In vivo three-dimensional mechanical actions of individual flexor-pronator muscles: Role in elbow valgus stability

The flexor-pronator mass is thought to be the primary dynamic valgus stabilizer of the elbow and protects the ulnar collateral ligament. However, in vivo multiaxis actions of individual muscles of the flexor-pronator group and their roles in valgus stability have not been investigated quantitatively. This study tested the hypothesis that individual muscles of the flexor-pronator muscle group produce a significant varus moment that provides elbow valgus stability. The flexor carpi ulnaris, flexor carpi radialis, and pronator teres were selectively activated, and the resulting multiaxis moments at the elbow measured at 0°, 30°, 60°, and 90° of elbow flexion using a six-axis force sensor were analyzed for their role in generating varus moment and protecting the ulnar collateral ligament. Considerable offaxis moments were generated by each muscle tested. Through the range of elbow flexion, the varus moment was the major component of the multiaxis action of the flexor carpi ulnaris (p < .001). The flexor carpi radialis and pronator teres had significant actions as elbow flexors and pronators (p ≤ .032); these muscles also had a significant varus contribution at 90° elbow flexion (p ≤ .019). The results suggest that the flexor-pronator muscle group plays an important role in valgus stability of the elbow. In particular, the flexor carpi ulnaris creates a significant varus moment, which is important in unloading and protecting the ulnar collateral ligament. Rehabilitation and strengthening of the flexor-pronator muscle group may help prevent failure of the ulnar collateral ligament and may also help compensate for a medially insufficient elbow.