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Park J, Sohn D, Ko YJ. Anatomical location of motor branch points in the flexor digitorum superficialis for the injection site of botulinum toxin. Surg Radiol Anat 2023; 45:1593-1597. [PMID: 37897524 DOI: 10.1007/s00276-023-03260-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Accepted: 10/19/2023] [Indexed: 10/30/2023]
Abstract
OBJECTIVE To locate the intramuscular nerve branches of the flexor digitorum superficialis (FDS) and determine the accurate site for botulinum toxin injection. DESIGN This study anatomically dissected 24 arms of 12 fresh adult cadavers to find intramuscular nerve endings in the FDS. The motor branch points (MBPs), proximal limit points (PLPs), and distal limit points (DLPs) of the terminal intramuscular nerve endings were identified. These three parameters were expressed in longitudinal and transverse coordinates in relation to the FDS driving as a reference line. RESULTS The mean length of the reference line was 234.6 ± 11.2 mm. In the longitudinal coordinate, the MBPs, PLPs, and DLPs were located at 41.6% (standard deviation (SD) 2.6%), 35.1% (SD 4.1%), and 53.4% (SD 4.6%) of the reference line in the first main branch and 72.4% (SD 4.5%), 67.5% (SD 1.5%), and 82.0% (SD 5.7%) in the second main branch, respectively. The mean value of the transverse coordinate was not greatly deviated from the reference line. CONCLUSION The MBPs of the first and second main branches are located approximately 41.6% and 72.4% of the reference line, which considers the FDS direction, respectively. This finding helps determine the optimal injection site for botulinum toxin in the FDS.
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Affiliation(s)
- Jihye Park
- Department of Rehabilitation Medicine, Graduate School, The Catholic University of Korea, Seoul, Republic of Korea
- Department of Rehabilitation Medicine, Eunpyung St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Donggyun Sohn
- Graduate School of Public Health, Seoul National University, Seoul, Republic of Korea
- Outpatient Medical Rehabilitation Center, Korea Workers' Compensation Welfare Service Incheon Hospital, Incheon, Republic of Korea
| | - Young Jin Ko
- Department of Rehabilitation Medicine, Graduate School, The Catholic University of Korea, Seoul, Republic of Korea.
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Arakawa T, Campisi E, Tran J, Agur AMR. Dissection, digitization, and three-dimensional modelling: a high-fidelity anatomical visualization and imaging technology. Anat Sci Int 2023:10.1007/s12565-023-00725-7. [PMID: 37184810 DOI: 10.1007/s12565-023-00725-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Accepted: 04/07/2023] [Indexed: 05/16/2023]
Abstract
Technological advances have enabled the development of a novel technique of dissection, digitization and three-dimensional modelling of skeletal muscle and other tissues including neurovascular structures as in situ over the last 25 years. Meticulous serial dissection followed by digitization is used to collect Cartesian coordinate data of the contractile and connective tissue elements throughout the entire muscle volume. The Cartesian coordinate can then be used to construct high-fidelity three-dimensional models that capture the spatial arrangement of the contractile and connective tissue elements as in situ enabling detailed studies of the arrangement of the fiber bundles and their attachment sites to aponeuroses, tendon, and bone. In the laboratory, we have concurrently developed a computational methodology to quantify architectural parameters, including fiber bundle length, pennation angle, volume, physiological cross-sectional area in three-dimensional space. In this paper, a flexor digitorum superficialis specimen will be used to demonstrate the high-fidelity outcomes of dissection, digitization, and three-dimensional modelling. This three-step methodology provides a unique opportunity to study muscle architecture in three dimensions, as in situ. Knowledge translation from the anatomy laboratory to the clinical setting has been highly successful.
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Affiliation(s)
- Takamitsu Arakawa
- Department of Rehabilitation Sciences, Kobe University Graduate School of Health Sciences, 7-10-2, Tomogaoka, Suma-Ku, Kobe, 654-0142, Japan
| | - Emma Campisi
- Musculoskeletal and Peripheral Nerve Anatomy Laboratory, Division of Anatomy, Department of Surgery, University of Toronto, 1 King's College Circle Room 1158, Toronto, ON, M5S 1A8, Canada
| | - John Tran
- Musculoskeletal and Peripheral Nerve Anatomy Laboratory, Division of Anatomy, Department of Surgery, University of Toronto, 1 King's College Circle Room 1158, Toronto, ON, M5S 1A8, Canada
| | - Anne M R Agur
- Musculoskeletal and Peripheral Nerve Anatomy Laboratory, Division of Anatomy, Department of Surgery, University of Toronto, 1 King's College Circle Room 1158, Toronto, ON, M5S 1A8, Canada.
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Old name, new face: A systematic analysis of flexor digitorum superficialis muscle with "chiasma antebrachii". Ann Anat 2023; 247:152052. [PMID: 36690043 DOI: 10.1016/j.aanat.2023.152052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2022] [Revised: 01/04/2023] [Accepted: 01/12/2023] [Indexed: 01/21/2023]
Abstract
The gross anatomy of the forearm flexors, particularly that of the flexor digitorum superficialis (FDS) muscle, has been described and graphically illustrated in several anatomical books and atlases starting in the middle of the century before last. However, in anatomical dissection studies as well as in clinical-anatomical courses training muscle-specific targeted injections due to movement disorders such as dystonia or spasticity, it has become apparent that there is a need for a closer investigation of the complex construction of the FDS muscle. To this end, we studied the structure of the muscle bellies and tendons of FDS on 46 human body donates that have been used either in our dissection or clinical-anatomical training courses. With this, we demonstrate here the topographical configuration of the individual muscle belly for each of digits 2 through 5 and the exact paths of their tendons until their passing through the carpal tunnel. Furthermore, we demonstrate the presence of a chiasm of the FDS tendons for the digits 2 and 3, approximately 3-4 cm proximal of the carpal tunnel. Thus, we introduce herewith the terminology "chiasma antebrachii". These findings were confirmed in situ by imaging of fixed human body donates via MRI and corroborated by MRI and ultrasound imaging in two volunteers. Taken together, the present findings enable an updated understanding of the complex organization of the heads, bellies, and tendons of FDS that is relevant not only for anatomical teaching but also clinical interventions.
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Meyer MR, Jung JP, Spear JK, Araiza IF, Galway-Witham J, Williams SA. Knuckle-walking in Sahelanthropus? Locomotor inferences from the ulnae of fossil hominins and other hominoids. J Hum Evol 2023; 179:103355. [PMID: 37003245 DOI: 10.1016/j.jhevol.2023.103355] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Revised: 03/03/2023] [Accepted: 03/03/2023] [Indexed: 04/03/2023]
Abstract
Because the ulna supports and transmits forces during movement, its morphology can signal aspects of functional adaptation. To test whether, like extant apes, some hominins habitually recruit the forelimb in locomotion, we separate the ulna shaft and ulna proximal complex for independent shape analyses via elliptical Fourier methods to identify functional signals. We examine the relative influence of locomotion, taxonomy, and body mass on ulna contours in Homo sapiens (n = 22), five species of extant apes (n = 33), two Miocene apes (Hispanopithecus and Danuvius), and 17 fossil hominin specimens including Sahelanthropus, Ardipithecus, Australopithecus, Paranthropus, and early Homo. Ulna proximal complex contours correlate with body mass but not locomotor patterns, while ulna shafts significantly correlate with locomotion. African apes' ulna shafts are more robust and curved than Asian apes and are unlike other terrestrial mammals (including other primates), curving ventrally rather than dorsally. Because this distinctive curvature is absent in orangutans and hylobatids, it is likely a function of powerful flexors engaged in wrist and hand stabilization during knuckle-walking, and not an adaptation to climbing or suspensory behavior. The OH 36 (purported Paranthropus boisei) and TM 266 (assigned to Sahelanthropus tchadensis) fossils differ from other hominins by falling within the knuckle-walking morphospace, and thus appear to show forelimb morphology consistent with terrestrial locomotion. Discriminant function analysis classifies both OH 36 and TM 266 with Pan and Gorilla with high posterior probability. Along with its associated femur, the TM 266 ulna shaft contours and its deep, keeled trochlear notch comprise a suite of traits signaling African ape-like quadrupedalism. While implications for the phylogenetic position and hominin status of S. tchadensis remain equivocal, this study supports the growing body of evidence indicating that S. tchadensis was not an obligate biped, but instead represents a late Miocene hominid with knuckle-walking adaptations.
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Affiliation(s)
- Marc R Meyer
- Department of Anthropology, Chaffey College, Rancho Cucamonga, CA 91737, USA.
| | - Jason P Jung
- Department of Biology, California State University, San Bernardino, CA 92407, USA
| | - Jeffrey K Spear
- Center for the Study of Human Origins, Department of Anthropology, New York University, 25 Waverly Place, New York, NY 10003, USA; New York Consortium in Evolutionary Primatology, New York, NY 10024, USA
| | - Isabella Fx Araiza
- Center for the Study of Human Origins, Department of Anthropology, New York University, 25 Waverly Place, New York, NY 10003, USA; New York Consortium in Evolutionary Primatology, New York, NY 10024, USA
| | - Julia Galway-Witham
- Center for the Study of Human Origins, Department of Anthropology, New York University, 25 Waverly Place, New York, NY 10003, USA; New York Consortium in Evolutionary Primatology, New York, NY 10024, USA
| | - Scott A Williams
- Center for the Study of Human Origins, Department of Anthropology, New York University, 25 Waverly Place, New York, NY 10003, USA; New York Consortium in Evolutionary Primatology, New York, NY 10024, USA
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Masuma H, Kenmoku T, Saito K, Kawabata M, Watanabe H, Miida K, Onuma K, Sukegawa K, Tazawa R, Otake Y, Takaso M. Evaluation of flexor digitorum superficialis function in adolescent baseball players. JSES Int 2022; 7:143-146. [PMID: 36820414 PMCID: PMC9937837 DOI: 10.1016/j.jseint.2022.09.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Hypothesis and/or Background Increased flexor digitorum superficialis (FDS) tendon activity can be a therapeutic target for elbow disorders in adolescent baseball players. The proportion of adolescent baseball players who can use FDS independently is unknown, and which finger is most often used remains unclear. This study investigated whether adolescent baseball players intentionally used FDS on each finger. Methods Adolescent baseball players were recruited and assessed for FDS function for each finger using the standard technique. Results Sixty-nine participants (mean age: 10.4 years) were recruited. Participants numbered 33, 56, 59, and 25 on the throwing side and those numbered 28, 46, 54, and 33 on the nonthrowing side could independently flex the proximal interphalangeal joint while holding their palms in the index, middle, ring, and small fingers, respectively. When assessing both throwing and nonthrowing participants, a significant number of participants could independently flex the proximal interphalangeals of the ring and middle fingers but had difficulty with the index and small fingers (P < .001). No significant difference was noted between the throwing and nonthrowing participants in any finger (P > .05). Discussion and/or Conclusion One study reported that participating baseball players with elbow pain have more medial elbow joint space than those without pain symptoms. In another study on finger movements during pitching motion, the force of the thumb, index, middle, and ring fingers was greatest immediately before maximum external rotation. According to both reports, FDS function, especially in the index finger, can be a therapeutic target for medial-sided elbow injuries in adolescent baseball players.
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Affiliation(s)
- Hiroyoshi Masuma
- Department of Rehabilitation, Kitasato University Hospital, Sagamihara, Japan
| | - Tomonori Kenmoku
- Department of Orthopaedic Surgery, School of Medicine, Kitasato University Sagamihara, Japan
- Corresponding author: Tomonori Kenmoku, MD, PhD, Department of Orthopaedic Surgery, School of Medicine, Kitasato University, 1-15-1 Kitasato, Minami-ku, Sagamihara, Kanagawa 252-0570, Japan.
| | - Kazuo Saito
- Department of Health Science, Tokyo Kasei University, Sayama, Japan
| | - Masashi Kawabata
- Department of Allied Health Sciences, Kitasato University, Sagamihara, Japan
| | - Hiroyuki Watanabe
- Department of Allied Health Sciences, Kitasato University, Sagamihara, Japan
| | - Kazumasa Miida
- Department of Rehabilitation, Kitasato University Hospital, Sagamihara, Japan
| | - Kenji Onuma
- Department of Orthopaedic Surgery, School of Medicine, Kitasato University Sagamihara, Japan
| | - Koji Sukegawa
- Department of Orthopaedic Surgery, School of Medicine, Kitasato University Sagamihara, Japan
| | - Ryo Tazawa
- Department of Orthopaedic Surgery, School of Medicine, Kitasato University Sagamihara, Japan
| | - Yuya Otake
- Department of Orthopaedic Surgery, School of Medicine, Kitasato University Sagamihara, Japan
| | - Masashi Takaso
- Department of Orthopaedic Surgery, School of Medicine, Kitasato University Sagamihara, Japan
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Tsubono K, Kudo R, Yokota H, Hirabayashi R, Sekine C, Maruyama S, Shagawa M, Togashi R, Yamada Y, Edama M. Changes in medial elbow joint space with differences in contraction strength of flexor-pronator muscle under elbow valgus stress. J Shoulder Elbow Surg 2022; 31:2011-2016. [PMID: 35550429 DOI: 10.1016/j.jse.2022.03.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Revised: 03/20/2022] [Accepted: 03/27/2022] [Indexed: 02/01/2023]
Abstract
BACKGROUND The relationship between contraction strength of the flexor-pronator muscles (FPMs) and elbow valgus braking function has not been clarified. HYPOTHESIS/PURPOSE The purpose of this study was to investigate changes in medial elbow joint space when there is a difference in contraction strength of FPMs under elbow valgus stress. METHODS Subjects were 20 healthy male university students, and the elbow joint on the nondominant hand side was used for measurements. The body position for limb measurement was sitting in a chair, with the shoulder abducted 60° and in 90° of external rotation, with 90° of elbow flexion. At first, maximum voluntary contraction (MVC) of the FPMs by grip motion was measured using a hand grip dynamometer under 60-N valgus stress. Contraction strengths of 10% MVC, 30% MVC, and 50% MVC were used. Ultrasonographic images of the medial elbow joint space (JS) were taken in the starting limb position. Using the Telos device system, load was then gradually increased by +10 N/s, and at the time of 60-N valgus stress, an image of the JS was taken. Furthermore, the subject adjusted to the set contraction strength (for about 5 sec) with 60-N valgus stress applied, and an image of the JS was taken while maintaining the set contraction strength. Each MVC condition (10% MVC, 30% MVC, and 50% MVC) was performed randomly. Three ultrasonographic images were taken within 10 seconds, and the average value of the three images was adopted as the JS. RESULTS Compared with the JS under 60-N valgus stress, the JS was significantly reduced under 60-N valgus stress + 50% MVC. No significant difference was observed between the starting limb position and 60-N valgus stress + 50% MVC. CONCLUSION FPMs may require muscle activity ≥50% MVC to brake 60-N elbow valgus stress.
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Affiliation(s)
- Kei Tsubono
- Institute for Human Movement and Medical Sciences, Niigata University of Health and Welfare, Niigata, Japan
| | - Ryodai Kudo
- Institute for Human Movement and Medical Sciences, Niigata University of Health and Welfare, Niigata, Japan
| | - Hirotake Yokota
- Institute for Human Movement and Medical Sciences, Niigata University of Health and Welfare, Niigata, Japan
| | - Ryo Hirabayashi
- Institute for Human Movement and Medical Sciences, Niigata University of Health and Welfare, Niigata, Japan
| | - Chie Sekine
- Institute for Human Movement and Medical Sciences, Niigata University of Health and Welfare, Niigata, Japan
| | - Sae Maruyama
- Institute for Human Movement and Medical Sciences, Niigata University of Health and Welfare, Niigata, Japan
| | - Mayuu Shagawa
- Institute for Human Movement and Medical Sciences, Niigata University of Health and Welfare, Niigata, Japan
| | - Ryoya Togashi
- Institute for Human Movement and Medical Sciences, Niigata University of Health and Welfare, Niigata, Japan
| | - Yuki Yamada
- Institute for Human Movement and Medical Sciences, Niigata University of Health and Welfare, Niigata, Japan
| | - Mutsuaki Edama
- Institute for Human Movement and Medical Sciences, Niigata University of Health and Welfare, Niigata, Japan.
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Ikezu M, Kudo S, Edama M, Ueda M, Kubo T, Hirata M, Watanuki M, Takeuchi H, Kaneiwa J, Iizuka Y, Hayashi H. Sites of flexor-pronator muscle injury and relationship between ulnar collateral ligament injury and flexor-pronator muscle injury in baseball players: a retrospective cohort study. J Shoulder Elbow Surg 2022; 31:1588-1594. [PMID: 35189370 DOI: 10.1016/j.jse.2022.01.135] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Revised: 01/07/2022] [Accepted: 01/16/2022] [Indexed: 02/01/2023]
Abstract
BACKGROUND Ulnar collateral ligament (UCL) and flexor-pronator muscle (FPM) injuries are common in baseball players. However, the sites of FPM injuries and the relationship between UCL and FPM injuries in baseball players have not been fully clarified. The purpose of this study was to identify the sites of FPM injuries and to determine the relationships of location and severity of UCL injury with the presence of FPM injuries in baseball players. METHODS UCL and FPM injuries were diagnosed using magnetic resonance imaging in 99 baseball players. The sites of FPM injuries were identified on coronal, sagittal, and axial images. UCL injury severity was classified into four grades: chronic changes, low-grade partial tear, high-grade partial tear, and complete tear. UCL injury location was classified as proximal UCL tear or distal UCL tear. All images were assessed by a musculoskeletal radiologist and an orthopedic surgeon. RESULTS Combined UCL and FPM injuries were observed in 45 of 99 players, of which 40 of 45 (89%) involved injury of the flexor digitorum superficialis (FDS). All FDS injuries were in the deep layer of the muscle belly. There was no significant difference between the severity of UCL injury and presence of FPM injuries (P = .352). There was a significant association of distal UCL tears with FPM injuries (P < .001). CONCLUSION FDS injury occurs most commonly in the muscle belly of the second and fifth digits. There may be no relationship between the severity of UCL injury and presence of FPM injury in baseball players. FPM injuries may be a contributing factor in the failure of nonoperative management of distal UCL tears in baseball players.
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Affiliation(s)
- Masahiro Ikezu
- Department of Rehabilitation, AR-Ex Oyamadai Orthopedic Clinic Tokyo Arthroscopy Center, Tokyo, Japan; Inclusive Medical Science Research Institute, Morinomiya University of Medical Sciences, Osaka, Japan.
| | - Shintarou Kudo
- Inclusive Medical Science Research Institute, Morinomiya University of Medical Sciences, Osaka, Japan; AR-Ex Medical Research Center, Tokyo, Japan
| | - Mutsuaki Edama
- Institute for Human Movement and Medical Sciences, Niigata University of Health and Welfare, Niigata, Japan
| | - Mizuho Ueda
- Department of Radiology, Saku Central Hospital, Nagano, Japan
| | - Takanori Kubo
- Department of Orthopaedic Surgery, AR-Ex Oyamadai Orthopedic Clinic Tokyo Arthroscopy Center, Tokyo, Japan
| | - Masazumi Hirata
- Department of Orthopaedic Surgery, AR-Ex Oyamadai Orthopedic Clinic Tokyo Arthroscopy Center, Tokyo, Japan
| | - Makoto Watanuki
- Department of Orthopaedic Surgery, AR-Ex Oyamadai Orthopedic Clinic Tokyo Arthroscopy Center, Tokyo, Japan
| | - Hiroki Takeuchi
- Department of Rehabilitation, AR-Ex Oyamadai Orthopedic Clinic Tokyo Arthroscopy Center, Tokyo, Japan; AR-Ex Medical Research Center, Tokyo, Japan
| | - Jumpei Kaneiwa
- Department of Rehabilitation, AR-Ex Oyamadai Orthopedic Clinic Tokyo Arthroscopy Center, Tokyo, Japan; AR-Ex Medical Research Center, Tokyo, Japan
| | - Yasuhiko Iizuka
- Department of Radiology, AR-Ex Oyamadai Orthopedic Clinic Tokyo Arthroscopy Center, Tokyo, Japan
| | - Hidetoshi Hayashi
- Department of Orthopaedic Surgery, AR-Ex Oyamadai Orthopedic Clinic Tokyo Arthroscopy Center, Tokyo, Japan
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Edama M, Matsuzawa K, Yokota H, Hirabayashi R, Sekine C, Maruyama S, Sato N. Elbow valgus stability of the transverse bundle of the ulnar collateral ligament. BMC Musculoskelet Disord 2021; 22:873. [PMID: 34641828 PMCID: PMC8513277 DOI: 10.1186/s12891-021-04760-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Accepted: 10/05/2021] [Indexed: 12/03/2022] Open
Abstract
Background The purpose of this study was to clarify elbow valgus stability of the transverse bundle (TB). We hypothesized that the transverse bundle is involved in elbow valgus stability. Methods Twelve elbows of six Japanese Thiel-embalmed cadavers were evaluated. The skin, subcutaneous tissue and origin of forearm flexors were removed from about 5 cm proximal to the elbow to about 5 cm distal to the elbow, and the ulnar collateral ligament was dissected (intact state). The cut state was defined as the state when the TB was cut in the middle. The joint space of the humeroulnar joint (JS) was measured in the intact state and then in the cut state. With the elbow flexed to 30°, elbow valgus stress was gradually increased to 30, 60 N using the Telos Stress Device, and the JS was measured by ultrasonography under each load condition. Paired t-testing was performed to compare the JS between the intact and cut states under each load. Results No significant difference in JS was identified between the intact and cut state at start limb position. The JS was significantly higher in the cut state than in the intact state at both 30 N and 60 N. Conclusion The findings from this study suggested that the TB may be involved in elbow valgus stability.
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Affiliation(s)
- Mutsuaki Edama
- Institute for Human Movement and Medical Sciences, Niigata University of Health and Welfare, Niigata, Shimami-cho 1398, Kita-ku, Niigata City, 950-3198, Japan.
| | - Kanta Matsuzawa
- Institute for Human Movement and Medical Sciences, Niigata University of Health and Welfare, Niigata, Shimami-cho 1398, Kita-ku, Niigata City, 950-3198, Japan
| | - Hirotake Yokota
- Institute for Human Movement and Medical Sciences, Niigata University of Health and Welfare, Niigata, Shimami-cho 1398, Kita-ku, Niigata City, 950-3198, Japan
| | - Ryo Hirabayashi
- Institute for Human Movement and Medical Sciences, Niigata University of Health and Welfare, Niigata, Shimami-cho 1398, Kita-ku, Niigata City, 950-3198, Japan
| | - Chie Sekine
- Institute for Human Movement and Medical Sciences, Niigata University of Health and Welfare, Niigata, Shimami-cho 1398, Kita-ku, Niigata City, 950-3198, Japan
| | - Sae Maruyama
- Institute for Human Movement and Medical Sciences, Niigata University of Health and Welfare, Niigata, Shimami-cho 1398, Kita-ku, Niigata City, 950-3198, Japan
| | - Noboru Sato
- Division of Gross Anatomy and Morphogenesis, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
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Matsuzawa K, Edama M, Ikezu M, Otsuki T, Maruyama S, Sato N. Contributions of the Third and Fourth Digits and the Second and Fifth Digits of the Flexor Digitorum Superficialis Muscle to Elbow Valgus Stability. Orthop J Sports Med 2021; 9:23259671211026247. [PMID: 34541011 PMCID: PMC8445534 DOI: 10.1177/23259671211026247] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Accepted: 02/28/2021] [Indexed: 11/17/2022] Open
Abstract
Background: Thiel cadavers have been reported to have lifelike flexibility and mechanical properties, but whether they are useful for measurement of the ulnohumeral joint space (JS) is unclear. The contributions of the third and fourth digits and the second and fifth digits of the flexor digitorum superficialis (FDS) to elbow valgus stability are also unknown. Purpose: To (1) clarify whether Thiel cadavers can be used for JS measurement on ultrasound and (2) identify the contributions to valgus stability of the third and fourth digits and the second and fifth digits of the FDS. Study Design: Descriptive laboratory study. Methods: In experiment 1 (12 elbows from human volunteers and 12 elbows from Thiel cadavers), valgus stress was increased gradually from 0 to 30 to 60 N, and the JS was compared on ultrasound between groups at each load. In experiment 2 (13 elbows from Thiel cadavers), specimens were divided into 2 groups, and the JS was measured for group 1 with the FDS intact, with tendinous insertions of the third and fourth digits cut (3/4-cut state), and with tendinous insertions of all fingers cut (all-cut state); and for group 2 at intact FDS, with tendinous insertions of the second and fifth digits cut (2/5-cut state), and at all-cut. Results: In experiment 1, the rate of change of the JS increased significantly with elbow valgus stress in both humans and Thiel cadavers, with no significant difference between groups. In experiment 2, the JS was significantly greater in the 3/4- and 2/5-cut states compared with the intact state at both 30 N (Δ3/4-cut vs intact = 0.23 mm [P = .01]; Δ2/5-cut vs intact = 0.32 mm [P = .02]) and 60 N (Δ3/4-cut vs intact = 0.33 mm [P = .002]; Δ2/5-cut vs intact = 0.37 mm [P = .04]). There was no significant difference in JS measurements between the 3/4- and 2/5-cut states at any load. Conclusion: Thiel cadavers showed JS changes similar to those of humans when valgus stress was applied. The third and fourth digits and the second and fifth digits of the FDS were involved in valgus stability, and there was no difference in their respective contributions. Clinical Relevance: This study may help in identifying function of the FDS based on structure.
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Affiliation(s)
- Kanta Matsuzawa
- Institute for Human Movement and Medical Sciences, Niigata University of Health and Welfare, Niigata, Japan
| | - Mutsuaki Edama
- Institute for Human Movement and Medical Sciences, Niigata University of Health and Welfare, Niigata, Japan.,Division of Gross Anatomy and Morphogenesis, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - Masahiro Ikezu
- Department of Rehabilitation, AR-Ex Oyamadai Orthopedic Clinic, Tokyo Arthroscopy Center, Tokyo, Japan
| | - Tomofumi Otsuki
- Institute for Human Movement and Medical Sciences, Niigata University of Health and Welfare, Niigata, Japan
| | - Sae Maruyama
- Institute for Human Movement and Medical Sciences, Niigata University of Health and Welfare, Niigata, Japan
| | - Noboru Sato
- Division of Gross Anatomy and Morphogenesis, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
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Sakata J, Miyazaki T, Akeda M, Yamazaki T. Return-to-play outcomes in high school baseball players after ulnar collateral ligament injuries: dynamic contributions of flexor digitorum superficialis function. J Shoulder Elbow Surg 2021; 30:1329-1335. [PMID: 33069902 DOI: 10.1016/j.jse.2020.09.022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2020] [Revised: 09/19/2020] [Accepted: 09/21/2020] [Indexed: 02/01/2023]
Abstract
BACKGROUND Ulnar collateral ligament (UCL) injuries are common in baseball pitchers. The purpose of this study was to evaluate changes to medial elbow joint laxity under valgus stress, as well as under valgus stress with flexor digitorum superficialis (FDS) contraction, and its ability to predict rehabilitation outcomes. METHODS Sixty-one UCL injuries were diagnosed. All patients were high school students who initially received rehabilitation treatment. Rates of return to play and return to the same level of play or higher (RTSP) were calculated and correlated with joint gapping under the following conditions: elbow gravity valgus stress and intra-articular ring-down artifact (RDA) at rest, elbow gravity valgus stress, and elbow gravity valgus stress with maximum FDS contraction. RESULTS The overall RTSP rate in patients receiving nonoperative treatment was 83.6% (51 of 61 patients). The RDA at rest significantly differed between the RTSP and non-RTSP groups, with an odds ratio of 17.5. This result indicated that the RDA could be a predictor of rehabilitation outcomes. Moreover, there were significant differences in the RDA under gravity valgus stress conditions with FDS contraction between the 2 groups, with an odds ratio of 98.0. Multivariate logistic regression analysis identified 1 variable (RDA under valgus stress with FDS contraction) as the most significant predictive factor for successful treatment of UCL elbow injury. CONCLUSIONS UCL injuries in high school baseball players can be successfully treated nonoperatively in most cases. Stress ultrasound with FDS muscle contraction can help predict the potential for RTSP.
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Affiliation(s)
- Jun Sakata
- Department of Rehabilitation, Toyota Memorial Hospital, Toyota, Japan.
| | - Tetsuya Miyazaki
- Department of Rehabilitation, Yokohama Sports Medical Center, Yokohama, Japan
| | - Masaki Akeda
- Department of Rehabilitation, Yokohama Sports Medical Center, Yokohama, Japan; Department of Orthopedic Sports Medicine, Yokohama Minami Kyosai Hospital, Yokohama, Japan; Department of Orthopedics, Yokohama Sports Medical Center, Yokohama, Japan
| | - Tetsuya Yamazaki
- Department of Orthopedic Sports Medicine, Yokohama Minami Kyosai Hospital, Yokohama, Japan
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Matsuzawa K, Edama M, Otsuki T, Maruyama S, Ikezu M, Kageyama I. Relationship between morphology of transverse bundle of ulnar collateral ligament and adjacent tissues. Surg Radiol Anat 2021; 43:1603-1607. [PMID: 33907911 DOI: 10.1007/s00276-021-02753-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Accepted: 04/15/2021] [Indexed: 01/09/2023]
Abstract
PURPOSE The purpose of this study was to clarify the incidence of the transverse bundle (TB) of the ulnar collateral ligament (UCL), the relationships between TB morphology and morphology of the anterior bundle (AB) or posterior bundle (PB) of the UCL, and the relationship between the TB and the posterior common tendon (PCT). METHODS This study examined 38 elbows from 23 cadavers. TB, AB, and PB were classified morphologically. The TB was classified as: type I, TB does not continue the entire length of the AB; or type II, TB continues the entire length of the AB. The AB and PB were classified as: type I, could be separated as single bundles; or type II, could not be separated. We also observed specimens by focusing on the continuity between the TB and PCT. Fisher's exact test was used to examine the relationship between TB type and AB or PB type. RESULTS A TB was identified in all 38 elbows (100%), and continued to the AB in all specimens. No significant relationship was evident between TB type and AB or PB type. Continuity of TB fibers and the PCT was seen in 26 elbows (72%). CONCLUSION This study suggested that the morphology of the transverse bundle may be unrelated to the morphology of the anterior bundle or posterior bundle.
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Affiliation(s)
- Kanta Matsuzawa
- Institute for Human Movement and Medical Sciences, Niigata University of Health and Welfare, 1398 Shimami-cho, Kita-ku, Niigata, Niigata, 950-3198, Japan.
| | - Mutsuaki Edama
- Institute for Human Movement and Medical Sciences, Niigata University of Health and Welfare, 1398 Shimami-cho, Kita-ku, Niigata, Niigata, 950-3198, Japan
- Department of Anatomy, School of Life Dentistry at Niigata, Nippon Dental University, Niigata, Japan
| | - Tomofumi Otsuki
- Institute for Human Movement and Medical Sciences, Niigata University of Health and Welfare, 1398 Shimami-cho, Kita-ku, Niigata, Niigata, 950-3198, Japan
| | - Sae Maruyama
- Institute for Human Movement and Medical Sciences, Niigata University of Health and Welfare, 1398 Shimami-cho, Kita-ku, Niigata, Niigata, 950-3198, Japan
| | - Masahiro Ikezu
- Department of Rehabilitation, AR-Ex Oyamadai Orthopedic Clinic Tokyo Arthroscopy Center, Tokyo, Japan
| | - Ikuo Kageyama
- Department of Anatomy, School of Life Dentistry at Niigata, Nippon Dental University, Niigata, Japan
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