Intra-articular Pressure in the Distal Radioulnar Joint: A Biomechanical Study

Rodrigo Gutiérrez-Monclus; Héctor Gutiérrez-Espinoza; Felipe Araya-Quintanilla; Carlos Gutierrez-Novoa; Paúl Cordero-Barzallo; Alfonso Rodríguez-Baeza; Ángel Ferreres-Claramunt; Marc García-Elias

doi:10.1016/j.jhsa.2023.11.015

Intra-articular Pressure in the Distal Radioulnar Joint: A Biomechanical Study

J Hand Surg Am. 2023 Dec 8:S0363-5023(23)00616-0. doi: 10.1016/j.jhsa.2023.11.015. Online ahead of print.

Authors

Rodrigo Gutiérrez-Monclus¹, Héctor Gutiérrez-Espinoza², Felipe Araya-Quintanilla³, Carlos Gutierrez-Novoa⁴, Paúl Cordero-Barzallo⁵, Alfonso Rodríguez-Baeza⁶, Ángel Ferreres-Claramunt⁷, Marc García-Elias⁷

Affiliations

¹ Hand Team of Traumatology Institute of Santiago, Santiago, Chile.
² Escuela de Fisioterapia, Universidad de las Americas, Quito, Ecuador. Electronic address: hector.gutierrez@udla.edu.ec.
³ Escuela de Kinesiología, Facultad de Odontología y Ciencias de la Rehabilitación, Universidad San Sebastián, Santiago, Chile.
⁴ Instituto de Seguridad del Trabajo, Equipo de Mano y Microcirugía, Santiago, Chile.
⁵ Department of Emergency and Clinic, Hospital of Worker, Safety Association of Chile (SACH), Santiago, Chile.
⁶ Facultat de Medicina, Universitat Autònoma de Barcelona, Barcelona, Spain.
⁷ Institut Kaplan, Barcelona, Spain.

PMID: 38069956
DOI: 10.1016/j.jhsa.2023.11.015

Abstract

Purpose: The aim of the study was to use cadaveric models to assess the effect of loading the forearm muscles in different forearm rotations, with or without disruption to the stabilizing components, on the intra-articular pressure of the distal radioulnar joint (DRUJ).

Methods: Ten forearms with no severe osteoarthritis or injury to the DRUJ stabilizers were used. They were placed in a vertical support, and pressure sensors measured pressure within the DRUJ in 5 forearm rotations (neutral, pronation, supination, extension, and flexion) under the following 6 conditions: 1) no loading; 2) loading (at 1/5 of the load per cross-sectional area) with no disruption; 3) loading with disruption of the triangular fibrocartilage complex (TFCC); 4) loading with disruption of the TFCC and ulnar ligaments (ULs); 5) loading with disruption of the TFCC, ULs and interosseous membrane (IM); and 6) loading with disruption of the TFCC, ULs, IM, and pronator quadratus (PQ).

Results: Under the no disruption-no load, no disruption-loaded, and disrupted TFCC conditions, the highest intra-articular pressures were recorded in supination. Compared with the no-load condition, pressure was greater in the no disruption-loaded condition with a mean difference (MD) of 1.57 kg/cm² in a neutral position. In flexion, pressure was greater with a disrupted TFCC (MD, 4.3 kg/cm²). In supination, pressure was only greater with a disrupted TFCC (MD, 3.3 kg/cm²), and pressure decreased in the other disruption conditions. The pressures recorded did not differ from the no disruption-no load condition in pronation or extension.

Conclusions: Pressures within the DRUJ changed with forearm rotations. In the no disruption-no load, no disruption-loaded, and disrupted TFCC conditions, intra-articular pressure was highest in supination. In flexion and supination with load and disruption of stabilizers, intra-articular pressure only increased significantly in the disrupted TFCC condition compared with no load.

Clinical relevance: Based on our findings, exercises in supination should be avoided during the first phase of rehabilitation of TFCC injuries given the increased pressure on the DRUJ.

Keywords: Biomechanical phenomena; cadaver; distal radioulnar joint; intra-articular pressure.