Year of Publication
Doctor of Philosophy (PhD)
Dr. David Pienkowski
Optimal management of fractures, post-traumatic arthritis and instability of the distal radioulnar joint (DRUJ) requires an understanding of the forces existing across this joint as a function of the activities of daily living. However, such knowledge is currently incomplete. The goal of this research was to quantify the loads that occur at the DRUJ during forearm rotation and to determine the effect that individual muscles have on those loads.
Human and cadaver studies were used to analyze the shear (A-P), transverse (M-L) and resultant forces at the DRUJ and to determine the role that 15 individual muscles had on those forces. Data for scaling the muscles forces came from EMG analysis measuring muscle activity at nine positions of forearm rotation in volunteers during isometric pronation and supination. Muscle orientations were determined from the marked muscle origin and insertion locations of nine cadaveric arms at various stages of forearm rotation. The roles that individual muscles played in DRUJ loading were analyzed by removing the muscle of interest from the analysis and comparing the results.
The EMG portion of this study found that the pronator quadratus, pronator teres, brachioradialis, flexor carpi radialis and palmaris longus contribute significantly to forearm pronation. The supinator, biceps brachii, and abductor pollicis longus were found to contribute significantly to supination.
The results of the DRUJ analysis affirm that large transverse forces pass from the radius to the ulnar head at all positions of forearm rotation during pronation and supination (57.5N-181.4N). Shear forces exist at the DRUJ that act to pull the radius away from the ulna in the AP direction and are large enough to merit consideration when examining potential treatment options (7.9N-99.5N).
Individual muscle analysis found that the extensor carpi radialis brevis, extensor pollicis longus, extensor carpi ulnaris, extensor indicis and palmaris longus had minimal effect on DRUJ loading. Other than the primary forearm rotators (pronator quadratus, pronator teres, supinator, biceps brachii), the muscles that exhibited the largest influence on DRUJ loading were the abductor pollicis longus, brachialis, brachioradialis, extensor carpi ulnaris, flexor carpi radialis, and flexor carpi ulnaris.
Bader, Joseph Scott, "DISTAL RADIOULNAR JOINT BIOMECHANICS AND FOREARM MUSCLE ACTIVITY" (2011). University of Kentucky Doctoral Dissertations. 825.