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A-1154 Anatomy of the Distal Radioulnar Joint and Ulnocarpal Complex
Elisabet Hagert, Stockholm, Sweden
Friday, June 15, 2018 · 8:01 a.m. · 09m 56s
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well i mean i as well uh there were go so happy to have so many of you here so bright and
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early on on friday morning i will discuss the anatomy of video you j. and they all know carpal complex
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as you all know we usually talk about the thumb being the primary reason for us that uh evolution icing from a
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monkey to the human man we are today i would say it's not the thumb it's that here you jay
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the tear you j. s. you know was a very important joint in the fact that it
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allows us an enormous freedom of movement but it also is incredibly important weight bearing joint
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but in order to have a freedom of movement and in order to have a weight bearing joints we must have the stability of
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the joint so i will not just discussed here you j. anatomy
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today i will discuss and that's me in relation to stability
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because if we don't understand stability we don't understand the problems of the d. i. u. k.
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so with regard to d. r. u. j. anatomy we need to understand that this is dependent on last year's
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can cruelty ligament is integrity muscular compression and pro perception
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i will go through this one by one
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if we start by looking at the also use can cruelty of the d.
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r. u. j. this really is the core of deer you taste ability
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it is dependent on the com cruelty of joint surfaces and this is a problem when it comes to the
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t. or you take as there is a discrepancy in the articulation between the radius and you all know
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if you look at this i mean lunar not sure it has to fifteen
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millimetre radius of curvature with the centre at the older style it
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whereas if you look at the older had it has a ten millimetre radius of curvature with that centre at the full via
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this discrepancy means that if you have the d. r. u. j. in a neutral position
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you have a sixty percent of particular contact where's improvements to punish and you actually
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only have about ten percent of particular contact this means that it for
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instance in the case but just a radius fracture even the slightest melange relation
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will cause an income cruelty of the d. r. u. g. a.
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i taught at now described in nineteen ninety six in the journal
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of hand surgery that for different types of of yes
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type a. b. c. and d. and the various types of phobias can
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also predisposed instability or stability doing a form rotations the most
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common types or type a founded about forty two percent of cat
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of eric specimens was type c. was found in thirty percent
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with regard to also use can grow to we also need to look at all
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the variance owner variance is just the just or discrepancy in the length of
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the on that in relation to the radius this was funded primarily founded on
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the study by showing that out and gentle hand surgeon nineteen ninety one
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baseline kind of eric studies on a hundred and twenty caucasian specimens what they found was that
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there was an average a point nine millimetres up on the minus and the rest
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but what the variability of four point two millimetres on the minus two two point three millimetres of on the plus
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when it comes to actually regarding the length of the on it's extremely
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important that you do a true andrew posterior x-ray if you
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place your persists patient in an x. ray machine and the x. them to extend the arm and fully prone ate it
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you will realise that all no height is the greatest a full probation so you will actually no with the length of the older
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what you need to do was make sure you kind has the arm fully eighty directed towards the body
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unusual position in the for our and then place the x. ray beam in relation to that
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let's move on to the ligament is integrity that d. r. u. j. has gone through an evolutionary change in the on the rest
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where in the four foot uh animal it is sin does more taken the old that is very long
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whereas if you look in the human we have more of a suspension motion
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of the just alone or with the onus the stable head of access
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centre of rotation around which the entire radius in corpus rotates it allows
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the global motion of the radius in corpus around the on the
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as you all know the primary stable i search the video you
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j. or the dorsal and the bowler radio on the ligaments
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the secondary are they all know carpal ligament here seen as the on
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the track which are like meant and the all the lunatic ligament
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i remember we talked about the discrepancy in curvature with regard to the austria's country witty
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well what's interesting to note is that the axis of rotation with the owner head corresponds to the full field
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insertion of the just a radio on the ligaments where's the axis of rotation with regard to the radius
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corresponds to the insertion point on the older style lloyd
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this allows for stability of the gist of it you'll know ligaments throughout the motion approaches to punish
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but there is a controversy with regard to the radio on the ligaments are
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the dorsal ligaments able to stable lies improve nation pretty stable license
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super nation can we test this clinically by just doing it here you g. shift test well the answer really is not so we see
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what i would like to note for you is when you look at that dorsal
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than the ball radio ligaments and the insertion point into the phobia when
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you follow these fibres you can see that they are actually not just a
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straight incision but they have a spiral configuration into the phone via
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this type of he look or it'll bundle i believe explains a
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lot with regard to the review on the ligaments so
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if you look at the radius when it isn't pro nation and you look at the owner had like this
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you will see at first appearance it looks as though the dorsal
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radio all the ligaments are taught whereas the bowler are slack
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you see this like this here and the tightness there well if you start going
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through these healy cortical bundles of ligaments one by one from the surface
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down to the insertion point you will actually once you reach the bottom find that
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the ball ready on the ligaments are tight where's the dorsal or slack
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and then when you realise all of that you find that the door solar slack simply
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because here you have a compression point between the distal radios and you'll know
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so you have an action of tension in the ligament and compression on the opposite side
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this action of combine tension and compression is what constitutes the concept of ten factory
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ten security as described by architect documents to folder is described as tension and compression are inseparable
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and coordinate functions of structural systems were continues tension
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and local compression leads to inherent stability
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memory disk regard the ligament the stability of the d. r. u.
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j. we also must pay attention to the interest is membrane
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the interest just membrane of course provides for on rotational stability where
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the most important action with regard to the distal ready on
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the joint is the distal oblique bundle as here seen by node
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i'm co workers and j. just two thousand and nine
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the d. o. b. is important for distal forearm and d. r. u. g.'s stability
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let's move on to the muscular compression of the joint the muscular compression is really
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the dynamic stability of that here you j. and the all the rest
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where the primary stable asserts the prone adequate racists and anti studies
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of the deep head of the printed a quite great
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as it is found to actually stayed like boston pro nation is super nation by compression of that year you jay
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secondary muscular stable asserts also the easy you and the ease use up sheet
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which are important for own wrist ability as well as motion
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this provides dear you g. stability in super nation and controls all know carpal motion
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finally let's move on to prop reception that one the littles
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a wonderful little sensory mechanism that controls the joint stability
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as all of you probably know the presence of mccann receptors in the rest and the t. f. c. c.
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uh allows us to know that we have have front information that goes from the joint
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and the ligaments to the spinal cord and muscles controlling stability of that joint
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if we look at the mccann receptor innovation of the t. f. c. c. we
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find that the radio all the ligaments have the greatest mccann receptive populations
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this means that they have an important prop receptive function in addition to their stable icing function
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what's interesting to note is that the mccann receptive type called goldie receptor which is very rare and the rest
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is a large type uh mccann receptor that's signals extremes of joint motion these
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and goldie receptors i found in the easy to use up she's
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as well as in the radio on the ligaments allowing detection
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the motion throughout a wide range of uh the motion
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the most common or bending on the other hand in the entirety of
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c. c. complex is the free nerve ending the free nerve ending
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is the painter bending and so this might be one of the
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reasons why we have so much inherent all decided to spain
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so remember we need also just conclude t. we need ligament is integrity we need muscular compression
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and we need prop reception and all of those together create it here you chased ability
Conference Program
A-1153 Introduction
David Shewring, UK
June 15, 2018 · 8:01 a.m.
A-1154 Anatomy of the Distal Radioulnar Joint and Ulnocarpal Complex
Elisabet Hagert, Stockholm, Sweden
June 15, 2018 · 8:01 a.m.
284 views
A-1155 The Common Culprits (start)
Alex Lluch, Barcelona, Spain
June 15, 2018 · 8:11 a.m.
155 views
A-1155 The Common Culprits (main)
June 15, 2018 · 8:13 a.m.
138 views
A-1156 Assessment and Investigation
Michael Solomons, South Africa
June 15, 2018 · 8:23 a.m.
126 views
