title: Pronation and supination of the hand: Anatomy and biomechanics.
abstract: Proper functioning of the hand relies on its capacity to rotate and point the palm upward (i.e. supination) or downward (i.e. pronation) when standing up with the elbow in 90° flexion. Hand rotation is possible because of forearm rotation and also rotation of the whole upper limb at the shoulder. Two distinct mechanisms contribute to hand rotation: one in which the ulna is immobile and another in which the ulna is mobile. In this review, we first summarize how evolution of the human species has led to the progressive development of specific forearm anatomy that allows for pronation and supination. Then we analyze how the three joints of the forearm (i.e. proximal, middle and distal radioulnar joints), in association with the characteristic shape of both forearm bones, allow the forearm to rotate around a single axis. Lastly, we describe the neuromuscular anatomy that controls these complex rotational movements. The anatomical and biomechanical points developed in this paper are analyzed while considering clinical applications.
authors.affiliation: University Paris Sud, Faculty of Medicine, 63, rue Gabriel-Péri, 94270 Le Kremlin-Bicêtre, France; Department of Orthopaedic Surgery, University Hospital of Bicêtre (Public Assistance Hospitals of Paris), 78, rue du Général-Leclerc, 94270 Le Kremlin-Bicêtre, France. Electronic address: soubeyrand.marc@gmail.com.
authors.forename: M
authors.initials: M
authors.lastname: Soubeyrand
authors.affiliation: University Paris Sud, Faculty of Medicine, 63, rue Gabriel-Péri, 94270 Le Kremlin-Bicêtre, France.
authors.forename: B
authors.initials: B
authors.lastname: Assabah
authors.affiliation: Department of Orthopaedic Surgery, University Hospital of Bicêtre (Public Assistance Hospitals of Paris), 78, rue du Général-Leclerc, 94270 Le Kremlin-Bicêtre, France.
authors.forename: M
authors.initials: M
authors.lastname: Bégin
authors.affiliation: Laboratory of microcirculation, université Paris-Diderot, Faculty of Medicine Lariboisière, 10, avenue de Verdun, 75010 Paris, France.
authors.forename: E
authors.initials: E
authors.lastname: Laemmel
authors.affiliation: Department of Orthopaedic Surgery, University Hospital of Bicêtre (Public Assistance Hospitals of Paris), 78, rue du Général-Leclerc, 94270 Le Kremlin-Bicêtre, France.
authors.forename: A
authors.initials: A
authors.lastname: Dos Santos
authors.affiliation: University Paris Sud, Faculty of Medicine, 63, rue Gabriel-Péri, 94270 Le Kremlin-Bicêtre, France; Department of Radiology, University Hospital of Bicetre (Public Assistance Hospitals of Paris), 78, rue du Général-Leclerc, 94270 Le Kremlin-Bicêtre, France.
authors.forename: M
authors.initials: M
authors.lastname: Crézé
mesh_terms: D050280:Arm Bones / Q000033:anatomy & histology / Q000502:physiology; D005075:Biological Evolution; D001696:Biomechanical Phenomena / Q000502:physiology; D004838:Epiphyses / Q000033:anatomy & histology / Q000502:physiology; D005542:Forearm / Q000033:anatomy & histology / Q000502:physiology; D006225:Hand / Q000033:anatomy & histology / Q000502:physiology; D006801:Humans; D011403:Pronation / Q000502:physiology*; D013484:Supination / Q000502:physiology*; D014955:Wrist Joint / Q000033:anatomy & histology / Q000502:physiology
keywords: Anatomie; Anatomy; Articulation radio-ulnaire distale; Articulation radio-ulnaire moyenne; Articulation radio-ulnaire proximale; Distal radioulnar joint; Forearm rotation; Interosseous membrane; Membrane interosseuse; Middle radioulnar joint; Pronation; Proximal radioulnar joint; Rotation de l’avant-bras; Supination