That the Lateral Movement of the Ulna in Pronation and Supination Takes Place at the Shoulder-Joint


Cathcart, C.W.

Transactions of the Medico-Chirurgical Society of Edinburgh 4: 219-223

1885


LATERAL
MOVEMENT
OF
THE
ULNA.
219
2.
THAT
THE
LATERAL
MOVEMENT
OF
THE
ULNA
IN
PRONATION
AND
SUPINATION
TAKES
PLACE
AT
THE
SHOULDER-JOINT.
By
CHARLES
W.
CATHCART,
M.B.,
F.R.C.S.
Ed.,
Assistant
Surgeon,
Royal
Infir-
mary,
Edinburgh
;
Lecturer
on
Surgery,
School
of
Medicine,
Edinburgh.
SINCE
the
title
of
my
paper
assumes
that
the
ulna
moves
in
proration
and
supination,
and
since
this
has
long
been
a
disputed
point,
it
may
be
well
to
recapitulate
briefly
the
arguments
on
which
the
present
belief
is
based.
1.
Observation
of
the
styloid
process
of
the
ulna
while
the
hand
is
being
pronated
and
supinated.
If
we
supinate
the
forearm,
place
a
finger
on
the
styloid
process
of
the
ulna,
and
then
pronate
in
the
ordinary
way,
it
will
be
quite
evident
that
the
bony
point
moves
from
its
place.
It
will
return
again
when
the
hand
is
again
supinated.
2.
Lecomte's
Ring
Experiment.—If
the
radius
alone
moves,
then,
since
the
axis
of
movement
at
the
wrist
passes
through
the
head
of
the
ulna,'
the
transverse
diameter
of
the
forearm
there
will
be
only
about
half
of
the
diameter
of
the
circle,
part
of
whose
circumference
is
traversed
by
the
styloid
process
of
the
radius
in
proration
and
supination.
In
other
words,
so
long
as
the
ulna
is
stationary,
it
will
be
impossible
to
rotate
the
wrist
within
a
ring
whose
diameter
is
only
slightly
greater
than
that
of
the
wrist
itself.
If,
on
the
other
hand,
the
ulna
be
moving
in
the
reverse
direction
to
that
taken
by
the
radius,
the
real
axis
of
movement
will
be
thrown
more
into
the
centre
of
the
forearm,
and
the
styloid
process
of
the
radius
will
traverse
part
of
the
circumference
of
a
much
smaller
circle
than
it
would
otherwise
do.
Lecomte
2
adapted
a
circular
metal
ring
to
his
forearm
near
the
wrist,
and
found
that
he
could
easily
pronate
and
supinate
his
forearm
within
the
ring,
when
it
was
being
held
quite
steady.
From
this
he
argued
that
the
ulna
must
also
move,
and
this
conclusive
proof
has
since
been
known
as
Lecomte's
ring
experiment.
With
a
little
practice,
it
is
quite
possible
to
perform
a
sort
of
flapping
movement
of
the
hand,
in
which
the
ulna
is
nearly
stationary,
but
it
will
be
then
found
that
the
forearm
can-
not
rotate
within
one
of
Lecomte's
rings,
and
it
will
be
necessary
either
to
allow
the
ring
to
move
with
the
forearm,
or
if
the
ring
be
still
fixed,
to
return
to
the
ordinary
rotatory
movements
of
prona-
tion
and
supination.
It
will
easily
be
seen
that
Ward's
axis
of
movement
is
not
in
any
way
disputed,
but
only
that
this
axis
itself
is
held
to
move.
In
this
way
the
axis
of
actual
movement
passes
more
nearly
through
the
centre
of
the
forearm.
1
Ward,
Osteology,
1875,
p.
221.
2
Lecomte,
Archives
Geiteral
de
Me'clecine,
Aout
1874.
220
LATERAL
MOVEMENT
OF
THE
ULNA,
3.
Axis
of
Movement
Arguments.—If
the
axis
of
movement,
as
laid
down
by
Ward,
be
the
only
one,
then
the
centre
of
movement
at
the
finger
should
be
round
the
little
or
ring
finger.
As
a
matter
of
every-day
experience,
however,
this
is
nearer
the
radial
than
the
ulnar
side
of
the
hand,
which
can
be
easily
accounted
for
when
we
allow
that
the
ulna
moves
in
such
a
way
as
to
throw
the
actual
axis
of
motion
towards
the
centre
of
the
forearm,
as
has
been
already
indicated.
4.
Heiberg'
s
Graphic
Method
of
Demonstration.—Professor
Heiberg'
took
the
arm
of
a
subject
from
the
dissecting-room,
nailed
the
humerus
to
a
board,
placed
a
circular
ring
round
the
lower
end
of
the
bones
of
the
forearm,
cut
away
the
hand,
and
fastened
a
paint
brush
into
the
ends
of
the
radius
and
ulna,
so
as
to
register
their
movements
on
a
piece
of
paper
held
looking
towards
them.
He
then
moved
the
bones
in
pronation
and
supination,and
found
that
the
ulnas
brush
registered
a
circular
movement
in
the
reverse
direction
to
that
taken
by
the
radial
brush.
This
experiment
was
confirmed
by
strapping
over
the
ulna
in
a
living
arm
a
steel
rod
bearing
a
brush,
which,
when
the
arm
was
bent,
projected
as
far
behind
the
elbow-joint
as
the
styloid
process
of
the
ulna
was
in
front
of
it.
A
circular
ring
was
adapted
at
the
wrist,
and
movements
of
prona-
tion
and
supination
voluntarily
performed,
when
it
was
found
that
the
ulnar
brush
performed
movements
essentially
like
those
regis-
tered
in
the
first
experiment.
Next
as
to
the
kind
of
movements
performed,
careful
observa-
tion
of
the
ulna
in
the
living
arm
will
show
that
the
variety
of
movement
must
be
that
known
as
circumduction,
i.e.,
a
circular
movement
of
the
end
of
the
ulna,
the
result
of
the
combination
of
movements
in
two
planes
at
right
angles
to
one
another.
When
the
upper
arm
hangs
by
the
side,
and
the
forearm
is
flexed
to
a
right
angle,
one
of
these
planes
would
be
a
vertical
one
produced
by
flexion
and
extension
movements
at
the
elbow.
The
other
would
be
a
horizontal
one,
involving
a
lateral
movement
of
the
ulna,
the
exact
seat
of
which
it
is
the
purpose
of
this
paper
to
discuss.
Possibly
this
horizontal
movement
might
be
incapable
of
being
separated
from
its
vertical
combination,
i.e.,
an
oblique
movement
might
be
alone
possible
at
the
elbow.
Possibly
a
horizontal
move-
ment
might
be
possible
at
the
_elbow;
or
possibly
the
movement
might
not
be
at
the
elbow
at
all,
but
at
the
shoulder-joint.
In
this
case
either
a
lateral
rotation
of
the
humerus,
the
ulna
being
set
at
an
angle
to
it,
or
an
adduction
or
abduction
of
the
humerus
combined
with
flexion
or
extension
and
rotation,
would
produce
the
necessary
lateral
alteration
in
the
position
of
the
ulna.
The
view
which
.I
formerly
maintained
and
still
hold
to
is
that
while
this
lateral
movement
of
the
ulna
may,
and
probably
does
take
place,
to
a
limited
extent,
by
an
oblique
movement
at
the
elbow,
it
chiefly
occurs
at
the
shoulder-joint.
It
is
to
the
latter
of
I
Heiberg,
Christiania
Videns.
Forh.,
1883,
No.
8.
BY
MR
CHARLES
W.
CATHCART.
221
these
movements
that
I
wish
to
direct
attention
in
this
paper.
No
one,
of
course,
denies
that
in
forcible
pronation
and
supination
the
upper
arm
moves
to
and
from
the
side.
It
is
in
gentle
movements
of
rotation,
however,
when
the
upper
arm
can
be
maintained
to
all
appearance
steady,
that
there
is
difficulty
in
deciding,
and
it
is
in
such
movements
that
I
hope
to
prove
that
a
rotation
of
the
humerus
is
the
chief
agent
for
the
lateral
movement
of
the
ulna.
By
referring
to
Professor
Heiberg's'
collection
of
the
literature
of
the
subject,
I
find
that
this
view
is
held
by
Dr
R
W.
Einthoven.
2
Dr
Einthoven
believes
that
by
firmly
pressing
over
the
condyles
with
the
fingers
while
the
forearm
is
rotating
within
one
of
Lecomte's
rings,
the
slight
rotatory
movements
of
the
humerus
can
be
recognised,
and
their
similarity
noted
to
purely
rotatory
movements
without
accompanying
pronation
or
supination.
Pro-
fessor
Heibert
criticises
this
view
in
an
appendix
to
his
paper,
and
brings
two
objections
against
it.
(1.)
That
he
has
failed
to
get
the
same
results
in
repeating
Dr
Einthoven's
experiments
;
(2.)
That
by
experimenting
on
a
dead
arm
he
has
found
that
as
much
move-
ment
as
is
necessary
is
possible
at
the
elbow
without
calling
into
play
the
shoulder-joint
at
all.
In
regard
to
the
first
objection,
I
can
only
say
that,
working
independently
of
Dr
Einthoven,
I
had
come
to
much
the
same
results
from
similar
experiments,
with
only
this
exception,
that
I
could
not
say
that
the
ordinary
movement
of
rotation
of
the
humerus
was
exactly
like
that
in
pronation
and
supination.
This,
however,
I
accounted
for
by
the
complication
of
surrounding
muscular
contractions
in
the
latter
case,
which
was
not
present
in
the
former.
As
to
the
second
objection,
it
might
be
transposed
so
as
to
tell
as
much
against
the
elbow
movement
as
for
it
;
since
by
arranging
a
dead
arm
properly
the
necessary
lateral
movement
of
the
ulna
might
be
made
to
take
place
at
the
shoulder-joint
without
calling
into
play
the
elbow.
I
would
rather,
however,
not
appeal
to
the
dead
arm
at
all
until
we
have
exhausted
every
possible
means
of
inquiry
on
the
living.
Undoubtedly
the
inquiry
is
a
difficult
one.
The
amount
of
movement
of
the
condyles
of
the
humerus
is
at
most
very
small
(about
1
inch
or
5
mm.)
;
the
skin
is
so
movable
that
such
slight
movements
of
the
bones
are
difficult
to
observe
accurately,
and
the
contraction
of
muscles
in
the
neigh-
bourhood
is
decidedly
confusing
to
one's
sense
of
touch.
Is
there
no
other
way,
one
naturally
asks,
to
bring
the
matter
to
a
more
searching
test
?
One
way
would
be
to
screw
long
needles
or
pointers
into
one
or
both
condyles
of
a
living
arm,
but
this
seems
to
be
attended
with
rather
too
much
risk
to
be
lightly
undertaken.
On
thinking
the
matter
over,
however,
it
occurred
to
me
that
there
was
still
another
method
available,
i.e.,
to
study
the
movements
of
pronation
and
supination
in
patients
where
by
an
anchylosis
of
1
Heiberg,
Christiania
Videns.
Forh.,
1885,
No.
11.
2
Einthoven,
Archives
Nierlandaises,
tome
/vii.
p.
289.
222
LATERAL
MOVEMENT
OF
THE
ULNA,
the
shoulder
the
movements
of
that
joint
are
eliminated.
If
the
shoulder
is
not
involved
in
pronation
and
supination,
its
anchylosis
should
make
no
difference
to
these
movements.
If
the
shoulder,
however,
is
normally
involved,
then
its
anchylosis
should
bring
about
some
deviation
from
the
normal
mode
of
performing
prona-
tion
and
supination,
which
ought
to
be
traceable
to
this
cause.
Such
cases
of
anchylosis
of
the
shoulder,
although
not
uncommon,
are
not
always
easy
to
find
when
one
wants
them.
I
have
had
an
opportunity
of
examining
three,
although
it
is
only
to
the
last
of
them—at
present
within
reach
in
Edinburgh—that
I
wish
to
refer
at
present.
They
all
corroborate
the
view
that
the
shoulder-joint
is
concerned
in
pronation
and
supination.
The
present
case
brought
before
the
Society
is
that
of
a
young
man
zet.
23.
At
8
or
9
years
of
age
he
suffered
from
what
appears
to
have
been
disease
of
his
right
shoulder-joint,
for
which
the
actual
cautery
was
freely
applied
by
the
late
Professor
Spence.
The
disease
subsided,
but
left
behind
it
a
firm
anchylosis
of
the
joint,
which
has
persisted
ever
since.
As
is
usual
in
such
cases,
the
compensatory
mobility
of
the
scapula
is
so
great
that
it
would
be
difficult
to
believe
that
his
right
shoulder
had
not
its
full
use,
were
it
not
that
a
careful
examination
manifests
the
contrary.
As
a
proof
of
the
usefulness
of
his
right
arm,
I
may
mention
that
he
served
in
the
militia
during
part
of
six
consecutive
years
without
the
condition
of
his
right
arm
having
been
discovered.
When
stripped,
his
chest
and
back
muscles
are
seen
to
be
well
developed,
the
pectoralis
major
being
rather
stronger
on
the
left
side,
and
the
upper
part
of
the
trapezius
on
the
right.
The
right
deltoid
is
much
atrophied.
A
large
scar
resulting
from
the
cautery
is
seen
in
front
and
behind
his
right
shoulder-joint.
The
right
arm
from
the
acromion
process
to
the
tip
of
the
middle
finger
measures
4
inches
less
than
the
left.
Of
this
3i
inches
is
due
to
shortness
of
the
humerus,
and
one-half
to
that
of
the
forearm
and
hand.
The
muscular
development
of
the
right
arm
is
good,
the
del-
toid
being
excepted—upper
arm
si
inches,
forearm
9
inches.
On
the
left
side
these
measurements
are
I
inch
greater
in
each
case.
The
remaining
joints
of
the
right
arm
are
perfectly
free,
and
their
movements,
to
all
appearance,
quite
natural.
1.
When
the
right
forearm
is
flexed
to
about
a
right
angle,
and
a
circular
metal
ring
adapted
closely
round
the
wrist
and
held
steady,
the
patient
can
rotate
his
forearm
within
the
ring.
With
each
movement
of
supination,
however,
the
humerus
is
brought
towards
the
side
to
about
the
same
extent
as
the
ulna
passes
from
without
inwards
in
the
horizontal
part
of
its
circumduction.
In
pronation
these
movements
are
reversed.
The
explanation
of
the
inward
movement
of
the
whole
humerus
appears
to
be
that,
as
a
rotation
of
the
humerus
is
necessarily
difficult
or
impossible,
the
next
best
way
to
gain
the
same
end
is
to
move
the
ulna
laterally
together
with
the
humerus.
When
BY
MR
CHARLES
W.
CATHCART.
223
this
was
hindered,
so
was
the
movement
of
pronation
and
supination.
2.
If
we
still
keep
on
the
ring,
and
now
ask
him
to
cross
his
upper
arm
forcibly
over
his
chest,
so
that
the
movements
of
his
scapula
and
consequently
of
his
humerus
are
restricted,
we
find
that
he
can
no
longer
rotate
his
forearm
within
the
ring.
He
can
still
perform
pronation
and
supination,
but
the
ring
must
be
allowed
to
move
with
his
radius
;
in
other
words,
his
radius
is
alone
moving,
since
the
opposite
movement
of
the
ulna,
which
was
necessary
to
diminish
the
curve
travelled
over
by
the
radius,
and
so
permit
rotation
within
the
ring,
has
been
restrained
simul-
taneously
with
the
restraint
of
the
humerus.
Had
the
lateral
movement
of
the
ulna
been
chiefly
in
the
elbow,
or
had
it
not
come
from
the
humerus,
why
should
the
restriction
of
the
move-
ments
of
the
humerus
have
made
so
much
difference
in
the
mode
of
performing
pronation
and
supination
?
As
soon
as
the
crossing
of
his
arm
is
sufficiently
relaxed
to
allow
the
scapula
to
move
again,
the
rotation
of
the
forearm
can
again
easily
be
performed
within
the
ring.
The
careful
observation
of
such
a
case
as
this
seems
to
me
to
be
of
the
greatest
value
in
the
investigation
of
the
movements
of
the
ulna
in
pronation
and
supination.
Possibly
there
may
be
a
slight
lateral
movement
at
the
elbow-joint,
but
undoubtedly,
as
this
and
other
similar
cases
show,
the
greatest
part
of
the
lateral
movement
takes
place
by
rotation
of
the
humerus
on
its
own
axis
at
the
shoulder-joint.
Professor
Chiene
(who
along
with
Mr
Bell
had
been
asked
by
the
President
to
examine
the
case
of
anchylosed
shoulder-joint)
said
he
felt
much
interested
in
Mr
Cathcart's
investigations
on
this
point.
He
thought
the
demonstration
proved
that
this
movement
took
place
at
the
shoulder.
If
it
were
proved
to
take
place
at
the
elbow,
then
one
of
the
most
valuable
diagnostic
signs
of
disease
of
that
joint
was
in
danger
of
being
lost.
That
fear,
which
had
been
present
to
his
mind
when
Mr
Cathcart
first
told
him
of
his
inves-
tigations,
was
now
quite
removed.
Mr
Joseph
Bell
said
he
was
quite
convinced
by
Mr
Cathcart's
demonstration.
The
fact
that
the
shoulder
was
not
completely
anchylosed
in
the
case
on
which
the
movements
were
shown
did
not,
he
thought,
militate
against
Mr
Cathcart's
argument,
but
was
rather
in
its
favour.
III.
CLINICAL
AND
PATHOLOGICAL
DEMONSTRATIONS.
1.
Dr
P.
A.
Young
showed
a
CHART
of
abnormally
LOW
TEMPERA-
TURE
in
a
gentleman
enjoying
good
health.
He
was
a
man
of
very
studious
habit,
able
to
go
through
a
great
deal
of
work,
and
about
fifty
years
of
age.
He
suffered
occasionally
from
indigestion,
and