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Concept: Ulna


BACKGROUND: Variations in the major arteries of the upper limb are estimated to be present in up to one fifth of people, and may have significant clinical implications. CASE PRESENTATION: During routine cadaveric dissection of a 69-year-old fresh female cadaver, a superficial brachioulnar artery with an aberrant path was found bilaterally. The superficial brachioulnar artery originated at midarm level from the brachial artery, pierced the brachial fascia immediately proximal to the elbow, crossed superficial to the muscles that originated from the medial epicondyle, and ran over the pronator teres muscle in a doubling of the antebrachial fascia. It then dipped into the forearm fascia, in the gap between the flexor carpi radialis and the palmaris longus. Subsequently, it ran deep to the palmaris longus muscle belly, and superficially to the flexor digitorum superficialis muscle, reaching the gap between the latter and the flexor carpi ulnaris muscle, where it assumed is usual position lateral to the ulnar nerve. CONCLUSION: As far as the authors could determine, this variant of the superficial brachioulnar artery has only been described twice before in the literature. The existence of such a variant is of particular clinical significance, as these arteries are more susceptible to trauma, and can be easily confused with superficial veins during medical and surgical procedures, potentially leading to iatrogenic distal limb ischemia.

Concepts: Brachial artery, Median nerve, Blood pressure, Muscle, Muscles of the upper limb, Ulna, Ulnar artery, Forearm


We describe and analyze a Neandertal postcranial skeleton and dentition, which together show unambiguous signs of right-handedness. Asymmetries between the left and right upper arm in Regourdou 1 were identified nearly 20 years ago, then confirmed by more detailed analyses of the inner bone structure for the clavicle, humerus, radius and ulna. The total pattern of all bones in the shoulder and arm reveals that Regourdou 1 was a right-hander. Confirmatory evidence comes from the mandibular incisors, which display a distinct pattern of right oblique scratches, typical of right-handed manipulations performed at the front of the mouth. Regourdou’s right handedness is consistent with the strong pattern of manual lateralization in Neandertals and further confirms a modern pattern of left brain dominance, presumably signally linguistic competence. These observations along with cultural, genetic and morphological evidence indicate language competence in Neandertals and their European precursors.

Concepts: Upper limb anatomy, Ulna, Bone, Upper limb, Humerus, Handedness, Left-handedness, Right-handedness


Members of the order Carnivora display a broad range of locomotor habits, including cursorial, scansorial, arboreal, semiaquatic, aquatic, and semifossorial species from multiple families. Ecomorphological analyses from osteological measurements have been used successfully in prior studies of carnivorans and rodents to accurately infer the locomotor habits of extinct species. This study uses 20 postcranial measurements that have been shown to be effective indicators of locomotor habits in rodents and incorporates an extensive sample of over 300 individuals from more than 100 living carnivoran species. We performed statistical analyses, including analysis of variance (ANOVA) and stepwise discriminant function analysis, using a set of 16 functional indices (ratios). Our ANOVA results reveal consistent differences in postcranial skeletal morphology among locomotor groups. Cursorial species display distal elongation of the limbs, gracile limb elements, and relatively narrow humeral and femoral epicondyles. Aquatic and semiaquatic species display relatively robust, shortened femora and elongate metatarsals. Semifossorial species display relatively short, robust limbs with enlarged muscular attachment sites and elongate claws. Both semiaquatic and semifossorial species have relatively elongate olecranon process of the ulna and enlarged humeral and femoral epicondyles. Terrestrial, scansorial, and arboreal species are characterized by having primarily intermediate features, but arboreal species do show relatively elongate manual digits. Morphological indices effectively discriminate locomotor groups, with cursorial and arboreal species more accurately classified than terrestrial, scansorial, or semiaquatic species. Both within and between families, species with similar locomotor habits converge toward similar postcranial morphology despite their independent evolutionary histories. The discriminant analysis worked particularly well to correctly classify members of the Canidae, but not as well for members of the Mustelidae or Ursidae. Results are used to infer the locomotor habits of extinct carnivorans, including members of several extinct families, and also 12 species from the Pleistocene of Rancho La Brea. J. Morphol., 2013. © 2012 Wiley Periodicals, Inc.

Concepts: Evolution, Mammal, Ulna, Olecranon fossa, Statistics, Variance, Analysis of variance, Carnivora


Resection of the ulnar head in cases of debilitating pain owing to arthrosis of the distal radioulnar joint can provide satisfying relief. However, there is mounting evidence that pain with heavier use, instability, and torque-generating weakness in more active individuals may result in less satisfying outcomes. Implant arthroplasty can provide a means to stabilize the radius to the ulna after ulnar head resection, but it requires significant attention to requisite soft tissue stabilization and alignment of the distal radius to the implant to be successful.

Concepts: Centrifugation, Ulna, Distal radioulnar articulation


The aim of this study was to compare different endurance parameters of elbow extensors between senior and junior athletes. A group of 23 junior (16.2±0.8years, BMI 21.8±2.9 kg/m2) and 16 senior athletes (23.1±6.2y, BMI 23.6±4.2 kg/m2) volunteered for the study. Strength measurements were performed on the isoacceleration dynamometer (5 sets of 10 maximal elbow extensions, 1 min resting period between each set). The following strength parameters were measured: maximal strength (MS), endurance strength (ES), fatigue rate (FR) and decrease in strength (DS). Both arms triceps brachii muscle mass (MM) was calculated using a series of cross-sectional images of upper arms obtained by the MRI. Triceps brachii muscle mass for both arms in senior athletes showed significantly higher values (1286.9±323.7 g) compared to young athletes (948.9±171.1 g, p<0.01). ES was 50% higher in seniors, while FR was 10% higher in juniors. MS was 35% higher in seniors, but no difference was discovered when this parameter was expressed in relation to muscle mass. DS was significantly different between juniors and seniors, except in absolute values. No significant correlation was found between triceps brachii muscle mass and FR or DS. Different values of strength decrease throughout multiple contractions could be attributed to different characteristics of various sports.

Concepts: Ulna, Elbow, Triceps brachii muscle, Biceps brachii muscle


Background Chronic, dynamic bidirectional instability in the distal radioulnar joint (DRUJ) is diagnosed clinically, based on the patient’s complaints and the finding of abnormal laxity in the vicinity of the distal ulna. In cases where malunion is ruled out or treated and there are no signs of osteoarthritis, stabilization of the DRUJ may offer relief. To this end, several different techniques have been investigated over the past 90 years. Materials and Methods In this article we outline the procedure for a new technique using a tendon graft to reinforce the distal edge of the interosseous membrane. Description of Technique A percutaneous technique is used to harvest the palmaris longus tendon and to create a tunnel, just proximal to the sigmoid notch, through the ulna and radius in an oblique direction. By overdrilling the radial cortex, the knotted tendon can be pulled through the radius and ulna and the knot blocked at the second radial cortex, creating a strong connection between the radius and ulna at the site of the distal oblique bundle (DOB). The tendon is fixed in the ulna with a small interference screw in full supination, preventing subluxation of the ulna out of the sigmoid notch during rotation. Results Fourteen patients were treated with this novel technique between 2011 and October 2013. The QuickDASH score at 25 months postoperatively (range 16-38 months) showed an improvement of 32 points. Similarly, an improvement of 33 points (67-34 months) was found on the PRWHE. Only one recurrence of chronic, dynamic bidirectional instability in the DRUJ was observed. Conclusion This simple percutaneous tenodesis technique between radius and ulna at the position of the distal edge of the interosseous membrane shows promise in terms of both restoring stability and relieving complaints related to chronic subluxation in the DRUJ.

Concepts: Tendon, Reinforcement, Supinator muscle, Proximal radioulnar articulation, Ulnar nerve, Distal radioulnar articulation, Forearm, Ulna


Only two distal epiphyses of a radius and ulna are consensually attributed to the holotype skeleton of Proconsul heseloni, KNM-RU 2036. Here, we describe seven adult and immature distal antebrachial (radial and ulnar) epiphyses from two other individuals of P. heseloni from the Lower Miocene deposits of the Kaswanga Primate Site (KPS), Rusinga Island, Kenya. Because KNM-RU 2036 and KNM-KPS individuals III and VIII are conspecific and penecontemporaneous, their comparison provides the opportunity i) to characterize, for the first time, the morphological variation of the distal radioulnar joint in a Miocene ape, P. heseloni, and ii) to investigate the functional and evolutionary implications. Our results show that the distal antebrachial epiphyses of KNM-KPS III and VIII correspond to stages of bone maturation that are more advanced than those of KNM-RU 2036 (larger articulations and sharper articular borders and ligament attachments that are more developed). Accordingly, functional interpretations based solely on the skeleton of KNM-RU 2036 have involved an underestimation of the forearm rotation abilities of P. heseloni. In particular, the KPS fossils do not exhibit the primitive morphology of distal radioulnar syndesmosis, as those of KNM-RU 2036 and most nonhominoid primates, but rather the morphology of an incipient diarthrosis (as in extant lorisines and hominoids). The distal radioulnar diarthrosis permits more mobility and maintenance of the wrist during repeated and slow rotation of the forearms, which facilitates any form of quadrupedal locomotion on discontinuous and variably oriented supports. By providing the oldest evidence of a distal radioulnar joint in an early Miocene hominoid, the main conclusions of this study are consistent with the role of cautious climbing as a prerequisite step for the emergence of positional adaptations in apes.

Concepts: Ulna, Distal radioulnar articulation, Wrist, Hominidae, Bone, Primate, Ape, Forearm


Focal fibrocartilaginous dysplasia (FFCD) is a rare benign bone lesion, which mainly occurs in the proximal tibia. In the upper extremity, only 21 cases have been reported so far and 14 of these involved the ulna. We present an additional case of FFCD in the distal ulna that showed progressive bowing of the right forearm and the radial head dislocation. Resection of the abnormal tissue, osteotomy of the radius and ulna, and gradual lengthening of the ulna were performed. On the basis of the previously published data of 14 cases and our data, we have summarized the etiology, clinical features, natural history, and treatment of FFCD in the ulna.

Concepts: Wrist, Radial artery, Lesion, Ulnar nerve, Upper limb, Ulna, Forearm


OBJECTIVE To determine outcomes and complication rates of open reduction and cranial bone plate fixation of fractures involving the distal aspect of the radius and ulna in miniature- and toy-breed dogs. DESIGN Retrospective case series. ANIMALS 102 miniature- and toy-breed dogs (105 fractures) weighing ≤ 7 kg (15.4 lb) that had undergone open reduction and cranial bone plate fixation of a fracture involving the distal aspect of the radius and ulna from 2008 through 2015. PROCEDURES Medical records were reviewed and information extracted regarding dog and fracture characteristics, surgical variables, and follow-up examination data (including postoperative complications). Postoperative radiographs were examined for distal fragment size, implant placement, apposition, alignment, and healing stage. A long-term follow-up questionnaire was completed by telephone interview with dog owners at least 6 months after surgery. RESULTS Mean length of the distal bone fragment in all fractures was 19.2 mm, with a mean distal-to-total radial length ratio of 0.21. At last follow-up examination (typically 6 weeks after surgery), 97 (95%) dogs had no signs of lameness; minor lameness was identified in 5 (5%) dogs. Complications developed in 26 (25%) fractures (23 [22%] minor and 3 [3%] major complications). Sixty-eight of 71 (96%) owners rated the overall and long-term outcome as excellent and 3 (4%) as good; 68 of 71 (96%) dogs reportedly had no signs of residual lameness. CONCLUSIONS AND CLINICAL RELEVANCE Open reduction and cranial bone plate fixation for the treatment of radius-ulna fractures in miniature- and toy-breed dogs provided an excellent outcome with a low complication rate.

Concepts: Dog, Ulnar nerve, Orthopedic surgery, Forearm, Fracture, Bone fracture, Ulna, Bone


The extensor carpi ulnaris (ECU) muscle plays a key role not only in the active movements of wrist extension and ulnar deviation but also in providing stability to the ulnar side of the wrist. Its position relative to the other structures in the wrist changes with forearm pronation and supination. As such, it must be mobile yet stable. The ECU tendon relies on specific stabilising structures to hold it in the correct positions to perform its different functions. These structures can be injured in a variety of different athletic activities such as tennis, golf and rugby league, yet their injury and disruption is predictable when the mechanics of the ECU and the techniques of the sport are understood. The ECU tendon is also vulnerable to tendon pathologies other than instability. It lies subcutaneously and is easily palpated and visualised with diagnostic ultrasound, allowing early diagnosis and management of its specific conditions. Treatment includes rest, splintage and surgery with each modality having specific indications and recognised outcomes. This review described the functional anatomy in relevant sporting situations and explained how problems occur as well as when and how to intervene.

Concepts: Pathology, Ulna, Medical school, Wrist, Extensor carpi radialis longus muscle, Pronation, Forearm, Extensor carpi ulnaris muscle