How much can carpus rotate axially? An in vivo study

Background. Supination and pronation movements occur primarily at the forearm though are possible at the wrist joint too. The axial rotation of the wrist also called the radiometacarpal rotation has been quantified but for its passive range which may never occur during the day-to-day routine activities. It is normally not possible for the wrist joint to rotate axially in an active manner. However, voluntary effort to rotate the forearm while keeping the hand fixed on a custom designed device is able to provide active rotation of the wrist which occurs in a manner similar to that occurring during the daily routine activities. Methods. The present study measured axial rotation of the wrist in 20 asymptomatic volunteers who had axial CT done of their wrist with elbow in 10–30° flexion and forearm positioned parallel to the long axis of the table with thumb pointing up towards the roof. The examination was repeated twice while the subject actively tried to supinate and pronate the forearm against the fixed hand and the metacarpals using maximum voluntary effort on a custom designed positioning device. Findings. The mean radiometacarpal supination and pronation were 17.15° (SD 7.9) and 17.0° (SD 10) respectively. The movement was found to occur predominantly at midcarpal joint with radiocarpal joint contributing only 18% to supination and 31% to pronation. Interpretation. The radiometacarpal rotation has a crucial bearing in the development of the wrist prostheses. The design of the prostheses should consider accommodating axial movements that occur in the carpus during the activities of daily living.