Purpose
The purpose of this study was to investigate changes in length of the volar and dorsal
radioulnar ligaments (VRULs and DRULs), and the distal radioulnar joint (DRUJ) space
during unweighted and weighted rotation of the wrist using magnetic resonance imaging
and biplanar fluoroscopy.
Methods
Fourteen wrists in 7 normal adult volunteers were imaged to define the 3-dimensional
geometry of the DRUJ and the insertion sites of the superficial and deep bundles of
the VRULs and DRULs. Subjects were imaged at 10 positions of forearm rotation ranging
from full pronation to full supination, with or without a 5-pound weight. Lengths
of the superficial and deep VRUL and DRUL bundles and DRUJ space were measured (in
millimeters) at each position to evaluate ligament function and DRUJ stability.
Results
In the unweighted and weighted trials, maximal elongation of both deep and superficial
VRUL bundles occurred in supination and maximal lengths of the deep and superficial
DRUL bundles occurred in pronation. Maximum DRUJ space occurred during pronation and
a minimum occurred in 30° of supination. In weighted trials, there was a significant
increase in deep and superficial VRUL bundle length at positions between 30° of pronation
and 30° of supination; however, there was no effect of weight on DRULs length. In
weighted trials, there was a significant increase in DRUJ space at positions between
full pronation and 15° of supination.
Conclusions
This study demonstrates elongation of the VRULs in supination and the DRULs in pronation.
There was no evidence of reciprocal loading of superficial/deep ligament bundles on
either the dorsal or the volar aspects of the DRUJ. The effect of loading the wrist
during rotation was apparent primarily in the VRULs, but not the DRULs. The DRUJ space
was lowest at approximately 30° of supination.
Clinical relevance
These results add information to the literature regarding the complicated biomechanics
of the triangular fibrocartilage complex and DRUJ. Future work should evaluate changes
in biomechanics caused by triangular fibrocartilage complex tears to determine how
tear severity and location relate to clinical symptoms.
Key words
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Article info
Publication history
Published online: August 12, 2020
Accepted:
June 23,
2020
Received:
August 14,
2019
Footnotes
No benefits in any form have been received or will be received related directly or indirectly to the subject of this article.
Identification
Copyright
© 2020 by the American Society for Surgery of the Hand. All rights reserved.
