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Journal of Anatomy May 2008The immunohistochemical labelling patterns of the extracellular matrix at the insertion of the flexor carpi ulnaris tendon and the entheses at both ends of the...
The immunohistochemical labelling patterns of the extracellular matrix at the insertion of the flexor carpi ulnaris tendon and the entheses at both ends of the pisometacarpal and pisohamate ligaments were compared in order to relate the molecular composition of the attachment sites to their mechanical environment. Tissue was obtained from elderly dissecting room cadavers and labelled with a panel of monoclonal antibodies directed against collagens, glycosaminoglycans, proteoglycans and matrix proteins. All entheses were fibrocartilaginous and labelled positively for molecules typically associated with articular cartilage (type II collagen, chondroitin 6 sulphate, aggrecan and link protein). Labelling for type II collagen was most conspicuous at the attachment of the flexor carpi ulnaris tendon. In the ligaments, type II collagen labelling was always greater at the pisiform end. Matrilin 1 was universally present at all five entheses examined and fibromodulin labelling was most intense around the tidemark. Fibromodulin may thus be involved in anchorage and/or the control of mineralization at the hard-soft tissue interface of entheses. The greater prominence of fibrocartilage at the pisiform enthesis of the flexor carpi ulnaris tendon than at any ligament attachment may relate to the marked change in the tendon insertional angle that occurs with wrist movements. We also suggest that the more fibrocartilaginous character of the proximal compared with the distal ends of the ligaments relates to the fact that the pisiform is anchored in position and is thus at the centre of rotation of any movement of ligaments attached to it.
Topics: Aged; Aged, 80 and over; Aggrecans; Chondroitin Sulfates; Collagen; Extracellular Matrix; Extracellular Matrix Proteins; Fibromodulin; Glycosaminoglycans; Humans; Immunohistochemistry; Ligaments, Articular; Pisiform Bone; Proteoglycans; Tendons
PubMed: 18399959
DOI: 10.1111/j.1469-7580.2008.00887.x -
BMJ Case Reports Apr 2010
Topics: Female; Fractures, Bone; Humans; Middle Aged; Pisiform Bone; Radiography; Splints; Wrist Injuries
PubMed: 22736214
DOI: 10.1136/bcr.07.2009.2132 -
Anatomy & Cell Biology Jun 2011Muscular variations of the flexor compartment of forearm are usual and can result in multiple clinical conditions limiting the functions of forearm and hand. The...
Muscular variations of the flexor compartment of forearm are usual and can result in multiple clinical conditions limiting the functions of forearm and hand. The variations of the muscles, especially accessory muscles may simulate soft tissue tumors and can result in nerve compressions. During a routine dissection of the anterior region of the forearm and hand, an unusual muscle was observed on the left side of a 65-year-old male cadaver. The anomalous muscle belly arose from the medial epicondyle approxiamately 1 cm posterolateral to origin of normal flexor carpi ulnaris muscle (FCU), and from proximal part of the flexor digitorum superficialis muscle. It inserted to the triquetral, hamate bones and flexor retinaculum. Passive traction on the tendon of accessory muscle resulted in flexion of radiocarpal junction. The FCU which had one head, inserted to the pisiform bone hook of hamate and palmar aponeurosis. Its contiguous muscles displayed normal morphology. Knowledge of the existence of muscle anomalies as well as the location of compression is useful in determining the pathology and appropriate treatment for compressive neuropathies. In this study, a rare accessory muscle has been described.
PubMed: 21829760
DOI: 10.5115/acb.2011.44.2.160 -
Clinical Biomechanics (Bristol, Avon) Oct 2010Carpal tunnel release and conservative interventions are widely used in clinical therapies of carpal tunnel syndrome. The efficacy of these treatment and interventions...
BACKGROUND
Carpal tunnel release and conservative interventions are widely used in clinical therapies of carpal tunnel syndrome. The efficacy of these treatment and interventions mainly lies in the exploitation of the mechanical properties of carpal tunnel. This study investigated the structural mechanics of the transverse carpal arch using cadaveric hands.
METHODS
Paired force was applied to the insertion sites of the transverse carpal ligament at both the distal (hamate-trapezium) and proximal (pisiform-scaphoid) levels of the carpal tunnel. The two pairs of forces were simultaneously applied in an inward or outward direction when the transverse carpal ligament was intact and transected. Transverse carpal arch and carpal tunnel compliance in response to the forces were analyzed. Three-way repeated measures ANOVA were used to examine the effect of the transverse carpal ligament status (intact/transected), the level of the carpal tunnel (distal/proximal) and the force application direction (inward/outward) on the biomechanics of the transverse carpal arch.
FINDINGS
Transverse carpal ligament plays a stabilizing role in resisting outward deformation of the carpal tunnel. The carpal tunnel at the proximal level is more flexible than the carpal tunnel at the distal level. The carpal tunnel is more compliant under the inward force application than under the outward force application.
INTERPRETATION
The understanding of carpal tunnel mechanics potentially helps to improve the existing strategies and to develop alternatives for the treatment of carpal tunnel syndrome.
Topics: Biomechanical Phenomena; Carpal Bones; Female; Hamate Bone; Humans; In Vitro Techniques; Ligaments, Articular; Male; Middle Aged; Trapezium Bone
PubMed: 20579787
DOI: 10.1016/j.clinbiomech.2010.05.011 -
Annals of Surgery Aug 1911
PubMed: 17862721
DOI: 10.1097/00000658-191108000-00013 -
British Journal of Sports Medicine Dec 1978Three squash racquets and one badminton player presented with pain in the base of the hypothenar eminence, due to minor degrees of subluxation of the pisiform bone. Two...
Three squash racquets and one badminton player presented with pain in the base of the hypothenar eminence, due to minor degrees of subluxation of the pisiform bone. Two of them also showed chondromalacia of the articular cartilage of the pisotriquetral joint. All four patients were relieved by excision of the pisiform bone and had returned to their normal daily and sporting activities within three months of their operation.
Topics: Adolescent; Adult; Athletic Injuries; Carpal Bones; Chronic Disease; Female; Humans; Joint Dislocations; Male; Sports; Wrist Injuries
PubMed: 444806
DOI: 10.1136/bjsm.12.4.195 -
British Journal of Sports Medicine Dec 2007Tendinopathy of the flexor carpi ulnaris tendon is a rare entity. Recent research revealed the role of a neurovascular ingrowth at the point of pain in various...
BACKGROUND
Tendinopathy of the flexor carpi ulnaris tendon is a rare entity. Recent research revealed the role of a neurovascular ingrowth at the point of pain in various tendinopathic locations, such as at the Achilles and patellar tendon, in plantar fasciitis as well as in supraspinatus and tennis elbow tendinopathy. However, beyond the elbow no such neovascularisation has been reported to date.
METHODS
We present a 35-year old tennis player suffering tremendous pain (visual analogue scale (VAS) rating of 9/10) at the flexor carpi ulnaris tendon with adjacent calcification in close proximity to the pisiform bone. The patient was assessed with power Doppler and laser Doppler quantification of neovascularisation at the point of pain.
RESULTS
Power Doppler and laser Doppler quantification of neovascularisation at the point of pain identified higher capillary blood flow at three points over the painful vs the non-painful tendon (146/240/232rU vs 93/74/70rU at the non-affected side). Sclerosing therapy using polidocanol under power and laser Doppler guidance was initiated, with immediate decrease of capillary blood flow by 25% with resolution of the neovascularisation in power Doppler. Immediately following sclerosing, the patient's reported pain level on the VAS was reduced from 9/10 to 4/10. Following a short period of rest, eccentric training of the forearm muscle was initiated over 12 weeks with functional complete recovery and complete resolution of wrist pain.
CONCLUSION
Sclerosing therapy using polidocanol under power- and laser-Doppler guidance can decrease capillary blood flow by 25% with resolution of the neovascularisation. Subsequent eccentric training of the forearm muscle over 12 weeks can result in complete resolution of wrist pain.
Topics: Adult; Exercise Therapy; Feasibility Studies; Humans; Male; Pain Measurement; Polidocanol; Polyethylene Glycols; Sclerosing Solutions; Tendinopathy; Tennis; Treatment Outcome; Ultrasonography; Wrist Injuries
PubMed: 17496066
DOI: 10.1136/bjsm.2007.036558 -
BMJ Case Reports Jan 2013A 53-year-old man presented with an open fracture of the pisiform after a fall on his left wrist. Treatment of the patient presented a dilemma between excision of the...
A 53-year-old man presented with an open fracture of the pisiform after a fall on his left wrist. Treatment of the patient presented a dilemma between excision of the proximal fragment and internal fixation. The patient underwent internal fixation with a 2.5 cortical screw. At 6 months follow-up the fracture appeared fully consolidated with full functional recovery of the wrist.
Topics: Bone Screws; Decision Making; Fracture Fixation, Internal; Fractures, Open; Humans; Male; Middle Aged; Osteotomy; Pisiform Bone; Radiography; Wrist Injuries
PubMed: 23307459
DOI: 10.1136/bcr-2012-007621 -
Romanian Journal of Morphology and... 2017Chondrosarcoma is a malignant hyaline cartilage forming tumor. It is a rare pathology, with an estimated incidence of one in 200 000 individuals per year. It appears in...
Chondrosarcoma is a malignant hyaline cartilage forming tumor. It is a rare pathology, with an estimated incidence of one in 200 000 individuals per year. It appears in two forms: primary, representing 90% of all cases and secondary emergence that develops on preexistent lesions. Primary chondrosarcomas are uncommon in the hand, with a frequency of only 1.5-3.2% of all chondrosarcomas. In conventional chondrosarcoma (cCS), the histological malignancy grading represents the main prognostic factor for surgical planning and prognosis. We present the case of a 60-year-old male, examined in the First Department of Orthopedics and Traumatology, "Dr. Pius Branzeu" Clinical Hospital, Timisoara, Romania, with non-specific symptoms in the right hand. After clinical examination and imagistics, surgery and histopathological examination of the tumor were performed. This showed a conventional well differentiated - G1 chondrosarcoma, as suggested also by imagistic and clinical context.
Topics: Bone Neoplasms; Chondrosarcoma; Hamate Bone; Hand; Humans; Magnetic Resonance Imaging; Male; Middle Aged; Pisiform Bone; Synovial Membrane
PubMed: 28523331
DOI: No ID Found -
Advances in Orthopedics 2011We report a case of isolated paralysis of the right adductor pollicis in a 30-year-old woman. Electromyographic study showed involvement of the deep motor branch of the...
We report a case of isolated paralysis of the right adductor pollicis in a 30-year-old woman. Electromyographic study showed involvement of the deep motor branch of the ulnar nerve. A ganglion and an anomalous muscle were both ruled out clinically and by MRI as a possible cause of the paralysis. At surgical exploration, we found a fibrous band joining the pisiform and the hook of the hamate bone that compressed the deep motor branch of the ulnar nerve. The fibrous band was excised, and a neurolysis of the motor branch of the ulnar nerve was performed. At followup, eight months later, the patient had fully recovered strength of the adductor muscle.
PubMed: 21991410
DOI: 10.4061/2011/321020