The Parallelogram Effect: The Association Between Central Band and Positive Ulnar Variance

Ulnar impaction syndrome is a poorly understood degenerative wrist condition characterized by symptoms of pain thought to be caused by increased loads between the ulnar head and the carpals. Radiographic evaluation often reveals an ulnar-positive wrist. We hypothesize that progressive elongation of the central band of the forearm interosseous ligaments changes the longitudinal radial-ulnar relationships, resulting in an ulnar-positive wrist. The objective of the study was to identify a relationship between the loss of integrity of the forearm interosseous ligaments and increased ulnar variance.

Six cadaveric human forearms were used to measure displacement of the radius relative to the ulna during axial loading of the lunate fossa of the radius. Radial heights were measured in supination and pronation under a 5-lbF (22-N) preload. Gradual axial loads were applied up to 50 lbF (222N); the resultant axial displacement was measured in supination and pronation. All measurements were evaluated with the interosseous ligament intact and repeated with the central band cut.

With an applied 5-lbF preload, cutting the central band increased ulnar variance by 3.02 ± 0.80 mm in supination and by 2.15 ± 0.79 mm in pronation. In supination, when the loads were increased from the 5-lbF preload to 50 lbF, the radius displaced 2.1 times further after the central band was cut (3.00 mm) compared with the group with the intact forearm construct (1.41 mm). In pronation, when the loads were increased from the 5-lbF preload to 50 lbF, the radius displaced 1.8 times further when the central band was cut (2.84 mm) than with the intact forearm construct (1.57 mm).

Because of a parallelogram effect, the radius shifted proximally under a 5-lbF preload, creating an ulnar-positive wrist relationship. Dynamic loading of the forearm after ligament excision resulted in significant additional radial displacement relative to the intact forearm.

Deficiency in the ligamentous restraints of the central band leads to positive ulnar variance, which could be a factor (among others) that contributes to idiopathic ulnar impaction syndrome.