INTRODUCTION: The arthrokinematics of the proximal radioulnar joint (PRUJ) are believed to follow the convex-concave rule, meaning that when the convex radial head articulates with the concave radial notch on the ulna, rolling and gliding occur in opposite directions during forearm pronation and supination. Previous research using helical computerized tomography (CT) identified that the sequence of joint actions is in contrast with this rule, which would indicate a posterior glide of the radius on the ulna during pronation movement and the converse during supination.
OBJECTIVES: The aims of this study are to determine the arthrokinematics of the PRUJ while being assessed via ultrasound (US) imaging and to assess the impact the direction of joint mobilization has on active and passive range of motion (ROM) during forearm supination and pronation at the PRUJ.
METHODS: A convenience sample of 53 healthy individuals were recruited. The arthrokinematics of the PRUJ were observed via US cine-loops. A linear US transducer was applied in the transverse plane and placed over the radial head during all testing conditions. A metronome standardized the rate of forearm pronation and supination at 1Hz (60 bpm) during US cine-loops acquisition. Radial head motion was assessed in two different elbow positions during US and joint range of motion assessment. The elbow was flexed to 90° with a neutral forearm position and fully extended with a neutral forearm position. The glenohumeral joint was stabilized during all testing conditions. A repeated measures design randomizing joint mobilization direction to the radial head was utilized to assess forearm pronation and supination via inclinometer data measured in degrees. Joint glides were applied to the radial head according to the convex-concave rule to facilitate forearm supination and pronation. An anteromedial glide to facilitate forearm supination and a posterolateral glide to facilitate forearm pronation. A metronome standardized the rate of joint mobilization at a rate 2Hz (120 bpm). A bubble inclinometer assessed active and passive PRUJ ROM at the wrist during all testing conditions.
RESULTS:US imaging cine-loops showed the radial head rolled anteromedially during pronation and posterolaterally during supination, with no translation/gliding evident. Multivariate analysis revealed that the direction of joint mobilization had a significant impact on ROM F(1,47.0)= 6.964, p=.011, partial η2 =.129), with anterior mobilization increasing pronation and posterior mobilization increasing supination. Supination ROM was significantly increased F1(1, 47.0) = 78.03, p
CONCLUSION: Our findings are in conflict with the convex-concave rule, which is frequently used by physical therapists to improve joint motion. Should we now reconsider applying this rule to improve joint ROM at the PRUJ
