6e. Radioulnar Articulation

(Articulatio Radioulnaris)

The articulation of the radius with the ulna is effected by ligaments which connect together the extremities as well as the bodies of these bones. The ligaments may, consequently, be subdivided into three sets: 1, those of the proximal radioulnar articulation; 2, the middle radioulnar ligaments; 3, those of the distal radioulnar articulation. 1 Proximal Radioulnar Articulation (articulatio radioulnaris proximalis; superior radioulnar joint).—This articulation is a trochoid or pivot-joint between the circumference of the head of the radius and the ring formed by the radial notch of the ulna and the annular ligament. 2

FIG. 333– Annular ligament of radius, from above. The head of the radius has been sawn off and the bone dislodged from the ligament. (See enlarged image) The Annular Ligament (ligamentum annulare radii; orbicular ligament) (Fig. 333).—This ligament is a strong band of fibers, which encircles the head of the radius, and retains it in contact with the radial notch of the ulna. It forms about four-fifths of the osseo-fibrous ring, and is attached to the anterior and posterior margins of the radial notch; a few of its lower fibers are continued around below the cavity and form at this level a complete fibrous ring. Its upper border blends with the anterior and posterior ligaments of the elbow, while from its lower border a thin loose membrane passes to be attached to the neck of the radius; a thickened band which extends from the inferior border of the annular ligament below the radial notch to the neck of the radius is known as the quadrate ligament. The superficial surface of the annular ligament is strengthened by the radial collateral ligament of the elbow, and affords origin to part of the Supinator. Its deep surface is smooth, and lined by synovial membrane, which is continuous with that of the elbow-joint. 3 Movements.—The movements allowed in this articulation are limited to rotatory movements of the head of the radius within the ring formed by the annular ligament and the radial notch of the ulna; rotation forward being called pronation; rotation backward, supination. Supination is performed by the Biceps brachii and Supinator, assisted to a slight extent by the Extensor muscles of the thumb. Pronation is performed by the Pronator teres and Pronator quadratus. 4 Middle Radioulnar Union.—The shafts of the radius and ulna are connected by the Oblique Cord and the Interosseous Membrane. 5 The Oblique Cord (chorda obliqua; oblique ligament) (Fig. 329).—The oblique cord is a small, flattened band, extending downward and lateralward, from the lateral side of the tubercle of the ulna at the base of the coronoid process to the radius a little below the radial tuberosity. Its fibers run in the opposite direction to those of the interosseous membrane. It is sometimes wanting. 6 The Interosseous Membrane (membrana interossea antebrachii).—The interosseous membrane is a broad and thin plane of fibrous tissue descending obliquely downward and medialward, from the interosseous crest of the radius to that of the ulna; the lower part of the membrane is attached to the posterior of the two lines into which the interosseous crest of the radius divides. It is deficient above, commencing about 2.5 cm. beneath the tuberosity of the radius; is broader in the middle than at either end; and presents an oval aperture a little above its lower margin for the passage of the volar interosseous vessels to the back of the forearm. This membrane serves to connect the bones, and to increase the extent of surface for the attachment of the deep muscles. Between its upper border and the oblique cord is a gap, through which the dorsal interosseous vessels pass. Two or three fibrous bands are occasionally found on the dorsal surface of this membrane; they descend obliquely from the ulna toward the radius, and have consequently a direction contrary to that of the other fibers. The membrane is in relation, in front, by its upper three-fourths, with the Flexor pollicis longus on the radial side, and with the Flexor digitorum profundus on the ulnar, lying in the interval between which are the volar interosseous vessels and nerve; by its lower fourth with the Pronator quadratus; behind, with the Supinator, Abductor pollicis longus, Extensor pollicis brevis, Extensor pollicis longus, Extensor indicis proprius; and, near the wrist, with the volar interosseous artery and dorsal interosseous nerve. 7 Distal Radioulnar Articulation (articulatio radioulnaris distalis; inferior radioulnar joint).—This is a pivot-joint formed between the head of the ulna and the ulnar notch on the lower end of the radius. The articular surfaces are connected together by the following ligaments: 8

The Volar Radioulnar.		The Dorsal Radioulnar.
The Articular Disk.

The Volar Radioulnar Ligament (anterior radioulnar ligament) (Fig. 334).—This ligament is a narrow band of fibers extending from the anterior margin of the ulnar notch of the radius to the front of the head of the ulna. 9 The Dorsal Radioulnar Ligament (posterior radioulnar ligament) (Fig. 335).—This ligament extends between corresponding surfaces on the dorsal aspect of the articulation. 10

The Articular Disk (discus articularis; triangular fibrocartilage) (Fig. 336).—The articular disk is triangular in shape, and is placed transversely beneath the head of the ulna, binding the lower ends of the ulna and radius firmly together. Its periphery is thicker than its center, which is occasionally perforated. It is attached by its apex to a depression between the styloid process and the head of the ulna; and by its base, which is thin, to the prominent edge of the radius, which separates the ulnar notch from the carpal articular surface. Its margins are united to the ligaments of the wrist-joint. Its upper surface, smooth and concave, articulates with the head of the ulna, forming an arthrodial joint; its under surface, also concave and smooth, forms part of the wrist-joint and articulates with the triangular bone and medial part of the lunate. Both surfaces are clothed by synovial membrane; the upper, by that of the distal radioulnar articulation, the under, by that of the wrist. 11

FIG. 334– Ligaments of wrist. Anterior view (See enlarged image) Synovial Membrane (Fig. 336).—The synovial membrane of this articulation is extremely loose, and extends upward as a recess (recessus sacciformis) between the radius and the ulna. 12

FIG. 335– Ligaments of wrist. Posterior view. (See enlarged image) Movements.—The movements in the distal radioulnar articulation consist of rotation of the lower end of the radius around an axis which passes through the center of the head of the ulna. When the radius rotates forward, pronation of the forearm and hand is the result; and when backward, supination. It will thus be seen that in pronation and supination the radius describes the segment of a cone, the axis of which extends from the center of the head of the radius to the middle of the head of the ulna. In this movement the head of the ulna is not stationary, but describes a curve in a direction opposite to that taken by the head of the radius. This, however, is not to be regarded as a rotation of the ulna—the curve which the head of this bone describes is due to a combined antero-posterior and rotatory movement, the former taking place almost entirely at the elbow-joint, the latter at the shoulder-joint. 13

FIG. 336– Vertical section through the articulations at the wrist, showing the synovial cavities. (See enlarged image)

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