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The Journal of Hand Surgery Jul 2018To identify the layered relationship anatomically between the musculotendinous structures of the adductor pollicis, the ulnar collateral ligament, and the capsule of the...
Intramuscular Tendon of the Adductor Pollicis and Underlying Capsule of the Metacarpophalangeal Joint: An Anatomical Study With Possible Implications for the Stener Lesion.
PURPOSE
To identify the layered relationship anatomically between the musculotendinous structures of the adductor pollicis, the ulnar collateral ligament, and the capsule of the metacarpophalangeal joint in terms of understanding the pathomechanism of a Stener lesion.
METHODS
We macroscopically analyzed 37 cadaveric thumbs to identify the intramuscular tendon of the adductor pollicis and bony attachments of the joint capsule including the ulnar collateral ligament. In addition, we histologically analyzed 3 thumbs and made a 3-dimensional image of 3 other thumbs, using micro-computed tomography.
RESULTS
The adductor pollicis has 3 components of an intramuscular tendon (dorsal, palmar, and distal), which connect to form a lambda shape. The dorsal part inserts into the joint capsule dorsal to the ulnar sesamoid. The palmar part inserts into the ulnar sesamoid. The distal part inserts into the lateral tubercle of the proximal phalanx. The thickened and cord-like part of the joint capsule, which has generally been referred to as the proper ulnar collateral ligament, has a distinct bony attachment on the proximal slope of the lateral tubercle of the proximal phalanx separate from the adductor pollicis insertion.
CONCLUSIONS
Of the 3 components of the intramuscular tendon of the adductor pollicis muscle, the dorsal part inserted into not only the aponeurosis but also the joint capsule.
CLINICAL RELEVANCE
The results of the current study suggest the anatomic basis for a possible pathomechanism of the Stener lesion.
Topics: Aged, 80 and over; Cadaver; Collateral Ligament, Ulnar; Female; Humans; Imaging, Three-Dimensional; Joint Capsule; Male; Metacarpophalangeal Joint; Tendons; Thumb; X-Ray Microtomography
PubMed: 29395587
DOI: 10.1016/j.jhsa.2017.12.009 -
Computational and Mathematical Methods... 2021The treatment of type I-B triangular fibrocartilage complex superficial injury is always a challenge to orthopedists. The traditional outside-in suture method often...
BACKGROUND
The treatment of type I-B triangular fibrocartilage complex superficial injury is always a challenge to orthopedists. The traditional outside-in suture method often causes a risk of nervous irritation. We designed a modified outside-in suture through the joint capsule to repair the Palmer I-B triangular fibrocartilage complex superficial injury.
METHODS
From December 2014 to December 2018, we retrospectively collected the medical records of 18 patients in our hospital who used the modified outside-in suture through the joint capsule to repair type I-B triangular fibrocartilage complex superficial injury. Among them, there were 12 males and 6 females, with an average age of 36.2 years. There were 6 cases on the left side and 12 cases on the right side. Record the healing time of all patients after surgery and the occurrence of related complications, and record the pain visual analogue scale (VAS), grip strength, wrist flexion and extension, radioulnar deviation and forearm rotation range of motion, modified Mayo wrist joint function score, and disability of arm-shoulder-hand (DASH) score before operation and at the last follow-up.
RESULTS
One patient was lost to follow-up, and a total of 17 patients received the final follow-up. Patients were followed up for 24 to 36 months, with an average of 29.6 ± 3.0 months. No wound infection, nerve damage, or irritation occurred after the operation. At the last follow-up, 15 cases of wrist pain disappeared completely, and 2 cases had mild discomfort during exercise. At the last follow-up, VAS decreased from 3.8 ± 0.7 points before operation to 0.8 ± 0.7 points ( < 0.05); grip strength increased from 15.1 ± 3.1 kg before operation to 23.2 ± 1.5 kg ( < 0.05); wrist flexion and extension, radioulnar deflection, and forearm rotational mobility increased from 116.3 ± 2.2°, 37.0 ± 3.5°, and 141.6 ± 2.2° before operation to 117.2 ± 2.5° ( < 0.05), 38.9 ± 3.0° ( < 0.05), and 142.4 ± 1.9° ( < 0.05), respectively; the modified Mayo wrist joint function score increased from 66.1 ± 3.6 points to 82.5 ± 3.9 points ( < 0.05), of which 10 cases were excellent, 5 cases were good, 2 cases were fair, and the excellent and good rate was 88.2%; DASH score improved from 37.0 ± 5.7 points preoperatively to 8.0 ± 2.5 points ( < 0.05).
CONCLUSION
The modified outside-in suture through the joint capsule to repair the superficial injury of Palmer I-B triangular fibrocartilage complex has a good clinical effect and is worthy of clinical widespread promotion.
Topics: Adult; Computational Biology; Female; Hand Strength; Humans; Joint Capsule; Male; Range of Motion, Articular; Retrospective Studies; Suture Techniques; Treatment Outcome; Triangular Fibrocartilage; Wrist Injuries; Wrist Joint
PubMed: 34804195
DOI: 10.1155/2021/8387813 -
Archives of Orthopaedic and Trauma... Jul 2014The purpose of this study was to examine the arthroscopic anatomy of posteromedial capsule and magnetic resonance imaging (MRI) findings in internal derangement of the...
PURPOSE
The purpose of this study was to examine the arthroscopic anatomy of posteromedial capsule and magnetic resonance imaging (MRI) findings in internal derangement of the knee joint and to analyze the relationship between popliteal cysts and the posteromedial capsule.
METHODS
From 2011 to 2012, a prospective study included 194 knees of consecutive arthroscopic surgeries for assorted knee problems. The anatomy of the posteromedial joint capsule was evaluated arthroscopically and divided into three types by the presence of capsular fold and opening: no capsular fold and no opening (type I), capsular fold without opening (type II), capsular fold with opening (type III). The presence and size of popliteal cyst were documented by MRI.
RESULTS
Type I was observed in 160 knees (82.5 %), type II in 10 (5.1 %) and type III in 24 (12.4 %). Popliteal cysts were found in 25 knees (12.9 %) by MRI. Of these cases, symptomatic popliteal cysts were identified in 12 knees (6.9 %). On 160 knees demonstrated to be type I, only 3 knees (1.9 %) had popliteal cysts in MRI, 6 knees (60 %) in 10 knees of type II and 16 knees (66.7 %) in 24 knees of type III. Therefore, there was a statistically significant relationship between the type of anatomy in the posteromedial capsule and the popliteal cyst (p < 0.001).
CONCLUSION
An association between popliteal cyst and arthroscopic anatomy of posteromedial capsule was demonstrated. Comprehensive understanding and knowledge of the arthroscopic anatomy of posteromedial capsule would contribute to the arthroscopic approach in understanding the pathogenesis of popliteal cyst.
STUDY DESIGN
Development of diagnostic criteria on basis of consecutive patients.
LEVEL OF EVIDENCE
2.
Topics: Adolescent; Adult; Aged; Arthroscopy; Female; Humans; Imaging, Three-Dimensional; Joint Capsule; Knee Joint; Magnetic Resonance Imaging; Male; Middle Aged; Popliteal Cyst; Prospective Studies; Treatment Outcome
PubMed: 24781525
DOI: 10.1007/s00402-014-2001-0 -
Journal of Shoulder and Elbow Surgery 2009We hypothesized that both the AC joint capsule and CC ligaments are biomechanically robust structures in the anterior-posterior (AP) and superior-inferior (SI) planes...
HYPOTHESIS
We hypothesized that both the AC joint capsule and CC ligaments are biomechanically robust structures in the anterior-posterior (AP) and superior-inferior (SI) planes with low loads, and that these ligaments provide essential function in AC joint stability.
MATERIALS AND METHODS
Anterior-posterior (AP) and superior-inferior (SI) AC joint translations were quantified in 6 cadaver matched pairs with AC joint compressions of 10N, 20N and 30N, and with translational loads of 10N and 15N. Either the AC joint capsule or CC ligaments were transected, and measurements were then repeated. Biomechanical characteristics of the remaining AC joint capsule or CC ligaments were compared.
RESULTS
There were significant increases in AP translation with the cut AC joint capsule, and significant increases in SI translation with the cut CC ligaments (P < 0.0001). Compression significantly decreased translation (P < 0.0001).
DISCUSSION
Our study is supported by, and further develops, recent studies and anatomical knowledge. It offers two interpreted pieces of information for the sports medicine physician to consider for reconstruction of the AC joint. First, resection of the distal clavicle may have a detrimental effect. Second, repair of the AC joint capsule, in addition to the customarily repaired CC ligaments, appears to have a beneficial effect.
CONCLUSION
The AC joint capsule is a robust anatomical structure that contributes significantly to the AC joint stability, especially in the AP plane. Compression increases stability.
LEVEL OF EVIDENCE
Basic science study.
Topics: Acromioclavicular Joint; Aged; Biomechanical Phenomena; Cadaver; Female; Humans; Joint Capsule; Ligaments, Articular; Male; Middle Aged
PubMed: 19111475
DOI: 10.1016/j.jse.2008.08.003 -
Clinical Orthopaedics and Related... Jul 1994The effects of immobilization on the function of the glenohumeral joint and its capsule were investigated in eight beagle dogs. One foreleg of each animal was...
The effects of immobilization on the function of the glenohumeral joint and its capsule were investigated in eight beagle dogs. One foreleg of each animal was immobilized in a spica cast, and the dogs were euthanized after 4, 8, 12, and 16 weeks of immobilization in groups of two. The contralateral limb and the forelegs of two normal beagles were used as controls. At the time of euthanasia, the range of motion, intraarticular filling volume during passive movements of the joint, and intraarticular filling volume to rupture the capsule were measured. The synovium, including the capsule and the subscapular bursa, were examined histologically. In the immobilized limb, there was progressive restriction in the range of motion with increases in intraarticular pressure, and the filling volume that was required to cause a rupture of the capsule diminished. Morphologically, the capsule and the subscapular bursa showed focal adhesions. Thus, it appeared that immobilization of these canine forelimbs produced changes in the glenohumeral joint that resembled those of frozen shoulder in humans.
Topics: Animals; Bursa, Synovial; Dogs; Female; Immobilization; Joint Capsule; Range of Motion, Articular; Rupture; Shoulder Joint; Synovial Membrane
PubMed: 8020232
DOI: No ID Found -
Arthroscopy : the Journal of... Feb 2024Hip capsulotomy and capsule repair have minimal effect on joint kinematics during activities of daily living. With low demands placed on the hip, the hip capsule may...
Hip capsulotomy and capsule repair have minimal effect on joint kinematics during activities of daily living. With low demands placed on the hip, the hip capsule may provide little to no role on hip stability or microinstability. But the majority, if not all, patients undergoing hip arthroscopy are not content with only resuming basic activities of daily living. Seeking to optimize the hip joint to its maximum capacity should be the goal. Capsule repair is necessary in most to achieve that goal.
Topics: Humans; Femoracetabular Impingement; Arthroscopy; Activities of Daily Living; Joint Capsule; Hip Joint
PubMed: 38296441
DOI: 10.1016/j.arthro.2023.07.013 -
Journal of Oral and Maxillofacial... Jan 2007The aim of this work was to clarify the arrangement of the posterior segment of the temporomandibular joint capsule and its pertinent relationships.
PURPOSE
The aim of this work was to clarify the arrangement of the posterior segment of the temporomandibular joint capsule and its pertinent relationships.
MATERIALS AND METHODS
The temporomandibular region was dissected bilaterally in 20 adult cadavers. Natural stained latex was injected into 16 cadavers through the external carotid artery to facilitate the dissection of the arterial vessels.
RESULTS
The posterior segment of the joint capsule is made up of the so-called "bilaminar zone" of the articular disc. The upper internal portion of the posterior segment of the capsule was reinforced by the discomalleolar ligament. The retroarticular space was filled with loose connective tissue and the anterior branches of the anterior tympanic artery were distributed throughout the posterior segment of the joint capsule.
CONCLUSION
The posterior segment of the temporomandibular joint capsule corresponds to the bilaminar zone of the articular disc. The structures of the retroarticular space are extracapsular.
Topics: Aged; Arteries; Cadaver; Connective Tissue; Ear, Middle; Female; Humans; Joint Capsule; Ligaments, Articular; Male; Maxillary Artery; Middle Aged; Temporal Arteries; Temporomandibular Joint; Temporomandibular Joint Disc
PubMed: 17174760
DOI: 10.1016/j.joms.2005.11.099 -
Regional Anesthesia and Pain Medicine 2015Chronic knee pain is common in all age groups. Some patients who fail conservative therapy benefit from radiofrequency neurotomy. Knowledge of the anatomy is critical to... (Review)
Review
BACKGROUND AND OBJECTIVES
Chronic knee pain is common in all age groups. Some patients who fail conservative therapy benefit from radiofrequency neurotomy. Knowledge of the anatomy is critical to ensure a successful outcome. The purpose of this study was to reanalyze the innervation to the anterior knee capsule from the perspective of the interventional pain practitioner.
METHODS
The study included a comprehensive literature review followed by dissection of 8 human knees to identify the primary capsular innervation of the anterior knee joint. Photographs and measurements were obtained for each relevant nerve branch. Stainless-steel wires were placed along the course of each primary innervation, and radiographs were obtained.
RESULTS
Literature review revealed a lack of consensus on the number and origin of nerve branches innervating the anterior knee capsule. All dissections revealed the following 6 nerves: superolateral branch from the vastus lateralis, superomedial branch from the vastus medialis, middle branch from the vastus intermedius, inferolateral (recurrent) branch from the common peroneal nerve, inferomedial branch from the saphenous nerve, and a lateral articular nerve branch from the common peroneal nerve. Nerve branches showed variable proximal trajectories but constant distal points of contact with femur and tibia. The inferolateral peroneal nerve branch was found to be too close to the common peroneal nerve, making it inappropriate for radiofrequency neurotomy.
CONCLUSIONS
The innervation of the anterior capsule of the knee joint seems to follow a constant pattern making at least 3 of these nerves accessible to percutaneous ablation. To optimize clinical outcome, well-aligned radiographs are critical to guide lesion placement.
Topics: Anatomic Landmarks; Catheter Ablation; Dissection; Humans; Joint Capsule; Knee Joint; Peripheral Nerve Injuries; Radiography
PubMed: 26066383
DOI: 10.1097/AAP.0000000000000269 -
Hand Clinics Nov 2010For the distal radioulnar joint (DRUJ) to be stable, not only do the articulating surfaces need to be congruent and well aligned but also the capsule and ligaments need... (Review)
Review
For the distal radioulnar joint (DRUJ) to be stable, not only do the articulating surfaces need to be congruent and well aligned but also the capsule and ligaments need to be mechanically and sensorially competent. According to recent investigations, ligaments should not be regarded as simple static structures maintaining articular alignment but as complex arrangements of collagen fibers containing mechanoreceptors, which are able to generate neural reflexes aiming at a more efficient and a more definitive muscular stabilization. By careful planning and meticulous execution of surgical incisions to approach the DRUJ, the nerve endings innervating the capsule and DRUJ ligaments may be safeguarded, thus preserving the proprioceptive function of the joint.
Topics: Humans; Intraoperative Complications; Joint Capsule; Ligaments, Articular; Wrist Joint
PubMed: 20951897
DOI: 10.1016/j.hcl.2010.05.001 -
The Journal of Hand Surgery Nov 2013The Andrew J. Weiland Medal is presented by the American Society for Surgery of the Hand to a midcareer researcher who is dedicated to advancing patient care in the... (Review)
Review
The Andrew J. Weiland Medal is presented by the American Society for Surgery of the Hand to a midcareer researcher who is dedicated to advancing patient care in the field of hand surgery. This essay, awarded the Weiland Medal in 2012, focuses on posttraumatic elbow joint contractures. Joint contractures are well known to hand surgeons because they limit function of our patients. There is a thorough understanding of the pathoanatomy underlying joint contractures. However, the mechanisms leading to the pathoanatomy are either unknown or partially understood, depending on the etiology of the particular clinical condition. This review describes our research over the past 14 years on posttraumatic elbow joint contractures. It defines pathologic cellular, matrix, and growth factor changes in the joint capsule, elaborates on the development of an animal model of posttraumatic joint contractures, presents an evaluation of a potential prevention strategy based on our research, and outlines future plans to bring this work to the clinical realm for the benefit of patients.
Topics: Animals; Contracture; Disease Models, Animal; Elbow Joint; Humans; Joint Capsule; Ketotifen; Myofibroblasts; Elbow Injuries
PubMed: 24075128
DOI: 10.1016/j.jhsa.2013.07.031