MOB TCD

Superior and Inferior

Radioulnar Joint
Professor Emeritus Moira O’Brien
FRCPI, FFSEM, FFSEM (UK), FTCD
Trinity College
Dublin
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Supination
• Supination is when the bones of
forearm are parallel
• Palm of hand is facing anteriorly
• Supination with the elbow flexed is
a more powerful movement than
pronation
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Pronation
• Radius crosses the ulnar
• Palm of the hand is facing posteriorly
• Radial styloid is more distal than ulnar
styloid
• The axis of rotation passes through the
middle of the head of the radius to the
base of the styloid process of the ulna
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Supination and Pronation

• Three joints
• Superior radioulnar joint
• Interosseous membrane
• Inferior radioulnar joint
• Axis of rotation
• Middle of head of radius
• Base of styloid process of ulnar
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Superior Radioulnar Joint

• Synovial pivot joint
• Circumference of head of radius
• Radial notch of ulnar
• Annular ligament covered with
articular cartilage
• Quadrate membrane
• Capsular ligament
• Articular surfaces hyaline
cartilage
• Synovial membrane continuous
with elbow joint
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Superior Radioulnar Joint

• Annular ligament attached to
anterior and posterior borders
of radial notch
• Lateral ligament of elbow to
upper margin
• Annular ligament covered with
articular cartilage
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Superior Radioulnar Joint

• Capsule is attached
• Lower border of the annular
ligament
• Neck of radius
• Ulnar below the radial notch
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Superior Radioulnar Joint

• Quadrate membrane
• Lower margin of the radial notch
ulnar
• Neck of radius
• Synovial membrane
• Lines capsule, non-articular
structures
• Continuous above the annular
ligament with synovial membrane
of elbow
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Interosseous Membrane
• Syndesmosis
• Fibres pass mainly
downwards and
medially
• Radius to ulna
• Extends origins of
muscles
• Pierced by anterior
interosseous artery
• Transmits force
from radius to ulna
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Interosseous Membrane
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Superior Radioulnar Joint

• Radial styloid is
more distal than
ulnar
• Synovial pivot joint
• L-shaped ulnar
notch of radius
• Lateral and distal
aspect of head of
ulna
• Triangular fibro-
cartilaginous disc
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Inferior Radioulnar Joint

• Radial styloid process is more
distal than ulnar styloid process
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Inferior Radioulnar Joint

• Synovial pivot
• L-shaped
• Medial and distal aspect of
head of ulna
• Ulnar notch of radius
• Triangular cartilaginous disc
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Inferior Radioulnar Joint

• Articular surfaces
• Hyaline cartilage
• Capsule just beyond articular
margins
• Synovial membrane lines
capsule and non-articular
structures
• Radial styloid process is more
distal than ulnar styloid process
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Supinators: Biceps Brachii and Supinator

• Biceps brachii with the elbow

flexed
• More powerful
• Musculocutaneous C5,6
• Supinator (two heads) with
elbow extended
• Posterior interosseous C5,6
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Supinator
• Supinator has two heads of origin
• The superficial head arises from
the lateral epicondyle of the
humerus, the lateral ligament of
the elbow and the annular
ligament
• The deep head arises from the
supinator crest and supinator
fossa of the ulna
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Supinator
• Supinator is inserted into the
upper third of the outer surface of
the radius
• When the elbow is extended
• The supinator muscle supinates
the forearm i.e. it rotates the
radius to turn the palm anteriorly
• Supplied by the posterior
interosseous nerve C6,7, which
passes between the two heads
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Pronator Teres

• Arises from two heads

• The common flexor origin
• The medial margin of the coranoid
process of the ulna
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Pronator Teres

• It is inserted into the most convex aspect

of the shaft of the radius
• The radial artery passes superficial to
the two heads
• The ulnar artery deep to the two heads
• The median nerve between the two
heads
• Its action is to assist pronator quadratus
in rapid or forceful pronation of the
forearm
• It is also a weak flexor of the elbow
• Median nerve C6
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Pronator Quadratus
• Arises from the anterior aspect of the
distal portion of the ulna
• Inserted into the distal aspect of the radius
• It is a pronator of the forearm
• Supplied by the anterior interosseous
branch of the median nerve
• The pronator quadratus is the prime mover
in pronation
• Pronator teres contracts when further
speed or strength is required
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Brachioradialis
• Arises from the upper third of the lateral
supracondylar line of the humerus
• Inserted into the distal aspect of the radius
• Radial nerve C5,6
• Flexor of elbow
• In the mid position it can initiate, either
pronation or supination
• It is used, for example, in the back cast
when fly-fishing
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Radial Epiphysis
• Slipped radial epiphysis
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