Role of the interosseous membrane and annular ligament in stabilizing the proximal radial head

Anderson, Ashley; Werner, Frederick W.; Tucci, Emily R.; Harley, Brian J.

doi:10.1016/j.jse.2015.05.030

Cited by 27 publications

(39 citation statements)

References 22 publications

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“…Many techniques have been described for the reconstruction of the CB in chronic Essex-Lopresti injuries, including: bone-patellar tendon-bone graft (Gaspar et al 2018); synthetic grafts (Sabo & Watts, 2012); tightrope tenodesis (Brin et al 2014); tendons grafts, such as the anterior tibial (Miller et al 2016), palmaris longus (Tejwani et al 2005), flexor carpi radialis (Skahen et al 1997), semitendinosus (Soubeyrand et al 2006), Achilles tendon (Stabile et al 2005), fascia lata (Bigazzi et al 2017), and pronator teres rerouting (Chloros et al 2008). Based on the present study, the CB is sparsely innervated, which accords with its static stability functions (Werner et al 2011;Anderson et al 2015), and reconstruction could be performed with non-sensory tissue (Skahen et al 1997;Tejwani et al 2005;Soubeyrand et al 2006;Miller et al 2016) or material (Sabo & Watts, 2012;Brin et al 2014) from the proprioceptive point of view.…”

Section: Figsupporting

confidence: 71%

Immunofluorescence analysis of sensory nerve endings in the interosseous membrane of the forearm

et al. 2019

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The human interosseous membrane (IOM) is a fundamental stabilizer during forearm rotation. To investigate the dynamic aspects of forearm stability, we analyzed sensory nerve endings in the IOM. The distal oblique bundle (DOB), the distal accessory band (DAB), the central band (CB), the proximal accessory band (PAB), the dorsal oblique accessory cord (DOAC) and the proximal oblique cord (POC) were dissected from 11 human cadaver forearms. Sensory nerve endings were analyzed at two levels per specimen as total cell amount/mm 2 after immunofluorescence staining with low-affinity neurotrophin receptor p75, protein gene product 9.5, S-100 protein and 4 0 , 6-diamidino-2-phenylindole on an Apotome microscope, according to Freeman and Wyke's classification. Sensory nerve endings were significantly more commonly found to be equally distributed throughout the structures, rather than being epifascicular, interstitial, or close to the insertion into bone (P ≤ 0.001, respectively). Free nerve endings were the predominant mechanoreceptor in all six structures, with highest density in the DOB, followed by the POC (P ≤ 0.0001, respectively). The DOB had the highest density of Pacini corpuscles. The DOAC and CB had the lowest amounts of sensory innervation. The high density of sensory corpuscles in the DOB, PAB and POC indicate that proprioceptive control of the compressive and directional muscular forces acting on the distal and proximal radioulnar joints is monitored by the DOB, PAB and POC, respectively, due to their closed proximity to both joints, whereas the central parts of the IOM act as structures of passive restraint.

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Section: Figsupporting

confidence: 71%

Immunofluorescence analysis of sensory nerve endings in the interosseous membrane of the forearm

et al. 2019

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“…These results indicate that the IOM is an important stabilizer in preventing anterior radial head dislocation, regardless of forearm position. In previous studies, the central band of the IOM was reported to be the stiffest stabilizing structure of the forearm [ 11 , 12 ], contributing more to radial head stability than the annular ligament and proximal band of the IOM [ 4 ] during forearm pronation and supination. Thus, the presence of anterior radial head dislocation in clinical practice may suggest more severe soft tissue damage than that present with lateral and posterior dislocation.…”

Section: Discussionmentioning

confidence: 99%

“…Although the annular ligament is the primary stabilizer of the proximal radioulnar joint [ 2 , 3 ], the contributions of other stabilizing structures such as the quadrate ligament and interosseous membrane (IOM) are not completely understood. A biomechanical study investigating the relative contributions of the annular ligament and the IOM (proximal, central, and distal bands) to preventing radial head dislocation [ 4 ] found that no single structure provided a significantly different percentage of static stability. Although those authors demonstrated the importance of the central band of the IOM in providing dynamic stability during forearm rotation, few specimens showed radial head dislocation, and there was minimal displacement (2–3 mm) in their motion simulation experiment.…”

Section: Introductionmentioning

confidence: 99%

Biomechanical study of isolated radial head dislocation

Hayami

Omokawa

Iida

et al. 2017

BMC Musculoskelet Disord

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BackgroundIsolated radial head dislocation is a rare injury with an unclear pathomechanism, and the treatment is controversial. The purpose of the present study was to investigate the biomechanical contributions of the annular ligament, quadrate ligament, interosseous membrane, and annular ligament reconstructions to proximal radioulnar joint stability.MethodsFive fresh frozen cadaveric upper extremities were amputated above the elbow and solidly fixed on a customized jig. Radial head dislocation was reproduced by sequential sectioning of ligamentous structures and passive mobility testing. Radial head displacement during mobility testing was measured with an electromagnetic tracking device in three forearm rotation positions. The data were compared among different sectioning stages and between two types of simulated ligamentous reconstruction.ResultsLateral displacement of the radial head significantly increased in the neutral forearm rotation after annular ligament sectioning (46 ± 10%, p < 0.05). After quadrate ligament sectioning, we found significant posterior (67 ± 36%, p < 0.05) and lateral (74 ± 24%, p < 0.01) displacement in neutral forearm rotation and pronation. Significant radial head displacement was found in all directions and in all forearm positions after sequential sectioning of the proximal half of the interosseous membrane. Anatomical annular ligament reconstruction stabilized the proximal radioulnar joint except for anterior laxity in neutral forearm rotation (15 ± 6%, p < 0.05). The radial head with Bell Tawse procedure was significantly displaced in all directions.ConclusionThe direction of radial head instability varied depending on the degree of soft tissue sectioning and specific forearm rotation. Anterior radial head dislocation may involve more severe ligament damage than other types of dislocation. Anatomical annular ligament reconstruction provided multidirectional radial head stability.

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“…With respect to forearm transverse stability, the IOM and the annular ligament have been shown to provide stability of the forearm preventing subluxation or dislocation of the proximal radial head. 9 Less is known about whether damage to the IOM affects transverse stability of the distal radioulnar joint (DRUJ) during forearm rotation. Watanabe et al have evaluated the role of the IOM in providing DRUJ dorsal/volar constraint at specific forearm positions.…”

mentioning

confidence: 99%

“…Only the tendon clamps are shown for the biceps and pronator teres. (Reprinted with permission from Anderson et al9…”

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confidence: 99%

Role of the Interosseous Membrane in Preventing Distal Radioulnar Gapping

et al. 2016

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Background?Damage to the interosseous membrane (IOM) can alter load transmission between the radius and ulna and decrease their axial stability. Less is known about the effect of IOM sectioning on the transverse stability between the radius and ulna. Purpose?The purpose of this study was to quantify the radioulnar gapping at the distal radioulnar joint (DRUJ) during forearm rotation when the IOM was experimentally sectioned while maintaining the integrity of the distal radioulnar ligaments. Methods?In 12 fresh-frozen cadaver forearms tested in a combined wrist?forearm simulator, the increase in gap between the radius and ulna, at the level of the DRUJ, was determined during cyclic forearm rotation following IOM sectioning. Results?IOM sectioning caused a significant increase in dorsal gapping at the DRUJ by 2.1?mm in supination and 0.6?mm in pronation. It also caused an increase in palmar gapping by 1.3?mm in supination and 0.5?mm in pronation. Conclusion?This experiment has shown that the IOM has an important role in stabilizing the DRUJ, especially in supination, and that IOM sectioning caused greater loads on the palmar and dorsal radioulnar ligaments. Since DRUJ instability is primarily treated by fixing the laxity at the dorsal radioulnar ligament (DRUL) and palmar radioulnar ligament (PRUL), untreated IOM damage could permit additional injury and instability to the radioulnar ligaments or their reconstruction. Clinical Relevance?Reconstruction of a torn IOM should be considered in the presence of persistent DRUJ instability following DRUJ reconstruction.

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Role of the interosseous membrane and annular ligament in stabilizing the proximal radial head

Cited by 27 publications

References 22 publications

Immunofluorescence analysis of sensory nerve endings in the interosseous membrane of the forearm

Immunofluorescence analysis of sensory nerve endings in the interosseous membrane of the forearm

Biomechanical study of isolated radial head dislocation

Role of the Interosseous Membrane in Preventing Distal Radioulnar Gapping

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