Which ligament stabilizes the head of the radius

Most of the muscles that straighten the fingers and wrist come together and attach to the medial epicondyle, or the bump on the inside of your arm just above the elbow. These two tendons are important to understand because they are common locations of tendonitis. All of the nerves that travel down the arm pass across the elbow. Three main nerves begin together at the shoulder the radial nerve, the ulnar nerve and the medial nerve. These nerves are responsible for signaling your muscles to work and to also relay sensations such as touch, pain and temperature.

Louis Children's Hospital St. There are several surgical procedures available for the treatment of chronic radial head dislocation, including osteotomy of the ulna [ 19 , 20 , 21 , 22 ] with or without annular ligament reconstruction [ 16 , 23 , 24 , 25 ].

Annular ligament reconstruction according to the Bell Tawse procedure is one popular technique, in which a slip of the triceps tendon is looped around the radial neck to stabilize the radial head.

Although this procedure reduces anterior radial head dislocation, it is difficult to stabilize the radial head in the lateral and posterior directions with this technique because of the non-anatomical nature of the procedure Fig. In the current study, the Bell Tawse procedure allowed posterolateral radial head instability, whereas anatomical reconstruction stabilized the radial head in all directions. Anatomical annular ligament reconstruction may provide multidirectional stability of the proximal radioulnar joint in patients with gross instability of the radial head.

Thus, despite the rarity of the condition in clinical practice, the authors recommend performing anatomical annular ligament reconstruction rather than non-anatomical reconstruction procedures for patients with chronic radial head dislocation. Schema of annular ligament reconstructions. This study has several limitations. First, the soft tissue perhaps cannot tolerate repeated load and stretched during the experiment. To minimize this error, the load should not be too high, so 20 N of force was chosen.

The same load was used previously in biomechanical studies of the wrist [ 27 , 28 ]. Second, the sequence of ligament sectioning may differ from the clinical scenario in radial head dislocation. We modified the sequence of ligament sectioning from a previous biomechanical study [ 29 ], sectioning the stabilizing structures from the proximal to distal direction. A randomized or different sequence of ligamentous and IOM sectioning would provide additional information.

Third, we did not assess the dynamic effects of the muscles around the radial head. Salama et al. The dynamic effect of the biceps muscle may increase anterior displacement. Isolated radial head dislocation is extremely rare. Nevertheless, the current study provided useful information related to the contributions of the annular ligament, the quadrate ligament, and the proximal half of IOM to radial head stability.

Our findings may help with appropriate choice of post-reduction forearm position in acute injury and choice of reconstruction technique for chronic injury. Hamilton W, Parkes JC 2nd. Isolated dislocation of the radial head without fracture of the ulna. Clin Orthop Relat Res. Article Google Scholar.

Isolated traumatic dislocation of the radial head in children. J Bone Joint Surg Br. Traumatic dislocation of the radius at the elbow. Role of the interosseous membrane and annular ligament in stabilizing the proximal radial head. J Shoulder Elb Surg. Spinner M, Kaplan EB. The quadrate ligament of the elbow--its relationship to the stability of the proximal radio-ulnar joint.

Acta Orthop Scand. The morphology and function of the quadrate ligament. Folia Morphol Warsz. CAS Google Scholar. Treatment of chronic post-traumatic dislocation of the radial head in children.

Surgical treatment for chronic radial head dislocation. J Bone Joint Surg Am. Article PubMed Google Scholar. Bell Tawse AJ. The treatment of malunited anterior Monteggia fractures in children. Itadera E, Ueno K. Recurrent anterior instability of the radial head: case report. J Hand Surg Am. Interosseous membrane of the forearm: length change of ligaments during forearm rotation.

Structural properties of 6 forearm ligaments. Rare cause of block to reduction after radial head dislocation in children. J Orthop Trauma. Morphologic evaluation of chronic radial head dislocation: three-dimensional and quantitative analyses. Unusual anterior radial head dislocation associated with transposed biceps tendon: a case report. Chronic posttraumatic anterior dislocation of the radial head in children: thirteen cases treated by open reduction, ulnar osteotomy, and annular ligament reconstruction through a Boyd incision.

Dhawan A, Hospodar PP. Isolated posttraumatic posterior dislocation of the radial head in an adult. Google Scholar. The biomechanical and functional relationships of the proximal radioulnar joint, distal radioulnar joint, and interosseous ligament.

J Hand Surg Eur Vol. Open reduction, ulnar osteotomy and external fixation for chronic anterior dislocation of the head of the radius. Exner GU. Missed chronic anterior Monteggia lesion. Closed reduction by gradual lengthening and angulation of the ulna.

Bhaskar A. Missed Monteggia fracture in children: is annular ligament reconstruction always required? Indian J Orthop. Chronic Monteggia fractures in children: outcome after treatment with the bell-Tawse procedure.

J Pediatr Orthop B. Evaluation of outcome of corrective ulnar osteotomy with bone grafting and annular ligament reconstruction in neglected monteggia fracture dislocation in children. J Clin Diagn Res. Modified technique for correction of isolated radial head dislocation without apparent ulnar bowing: a retrospective case study. Int J Clin Exp Med. Outcome of radial head preserving operations in missed Monteggia fracture in children. Anterior dislocation of the radial head in children: aetiology, natural history and management.

Effect of wrist position on distal radioulnar joint stability: a biomechanical study. J Orthop Res. Weiss AP. Feger, J. Annular ligament of the elbow. Reference article, Radiopaedia. Annular ligament Annular ligament of the proximal radioulnar joint Annular ligament elbow. URL of Article. On this page:. Article: Gross anatomy Radiographic features Related pathology References. Insights Imaging. The Annular Ligament-Revisited. J Shoulder Elbow Surg. Promoted articles advertising.

Loading more images Close Please Note: You can also scroll through stacks with your mouse wheel or the keyboard arrow keys. Loading Stack - 0 images remaining.