title: 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.
authors.affiliation: Department of Orthopaedics at Warren-Alpert School of Medicine at Brown University, Rhode Island Hospital, Providence, Rhode Island.
authors.forename: Patrick M
authors.initials: PM
authors.lastname: Kane
authors.affiliation: Department of Orthopaedics at Warren-Alpert School of Medicine at Brown University, Rhode Island Hospital, Providence, Rhode Island.
authors.forename: Bryan G
authors.initials: BG
authors.lastname: Vopat
authors.affiliation: Department of Orthopaedics at Warren-Alpert School of Medicine at Brown University, Rhode Island Hospital, Providence, Rhode Island.
authors.forename: Christopher
authors.initials: C
authors.lastname: Got
authors.affiliation: Department of Orthopaedics at Warren-Alpert School of Medicine at Brown University, Rhode Island Hospital, Providence, Rhode Island.
authors.forename: Kaveh
authors.initials: K
authors.lastname: Mansuripur
authors.affiliation: Department of Orthopaedics at Warren-Alpert School of Medicine at Brown University, Rhode Island Hospital, Providence, Rhode Island.
authors.forename: Edward
authors.initials: E
authors.lastname: Akelman
keywords: supination/pronation; wrist kinematics
references.citation: J Hand Surg Am. 2002 May;27(3):537-41
references.pmid: 12015732
references.citation: J Hand Surg Am. 2011 Jan;36(1):81-8
references.pmid: 21193130
references.citation: J Hand Surg Am. 2010 Apr;35(4):628-32
references.pmid: 20353863
references.citation: Clin Biomech (Bristol, Avon). 2005 Feb;20(2):177-83
references.pmid: 15621323
references.citation: J Hand Surg Eur Vol. 2008 Feb;33(1):3-8
references.pmid: 18332013
references.citation: J Hand Surg Am. 2003 Jul;28(4):622-7
references.pmid: 12877850
references.citation: J Hand Surg Am. 2011 Feb;36(2):284-90
references.pmid: 21276892
references.citation: Clin Biomech (Bristol, Avon). 2006;21 Suppl 1:S9-12
references.pmid: 16321461
references.citation: Injury. 2010 Jun;41(6):643-6
references.pmid: 20303079
references.citation: J Bone Joint Surg Am. 2011 Jan 19;93(2):169-77
references.pmid: 21248214
references.citation: J Hand Surg Am. 2011 Dec;36(12):1981-7
references.pmid: 22100813
references.citation: J Hand Surg Am. 1976 Sep;1(2):110-8
references.pmid: 1018078
references.citation: J Hand Surg Am. 1986 Sep;11(5):711-7
references.pmid: 3760500
references.citation: J Shoulder Elbow Surg. 2008 Mar-Apr;17(2):271-5
references.pmid: 18036849
references.citation: J Bone Joint Surg Am. 2005 Dec;87(12):2729-2740
references.pmid: 16322624
references.citation: J Hand Surg Br. 1988 Aug;13(3):288-90
references.pmid: 3171295
references.citation: Acta Morphol Neerl Scand. 1961;3:287-303
references.pmid: 13758689
references.citation: J Hand Surg Am. 2009 Mar;34(3):401-8
references.pmid: 19258136
references.citation: J Hand Surg Am. 2013 Apr;38(4):712-20
references.pmid: 23474161
references.citation: Z Orthop Ihre Grenzgeb. 2002 Jan-Feb;140(1):72-6
references.pmid: 11898068
references.citation: J Bone Joint Surg Br. 2001 Sep;83(7):1029-33
references.pmid: 11603517
references.citation: J Hand Surg Am. 1986 Nov;11(6):798-804
references.pmid: 3794232
references.citation: J Neurophysiol. 2012 Feb;107(4):1230-40
references.pmid: 22131378