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Tankink T, Houdijk H, Hijmans JM. Human‐in‐the‐loop optimized rocker profile of running shoes to enhance ankle work and running economy. Eur J Sport Sci 2024; 24:164-173. [PMCID: PMC11235892 DOI: 10.1002/ejsc.12054] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2023] [Revised: 10/02/2023] [Accepted: 10/09/2023] [Indexed: 01/01/2025]
Abstract
Increasing the efficiency at which muscles generate mechanical power could improve running economy. A potential way to reduce muscle fiber shortening velocities and enhance energy storing of the Triceps Surae is changing their gear ratio at the ankle via optimization of shoe rollover profile. The aim of the current study was to individually optimize rollover profile of rocker shoes via human‐in‐the‐loop optimization to maximize positive ankle work to redistribute joint work from the hip and knee to the ankle and improve running economy. A total of 10 runners ran on a treadmill with experimental rocker shoes in which apex position and angle were optimized using an evolution algorithm to maximize positive ankle work. We compared experimental shoes with optimal settings, standard settings, and control shoes in terms of biomechanics and running economy. Optimal apex parameters differed considerably between participants. The optimal condition resulted in higher positive ankle work and a higher proportional share of the ankle in the total positive lower limb work compared to the standard condition. A difference in running economy between these conditions was not found. Human‐in‐the‐loop optimization can redistribute joint work from the hip and knee to the ankle by individually optimizing apex parameters. Although this did not improve running economy, the study showed that human‐in‐the‐loop optimization could improve the effectiveness of footwear with respect to the selected optimization parameter on an individual level. Human‐in‐the‐loop optimization is able to individually optimize apex position and apex angle of running shoes to enhance ankle work The increase in positive ankle work results in a redistribution of positive work generated around the lower limb joints from the hip and knee to the ankle The increase ankle work did not result in an increased running economy and therefore it should be further investigated which factors confound the theoretical benefit
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Affiliation(s)
- Thijs Tankink
- Department of Human Movement SciencesUniversity of GroningenUniversity Medical Center GroningenGroningenThe Netherlands
| | - Han Houdijk
- Department of Human Movement SciencesUniversity of GroningenUniversity Medical Center GroningenGroningenThe Netherlands
| | - Juha M. Hijmans
- Department of Rehabilitation MedicineUniversity of GroningenUniversity Medical Center GroningenGroningenThe Netherlands
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Anatomical study for elucidating the stabilization mechanism in the trapeziometacarpal joint. Sci Rep 2022; 12:20790. [PMID: 36456627 PMCID: PMC9715720 DOI: 10.1038/s41598-022-25355-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2022] [Accepted: 11/29/2022] [Indexed: 12/03/2022] Open
Abstract
To determine the pathogenesis of trapeziometacarpal (TMC) joint instability, which leads to osteoarthritis, we investigated the anatomical relationships among the surrounding ligaments, muscles (first dorsal interosseous [FDI] and opponens pollicis [OPP]), and joint capsule. We examined the bone morphology and cortical bone thickening in 25 cadaveric thumbs using micro-computed tomography and performed macroscopic and histological analyses. The dorsal trapezium had a tubercle with cortical bone thickening, corresponding to the attachment of the FDI aponeurosis intermingled with the joint capsule. Radially, the thin joint capsule was observed to underlie the muscular part of the OPP. Therefore, the dorsal ligaments, which have been previously considered static stabilizers, could be interpreted as parts of the capsuloaponeurotic complex consisting of the FDI aponeurosis and joint capsule. In the radial aspect, muscular OPP activation may be essential for TMC joint stabilization. Our findings may contribute to the appropriate management of TMC osteoarthritis.
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Fontaine C, D'Agostino P, Maes-Clavier C, Boutan M, Sturbois-Nachef N. Anatomy and biomechanics of healthy and arthritic trapeziometacarpal joints. HAND SURGERY & REHABILITATION 2021; 40S:S3-S14. [PMID: 34118467 DOI: 10.1016/j.hansur.2020.09.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Revised: 09/18/2020] [Accepted: 09/29/2020] [Indexed: 10/21/2022]
Abstract
Understanding the biomechanics of the trapeziometacarpal (TMC) or first carpometacarpal (CMC1) joint, the pathophysiology of basal thumb arthritis, the design and performance of surgical procedures require a solid anatomical basis. This review of literature summarizes the most recent data on the descriptive, functional, and comparative anatomy of healthy and arthritic TMC joints.
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Affiliation(s)
- C Fontaine
- Laboratoire d'Anatomie et Organogenèse, Faculté de Médecine Henri Warembourg, Université de Lille, Rue Michel Polonovski, 59045 Lille cedex, France; Laboratoire d'Automatique, de Mécanique et d'Informatique Industrielle et Humaine LAMIH, Université de Valenciennes et du Hainaut-Cambrésis, Le Mont Houy, 59313 Valenciennes cedex, France; Clinique de Traumatologie-Orthopédie, Hôpital Roger Salengro, Rue du Professeur Emile Laine, CHRU de Lille, 59037 Lille cedex, France.
| | - P D'Agostino
- Clinique de la Main, Bruxelles et Brabant-Wallon, Avenue Louise 284, 1050 Bruxelles, Belgique
| | - C Maes-Clavier
- Service de Chirurgie Orthopédique et Traumatologique, CHU Amiens-Picardie, Site sud Route départementale 408, 80054 Amiens cedex 1, France
| | - M Boutan
- Résidence Dryades, Bâtiment A1, 1, rue du 11 novembre, 40990 Saint-Paul-les-Dax, France
| | - N Sturbois-Nachef
- Clinique de Traumatologie-Orthopédie, Hôpital Roger Salengro, Rue du Professeur Emile Laine, CHRU de Lille, 59037 Lille cedex, France
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Three-dimensional geometric morphometric analysis of the first metacarpal distal articular surface in humans, great apes and fossil hominins. J Hum Evol 2019; 132:119-136. [DOI: 10.1016/j.jhevol.2019.04.008] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2018] [Revised: 04/23/2019] [Accepted: 04/23/2019] [Indexed: 11/18/2022]
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Odgers RA, Rayan GM. Axial Rotation Test for Trapeziometacarpal Joint Hypermobility in the Normal Population. J Hand Surg Asian Pac Vol 2018; 23:351-355. [DOI: 10.1142/s2424835518500352] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Background: The objective was to quantify joint laxity in healthy volunteers by measuring the passive axial rotation of the trapeziometacarpal joint using the axial rotation test. Methods: Eighty volunteers (34 men and 46 women) were subjected to the axial rotation shear test and the degree of total rotational motion (TRM) was assessed. Volunteers were divided into Group I with a range of 18–50 years old and Group II for 51 years and older. Statistical analysis was performed. Results: The average TRM in Group I was 32.3 mm for women, and 27.4 mm, for men (p = 0.04). The average TRM in women of Groups I and II, was 32.3 and 21.6 mm respectively, (p < 0.001). The average TRM in men of Groups I and II, was 27.4 and 19.4 mm (p < 0.001). In Group II the average TRM of women was 21.6 mm, and for men was 19.4 mm, which was not significantly different. Conclusions: Young women have greater degree of rotational laxity in the TM joint compared to men of the same age group and to older women. The axial rotation test can quantify the degree of rotational laxity of the TM joint.
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Affiliation(s)
- Ryan A. Odgers
- Hand Surgery Division, INTEGRIS Baptist Medical Center, Oklahoma City, OK, USA
| | - Ghazi M. Rayan
- Hand Surgery Division, INTEGRIS Baptist Medical Center, Oklahoma City, OK, USA
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He S, Xu L, Zhao S, Huang F. [Biomechanical evaluation of the first carpometacarpal joint stability by using different reconstruction methods]. ZHONGGUO XIU FU CHONG JIAN WAI KE ZA ZHI = ZHONGGUO XIUFU CHONGJIAN WAIKE ZAZHI = CHINESE JOURNAL OF REPARATIVE AND RECONSTRUCTIVE SURGERY 2017; 31:171-175. [PMID: 29786248 DOI: 10.7507/1002-1892.201610035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Objective To study the biomechanical differences of the first carpometacarpal joint stability by using different reconstruction methods so as to provide theoretical basis for the clinical choice of reconstruction method. Methods The upper limb specimens were selected from 12 fresh adult cadavers, which had no fracture, bone disease, dislocation of wrist joint, deformity, degeneration, or ligament injury on the anteroposterior and lateral X-ray films. The specimens were randomly divided into 5 groups: normal group, injury group, palmar carpometacarpal ligaments reconstruction group, dorsal carpometacarpal ligaments reconstruction group, and palmar and dorsal carpometacarpal ligaments reconstruction group. Three normal specimens were used as normal group, and then were made of the first carpometacarpal joint dislocation models (injury group); after the first carpometacarpal joint dislocation was established in the other 9 specimens; the volar ligament, dorsal ligament, and volar-dorsal ligaments were reconstructed with Eaton-Little method, Yin Weitian method, and the above two methods in 3 construction groups. The biomechanical test was done to obtain the load-displacement curve and to calculate the elastic modulus. Results During biomechanical test, ligament rupture and loosening of Kirschner wire occurred in 1 case of injury group and palmar carpometacarpal ligaments reconstruction group; no slipping was observed. The elastic modulus values were (11.61±0.20), (5.39±0.12), (6.33±0.10), (7.12±0.08), and (8.30±0.10) MPa in normal group, injury group, palmar carpometacarpal ligaments reconstruction group, dorsal carpometacarpal ligaments reconstruction group, and palmar and dorsal carpometacarpal ligaments reconstruction group respectively, showing significant differences among groups ( P<0.05). Conclusion Volar ligament reconstruction, dorsal ligament reconstruction, and volar-dorsal ligament reconstruction all can greatly improve the stability of the first carpometacarpal joint. And the effect of volar-dorsal ligament reconstruction is the best, but the stability can not restore to normal.
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Affiliation(s)
- Shukun He
- Department of Orthopedics, West China Hospital, Sichuan University, Chengdu Sichuan, 610041, P.R.China
| | | | - Sichun Zhao
- Department of Orthopedics, West China Hospital, Sichuan University, Chengdu Sichuan, 610041, P.R.China
| | - Fuguo Huang
- Department of Orthopedics, West China Hospital, Sichuan University, Chengdu Sichuan, 610041,
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Bilge O, Karalezli N. Current review of trapeziometacarpal osteoarthritis (rhizarthrosis). World J Rheumatol 2015; 5:90-95. [DOI: 10.5499/wjr.v5.i2.90] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2014] [Revised: 12/05/2014] [Accepted: 03/18/2015] [Indexed: 02/06/2023] Open
Abstract
Trapeziometacarpal (TMC) joint is the secondly affected joint for osteoarthritis in the hand. TMC joint arthritis affects most commonly postmenopausal women after the fifth decade of life, due to hormonal and structural factors. Rhizarthrosis may lead to a clinical spectrum from subtle symptoms to advanced symptoms such as; severe pain, limitation of range of motion, muscular weakness, bony deformities, and end up ultimately with disability. Regardless of the etiopathogenesis; a variety of non-surgical and surgical methods have been used for the treatment of rhizarthrosis, depending on the age of the patient, symptomatology and the stage of the disease. The main goals of the treatments are as follows; relief of pain, conservation or restoration the stability and mobility of the TMC joint with the optimal preservation of the strength of surrounding musculature. In this article, the current methods, which have been used for the treatment of TMC joint osteoarthritis, will be mainly reviewed, together with concise up-to-date information on both its diagnosis and the anatomy of the TMC joint.
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Ladd AL, Crisco JJ, Hagert E, Rose J, Weiss APC. The 2014 ABJS Nicolas Andry Award: The puzzle of the thumb: mobility, stability, and demands in opposition. Clin Orthop Relat Res 2014; 472:3605-22. [PMID: 25171934 PMCID: PMC4397810 DOI: 10.1007/s11999-014-3901-6] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2013] [Accepted: 08/14/2014] [Indexed: 01/31/2023]
Abstract
BACKGROUND The paradoxical demands of stability and mobility reflect the purpose and function of the human thumb. Its functional importance is underscored when a thumb is congenitally absent, injured, or afflicted with degenerative arthritis. Prevailing literature and teaching implicate the unique shape of the thumb carpometacarpal (CMC) joint, as well as its ligament support, applied forces, and repetitive motion, as culprits causing osteoarthritis (OA). Sex, ethnicity, and occupation may predispose individuals to OA. QUESTIONS/PURPOSES What evidence links ligament structure, forces, and motion to progressive CMC disease? Specifically: (1) Do unique attributes of the bony and ligamentous anatomy contribute to OA? (2) Can discrete joint load patterns be established that contribute to OA? And (3) can thumb motion that characterizes OA be measured at the fine and gross level? METHODS We addressed the morphology, load, and movement of the human thumb, emphasizing the CMC joint in normal and arthritic states. We present comparative anatomy, gross dissections, microscopic analysis, multimodal imaging, and live-subject kinematic studies to support or challenge the current understanding of the thumb CMC joint and its predisposition to disease. RESULTS The current evidence suggests structural differences and loading characteristics predispose the thumb CMC to joint degeneration, especially related to volar or central wear. The patterns of degeneration, however, are not consistently identified, suggesting influences beyond inherent anatomy, repetitive load, and abnormal motion. CONCLUSIONS Additional studies to define patterns of normal use and wear will provide data to better characterize CMC OA and opportunities for tailored treatment, including prevention, delay of progression, and joint arthroplasty.
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Affiliation(s)
- Amy L. Ladd
- />Department of Orthopaedic Surgery, Stanford University, Chase Hand Center, 770 Welch Road, Suite 400, Palo Alto, CA 94304 USA
| | - Joseph J. Crisco
- />Department of Orthopaedics, Warren Alpert Medical School of Brown University and Rhode Island Hospital, Providence, RI USA
| | - Elisabet Hagert
- />Hand & Foot Surgery Center, Karolinska Institutet, Stockholm, Sweden
| | - Jessica Rose
- />Department of Orthopaedic Surgery, Motion & Gait Analysis Laboratory, Lucile Packard Children’s Hospital, Palo Alto, CA USA
| | - Arnold-Peter C. Weiss
- />Department of Orthopaedics, Warren Alpert Medical School of Brown University and Rhode Island Hospital, Providence, RI USA
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D'Agostino P, Kerkhof FD, Shahabpour M, Moermans JP, Stockmans F, Vereecke EE. Comparison of the anatomical dimensions and mechanical properties of the dorsoradial and anterior oblique ligaments of the trapeziometacarpal joint. J Hand Surg Am 2014; 39:1098-107. [PMID: 24810939 DOI: 10.1016/j.jhsa.2014.02.025] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2013] [Revised: 02/19/2014] [Accepted: 02/20/2014] [Indexed: 02/02/2023]
Abstract
PURPOSE The respective roles of the dorsoradial (DRL) and anterior oblique (AOL) ligaments in stability of the highly mobile trapeziometacarpal (TMC) joint remain disputed. Earlier publications have pointed to the AOL as the key stabilizing structure; yet, more recent publications have challenged the stabilizing role of the AOL, favoring the DRL as the main TMC joint stabilizer. We executed an anatomical study of the ligaments, including detailed dissection to quantify the length, width, and thickness of the AOL and DRL and tested the material properties of these ligaments. METHODS Thirteen fresh frozen cadaveric thumbs from 9 specimens were used. Length, width, and thickness of the AOL and DRL were measured on magnetic resonance imaging and/or after dissection. Next, the first metacarpal and trapezium were isolated together with both ligaments, and both bones were cut sagittally to isolate a first metacarpal-AOL-trapezium and first metacarpal-DRL-trapezium complex from each thumb. These samples were subjected to cyclic loading in displacement-controlled tests. The obtained force-displacement curves were used to calculate stiffness and hysteresis of each sample. RESULTS Our results showed that the DRL is significantly shorter and thicker than the AOL, which is thin and ill-defined. Our results also indicate that the DRL has a higher stiffness than the AOL, making it a more likely candidate to provide joint stability. CONCLUSIONS Although the AOL has been asserted to be the primary restraint to dorsoradial subluxation, this view has been challenged over the past 10 years by several studies. These studies have shown the AOL to be relatively weak and compliant compared with the intermetacarpal and dorsoradial ligaments and have demonstrated that the DRL is the strongest and stiffest ligament of the TMC joint. Our studies confirm these findings. CLINICAL RELEVANCE This study indicates that the DRL is relatively stiff and thick, suggesting it should be repaired or reconstructed when disrupted to restore stability of the TMC joint.
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Affiliation(s)
- P D'Agostino
- Department of Development and Regeneration @ Kulak, Biomedical Sciences, KU Leuven, Belgium; Hand Clinic, Louise Medical Center, Brussels, Belgium; Europe Clinic, St-Elisabeth Clinic, Brussels, Belgium; Department of Radiology, UZ Brussel, Brussels, Belgium; Centre de Chirurgie de la Main, Clinique du Parc Léopold, Brussels, Belgium; HUDERF, ULB, Brussels, Belgium; Handgroep, AZ Groeninge, Kortrijk, Belgium.
| | - F D Kerkhof
- Department of Development and Regeneration @ Kulak, Biomedical Sciences, KU Leuven, Belgium; Hand Clinic, Louise Medical Center, Brussels, Belgium; Europe Clinic, St-Elisabeth Clinic, Brussels, Belgium; Department of Radiology, UZ Brussel, Brussels, Belgium; Centre de Chirurgie de la Main, Clinique du Parc Léopold, Brussels, Belgium; HUDERF, ULB, Brussels, Belgium; Handgroep, AZ Groeninge, Kortrijk, Belgium
| | - M Shahabpour
- Department of Development and Regeneration @ Kulak, Biomedical Sciences, KU Leuven, Belgium; Hand Clinic, Louise Medical Center, Brussels, Belgium; Europe Clinic, St-Elisabeth Clinic, Brussels, Belgium; Department of Radiology, UZ Brussel, Brussels, Belgium; Centre de Chirurgie de la Main, Clinique du Parc Léopold, Brussels, Belgium; HUDERF, ULB, Brussels, Belgium; Handgroep, AZ Groeninge, Kortrijk, Belgium
| | - J-P Moermans
- Department of Development and Regeneration @ Kulak, Biomedical Sciences, KU Leuven, Belgium; Hand Clinic, Louise Medical Center, Brussels, Belgium; Europe Clinic, St-Elisabeth Clinic, Brussels, Belgium; Department of Radiology, UZ Brussel, Brussels, Belgium; Centre de Chirurgie de la Main, Clinique du Parc Léopold, Brussels, Belgium; HUDERF, ULB, Brussels, Belgium; Handgroep, AZ Groeninge, Kortrijk, Belgium
| | - F Stockmans
- Department of Development and Regeneration @ Kulak, Biomedical Sciences, KU Leuven, Belgium; Hand Clinic, Louise Medical Center, Brussels, Belgium; Europe Clinic, St-Elisabeth Clinic, Brussels, Belgium; Department of Radiology, UZ Brussel, Brussels, Belgium; Centre de Chirurgie de la Main, Clinique du Parc Léopold, Brussels, Belgium; HUDERF, ULB, Brussels, Belgium; Handgroep, AZ Groeninge, Kortrijk, Belgium
| | - E E Vereecke
- Department of Development and Regeneration @ Kulak, Biomedical Sciences, KU Leuven, Belgium; Hand Clinic, Louise Medical Center, Brussels, Belgium; Europe Clinic, St-Elisabeth Clinic, Brussels, Belgium; Department of Radiology, UZ Brussel, Brussels, Belgium; Centre de Chirurgie de la Main, Clinique du Parc Léopold, Brussels, Belgium; HUDERF, ULB, Brussels, Belgium; Handgroep, AZ Groeninge, Kortrijk, Belgium
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Abstract
BACKGROUND Trapeziometacarpal (TMC) arthritis of the thumb is a common source of hand pain and disability. TMC ligamentous instability may play a role in TMC degeneration. However, the relative importance of the TMC ligaments in the etiology of degeneration and the use of surgery to treat instability in early-stage arthritis are unclear. QUESTIONS/PURPOSES In this review, we addressed several questions: (1) What are the primary ligamentous stabilizers of the thumb TMC joint? (2) What is the evidence for ligament reconstruction or ligament imbrication in the treatment of thumb TMC joint osteoarthritis? And (3) what is the evidence for thumb metacarpal osteotomy in the treatment of thumb TMC joint osteoarthritis? METHODS We performed a systematic review of the literature using PubMed (MEDLINE(®)) and Scopus(®) (EMBASE(®)) for peer-reviewed articles published until November 2012. Fifty-two studies fit the inclusion criteria. Twenty-four studies were anatomic, biomechanical, or histopathologic studies on TMC joint ligamentous anatomy, 16 studies were clinical studies concerning ligament reconstruction, and 12 studies were clinical studies on thumb metacarpal osteotomy. RESULTS Over the past two decades, increasing evidence suggests the dorsoradial ligament is the most important stabilizer of the TMC joint. Other ligaments consistently identified are the superficial anterior oblique, deep anterior oblique, intermetacarpal, ulnar collateral, and posterior oblique ligaments. Ligament reconstruction and metacarpal osteotomy relieve pain and improve grip strength based on Level IV studies. CONCLUSIONS The dorsal ligaments are the primary stabilizers of the TMC joint. Ligament reconstruction and metacarpal osteotomy ameliorate ligamentous laxity and relieve pain based on Level IV studies.
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Hirschmann A, Sutter R, Schweizer A, Pfirrmann CWA. The carpometacarpal joint of the thumb: MR appearance in asymptomatic volunteers. Skeletal Radiol 2013; 42:1105-12. [PMID: 23674185 DOI: 10.1007/s00256-013-1633-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2013] [Revised: 04/01/2013] [Accepted: 04/21/2013] [Indexed: 02/02/2023]
Abstract
PURPOSE To prospectively characterize the MR appearance of the carpometacarpal (CMC) joint of the thumb in asymptomatic volunteers. MATERIALS AND METHODS Thirty-four asymptomatic volunteers (17 women, 17 men, mean age, 33.9 ± 9.2 years) underwent MR imaging of the thumb after approval by the local ethical committee. Two musculoskeletal radiologists independently classified visibility and signal intensity (SI) characteristics of the anterior oblique (AOL/beak ligament), the posterior oblique (POL), the intermetacarpal (IML), and the dorsoradial ligaments (DRL) on a three-point Likert scale. The thickness of all ligaments, cartilage integrity, and presence of joint fluid were assessed. The alignment of the first metacarpal base with the trapezium was quantified on sagittal and coronal planes. RESULTS The ligaments of the CMC joint were constantly visible in all volunteers for the POL and IML, and in all but one for the AOL and DRL. On intermediate-weighted fat-saturated images the POL (65 %/74 % reader 1/reader 2) and DRL (58 %/64 %) were commonly of increased SI, while the IML had a striated appearance in 91 %/76 % of subjects. The AOL showed a variable SI (36 %/42 % low, 27 %/27 % increased, 36 %/30 % striated). The IML was the thickest ligament with a mean of 2.9 mm/3.1 mm and the DRL the thinnest (1.2 mm/1.4 mm). There was a mean dorsal subluxation of 1.8 mm/2.0 mm and radial subluxation of 2.8 mm/3.4 mm of the metacarpal base. The AOL was significantly thicker in men (1.7 mm) than in women (1.2 mm; p = 0.02). Radial subluxation was significantly larger in men (3.4 mm) than in women (2.2 mm; p = 0.02). No subluxation in palmar or ulnar direction was seen. CONCLUSIONS Radial and dorsal subluxation of the CMC joint can be a normal finding in a resting position at MR imaging. The CMC ligaments showed a considerable variability of signal intensity with a typically striated IML; thickness of the AOL is typically less than 2.2 mm, of the POL typically less than 2.9 mm.
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Affiliation(s)
- Anna Hirschmann
- Department of Radiology, Orthopedic University Hospital Balgrist, University of Zurich, Forchstrasse 340, 8008, Zurich, Switzerland.
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Ladd AL, Lee J, Hagert E. Macroscopic and microscopic analysis of the thumb carpometacarpal ligaments: a cadaveric study of ligament anatomy and histology. J Bone Joint Surg Am 2012; 94:1468-77. [PMID: 22992815 PMCID: PMC3412634 DOI: 10.2106/jbjs.k.00329] [Citation(s) in RCA: 86] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Stability and mobility represent the paradoxical demands of the human thumb carpometacarpal joint, yet the structural origin of each functional demand is poorly defined. As many as sixteen and as few as four ligaments have been described as primary stabilizers, but controversy exists as to which ligaments are most important. We hypothesized that a comparative macroscopic and microscopic analysis of the ligaments of the thumb carpometacarpal joint would further define their role in joint stability. METHODS Thirty cadaveric hands (ten fresh-frozen and twenty embalmed) from nineteen cadavers (eight female and eleven male; average age at the time of death, seventy-six years) were dissected, and the supporting ligaments of the thumb carpometacarpal joint were identified. Ligament width, length, and thickness were recorded for morphometric analysis and were compared with use of the Student t test. The dorsal and volar ligaments were excised from the fresh-frozen specimens and were stained with use of a triple-staining immunofluorescent technique and underwent semiquantitative analysis of sensory innervation; half of these specimens were additionally analyzed for histomorphometric data. Mixed-effects linear regression was used to estimate differences between ligaments. RESULTS Seven principal ligaments of the thumb carpometacarpal joint were identified: three dorsal deltoid-shaped ligaments (dorsal radial, dorsal central, posterior oblique), two volar ligaments (anterior oblique and ulnar collateral), and two ulnar ligaments (dorsal trapeziometacarpal and intermetacarpal). The dorsal ligaments were significantly thicker (p < 0.001) than the volar ligaments, with a significantly greater cellularity and greater sensory innervation compared with the anterior oblique ligament (p < 0.001). The anterior oblique ligament was consistently a thin structure with a histologic appearance of capsular tissue with low cellularity. CONCLUSIONS The dorsal deltoid ligament complex is uniformly stout and robust; this ligament complex is the thickest morphometrically, has the highest cellularity histologically, and shows the greatest degree of sensory nerve endings. The hypocellular anterior oblique ligament is thin, is variable in its location, and is more structurally consistent with a capsular structure than a proper ligament.
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Affiliation(s)
- Amy L. Ladd
- Robert A. Chase Hand & Upper Limb Center, Department of Orthopaedic Surgery, Stanford University, 770 Welch Road, Suite 400, Stanford, CA 94304. E-mail address for A.L. Ladd:
| | - Julia Lee
- Robert A. Chase Hand & Upper Limb Center, Department of Orthopaedic Surgery, Stanford University, 770 Welch Road, Suite 400, Stanford, CA 94304. E-mail address for A.L. Ladd:
| | - Elisabet Hagert
- Robert A. Chase Hand & Upper Limb Center, Department of Orthopaedic Surgery, Stanford University, 770 Welch Road, Suite 400, Stanford, CA 94304. E-mail address for A.L. Ladd:
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Imaeda T, Niebur G, Cooney WP, Linscheid RL, An KN. LIGAMENT LENGTH DURING CIRCUMDUCTION OF THE TRAPEZIOMETACARPAL JOINT AFTER LIGAMENT SECTIONING. ACTA ACUST UNITED AC 2011. [DOI: 10.1142/s0218957799000191] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Thumb motion and stability were examined after sequential division of support ligaments of the trapeziometacarpal (TMC) to simulate the pathologic condition of ligament laxity. The motion obtained with passive circumduction was measured with a magnetic tracking system. The lengths of the TMC joint ligaments were approximated by measuring the distance between origin and insertion of each ligament. The change in this apparent interorigin distance of the ligaments was measured before and after ligament sectioning. The anterior oblique ligament (AOL) and the ulnar collateral ligament (UCL) had the greatest effect on TMC joint stability during circumduction of the thumb. Division of the first intermetacarpal ligament (IML) did not produce a change in apparent length of other ligaments. We conclude that small changes in ligament length affect thumb stability and alter the path of circumduction. Neither the IML or posterior oblique ligaments were major stabilizers of the TMC joint during circumduction, prehensile grasp, or tip pinch. Reconstruction of the AOL and UCL ligaments should be considered for treatment of the initial stages of TMC instability.
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Affiliation(s)
- Toshihiko Imaeda
- Biomechanics Laboratory, Department of Orthopedics, Mayo Clinic and Mayo Foundation, Rochester, MN 55905, USA
| | - Glen Niebur
- Biomechanics Laboratory, Department of Orthopedics, Mayo Clinic and Mayo Foundation, Rochester, MN 55905, USA
| | - William P. Cooney
- Biomechanics Laboratory, Department of Orthopedics, Mayo Clinic and Mayo Foundation, Rochester, MN 55905, USA
| | - Ronald L. Linscheid
- Biomechanics Laboratory, Department of Orthopedics, Mayo Clinic and Mayo Foundation, Rochester, MN 55905, USA
| | - Kai-Nan An
- Biomechanics Laboratory, Department of Orthopedics, Mayo Clinic and Mayo Foundation, Rochester, MN 55905, USA
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14
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Current concepts of the anatomy of the thumb trapeziometacarpal joint. J Hand Surg Am 2011; 36:170-82. [PMID: 21193137 DOI: 10.1016/j.jhsa.2010.10.029] [Citation(s) in RCA: 109] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2010] [Accepted: 10/22/2010] [Indexed: 02/02/2023]
Abstract
This review article describes the anatomy of the thumb trapeziometacarpal joint. In the final phase of opposition screw home torque rotation of the volar beak of the thumb metacarpal in the pivot area of the trapezium recess and tension on the dorsal ligament complex create stability for power pinch and power grip. The resulting compressive shear forces can lead over time to trapeziometacarpal joint osteoarthritis.
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15
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Nanno M, Buford WL, Patterson RM, Andersen CR, Viegas SF. Three-dimensional analysis of the ligamentous attachments of the first carpometacarpal joint. J Hand Surg Am 2006; 31:1160-70. [PMID: 16945721 DOI: 10.1016/j.jhsa.2006.05.007] [Citation(s) in RCA: 36] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2006] [Revised: 05/05/2006] [Accepted: 05/08/2006] [Indexed: 02/07/2023]
Abstract
PURPOSE To show the ligamentous locations and attachments of the first carpometacarpal (CMC) joint on a 3-dimensional (3-D) surface model. METHODS Ten fresh-frozen cadaver wrists were used to dissect and identify the first CMC ligaments. Their ligamentous attachments and whole bone surfaces were digitized 3-dimensionally and their areas were calculated. The attachments of each ligament were represented in a model combining 3-D computed tomography surfaces overlaid by a digitized 3-D surface and also were shown visually by a specific color on 3-D bone images. The superimposed outlines of the ligamentous attachments on both the radial and ulnar base of the first metacarpal (MC) also are described. RESULTS Seven ligaments of the first CMC joint were identified: the dorsoradial ligament, the posterior oblique ligament, the superficial anterior oblique ligament, the deep anterior oblique ligament, the ulnar collateral ligament, the dorsal first MC ulnar base-second MC radial base intermetacarpal ligament, and the volar first MC ulnar base-second MC radial base intermetacarpal ligament. The detailed locations and areas of the ligamentous attachments of the first CMC joint were determined. The average locations of the centroid of the ligamentous attachments of the ulnar collateral and the dorsoradial ligaments were located ulnovolar and dorsoradial on the first MC base, respectively. CONCLUSIONS The anatomic 3-D attachment sites of the first CMC ligaments were shown qualitatively and their areas were quantified. The results of this study improve the knowledge and understanding of the normal anatomy and its impact on the mechanics of the first CMC joint. This should help in making an accurate assessment of radiographic images and treating injuries and degenerative changes in the first CMC joint by ligament reconstruction, repair, and arthroscopy.
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Affiliation(s)
- Mitsuhiko Nanno
- Department of Orthopaedic Surgery, Nippon Medical School, Tokyo, Japan
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16
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Pellegrini VD. The ABJS 2005 Nicolas Andry Award: osteoarthritis and injury at the base of the human thumb: survival of the fittest? Clin Orthop Relat Res 2005; 438:266-76. [PMID: 16131901 DOI: 10.1097/01.blo.0000176968.28247.5c] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
The basal joint complex, consisting of four trapezial articulations providing a foundation for the thumb, defines our anatomic evolution from a Simian ancestry by providing an opposable member. Ironically, the trapeziometacarpal joint also is responsible for the most common malady leading to operative reconstruction in the upper limb for arthritic disease. The paradoxic relationship between these two facts has stimulated investigation that has defined the scientific basis for common surgical procedures and provided a foundation for the development of novel treatments for conditions at the base of the thumb. Patterns of articular surface degeneration are determined by areas of contact loading in the joint. Ligament reconstruction, metacarpophalangeal joint flexion splinting, and extension metacarpal osteotomy for early disease resulting from instability all have biomechanical justification for their clinical application. Likewise, percutaneous pinning of Bennett's fracture dislocation is predicated on reestablishing functional continuity of the beak ligament and unloading the palmar joint surfaces. For advanced disease, ligament reconstruction has become the cornerstone of arthroplasty. Perhaps most importantly, the trapeziometacarpal joint as an instability model can provide insight into the interplay of mechanical and biological factors in producing the primary lesion associated with osteoarthritis.
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17
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Demir E, Wittemann M, Germann G, Sauerbier M. Treatment of Idiopathic Postmenopausal Osteoarthrosis of the Trapeziometacarpal Joint With the Epping Resection Arthroplasty Technique. Ann Plast Surg 2005; 54:147-52. [PMID: 15655464 DOI: 10.1097/01.sap.0000143607.46558.7a] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Surgical treatment of idiopathic postmenopausal osteoarthrosis of the trapeziometacarpal joint with the Epping resection arthroplasty was performed in 57 cases in 49 women. Data show good pain relief (between 58% and 76%), very good subjective results with 89% patient satisfaction and Disability of Arm, Shoulder, Hand (DASH) scores in the lower third of the scale after 35 months' follow-up. Good functional results with respect to radial abduction (51 degrees) and palmar flexion (45 degrees), as well as improvement in strength measurements, could be achieved. Some patients (13%) reported remaining problems with occasional pain during performance of activities of daily life and work. A significant proximal metacarpal migration (31%) without correlation to objective or subjective outcome was found. The Epping procedure has proven to be a valuable alternative procedure to treat idiopathic postmenopausal trapeziometacarpal arthrosis after a midterm follow-up period. Still, careful patient selection is important and sufficient preoperative information necessary.
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Affiliation(s)
- Erhan Demir
- Department of Hand, Plastic and Reconstructive Surgery, Burn Center, BG Trauma Center Ludwigshafen, Plastic and Hand Surgery of the University of Heidelberg, Ludwigshafen, Germany
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18
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Abstract
Biomechanics of the trapeziometacarpal joint (TMJ) are controversial, because of differences between its normal anatomical description and theories of its pathophysiology. The aim of this article is to explain the mechanisms underlying trapeziometacarpal osteoarthritis by means of the anatomy and physiology of the TM joint. Having described the main ligaments and their roles in the physiology of the joint, it is then difficult to understand why trapezectomy usually improves patients with TMO, when the ligaments are destroyed or only partially repaired by tendinoplasty. Different explanations of TMO are detailed but it seems, according to the literature, that TMO can be explained more by genetic considerations than anatomic dysfunction. The theory of Zancolli is not verified by facts, and other concepts such as ligament theory, and dysplasia of the caudal aspect of the trapezial bone are not sufficient to understand this disease. The same discussion is engaged with regard to explaining the automatic rotation of the thumb in the TM joint. The cantilever bending principle is described as proposed by Bettinger and al.
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Affiliation(s)
- M Rongieres
- Service d'orthopédie-traumatologie, CHU Purpan, place du Docteur-Beylac, 31059 Toulouse, France.
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19
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Bettinger PC, Linscheid RL, Cooney WP, An KN. Trapezial tilt: a radiographic correlation with advanced trapeziometacarpal joint arthritis. J Hand Surg Am 2001; 26:692-7. [PMID: 11466646 DOI: 10.1053/jhsu.2001.26187] [Citation(s) in RCA: 39] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Trapeziometacarpal (TMC) joint arthritis is a common and debilitating condition of the hand. We defined a radiographic measure of trapezial inclination (trapezial tilt) and found a positive correlation between an increased trapezial tilt and severity of TMC joint arthritis. Radiographs (Robert's views) were obtained from 50 pairs of normal hands to evaluate the trapezial tilt to assess radial inclination of the trapezium with respect to the second metacarpal. The trapezial tilt was also measured in 65 hands from 43 patients with various stages of TMC joint arthritis and compared with the normal value. The trapezial tilt for hands without arthritis was 42 degrees +/- 4 degrees, Eaton stages I and II was 42 degrees +/- 4 degrees, and Eaton stages III and IV was 50 degrees +/- 4 degrees. Trapezial tilt angles from the Eaton III and IV group were significantly greater than those of the normal and Eaton I and II groups. Advanced TMC joint arthritis (Eaton III and IV) is associated with an increased trapezial tilt. Mild TMC joint arthritis with an increased trapezial tilt may be treated surgically. We speculate that a trapezio-trapezoid and trapezio-II metacarpal arthrodesis, or an opening wedge osteotomy of the trapezium might arrest the progression of TMC joint arthritis by resetting the slope of the trapezium and decreasing the shear stress within the TMC joint.
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Affiliation(s)
- P C Bettinger
- Orthopaedic Biomechanics Lab, Mayo Graduate School of Medicine, Mayo Clinic, Rochester, MN 59505, USA
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20
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Abstract
Osteoarthritis at the base of the thumb is a common and extremely disabling condition that severely compromises function of the entire hand. Successful treatment is based on an understanding of the specific anatomy and the unique functional attributes of the human hand and thumb. Preservation of the web space is a priority in nonsurgical care and splinting as well as a principal goal of surgical reconstruction. Exercise regimens are designed to emphasize thenar strengthening to encourage preservation of the web space. Activity analysis and modification are focused on joint protection and the avoidance of positions that will accentuate the pathologic condition of trapeziometacarpal subluxation accompanying the retropulsion of the thumb that occurs with contracture of the web space. Surgical treatment is directed toward restoring the thumb-index web space and stabilizing the newly fabricated basal joint by reconstructing the beak ligament and providing a suitable interposition material. After-care likewise emphasizes restoration of the thumb web space, joint mobilization, and strengthening of the supporting thenar musculature. A well-integrated surgical and therapy team will produce uniformly good functional results in the treatment of this disabling condition at the base of the thumb that differentiates us from our simian ancestors.
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Affiliation(s)
- J U Poole
- Department of Orthopaedics and Rehabilitation, The Milton S. Hershey Medical Center, Hershey, Pennsylvania 17033, USA
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21
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Omokawa S, Ryu J, Tang JB, Han J, Kish VL. Trapeziometacarpal joint instability affects the moment arms of thumb motor tendons. Clin Orthop Relat Res 2000:262-71. [PMID: 10738436 DOI: 10.1097/00003086-200003000-00029] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
This study measured the changes in moment arm length of thumb motor tendons after simulated ligamentous instability and subsequent reconstruction of the trapeziometacarpal joint. Excursions of thumb motor tendons were measured simultaneously with the trapeziometacarpal joint angulation during flexion to extension and abduction to adduction motion. Tendon moment arms were calculated based on joint and tendon displacement techniques in the intact joint, after sequential sectionings of the capsuloligamentous restraints, and after the reconstruction procedure of Eaton and Littler. The results showed that moment arms of the abductor pollicis longus and extensor pollicis brevis tendons increased significantly as compared with those for normal joints during flexion to extension motion after sectioning the palmar capsuloligamentous components. After the ulnopalmar structures were cut, the moment arm of the extensor pollicis longus tendon had a statistically significant increase during abduction to adduction motion, and those of the extensor and flexor pollicis longus tendons decreased significantly during flexion to extension motion. Changed moment arms were restored to a normal level after the ligamentous reconstruction. These results indicate that ligamentous disruptions alter the mechanical balance of thumb motor tendons, which may contribute to joint deformities observed in trapeziometacarpal joint arthritis. Restoring joint stability is important to correct mechanical imbalance of the tendons.
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Affiliation(s)
- S Omokawa
- Department of Orthopedics, West Virginia University, Morgantown, USA
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22
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Bettinger PC, Linscheid RL, Berger RA, Cooney WP, An KN. An anatomic study of the stabilizing ligaments of the trapezium and trapeziometacarpal joint. J Hand Surg Am 1999; 24:786-98. [PMID: 10447171 DOI: 10.1053/jhsu.1999.0786] [Citation(s) in RCA: 149] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
We provide a detailed and comprehensive anatomic description of the ligaments stabilizing the trapezium and trapeziometacarpal joint. Sixteen ligaments were identified. Fourteen ligaments inserted onto the trapezium and 2 others attached independently to the thumb metacarpal. The ligaments inserting onto the trapezium were the superficial anterior oblique, deep anterior oblique (beak ligament), dorsoradial, posterior oblique, ulnar collateral, dorsal trapezio-trapezoid, volar trapezio-trapezoid, dorsal trapezio-second metacarpal, volar trapezio-second metacarpal, trapezio-third metacarpal, volar scaphotrapezial, radial scaphotrapezial, transverse carpal, and trapezio-capitate ligaments. The remaining 2 ligaments attach onto the thumb metacarpal and are the proper intermetacarpal and the dorsal intermetacarpal. The dorsoradial and deep anterior oblique ligaments play a substantial role in stabilizing the trapeziometacarpal joint, and the deep anterior oblique ligament may function as a pivot for the first metacarpal during palmar abduction to allow rotation (pronation). The dorsal trapezio-second metacarpal, volar trapezio-second metacarpal, and trapezio-third metacarpal ligaments function as tension bands and are required to prevent instability from cantilever bending forces on the trapezium.
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Affiliation(s)
- P C Bettinger
- Biomechanics Laboratory, Division of Orthopedic Research, Mayo Clinic and Mayo Foundation, Rochester, MN 55905, USA
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23
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Doerschuk SH, Hicks DG, Chinchilli VM, Pellegrini VD. Histopathology of the palmar beak ligament in trapeziometacarpal osteoarthritis. J Hand Surg Am 1999; 24:496-504. [PMID: 10357527 DOI: 10.1053/jhsu.1999.0496] [Citation(s) in RCA: 42] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Eighteen cadaver hands were studied to investigate the relationship between degeneration of the palmar beak ligament and articular disease of the trapeziometacarpal joint. Eight of 18 joints had chondromalacia alone; 10 contained areas of eburnation in the palmar aspect of the joint. Beak ligament degeneration correlated closely with the presence of articular degeneration; all joints with eburnation demonstrated frank detachment of the ligament from its metacarpal insertion site. Histologically, the collagen fibers of the beak ligament were disorganized at the metacarpal attachment. The normal insertional zone of fibrocartilage was often unrecognizable on the metacarpal side and, in more degenerative specimens, an intervening synovial recess appeared at the palmar beak of the metacarpal. The trapezial insertion of the beak ligament showed no degenerative change. Increasingly severe cartilage disease was associated with progressive and selective degeneration of the collagen framework of the beak ligament at its insertion onto the thumb metacarpal. These localized histopathologic findings further support the existence of an anatomically distinct intra-articular beak ligament essential to the normal function of the trapeziometacarpal joint and suggest an etiologic relationship to osteoarthritic disease.
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Affiliation(s)
- S H Doerschuk
- Department of Orthopaedics and Rehabilitation, The Pennsylvania State University, College of Medicine, Milton S. Hershey Medical Center, Hershey 17033, USA
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24
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Najima H, Oberlin C, Alnot JY, Cadot B. Anatomical and biomechanical studies of the pathogenesis of trapeziometacarpal degenerative arthritis. JOURNAL OF HAND SURGERY (EDINBURGH, SCOTLAND) 1997; 22:183-8. [PMID: 9149983 DOI: 10.1016/s0266-7681(97)80058-7] [Citation(s) in RCA: 37] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
An anatomical and biomechanical study of the stabilizing ligaments of the thumb trapeziometacarpal joint was conducted on 32 hand specimens. Five main ligamentous structures could be identified. The mechanical properties (in particular, strength) of the five ligaments using a strain-rate failure test were determined and evaluated quantitatively. The maximum tensile strength of each ligament was correlated with the condition of the trapeziometacarpal articular cartilage. In studying the anterior oblique ligament, maximum strength decreased from Grade 0 to Grade 1 by 51%. With the first intermetacarpal ligament, the drop from Grade 1 to Grade 2 was 53%. With the posterior oblique ligament, the decrease was closely related to the grade of the deterioration of the trapeziometacarpal articular surface. These three ligaments also significantly decreased in strength with age. Our results may suggest that the anterior oblique ligament, intermetacarpal ligament and posterior oblique ligament play a large role in stabilizing the trapeziometacarpal joint and that the decrease in their strength is related to the pathogenesis of trapeziometacarpal osteoarthritis.
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Affiliation(s)
- H Najima
- Department of Anatomy, University of Paris V, France
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25
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Abstract
Motion of the trapeziometacarpal joint was studied in 12 hands from fresh human cadavera. By use of a magnetic tracking system, a full range of motion of the first metacarpal was analyzed with respect to a defined trapezial coordinate system. The traces of the reference points on the head and base of the first metacarpal were monitored, and the instantaneous centers of rotation were calculated. During circumduction, the reference points on the head and base followed elliptical paths but in opposite directions. The average instantaneous center of circumduction was at approximately the center of the trapezial joint surface. In flexion-extension, the axis of rotation was located within the trapezium, and the path of the head was identical to the path of the base. In abduction-adduction, the axis of rotation was located distal to the trapezium within the base of the first metacarpal, and the base and head moved in opposite directions. There was no single center of rotation; rather, instantaneous motion occurred reciprocally between these centers of rotation within the trapezium and metacarpal base in the normal thumb. This changing instantaneous center of rotation results in a unique pattern of motion which is related to congruent, tightly constrained joint surfaces of two reciprocal saddle joints and to precisely positioned extraarticular ligaments.
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Affiliation(s)
- T Imaeda
- Department of Orthopedics, Mayo Clinic/Mayo Foundation, Rochester, Minnesota 55905
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26
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Abstract
This study was designed to examine the roles of ligaments in the maintenance of the articular kinematics of the trapeziometacarpal joint. Circumduction of the trapeziometacarpal joint was studied in 12 hands from fresh human cadavera. With use of a magnetic tracking system, changes in the motion of the base of the first metacarpal after ligament sectioning were analyzed and compared with those of the normal joint. Two sets of ligaments were sectioned: (a) the anterior oblique and ulnar collateral ligaments and (b) the first intermetacarpal ligament and the ulnar joint capsule. Sectioning of the anterior oblique and ulnar collateral ligaments resulted in a significant dorsal-ulnar shift in the path of the base of the first metacarpal. However, sectioning of the first intermetacarpal ligament did not affect the movement pattern of the center of the base. The anterior oblique and ulnar collateral ligaments provided constraint of the trapeziometacarpal joint during circumduction of the thumb.
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Affiliation(s)
- T Imaeda
- Department of Orthopedics, Clinic/Mayo Foundation, Rochester, Minnesota 55905
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27
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Abstract
The stabilizing ligaments of the thumb trapeziometacarpal joint were identified and studied during anatomic dissections of 30 hand specimens. Five main ligamentous structures were identified: (1) the anterior oblique ligament, (2) the ulnar collateral ligament, (3) the first intermetacarpal ligament, (4) the posterior oblique ligament, and (5) the dorsoradial ligament. It was observed that the anterior oblique ligament is the primary stabilizer of the trapeziometacarpal joint and is taut in abduction, extension, and pronation. The first intermetacarpal, ulnar collateral, and posterior oblique ligaments appear to be secondary stabilizers. In every specimen, the first intermetacarpal, ulnar collateral, and posterior oblique ligaments merged to form a force nucleus at the base of the first metacarpal. The dorsoradial ligament did not play a primary or secondary role in thumb stability. The clinical correlation of this anatomic study suggests that, at the minimum, the reconstruction of a primary thumb trapeziometacarpal ligament (anterior oblique ligament) is essential in the treatment of degenerative arthritis to maintain thumb stability.
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Affiliation(s)
- T Imaeda
- Orthopedic Biomechanics Laboratory, Mayo Clinic/Mayo Foundation, Rochester, Minn. 55905
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29
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van Oudenaarde E. The function of the abductor pollicis longus muscle as a joint stabiliser. JOURNAL OF HAND SURGERY (EDINBURGH, SCOTLAND) 1991; 16:420-3. [PMID: 1779157 DOI: 10.1016/0266-7681(91)90017-i] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
The abductor pollicis longus and extensor carpi ulnaris muscles function as a dynamic collateral ligament of the wrist. There are indications of a comparable situation over the carpo-metacarpal joint of the thumb. From experiments with tendon movements, we found that in passive motions of the thumb only the tendons of the superficial division show an excursion, regardless of the position of the wrist joint. However, in motions of the wrist joint the tendons show an identical excursion over an equal distance. These are small in pronation and supination but much larger in the mid-position between them. On some movements of the thumb and the wrist, no tendon excursions can be measured. There are strong indications that the deep division, particularly, has a stabilising function on the basal joint of the thumb.
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Affiliation(s)
- E van Oudenaarde
- Department of Anatomy and Embryology, University of Nijmegen, The Netherlands
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30
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Pellegrini VD. Osteoarthritis of the trapeziometacarpal joint: the pathophysiology of articular cartilage degeneration. I. Anatomy and pathology of the aging joint. J Hand Surg Am 1991; 16:967-74. [PMID: 1748767 DOI: 10.1016/s0363-5023(10)80054-1] [Citation(s) in RCA: 171] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
An anatomic study of the trapeziometacarpal joint was conducted on 47 cadaver thumb specimens. The superficial capsule restrained only metacarpal rotation about its long axis. Intracapsular anatomy was notable for a large anterior subthenar recess limited dorsally by the abductor pollicis longus insertion and palmarly by the deep palmar or "beak" ligament. This beak ligament was essential for translational stability of the metacarpal on the trapezium with flexion of the thumb ray. There was a direct correlation between the status of the articular surfaces and the integrity of the beak ligament. Normal surfaces were associated with an intact ligament confluent with the hyaline cartilage of the palmar lip of the metacarpal; degeneration of the palmar lip cartilage was always associated with attritional detachment of the beak ligament. Advanced articular disease occurred only in the palmar contact areas and was predicted by degeneration of the adjacent beak ligament; only nonprogressive chondromalacia was found on the dorsal portions of the articular surfaces.
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Affiliation(s)
- V D Pellegrini
- Department of Orthopaedics, University of Rochester School of Medicine and Dentistry, N.Y. 14642
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31
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Abstract
Radial and dorsal subluxation of the base of the first metacarpal is a frequent clinical and radiological phenomenon in association with the common condition of osteoarthrosis of the base of the thumb. In an attempt to determine if any ligamentous instability could be responsible for this displacement, a series of seventeen joints was dissected. The ligamentous structure is constant. Division of the first intermetacarpal ligament was alone found to be responsible for the development of the characteristic displacement of the base of the first metacarpal. In two specimens in which there was advanced osteoarthrosis, spontaneous attenuation of the first intermetacarpal ligament was demonstrated. In attempts at operative reconstruction it is the first intermetacarpal ligament which must be reinforced to provide stability.
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32
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Bojsen-Møller F. Extensor carpi radialis longus muscle and the evolution of the first intermetacarpal ligament. AMERICAN JOURNAL OF PHYSICAL ANTHROPOLOGY 1978. [DOI: 10.1002/ajpa.1330480209] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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