The Effect of Supination and Pronation on Wrist Range of Motion

Abstract

Wrist range of motion (ROM) is a combination of complex osseous articulations and intricate soft tissue constraints. It has been proposed that forearm rotation contributes significantly to carpal kinematics. However, no studies have investigated whether supination or pronation influence this course of motion. The purpose of this study is to examine whether supination and pronation affect the mechanical axis of the wrist. After being screened for gross anatomic abnormalities, six upper extremity cadaver specimens (three matched pairs) were fixed to a custom-designed jig that allows 24 different directions of wrist motion. Each specimen was tested in three separate forearm positions: neutral, full supination, and full pronation. Moments of ± 2 Nm were applied, and the applied moment versus wrist rotation data were recorded. Forearm position did not significantly (p > 0.31) affect the ROM values of the wrist. In forearm neutral, supination, and pronation positions the envelope of wrist ROM values was ellipsoidal in shape, consistent with prior neutral forearm biomechanical testing. The major axis of the ellipse was oriented in a radial extension to ulnar flexion direction, with the largest ROM in ulnar flexion. We hypothesized that forearm position would influence wrist ROM. However, our biomechanical testing showed no statistically significant difference in the orientation of the mechanical axis nor the passive ROM of the wrist. The primary passive mechanical axis in all three forearm positions tested (neutral, supination, and pronation) was aligned with radial extension and ulnar flexion. Although it has been shown that forearm position affects various radioulnar, radiocarpal, and ulnocarpal ligamentous tensions and lengths, it appears that wrist ROM is independent of forearm position. Consequently we feel our biomechanical testing illustrates that wrist ROM is primarily dependent on the osseous articulations of the carpus. Additionally, given that no change is observed in wrist ROM relative to forearm position, the significance of the contribution of the distal radioulnar joint (DRUJ) to wrist kinematics is debatable.

Keywords

supination/pronation - wrist kinematics

• References

• 1 Werner FW, Taormina JL, Sutton LG, Harley BJ. Structural properties of 6 forearm ligaments. J Hand Surg Am 2011; 36 (12) 1981-1987
• 2 Tanaka Y, Aoki M, Izumi T, Wada T, Fujimiya M, Yamashita T. Effect of elbow and forearm position on contact pressure between the extensor origin and the lateral side of the capitellum. J Hand Surg Am 2011; 36 (1) 81-88
• 3 Werner FW, Short WH, Palmer AK, Sutton LG. Wrist tendon forces during various dynamic wrist motions. J Hand Surg Am 2010; 35 (4) 628-632
• 4 King GJ, McMurtry RY, Rubenstein JD, Ogston NG. Computerized tomography of the distal radioulnar joint: correlation with ligamentous pathology in a cadaveric model. J Hand Surg Am 1986; 11 (5) 711-717
• 5 King GJ, McMurtry RY, Rubenstein JD, Gertzbein SD. Kinematics of the distal radioulnar joint. J Hand Surg Am 1986; 11 (6) 798-804
• 6 DiTano O, Trumble TE, Tencer AF. Biomechanical function of the distal radioulnar and ulnocarpal wrist ligaments. J Hand Surg Am 2003; 28 (4) 622-627
• 7 Chen YR, Tang JB. Changes in contact site of the radiocarpal joint and lengths of the carpal ligaments in forearm rotation: an in vivo study. J Hand Surg Am 2013; 38 (4) 712-720
• 8 SooHoo NF, McDonald AP, Seiler III JG, McGillivary GR. Evaluation of the construct validity of the DASH questionnaire by correlation to the SF-36. J Hand Surg Am 2002; 27 (3) 537-541
• 9 Crisco JJ, Heard WM, Rich RR, Paller DJ, Wolfe SW. The mechanical axes of the wrist are oriented obliquely to the anatomical axes. J Bone Joint Surg Am 2011; 93 (2) 169-177
• 10 Charles SK, Hogan N. Stiffness, not inertial coupling, determines path curvature of wrist motions. J Neurophysiol 2012; 107 (4) 1230-1240
• 11 Urban V, Kalberer F, Roos M, Dumont CE. Reliability of active range-of-motion measurement of the rotation in the forearm: comparison of three measurement devices [in German]. Z Orthop Ihre Grenzgeb 2002; 140 (1) 72-76
• 12 McGarry G, Gardner E, Muirhead A. Measurement of forearm rotation: an evaluation of two techniques. J Hand Surg [Br] 1988; 13 (3) 288-290
• 13 Colaris J, van der Linden M, Selles R, Coene N, Allema JH, Verhaar J. Pronation and supination after forearm fractures in children: Reliability of visual estimation and conventional goniometry measurement. Injury 2010; 41 (6) 643-646
• 14 Taleisnik J. The ligaments of the wrist. J Hand Surg Am 1976; 1 (2) 110-118
• 15 Landsmeer JM. Studies in the anatomy of articulation. I. The equilibrium of the “intercalated” bone. Acta Morphol Neerl Scand 1961; 3: 287-303
• 16 Xu J, Tang JB. In vivo length changes of selected carpal ligaments during wrist radioulnar deviation. J Hand Surg Am 2009; 34 (3) 401-408
• 17 Tang JB, Gu XK, Xu J, Gu JH. In vivo length changes of carpal ligaments of the wrist during dart-throwing motion. J Hand Surg Am 2011; 36 (2) 284-290
• 18 Jung JM, Baek GH, Kim JH, Lee YH, Chung MS. Changes in ulnar variance in relation to forearm rotation and grip. J Bone Joint Surg Br 2001; 83 (7) 1029-1033
• 19 Baeyens JP, Van Glabbeek F, Goossens M, Gielen J, Van Roy P, Clarys JP. In vivo 3D arthrokinematics of the proximal and distal radioulnar joints during active pronation and supination. Clin Biomech (Bristol, Avon) 2006; 21 (Suppl. 01) S9-S12
• 20 Li ZM, Kuxhaus L, Fisk JA, Christophel TH. Coupling between wrist flexion-extension and radial-ulnar deviation. Clin Biomech (Bristol, Avon) 2005; 20 (2) 177-183
• 21 Crisco JJ, Coburn JC, Moore DC, Akelman E, Weiss AP, Wolfe SW. In vivo radiocarpal kinematics and the dart thrower's motion. J Bone Joint Surg Am 2005; 87 (12) 2729-2740
• 22 Rickert M, Bürger A, Günther CM, Schulz CU. Forearm rotation in healthy adults of all ages and both sexes. J Shoulder Elbow Surg 2008; 17 (2) 271-275
• 23 Shaaban H, Pereira C, Williams R, Lees VC. The effect of elbow position on the range of supination and pronation of the forearm. J Hand Surg Eur Vol 2008; 33 (1) 3-8