpronation. With the arm in midpronation, the translation of the radius was significantly greater at 0° versus 45° 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° versus 90° 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° or 90° 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° compared with 90° of elbow flexion (129.3° ± 22.2° vs 152.8° ± 14.4°, F: 3.29, post hoc: 0.79; p = .09). The center of rotation shifted volarly and ulnarly with increasing elbow extension.ConclusionsElbow 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.