Comparison of the anatomical dimensions and mechanical properties of the dorsoradial and anterior oblique ligaments of the trapeziometacarpal joint.

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.

Elastographic characteristics of the metacarpal tendons in horses without clinical evidence of tendon injury.

Tendon and ligament injuries are common causes of impaired performance in equine athletes. Gray-scale ultrasonography is the current standard method for diagnosing and monitoring these injuries, however this modality only provides morphologic information. Elastography is an ultrasound technique that allows detection and measurement of tissue strain, and may provide valuable mechanical information about equine tendon and ligament injuries. The purpose of this study was to determine the feasibility, reproducibility, and repeatability of elastography; and to describe elastographic characteristics of metacarpal tendons in sound horses. Nineteen legs for 17 clinically sound horses without evidence of musculoskeletal pathology were included. Elastographic images of the superficial and deep digital flexor tendons and the branches of the suspensory ligament (tendon of the interosseous muscle) were described quantitatively and qualitatively. There was no statistically significant difference between operators (P = 0.86) nor within operators (P = 0.93). For qualitative assessments, reproducibility (0.46) was moderate and repeatability (0.78) was good. Similar to human Achilles tendons, equine tendons were classified as predominantly hard using elastography. There was no statistically significant difference in stiffness of the flexor tendons (P = 0.96). No significant difference in stiffness was found with altered leg position during standing (P = 0.84) and while nonweight bearing (P = 0.61). The flexor tendons were softer when imaged in longitudinal versus transverse planes (P < 0.01) however, the suspensory branches were not (P = 0.67). Findings supported future clinical application of elastography as a noninvasive "stall-side" imaging modality for evaluation of the tendons and ligaments of the distal forelimb in horses.

[The anatomical basis of the formation of the pedicled bone grafts on the upper extremity].

The study of the vascular bed of the upper extremities was performed by the method of anatomical preparation of 24 formalin-fixed cadaver specimens from 5 men and 7 women and by the injection of black latex into the arterial bed of 4 male and 4 female cadavers (16 specimens). The arteries, directly feeding the bones, and the arteries that provide blood supply to the muscles, attached to the bones, were studied. M. pectoralis major, m. pronator teres, m. pronator quadratus, mm. lumbricalis and interosseus were examined. These studies were followed by the experimental surgeries during which bone grafts on vascular pedicle were formed and moved. It was found that the feeding arteries of the bone grafts on musculo-vascular pedicle were: on the clavicula--the branches of a. thoracoacromialis, on the brachium--muscular branches of a. brachialis, on the proximal parts of forearm bones--muscular branches of a. radialis and ulnaris, on the distal parts of forearm bones--the branches of a. interosseous anterior, on the metacarpal bones--the branches of aa. metacarpalis palmaris and dorsalis. The size of the bone transplants is determined by the size of the defect of recipient field and varies from 3 to 8 cm. The displacement of vascularised bone graft can be made over the distance from 4 to 8 cm.

Design and validation of a simulator for equine joint injections.

Joint injections are commonly used in equine practice for diagnosis and treatment of joint disorders. Performing joint injections is hence an essential skill for equine practitioners. However, opportunities for veterinary students to practice this skill are often scarce in veterinary curricula. The aim of this study was to design and validate an equine joint injection simulator. We hypothesized that the simulator will enhance student ability and confidence in performing joint injections. The simulator was constructed around an equine forelimb skeleton with soft tissues rebuilt using building foam and rubber bands. An electrical circuit including a buzzer, a battery, wire wool in the joints, and a hypodermic needle at the end of the cable was incorporated. If the students placed the needle into the joint correctly, instant auditory feedback was provided by the buzzer. To validate the simulator, 45 veterinary students were allocated to three groups: cadaver limb, textbook, or simulator. Students' ability to perform joint injections was tested and students' opinions were evaluated with a questionnaire. The proportion of students performing a metacarpophalangeal (MCP) joint injection correctly was significantly higher in the cadaver (93%) and simulator (76%) groups compared to the textbook group (50%). There was no significant difference between groups for performing a distal interphalangeal (DIP) joint injection correctly. Students rated the learning experience with the cadaver and simulator group high and with the textbook group low. The joint injection simulator represents an affordable teaching aid that allows students to repeatedly practice this skill in their own time with immediate feedback.

An anatomic study on the junctura tendinum in the 4th intermetacarpal space and its clinical implication.

We report results of anatomic study in the fourth intermetacarpal space, focusing on the pattern of junctura tendinum and variations of extensor tendons of the little finger with its clinical implication on snapping of the little finger. Fifty unpaired cadaveric hands were dissected from the wrist to the middle phalanx of the ring and little fingers. The type of junctura tendinum was judged based on Von Schroder's classification and the relationship with EDC were recorded. EDC to the little finger and EDM were dissected and the numbers were recorded. Forty six hands (92%) exhibited a junctura tendinum in the fourth intermetacarpal space and it was Type III in 42 hands (84%). The EDC-little finger was absent in 76% (38 of 50 hands). When present, EDC-little finger originated most commonly as single thin tendon. The absence of an EDC-little finger was associated with increased incidence of Type III junctura tendinum (37 of 38 hands). An EDM was present in all 50 hands running from the fifth dorsal compartment. Based on these clinical and anatomic studies, we considered that the snapping of the little finger is more likely subluxation of junctura tendinum rather than subluxation/dislocation of EDC of the little finger.

Fossil evidence for early hominid tool use.

Although several Plio-Pleistocene hominids are found in association with stone and bone tools, it has been generally assumed that at any one time the hominid with the largest brain was the toolmaker. Fossils recovered over the last decade suggest that early hominids subsequent to 2.5 million years ago all might have used tools and occupied "cultural" niches. A test for humanlike precision grasping (the enhanced ability to manipulate tools) is proposed and applied to australopithecines and early Homo. The results indicate that tools were likely to have been used by all early hominids at around 2.0 million years ago. The earliest australopithecines, which predate the appearance of stone tools in the archaeological record, do not show signs of advanced precision grasping.

[Does the thumb have two phalanges or three? Development of ideas since Aristotle]. / Le pouce a-t-il deux ou trois phalanges ? Evolution des idées depuis Aristote.

Many controversies mark the long road of the history of anatomy. The hand is not exempt of them. Even Galen's clear thinking, founded on the strict determinism between the structure of an organ and its function, and based on animal dissection, was criticized. In view of the structural complexity of the hand, we will limit our study to one of the most symptomatic conceptual disagreements: whether the human thumb has two or three phalanges, according to whether we include the first metacarpus, or if the thumb's first phalanx is considered as the initial element. According to the latter theory, there is a missing element in the first digital row, and this missing element is the metacarpus. This theory is ancient and its evolution throughout history is discussed in our study. Finally, we explain the origin and bases of the reasoning that led us to suggest the word 'metaphalanx' to designate the first metacarpus.

[Hands and feet of prosimians primates. Attempts of morphologic characterization]. / Mains et pieds des primates prosimiens. Essai de caractérisation morphologique.

The length of the carpus and tarsus, the metacarpus and metatarsus, the fingers and toes of 142 prosimian apes was measured. The relationship expressed as a percentage was drawn up for each individual between the length of each osseous part and that of its third metacarpal in order to eliminate the differences related to the size of the rest of the body. This ratio was compared with that of man. The characteristic variations appeared at the level of the subfamilies. CONCERNING THE HAND: The carpus presented the same values as that of man except for that of the indris, which was shorter. The thumb had proportionally the same length as that of man, sometimes longer and sometimes smaller as in the Eulemurs, Hapalidea, Megalapidea, Indrises, Daubentonia and Perodictus. The different metacarpals, including the fourth, were a little shorter than the third. In these subfamilies, the second ray was also often shorter and even much shorter in the Megalapidea and the Perodictus. The other rays were a little longer, in particular the fourth which could exceed the third in rather many subfamilies. CONCERNING THE FOOT: The length of the tarsus was extremely variable. It was twice larger in the Galagoidae, definitely larger in the tarsius and discreetly in the Hapalidae, a little smaller in the other Lemurs and much smaller in the other Prosimian apes, joining in that the near totality of the simians. The hallux was proportionally as long as that of man and sometimes even longer. The metatarsals were sometimes a little longer, sometimes less long, but always appreciably of the same length between them. The other toes were short at the aye aye (daubentonia), of which the foot appeared even smaller than that of man. The toes of the other prosimious resembled much to the fingers and in the propithecus and the perodictus, the fourth took gigantic proportions. There has been establishment of an anatomical relation and functional calculus between the length of the last three rays of the hands and the feet of prosimian apes and the biomechanics of their trapezometacarpal and their first cuneometacarpal joints.

A dermatoglyphic study of the Kavalan aboriginal population of Taiwan.

By the 1970s, a number of dermatoglyphic studies of Taiwan aborigines (Gaoshan nationality) had been published, however in each only a few dermatoglyphic variables were addressed. Since that time, little new research has been conducted. In this study, we collected and analyzed the dermatoglyphs of 100 individuals of Kavalan, a Taiwan aboriginal population, and we reported a wide range of dermatoglyphic variables including total finger ridge count (TFRC), a-b total ridge count (a-b RC), atd angle and axial triradius percent distance (tPD), and frequencies of fingerprint pattern, palmar thenar pattern, palmar interdigital pattern, palmar hypothenar pattern, and simian line. This study is the first comprehensive dermatoglyphic research of any Taiwan aboriginal population.

Morphology of the thoracic limb of goat as evidenced by gross osteology and radiology.

The objective of this study was to provide the detailed normal gross osteology and radiographic anatomy of the thoracic limb in goats as a reference for clinical use and in biomedical research. Radiography of the thoracic limb was performed in five small East African goats. Radiographic findings were correlated with bone specimens from four adult small East African goats. The scapula was narrow. The major tubercle was large and extended proximally above the head of the humerus. The lateral supracondylar crest was less prominent. The lateral and medial epicondyles of the humerus were almost of the same size. The lateral surface of the lateral condyle of the humerus presented a prominent depression for the origin of extensors of the carpus and digits. The cranially located radial notch was deep seated and the radial tuberosity was represented by a rough area located nearer to the head of the radius. The fifth metacarpal bone was seen in all animals. The morphology of the thoracic limb of small East African goats indicated the presence of powerful extensor muscles and is restricted to forward and backward movements as an adaptation to terrestrial lifestyle.

Magnetic resonance imaging, ultrasonography and histology of the suspensory ligament origin: a comparative study of normal anatomy of warmblood horses.

REASONS FOR PERFORMING STUDY: The diagnosis of lameness caused by proximal metacarpal and metatarsal pain can be challenging. Magnetic resonance imaging (MRI) offers the possibility for further diagnosis but there have been no studies on the normal MRI appearance of the origin of the suspensory ligament (OSL) in conjunction with ultrasonography and histology. OBJECTIVES: To describe the MRI appearance of the OSL in fore- and hindlimbs of sound horses and compare it to the ultrasonographic and histological appearance. The findings can be used as reference values to recognise pathology in the OSL. METHODS: The OSL in the fore- and hindlimbs of 6 sound horses was examined by ultrasonography prior to death, and MRI and histology post mortem. Qualitative evaluation and morphometry of the OSL were performed and results of all modalities compared. RESULTS: Muscular tissue, artefacts, variable SL size and shape complicated ultrasonographic interpretation. In MRI and histology the forelimb OSL consisted of 2 portions, the lateral being significantly thicker than medial. The hindlimb SL had a single large area of origin. In fore- and hindlimbs, the amount of muscular tissue was significantly larger laterally than medially. Overall SL measurements using MRI were significantly higher than using histology and ultrasonography and histological higher than ultrasonographic measurements. Morphologically, there was a good correlation between MRI and histology. CONCLUSIONS: MRI provides more detailed information than ultrasonography regarding muscle fibre detection and OSL dimension and correlates morphologically well with histology. Therefore, ultrasonographic results should be regarded with caution. POTENTIAL RELEVANCE: MRI may be a diagnostic aid when other modalities fail to identify clearly the cause of proximal metacarpal and metatarsal pain; and may improve selection of adequate therapy and prognosis for injuries in this region.

Cross-sectional geometry of the metapodial bones in the calf and ox.

The purpose of this study was to present a detailed description of the cross-sectional geometry at three levels of the metapodial bones and to assess the bone strength from the bone geometry in calf and ox. For this purpose, 20 metapodial bones from five calves and 40 metapodial bones from ten oxen were used. Sections were made at 25, 50 and 75% of the bone length and scanned. The cortical thickness, endosteal and periosteal diameters, cortical and medullar areas as well as second moment of area and section modulus were obtained from the images with the aid of a computer program. The cortical thickness and area values were higher in the metatarsus than that those in the metacarpus. The smallest cortical area and the thinnest cortical thickness were found at the distal level of metapodial bone in both calf and ox. When compared with the calf, relative increases in cortical area were seen at the proximal and distal levels, and the increases in cortical thickness were pronounced in the medial, lateral and dorsal sides in the metacarpus of the ox. With respect to the second moment of area and the polar moment, significant differences between metacarpus and metatarsus were found at the distal half of the bones in the calf while these differences were at the proximal half in the ox. The results of the current study indicated that there were important differences between the metacarpus and metatarsus as well as between the levels of the same bone with regard to the values of the geometric and strength parameters.

Bilateral symmetry of the human metacarpal: implications for sample size calculations.

OBJECTIVE: The aim of this study was to assess the three-dimensional mechanical symmetry of the human second metacarpal and provide sample size estimates for future mechanical intervention studies of the metacarpal. DESIGN: Bone densitometry and digital image analysis were used to assess the morphometric, geometric and densitometric symmetry of the second human metacarpal. BACKGROUND: An assessment of the left-right mechanical symmetry of the human metacarpal is important in considering the suitability of using the contralateral metacarpal as a control and in providing sample size calculations for future studies involving a mechanical intervention to the metacarpal such as implantation of a metacarpophalangeal prosthesis. METHODS: Metaphyseal sectional areas, diaphyseal cortical sectional areas, second moments of area, average periosteal and medullary radii and bone densities were measured at nine transverse levels for each of seven pairs of index metacarpals using computed tomography and bone densitometry. Polar Fourier regression was used to assess the morphometry of sectional periosteal and endosteal boundaries. Differences between clinically important left-right parameters were assessed. RESULTS: Mean differences between clinically important left-right parameters were small (<3%) and similar to the degree of experimental precision. There were strong significant left-right correlations for the morphometric, geometric and densitometric parameters considered, indicating a high degree of bilateral mechanical symmetry. CONCLUSIONS: The contralateral bone is a suitable control for mechanical intervention studies of the human metacarpal, and the use of bilateral pairing results in an important reduction in sample size. RELEVANCE: Responses to mechanical interventions on the human metacarpal, such as implantation of a metacarpophalangeal prosthesis, are generally unknown. The degree of left-right mechanical symmetry in the human metacarpal provides a measure of the advantage of using paired design studies to address these questions.

Skeletal segments of the human pollical and hallucal rays: comparison and analysis of their intrinsic proportions.

Since in humans, the first digital ray has a different functional significance in the hand and in the foot, the comparison of the pollical and hallucal rays seems interesting in order to evaluate the influence of specific evolutionary functional factors and biomechanical constraints. The objective of this study was to provide original and detailed data on the intrinsic proportions of the three segments of the human pollical and hallucal rays (metacarpal or metatarsal bone, proximal phalanx, and distal phalanx) in order to allow a quantitative comparison of their relative development. No similar data evaluated from three-dimensional approaches (volumetric or ponderal) seem to be available in the literature. The material consisted of 77 skeletons of the pollical ray and 77 skeletons of the hallucal ray of normal adult individuals. The ponderal approach was used. The first metapodial represented a mean of 57.17% for the pollical ray and 68.48% for the hallucal ray, whereas the phalanges respectively represented 42.83% and 31.52%. The intrinsic phalangeal proportions were almost identical for the pollex and for the hallux (respectively, 71.76% and 72.88% for the proximal phalanx; and 28.24% and 27.12% for the distal phalanx). Since these intrinsic proportions are the reflection of biological, functional and evolutionary constraints, these data seem of interest for the analysis of the functional significance of these rays, for the characterization of malformative syndromes in clinical practice, for reference in comparative morphology, and for the interpretation of hominid fossil bones.

An uncommon form of the rare extensor carpi radialis accessorius.

Two accessory muscles were found in the lateral compartment of the forearm while dissecting a 92-year-old female cadaver. One of these originated from the extensor carpi radialis brevis, became tendinous and travelled between the two radial extensor tendons. It inserted independently into the second metacarpal bone, and may be regarded as an extensor carpi radialis intermedius. The other accessory muscle originated from the extensor carpi radialis longus, passed superficially over the parent tendon and inserted into the abductor pollicis brevis. This variation appeared to be a rare extensor carpi radialis accessorius, an additional muscle, which usually arises from below the extensor carpi radialis longus and inserts into the first metacarpal bone. Various forms of the accessorius have been described previously, including one that inserts into the abductor pollicis brevis. The tendon of the accessory muscle described in this study passed through its own dorsal tunnel under the extensor retinaculum, making it an uncommon form of the rare accessorius.

Third metacarpal bone laterality asymmetry and midshaft dimensions in Thoroughbred racehorses.

OBJECTIVE: The aims of this study were to test whether longer third metacarpal (MC3) bones had thicker dorsal cortices in a group of racehorses that were exercising at similar maximum speeds, and to establish if horses with larger differences in length between their right and left MC3 bones showed larger differences in the dorsal cortical thickness between the two limbs. DESIGN: An observational study. PROCEDURE: Forty Thoroughbred racehorses aged between 2 and 6 years and in training at racing speed at two racing stables were used. Two sets of radiographs of each left and right metacarpus of each horse were measured for bone length and dorsal cortical width according to standardised methods. RESULTS: The dorsal cortex thickness showed a linear relationship with bone length for the range of lengths between 25 and 30 cm for both the right MC3 (R2 = 0.30, P = 0.0003) and the left (R2 = 0.23, P = 0.002). The longer bones had thicker dorsal cortices. When results from the two limbs were combined to test if the difference in length between the right and left MC3 in an individual horse was associated with a thicker dorsal cortex in the longer MC3 there was no consistent relationship (R2 = 0.008, P = 0.58). CONCLUSION: In this sample of racehorses longer MC3 bones were likely to have been exposed to a greater dorsopalmar bending moment at the mid shaft that was reflected in a thicker dorsal cortex. The lack of a relationship between midshaft thickness and bone length within individual horses suggests that direct mechanical effects of conformation and environment were less important than the individual's level of skill (or the degree of laterality in their movements) developed before their exposure to fast exercise. It is likely that racehorses with longer right MC3 bones were more able to control the loading of the right MC3 than the left during fast exercise.

Human evolution. Comment on "Human-like hand use in Australopithecus africanus".

Skinner and colleagues (Research Article, 23 January 2015, p. 395), based on metacarpal trabecular bone structure, argue that Australopithecus africanus employed human-like dexterity for stone tool making and use 3 million years ago. However, their evolutionary and biological assumptions are misinformed, failing to refute the previously existing hypothesis that human-like manipulation preceded systematized stone tool manufacture, as indicated by the fossil record.

Human evolution. Response to Comment on "Human-like hand use in Australopithecus africanus".

Almécija and colleagues claim that we apply a simplified understanding of bone functional adaptation and that our results of human-like hand use in Australopithecus africanus are not novel. We argue that our results speak to actual behavior, rather than potential behaviors, and our functional interpretation is well supported by our methodological approach, comparative sample, and previous experimental data.

Human evolution. Human-like hand use in Australopithecus africanus.

The distinctly human ability for forceful precision and power "squeeze" gripping is linked to two key evolutionary transitions in hand use: a reduction in arboreal climbing and the manufacture and use of tools. However, it is unclear when these locomotory and manipulative transitions occurred. Here we show that Australopithecus africanus (~3 to 2 million years ago) and several Pleistocene hominins, traditionally considered not to have engaged in habitual tool manufacture, have a human-like trabecular bone pattern in the metacarpals consistent with forceful opposition of the thumb and fingers typically adopted during tool use. These results support archaeological evidence for stone tool use in australopiths and provide morphological evidence that Pliocene hominins achieved human-like hand postures much earlier and more frequently than previously considered.

Normal cortical bone mass in patients after long term coumadin therapy.

Clinical delineation of the warfarin embryopathy and the recent discovery of osteocalcin (a vitamin K-dependent bone protein) suggest that coumadin therapy could adversely affect the skeleton. Using bone densitometry and metacarpal cortical width measurement, we found normal cortical bone mass in 17 adults receiving long term coumadin therapy.