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 A NOTE ON THE RADIO-CARPAL ARTICULATION. 
 By Francis J. Shepherd, M.D., Professor of Anatomy, 
 M'Gill University, Montreal. 
 
 (Read at the meeting of the Associavion of American Anatomists held in Boston, 
 
 U.S.A., December 1890.) 
 
 One of the most complete and generalised forms of carpus is 
 seen in the Water-tortoise. In this animal it consists of two 
 rows of bones, the distal row containing five bones, and the 
 proximal three, with a central bone between the two rows. 
 The bones of the first or proximal row are the "radiale," 
 " ulnare," and " intermedium," which correspond in the human 
 carpus to the scaphoid, semilunar and pyramidal bones; the 
 radiale and ulnare articulate with the radius and ulna, while 
 the intermedium, as its name implies, is placed between the two 
 others, and articulates with both the radius and ulna. Now 
 the same thing occurs in the human carpus. The scaphoid 
 articulates with the radius, the pyramidal bone wilL the ulna 
 or with the cartilage interposed between its upper surface and 
 the ulna, while the semilunar bone (intermedium), by its upper 
 surface, articulates with radius, and also with the meniscus, 
 which separates it from the ulna. The object of my paper is to 
 show that the semilunar always articulates with the ulna, not 
 immediately but by means of the interposed cartilage or menis- 
 cus. In only a few text-books^ of anatomy is this fact stated. 
 The majority state that the upper surfaces of the scaphoid and 
 lunar bones correspond with the radius, and that the upper 
 surface of the pyramidal bone corresponds with the triangular 
 fibro-cartilage, which separates the ulna from the wrist-joint. 
 Henle many years ago taught the proper method of articu- 
 lation, and described it m his Handhuch ; but most of the text- 
 books on anatomy have ignored his observations. 
 
 ^ E.g., Henle, Quain, Cunningham, Ellis. In describing the semilunar bone, 
 all the works on Anatomy I have consulted fail to mention the connection of the 
 bone with the meniscus. 
 
350 
 
 PROFESSOR FRANCIS J. SHEPHERD. 
 
 If one looks at the upper surface of the semilunar, one will 
 find that it is somewhat triangular in shape, the rounded angle 
 of the apex of the triangle being toward the pyramidal bone, 
 and continuous with its upper surface and the base towards the 
 scaphoid. In the fresh state, when this surface of the semilunar 
 bone is covered with cartilage, a distinct line may be seen 
 separating the surface, articulating with the radius from that 
 opposite the fibro-cartilage. This latter surface, from the 
 examination of a number of subjects, I find varies considerably 
 in size and extends more to the palmar than the dorsal surface. 
 When the upper articular surface of the pyramidal bone is of 
 large size, then the facet on the lunar bone opposing the 
 meniscus is small, and vice versa. In some cases the upper 
 surface of the pyramidal bone may not be in contact with the 
 fibro-cartilage at all, except in extreme adduction ; when this 
 occurs there is a large surface of the semilunar bone in contact 
 with the fibro-cartilage, the small articular facet on the pyra- 
 midal being in contact with the capsule of the joint. In other 
 cases the portion of semilunar bone opposite the meniscus is so 
 small as hardly to be noticeable, consisting merely of a very 
 narrow strip, a line or two wide, on the ulnar side of the upper 
 articular surface. Years ago, not knowing what had been done 
 by Henle, my attention was directed to this articulation of the 
 lunar and pyramidal bones whilst investigating the frequency 
 of perforation of the triangular fibro-cartilage. I frequently 
 noticed that when there was a perforation of the meniscus it 
 was due to some form of synovitis or arthritis, and that the sur- 
 face of the carpus opposite the perforation was always a portion 
 of the semilunar bone. When the opening was small this 
 surface was dull, and did not glisten like the rest of the carti- 
 lage; later, as the opening wore larger and friction became 
 greater, portions of the cartilage became roughened and loose ; 
 later still, the cartilage disappeared altogether leaving a spot of 
 bare bone, which corresponded to the opening in the fibro- 
 cartilage. If the process still went on, this bare bone became 
 polished or eburnated as well as the lower end of the ulna, 
 which went through the same changes, though not so rapidly. 
 In such cases I was always struck by the fact that this roughened 
 or ebuniated surface was of larger extent on the semilunar than 
 
 *» 
 
NOTE ON THE RADIO-CARPAL ARTICULATION. 
 
 351 
 
 on the pyramidal bone. It is not uncommon to see the articular 
 surface of the lower radio-ulnar articulation and the surface 
 of the carpus opposite the disappearing meniscus disorganised, 
 whilst the rest of the wrist-joint remains perfectly healthy. 
 Perforation of the meniscus is, in my experience, rarely normal; 
 in nearly every instance I have found it due to some patho- 
 logical condition, cau-'id either by injury to or disease of the 
 lower radio-carpal ar'jiculation, 
 
 [A number of preparations, both moist and dry, illustrating 
 this paper, were exhibited to the members of the Association.]