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Distal Radioulnar Joint Biomechanics and Forearm Muscle Activity

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Distal Radioulnar Joint Biomechanics and Forearm Muscle Activity University of Kentucky UKnowledge University of Kentucky Doctoral Dissertations Graduate School 2011 DISTAL RADIOULNAR JOINT BIOMECHANICS AND FOREARM MUSCLE ACTIVITY Joseph Scott Bader University of Kentucky, [email protected] Right click to open a feedback form in a new tab to let us know how this document benefits ou.y Recommended Citation Bader, Joseph Scott, "DISTAL RADIOULNAR JOINT BIOMECHANICS AND FOREARM MUSCLE ACTIVITY" (2011). University of Kentucky Doctoral Dissertations. 825. https://uknowledge.uky.edu/gradschool_diss/825 This Dissertation is brought to you for free and open access by the Graduate School at UKnowledge. It has been accepted for inclusion in University of Kentucky Doctoral Dissertations by an authorized administrator of UKnowledge. For more information, please contact [email protected]. ABSTRACT OF DISSERTATION Joseph Scott Bader The Graduate School University of Kentucky 2011 DISTAL RADIOULNAR JOINT BIOMECHANICS AND FOREARM MUSCLE ACTIVITY __________________________________ ABSTRACT OF DISSERTATION __________________________________ A dissertation submitted in partial fulfillment of the requirements for the degree of Doctor of Philosophy in the Graduate School at the University of Kentucky. By Joseph Scott Bader Lexington, Kentucky Director: Dr. David Pienkowski, Associate Professor of Biomedical Engineering Lexington, Kentucky 2011 Copyright © Joseph Scott Bader 2011 ABSTRACT OF DISSERTATION DISTAL RADIOULNAR JOINT BIOMECHANICS AND FOREARM MUSCLE ACTIVITY Optimal management of fractures, post-traumatic arthritis and instability of the distal radioulnar joint (DRUJ) requires an understanding of the forces existing across this joint as a function of the activities of daily living. However, such knowledge is currently incomplete. The goal of this research was to quantify the loads that occur at the DRUJ during forearm rotation and to determine the effect that individual muscles have on those loads. Human and cadaver studies were used to analyze the shear (A-P), transverse (M- L) and resultant forces at the DRUJ and to determine the role that 15 individual muscles had on those forces. Data for scaling the muscles forces came from EMG analysis measuring muscle activity at nine positions of forearm rotation in volunteers during isometric pronation and supination. Muscle orientations were determined from the marked muscle origin and insertion locations of nine cadaveric arms at various stages of forearm rotation. The roles that individual muscles played in DRUJ loading were analyzed by removing the muscle of interest from the analysis and comparing the results. The EMG portion of this study found that the pronator quadratus, pronator teres, brachioradialis, flexor carpi radialis and palmaris longus contribute significantly to forearm pronation. The supinator, biceps brachii, and abductor pollicis longus were found to contribute significantly to supination. The results of the DRUJ analysis affirm that large transverse forces pass from the radius to the ulnar head at all positions of forearm rotation during pronation and supination (57.5N-181.4N). Shear forces exist at the DRUJ that act to pull the radius away from the ulna in the AP direction and are large enough to merit consideration when examining potential treatment options (7.9N-99.5N). Individual muscle analysis found that the extensor carpi radialis brevis, extensor pollicis longus, extensor carpi ulnaris, extensor indicis and palmaris longus had minimal effect on DRUJ loading. Other than the primary forearm rotators (pronator quadratus, pronator teres, supinator, biceps brachii), the muscles that exhibited the largest influence on DRUJ loading were the abductor pollicis longus, brachialis, brachioradialis, extensor carpi ulnaris, flexor carpi radialis, and flexor carpi ulnaris. KEYWORDS: distal radioulnar joint, electromyography, isometric muscle contraction, joint reaction forces, forearm biomechanics ____Joseph S Bader___________________ Student’s Signature ___ _9/7/2011_______________________ Date DISTAL RADIOULNAR JOINT BIOMECHANICS AND FOREARM MUSCLE ACTIVITY By Joseph Scott Bader ____David Pienkowski__________________ Director of Dissertation ____Abhijit Patwardhan________________ Director of Graduate Studies ____9/7/2011________________________ Date RULES FOR THE USE OF DISSERTATIONS Unpublished dissertations submitted for the Doctor's degree and deposited in the University of Kentucky Library are as a rule open for inspection, but are to be used only with due regard to the rights of the authors. Bibliographical references may be noted, but quotations or summaries of parts may be published only with the permission of the author, and with the usual scholarly acknowledgments. Extensive copying or publication of the dissertation in whole or in part also requires the consent of the Dean of the Graduate School of the University of Kentucky. A library that borrows this dissertation for use by its patrons is expected to secure the signature of each user. Name Date ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ DISSERTATION Joseph Scott Bader The Graduate School University of Kentucky 2011 DISTAL RADIOULNAR JOINT BIOMECHANICS AND FOREARM MUSCLE ACTIVITY __________________________________ DISSERTATION __________________________________ A dissertation submitted in partial fulfillment of the requirements for the degree of Doctor of Philosophy in the Graduate School at the University of Kentucky By Joseph Scott Bader Lexington, Kentucky Director: Dr. David Pienkowski, Associate Professor of Biomedical Engineering Lexington, Kentucky 2011 Copyright © Joseph Scott Bader 2011 For my parents, whose support and patience through MANY years of Graduate school, through good times and bad, have helped me to accomplish my goals in academia as well as my goals in life. ACKNOWLEDGEMENTS I would like to acknowledge the support and patience of my PhD advisor Dr. David Pienkowski throughout my time at the University of Kentucky. I would like to acknowledge Dr. Michael Boland for serving as the advisor for all clinical related matters, for finding ways to keep the project funded and for teaching me how truly amazing and complex the forearm is. I would like to thank Dr. Timothy Uhl for his biomechanics and research expertise as well as letting me use his extensive array of biomechanics research tools. I would like to thank Dr. Arthur Nitz for his EMG expertise and for patiently dealing with me as I developed the project and collected data on 44 subjects for which he had to be present. I would like to acknowledge Dr. Robert Shapiro for his help in the early stages of this project as well as for being the outside examiner. I would like to thank Dr. David Puleo and Dr. Keith Rouch for their guidance and patience as members of my dissertation committee. I would also like to thank the orthopedic residents that assisted in this project: Dr. Joseph Stone, Dr. Yanni Pappou and Dr. Robert Royalty as well as the medical students that assisted over the years. Lastly, I would like to thank the faculty, staff and students of the Center for Biomedical Engineering, Department of Orthopedics, Department of Kinesiology and Health Promotion as well as the College of Health Sciences Division of Physical Therapy for their support throughout my years at the University of Kentucky. iii TABLE OF CONTENTS ACKNOWLEDGEMENTS......................................................................................................iii LIST OF TABLES.................................................................................................................viii LIST OF FIGURES.................................................................................................................ix CHAPTER ONE: BACKGROUND............................................................................................1 1.1 The Distal Radioulnar Joint……………………………………………………………………………………….1 1.1.1 Anatomy and Function........................................................................................ 1 1.1.2 Dysfunction of the DRUJ…………………………………………………………………………………..5 1.1.2.1 DRUJ Dysfunction Incidence and Cost………………………………………………………5 1.1.2.2 DRUJ Fractures………………………………………………………………………………………..6 1.1.2.3 DRUJ Disease…………………………………………………………………………………………..7 1.1.3 Surgical Treatment of DRUJ Dysfunction…………………………………………………….…..7 1.1.3.1 DRUJ Prostheses………………………………………………………………………………………7 1.1.3.2 DRUJ Analysis and Reduction of Treatment Complications………………………9 1.2 Problem Statement and Purpose………………………………………………………………………………9 1.2.1 Problem Statement………………………………………………………………………………………….9 1.2.2 Purpose………………………………………………………………………………………………………….10 1.2.3 Research Plan…………………………………………………………………………………………………10 1.3 Electromyography…………………………………………………………………………………………………..11 1.3.1 EMG Background…………………………………………………………………………….…………….11 1.3.2 Forearm Rotation EMG Literature
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