Thumb Carpometacarpal Ligaments Inside and Out: A Comparative Study of Arthroscopic and Gross Anatomy from the Robert A. Chase Hand and Upper Limb Center at Stanford University

Zhang, Andrew; Nortwick, Sarah Van; Hagert, Elisabet; Yao, Jeffrey; Ladd, Amy L.

doi:10.1055/s-0033-1338108

Cited by 2 publications

(3 citation statements)

References 21 publications

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“…In tandem with the recent skepticism on the role of the AOL, new evidence has emerged on the sturdiness and superior stabilizing potential of the DRL (Bettinger et al, 2000, 1999; Colman et al, 2007; D’Agostino et al, 2014; Hagert et al, 2012; Ladd et al, 2012; Strauch et al, 1999, 1994; Tan et al, 2011; Van Brenk et al, 1998; Zhang et al, 2013). The DRL is located on the dorsal-radial side of the CMC joint, opposite the AOL, and is described by these studies as the most robust ligamentous structure in the joint.…”

Section: Introductionmentioning

confidence: 99%

“…It originates on the radial side of the dorsal trapezial tubercle and inserts on the radial-dorsal side of the metacarpal, fanning out like a deltoid. Dissection studies have reported that it is the widest, thickest, and shortest ligament (Bettinger et al, 2000, 1999; Colman et al, 2007; Strauch et al, 1994; Tan et al, 2011; Van Brenk et al, 1998; Zhang et al, 2013). Moreover, histological studies have determined that the DRL contains greater cellularity and sensory innervations when compared to the AOL, thus concluding that the DRL may have a neuromuscular function, in addition to being a more robust stabilizer (Hagert et al, 2012; Ladd et al, 2012).…”

Section: Introductionmentioning

confidence: 99%

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In vivo recruitment patterns in the anterior oblique and dorsoradial ligaments of the first carpometacarpal joint

Halilaj

Rainbow

Moore

et al. 2015

Journal of Biomechanics

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The anterior oblique ligament (AOL) and the dorsoradial ligament (DRL) are both regarded as mechanical stabilizers of the thumb carpometacarpal (CMC) joint, which in older women is often affected by osteoarthritis. Inferences on the potential relationship of these ligaments to joint pathomechanics are based on clinical experience and studies of cadaveric tissue, but their function has been studied sparsely in vivo. The purpose of this study was to gain insight into the functions of the AOL and DRL using in vivo joint kinematic data. The thumbs of 44 healthy subjects were imaged with a clinical computed tomography scanner in functional-task and thumb range-of-motion positions. The origins and insertion sites of the AOL and the DRL were identified on the 3D bone models and each ligament was modeled as a set of three fibers whose lengths were the minimum distances between insertion sites. Ligament recruitment, which represented ligament length as a percentage of the maximum length across the scanned positions, was computed for each position and related to joint posture. Mean AOL recruitment was lower than 91% across the CMC range of motion, whereas mean DRL recruitment was generally higher than 91% in abduction and flexion. Under the assumption that ligaments do not strain by more than 10% physiologically, our findings of mean ligament recruitments across the CMC range of motion indicate that the AOL is likely slack during most physiological positions, whereas the DRL may be taut and therefore support the joint in positions of CMC joint abduction and flexion.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

In vivo recruitment patterns in the anterior oblique and dorsoradial ligaments of the first carpometacarpal joint

Halilaj

Rainbow

Moore

et al. 2015

Journal of Biomechanics

View full text Add to dashboard Cite

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“…Within the last decade, outside-in gross dissection, inside-out arthroscopic evaluation, and microscopic analysis verified the more stout and cellularly organized ligamentous support dorsally and the rather thin support volarly. 16,17 More organized collagen structure and the presence of proprioceptive mechanoreceptors was also more consistent at the dorsal deltoid complex supporting its more stabilizing role. 16,18 The ulnar complex is also an important stabilizer and is formulated as the volar and dorsal trapeziometacarpal ligaments conjoin from their more central proximal locations.…”

Section: Relevant Anatomymentioning

confidence: 85%

Thumb Carpometacarpal Instability

Rabinovich

Polatsch

Shin

et al. 2021

J Am Acad Orthop Surg

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The basal joint complex of the thumb provides the framework necessary for function of the human hand. Although its unique saddle articulation allows for a wide range of motion necessary for routine function of the hand, it is rendered inherently unstable because of poor bony congruency and reliance on its capsuloligamentous support. Painful instability of this joint can stem from several causes including traumatic dislocation, various hypermobility conditions, and chronic overuse and microtrauma. A thorough history and examination as well adequate imaging is necessary for proper evaluation of instability. Treatment options range from nonoperative modalities to surgery, which entails closed, percutaneous, or open reduction with numerous ligament repair and reconstruction techniques. Arthroscopy can also serve to be a useful adjunct for assessment of the joint and stabilization of the critical capsuloligamentous structures. This review outlines the critical osseous and soft-tissue anatomy surrounding the thumb carpometacarpal joint, the key points in evaluating patients presenting with acute traumatic and chronic thumb carpometacarpal instability without fracture or arthritis, and reviews both nonoperative and operative treatments of this injury.

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Thumb Carpometacarpal Ligaments Inside and Out: A Comparative Study of Arthroscopic and Gross Anatomy from the Robert A. Chase Hand and Upper Limb Center at Stanford University

Cited by 2 publications

References 21 publications

In vivo recruitment patterns in the anterior oblique and dorsoradial ligaments of the first carpometacarpal joint

In vivo recruitment patterns in the anterior oblique and dorsoradial ligaments of the first carpometacarpal joint

Thumb Carpometacarpal Instability

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