The orbicular zone of the elbow is a circular reinforcement of the annular ligament capsular fibres that encircle the radial neck, distinct from but continuous with the proper annular ligament. It maintains the radial head within its fossa.
Provides circumferential constraint of the radial head within the proximal radioulnar joint, contributes to radiocapitellar stability, and maintains radial head contact with the capitellum during forearm rotation.
Disruption of the orbicular zone in nursemaid elbow (radial head subluxation) allows the radial head to slip distally from beneath the annular ligament. In children under 5, the orbicular zone is lax, predisposing to traction-induced subluxation with longitudinal pull on the arm.
Traction on the extended pronated elbow pulls the radial head through the lax orbicular zone in children, producing acute elbow pain with the arm held in pronation, reduced by hyperpronation or supination manoeuvre.
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