In fresh-frozen amputated- and cadaver arm specimens the anatomy and stability of the distal radio ulnar joint were investigated. The articulating surface of the sigmoid notch of the radius and the corresponding surface of the ulnar head facing the sigmoid notch were studied in transverse cryo sections. In each specimen the radius of the curvature of the sigmoid notch was 4-7 mm larger than that of the ulnar head and consequently pronation and supination are combined rotation-sliding movement in the distal radio ulnar joint. The radio ulnar ligament consists of a dorsal and a volar fibrous part, broadly attached to the distal rim of the sigmoid notch and converging towards the fovea of the ulnar head. The cartilaginous disc is centrally located between these fibrous strands. In neutral position the articulating surface of the sigmoid notch is optimally covering the articulating surface of the ulnar head. This contact area is gradually diminished during pronation-supination until only a marginal contact remains at the end of each movement. The distal radius is kept stable in pronation by the volar part and in supination by the dorsal part of the radio ulnar ligament.

Background: We have previously assessed the reproducibility of manual testing of the strength in 14 individual upper limb muscles in patients with or without upper limb complaints. This investigation aimed at additionally studying sensory disturbances, the mechanosensitivity of nerve trunks, and the occurrence of physical findings in patterns which may potentially reflect a peripheral neuropathy. The reproducibility of this part of the neurological examination has never been reported.

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Background Manual muscle testing has been termed a "lost art" and is often considered to be of minor value. The aim of this investigation was to study the inter-rater reliability of manual examination of the maximal voluntary strength in a sample of upper limb muscles.Patients and methods The material consisted of a series of 41 consecutive patients (82 limbs) who had been referred to a clinic of occupational medicine for various reasons. Two examiners who were blinded as to patient-related information classifi ed 14 muscles in terms of normal or reduced strength. In order to optimize the evaluation, the individual strength was assessed simultaneously on the right and left sides with the limbs in standardized positions that were specifi c for each muscle. Information on upper limb complaints (pain, weakness and/or numbness/tingling) collected by two other examiners resulted in 38 limbs being classifi ed as symptomatic and 44 as asymptomatic. For each muscle the inter-rater reliability of the assessment of strength into normal or reduced was estimated by κ-statistics. In addition, the odds ratio for the relation to symptoms of the defi nition in agreement of strength was calculated.Results The median κ-value for strength in the muscles examined was 0.54 (0.25-0.72). With a median odds ratio of 4.0 (2.5-7.7), reduced strength was signifi cantly associated with the presence of symptoms.Interpretation This study suggests that manual muscle testing in upper limb disorders has diagnostic potential.