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PubMed2004

Compression neuropathy of the radial palmar thumb nerve.

Compression neuropathy of a single digital nerve is a rare entity. We report the case of a patient with numbness in the distribution of the radial digital nerve of the thumb caused by the use of a walking stick. The nerve was compressed between the handle of the stick, the loop and the radial sesamoid bone of the first metacarpophalangeal joint. The site of the lesion was confirmed by electrophysiologic examination. Orthodromic recording of the sensory response from the radial palmar digital nerve of the thumb documented a complete absence of nerve action potential whereas the ulnar digital thumb nerve showed a normal response. Sensory function was restored when a padded ski glove was used to protect the area of the metacarpophalangeal joint whilst using the stick.

Canes↗
PubMed2005

New surgical approach to the plantar fetlock joint through the digital flexor tendon sheath wall and suspensory ligament apparatus in cases of concurrent septic synovitis in two cattle.

A new surgical approach to the infected fetlock joint is described in two cattle suffering from septic tenosynovitis of the lateral digital flexor tendon sheaths of the right lateral hind-digits with concurrent septic serofibrinous arthritis of the adjoining fetlock joints, caused by penetrating wounds. In both patients, the infected sheaths were opened and the superficial and deep digital flexor tendons were removed. Intraoperatively, a small entry through the fetlock joint capsule was detected, directly distal to the lateral proximal sesamoid bone. The tract was surgically enlarged and a second approach into the plantar fetlock joint pouch was created proximally by making a 3 cm long and 0.5 cm wide incision between the two lateral suspensory ligament branches. This allowed easy access to the plantar joint pouch, removal of fibrin clots and an effective joint lavage using 5L of sterile saline solution. The incisions of the fetlock joint capsules remained unsutured and were drained using soft polyurethane foam to preclude premature closure. The tendon sheath wounds remained unsutured. In both patients, the digital flexor tendon sheath and the fetlock joint were lavaged daily for the following three days. The infection was eliminated in both cattle and both fully recovered without residual lameness.

Animals↗
PubMed2006

The effect of hoof trimming on radiographic measurements of the front feet of normal Warmblood horses.

The understanding of the normal position of the third phalanx (P3) and the distal sesamoid bone in relation to the size and shape of the hoof capsule in sound horses is helpful in the diagnosis of equine foot lameness. Some measurements on radiographs used to define the position of the pedal bone within the hoof capsule are significantly influenced by hoof trimming and the height of the withers. In this study, the front hooves of 40 Warmblood horses were radiographed twice, eight weeks apart, both before and after their hooves were trimmed by an experienced farrier. Using the software programme Metron PX, 22 parameters on the lateromedial view and 16 parameters on the dorsopalmar view were measured and the effect of hoof trimming and height of the withers were calculated, respectively. Some of the hoof parameters showed mild positive correlation with the height of the withers. In 70% of the horses the left hoof capsule and P3 were significantly larger than the right. Hoof trimming had a remarkable influence on hoof conformation, especially for parameters in the toe region. Of all the measurements that describe the position of the third phalanx (P3) in relation to the hoof capsule, the distances between the distal tip of P3 to the solar surface of the foot, P3 to the tip of the toe and P3 to the point of break-over showed the greatest differences before and after trimming. The database of the present study can be used by farriers and veterinarians as a guideline for routine and corrective shoeing of Warmblood horses.

Analysis of Variance↗
PubMed1979

Causes of locking metacarpophalangeal joint of the thumb and its non-operative treatment.

The non-operative method of reduction of locking metacarpophalangeal joint of the thumb is described, and illustrated by four case reports. Experimental studies in the hands of a fresh cadaver are also described. Locking of the metacarpophalangeal joint of the thumb can be produced by slight external forces, insufficient to damage strong tissues. Incarceration of the sesamoid bone is anatomically impossible, but incarceration of the proximal portion of the volar plate is believed to be the true cause. This incarceration can be reduced easily by our non-operative method along with intra-articular injection of local anaesthetics.

Adult↗
PubMed1979

Clear view of the index sesamoid: a sign of irreducible metacarpophalangeal joint dislocation.

If the index sesamoid bone is clearly seen in the joint following significant injury to the index metacarpophalangeal joint on radiographic examination, there is the probability of incarceration of the volar plate. In almost all cases, an open reduction will be necessary to re-establish the normal relationship between the second metacarpal and the proximal phalanx. In a case of irreducible dislocation of the index metacarpophalangeal joint, attempted reduction caused the injury to appear as a subluxation.

Adolescent↗
PubMed1984

Functional sequelae after ulnar nerve repair. Study of forty-nine cases.

The full picture of functional ulnar deficiency, following suture or grafting, was studied and analyzed by two of the authors, who followed this series of patients on a long-term basis. The patients were tested using sphygmometric rubber bulbs in other to determine the overall closing force of the hand (making a fist), and the force of the pinch between the thumb and index ("energetic pinch"). Moreover, radionuclide vascular tests were used in order to find an eventual etiology of the "cold" disease, present in 2/3 of these injured hands. The principal functional deficiencies which bothered the patients and which we were able to demonstrate are as follows: deficient adduction of the thumb: the pinch between the thumb and index is diminished by approximately 50%, impairment, in the spreading of fingers, impairment in the overall force of the grasp, ulnar clawing which may embarrass function of the hand one year after the operation in one fourth of the cases. Therefore it appeared logical to propose an adduction plasty at the same time of repair, whether it was a primary suture or a secondary nerve graft. This adduction plasty uses the flexor digitorum sublimis of the ring finger which is rerouted and passed behind the profondus tendons and brought over to the lateral sesamoid bone of the thumb. This transfer is prolonged and tacked to the extensor pollicis longus in order to prevent the hyperflexion of the proximal phalanx of the thumb of which patients hardly ever complain but which denotes the severeness of ulnar nerve injury. An excellent correlation exists between the severeness of the functional deficiency and the importance of Froment's sign. The study of the other residual deficiencies shows that the restoration of the first dorsal interosseus, the reinforcement of the force of the flexores digitorum profundus of the middle and fourth fingers and of the intrinsics does not seem to be justified on an emergency basis. Zancolli's operation, which has been advocated by certain authors as an emergency procedure, does not seem to be necessary at this stage of repair, but remains a very interesting palliative procedure one year after the nerve repair if still judged necessary. Several clinical examples illustrate the value of long-term follow-up of these operated patients.

Adolescent↗
PubMed1995

Cyclic loading is harmful to articular cartilage from which proteoglycans have been partially depleted by retinoic acid.

We studied whether cyclic loading is harmful to degraded cartilage. Sets of four cartilage-bearing sesamoid bones were dissected from 5-year old cows. One bone from each set was cultured for 17 h in control medium to serve as an ex vivo control. The three others were cultured for 1 week in control medium to which 0, 10 or 300 ng/mL retinoic acid (RAc), which depletes the cartilage matrix of proteoglycans, had been added. Two were then cultured for another week in control medium. During the last week, one of the two was subjected to a cyclic load (1 MPa, 0.2 Hz). Following treatment with RAc, glycosaminoglycan content and synthesis were significantly decreased, as confirmed by safranin O staining and autoradiography. They were further diminished by loading during the second week of culture. Increased amounts of 3-B-3(-)epitope were found in cartilage that had been treated with 300 ng/mL RAc and then loaded. While loading cartilage matrix that was only slightly degraded proved to be damaging, loading severely degraded cartilage matrix apparently induced osteoarthritic-like changes.

Animals↗
PubMed1993

Proteoglycan depletion of intact articular cartilage by retinoic acid is irreversible and involves loss of hyaluronate.

Intact sesamoid bones from bovine metacarpophalangeal joints were cultured with retinoic acid for 9 days and allowed to recover in control medium for up to 17 days. Retinoic acid (300 ng/ml) induced 91.8% inhibition of glycosaminoglycan (GAG) synthesis and 50.6% loss of sulfated GAGs from the cartilage. Retinoic acid also induced 38.2% loss of hyaluronate from the matrix. The synthesis and content of the large aggregating proteoglycan (aggrecan) were preferentially decreased compared with that of the small nonaggregating species. The aggrecan synthesized was similar to control aggrecan in size, aggregation capacity, and composition of its GAGs. GAG synthesis was almost completely restored in control medium within the next 6 days. The GAGs synthesized during recovery were slightly shorter than control GAGs and showed a higher ratio of chondroitin-6-sulfate over chondroitin-4-sulfate. Neither the proteoglycan content nor the hyaluronate content recovered within 17 days. The aggregation capacity of newly synthesized aggrecan was normal. However, the retention of proteoglycans synthesized in the recovery period was much lower in treated cartilage than in control cartilage (T1/2 of 17 and 38 days, respectively). In conclusion, the retinoic-acid-induced proteoglycan depletion was irreversible in spite of the restored synthesis of aggrecan with a normal aggregation capacity. The reduced retention of newly synthesized aggrecan during recovery might be caused by a lack of hyaluronate. This model seems suitable to study aspects of cartilage destruction and repair.

Aggrecans↗
PubMedDate not supplied

Biomechanical abnormalities and ulcers of the great toe in patients with diabetes.

A prospective analysis was conducted to identify structural and biomechanical first ray abnormalities in consecutive diabetic patients presenting with their first great toe ulcer. Twenty-six patients (33 feet) met the inclusion criteria, with seven patients having bilateral hallux ulcers. There was no other history of ulcer, trauma, or surgery on the respective limb. Data were obtained during the patients' initial presentation with a great toe ulcer and included verbal history, standardized weight bearing radiographs, and standardized objective clinical measurements. Four patients (four feet) with subungual ulcers were included because of mechanical etiology. Twenty-four of the remaining 29 involved limbs exhibited gastrocnemius/soleus equinus and two other limbs had gastrocnemius equinus. Twenty-eight of 29 had structural hallux limitus. Twenty-four had hallux interphalangeal abductus. Twenty of the 33 ulcers were located plantar-medially at the interphalangeal joint area. Other frequent findings were first ray elevatus or dorsiflexion deformity (18 of 29), functional hallux limitus (14 of 29), interphalangeal joint sesamoid bone (13 of 29), hyperextended interphalangeal joint (13 of 29), and a prominent plantar-medial condyle of the proximalaspect of the distalphalanx (7 of 29). Halluxmalleus was less common (4 of 29), but consistently associated with plantar-distal tip ulceration. Metatarsus primus adductus was also infrequent (6 of 29). This study identifies and illustrates the importance of several biomechanical and structural factors present on initial presentation of great toe ulcers. Addressing these factors may improve the success of treatment and lessen the occurrence of this common and complex problem.

Biomechanical Phenomena↗
PubMed1998

A monoarthritis model in rabbits induced by repeated intra-articular injections of lipopolysaccharide.

We attempted to develop a monoarthritis model using repeated intra-articular injections of high-dose Lipopolysaccharide (LPS). Furthermore, the effect of dexamethasone on this arthritis model by intra-articular administration was studied to examine whether the model can be used to screen anti-rheumatic drugs in a short time. Arthritis was induced by one, two or three intra-articular injections of LPS (5-50 micrograms/joint) at 4-day intervals into the knee joint. The rabbits were sacrificed at 7 days following the last injection of LPS. Three intra-articular injections of LPS at 50 micrograms/joint resulted in persistent joint swelling. Hyperplasia of synovium with some discolouration was macroscopically observed. Infiltration of mononuclear cells and lymphoid follicles were histologically observed as the synovial lesions. Concerning the articular bone/cartilage, trabecular destruction of gastrocnemius sesamoid bone and severe loss of safranin-O staining of articular cartilage were observed. Immunohistochemical analysis revealed that inflammatory cells and lymphoid follicles in the synovial lesions consisted predominantly of CD4+ T cells, with few CD8+ T cells. Treatment with dexamethasone markedly reduced the joint swelling and the articular destruction. The results suggest that this arthritis model in rabbits can be utilized to screen anti-rheumatic drugs as a model of rheumatoid arthritis.

Animals↗
PubMed2000

Influence of interleukin-1beta and hyaluronan on proteoglycan release from equine navicular hyaline cartilage and fibrocartilage.

Proteoglycan (PG) release, in response to recombinant human interleukin-1beta (rh-IL-1beta), was measured in cartilage explants obtained from the equine distal sesamoid bone (navicular bone). Fibrocartilage from the surface of the navicular bone apposing the deep digital flexor tendon and hyaline cartilage from the surface of the navicular bone articulating with the middle phalanx were labelled with 35SO4. Hyaline cartilage from the distal metacarpus was used as a control tissue. Following radiolabel incorporation, the three cartilage types were treated with rh-IL-1beta (100 U/mL) in the presence of hyaluronan (0.2, 2, 20, 200 and 2000 microgram/mL). rh-IL-1beta-Induced PG release was measured by scintillation assay of PG-bound radiolabel. Increases in PG release of 94% (P < 0.01), 101% (P < 0.05) and 122% (P < 0.05), in response to rh-IL-1beta, were noted in fibrocartilage, navicular hyaline cartilage and metacarpal hyaline cartilage, respectively. Hyaluronan (0.2 microgram/mL) significantly reduced rh-IL-1beta-induced PG release in metacarpal hyaline cartilage (P < 0.01). In fibrocartilage and navicular hyaline cartilage, hyaluronan did not reduce PG release and at some concentrations appeared to increase PG release, although this was not statistically significant. These experiments show that (i) fibrocartilage and hyaline cartilage of the navicular bone release PGs in response to rh-IL-1beta, and (ii) hyaluronan does not prevent rh-IL-1beta-induced breakdown of navicular bone cartilage.

Adjuvants, Immunologic↗
PubMed2001

Topography, structure and function of the patella and the patelloid in marsupials.

The patella is a sesamoid bone that is found in most mammals and is regularly located in the insertion tendon of the quadriceps femoris muscle. Up to now, only a little has been known about the topography, structure and function of the patella in marsupials. Therefore the stifles of 61 marsupials of 30 different species were studied by radiography, necropsy and light microscopy. It was found that only the family of bandicoots (Peramelidae) possessed a typical patella. The other species revealed a patelloid consisting of fibrocartilage. The structure of the patelloid revealed common characteristic features in the following families of marsupials: (1) Dasyuridae, Phalangeridae. Pseudocheriidae, and Potoroidae; (2) Burramyidae; (3) Phascolarctidae, Vombatidae, and Dendrolagus; and (4) Superfamily Macropodoidea (except Dendrolagus and Potoroidae). Our results imply that the degree of differentiation in the fibrocartilage of the patelloid was strongly correlated to the mechanical forces acting on the patelloid which are a result of the specific kind of locomotion and the way of life. Generally the bony patella does not belong to the phylogenetic programme of the marsupials--with the exception of the bandicoots which are very closely related to the subclass of placental mammals (Eutheria).

Animals↗
PubMed1999

[Post-traumatic palmar instability of the thumb metacarpophalangeal joint. The "other skier's thumb"].

"Passive" and "active" stabilizers give the thumb metacarpophalangeal (MP) joint the necessary palmar stability. It is possible to temporarily stabilize the joint by means of the flexor muscles in cases where there is an injury to the palmar ligaments due to hyperextension trauma. However, sudden severe or prolonged strain may lead to palmar instability and/or stress-related pain. In an experimental study, the MP joints of 40 specimen thumbs were hyperextended to varying degrees. The extent of tissue damage was evaluated during dissection. Between 1984 and 1992, in 72 cases with acute hyperextension injury of the thumb MP joint, we X-rayed the thumb under stress during primary examination. Habitual instability was excluded by comparing X-ray films under stress of the opposite uninjured thumb. The treatment of the lesion depends on the degree of instability documented by the X-ray films. Experimentally, we found only partial lesions or ruptures with only slight dislocation of the ligament ends in cases where the MP joint was hyperextended up to 30 degrees. In cases with hyperextension of 60 degrees or more, there was usually a complete rupture of the ligaments or a fracture of the sesamoid bones with dislocation of the ligament ends as well as partial rupture of the thenar muscles. This injury pattern was also observed in clinical cases during surgery. Partial lesions of the palmar ligaments of the thumb MP joint can be treated conservatively with good results. In cases of complete palmar instability due to trauma, we saw better results after surgical reconstruction of the ligaments particularly in manual workers.

Athletic Injuries↗
PubMedDate not supplied

[Pollex flexus congenitus].

The authors report on the incidence, clinical picture, etiology, pathogenesis and treatment of congenital pollex flexus, and communicate the results of surgery on 52 thumbs. The permanent flexion anomaly in the interphalangeal joint and a hard, palpable knot in the long flexor tendon of the thumb over the metacarpophalangeal joint are typical for the deformity. Although these changes are sometimes observed immediately post partum, delayed diagnosis and treatment are more common. The hypothesis that it is a hereditary, endogenous condition is supported by observations in twins, relatively frequent bilateral occurrence and a high familial incidence. Constriction of the synovial sheath over the basal joint of the thumb is a key pathogenetic factor, although little is known about its causes; anatomical factors, influences affecting the growth of the sesamoid bones, and mechanical causes have been postulated. A more plausible hypothesis was first advanced by Jeannin. Like Hueston and Wilson 100 years later, he compared the tendon to a thick thread which had to be passed through a narrow eye of a needle: as a result, the "thread" would be frayed and compressed. The knot in the tendon is held to be a secondary phenomenon. The pathologicoanatomical picture varies. Lymphocyte and monocyte infiltration, and metaplasias to fiber cartilage have been detected in specimens excised from the tendon and the synovial sheath. However, pathologic changes have not been found in all cases. In the first year of life conservative therapy may be attempted, with temporary splinting of the thumb following manual correction of the flexion anomaly in the interphalangeal joint.(ABSTRACT TRUNCATED AT 250 WORDS)

Child↗
PubMed1991

How effective is the combined activator-headgear treatment?

The frequency and possible causes of failure and success with the combination activator-headgear as the sole appliance was analysed retrospectively in 32 girls and 46 boys. The subjects comprised all the patients who started treatment with this combination in the postgraduate courses in 1972-82 at the Orthodontic Department of the University of Oslo, and where fixed appliances were not included in the initial treatment plan. Only 14 subjects completed the treatment with entirely satisfactory results according to strict criteria set for an acceptable standard. Among the most co-operative patients less than 50 per cent ended with entirely satisfactory results, and no one with decreasing or poor co-operation had a satisfactory result. Neither sex, treatment time, nor ossification of the ulnar sesamoid bone seemed to influence the results significantly.

Activator Appliances↗
PubMed2006

Morphological change caused by loss of the taxon-specific polyalanine tract in Hoxd-13.

Sequence comparison of Hoxd-13 among vertebrates revealed the presence of taxon-specific polyalanine tracts in amniotes. To investigate their function at the organismal level, we replaced the wild-type Hoxd-13 gene with one lacking the 15-residue polyalanine tract by using homologous recombination. Sesamoid bone formation in knock-in mice was different from that in the wild type; this was observed not only in the homozygotes but also in the heterozygotes. The present study provides the first direct evidence that taxon-specific homopolymeric amino acid repeats are involved in phenotypic diversification at the organismal level.

Amino Acid Sequence↗
PubMedDate not supplied

Metatarsophalangeal joint of the great toe: normal MR, MR arthrographic, and MR bursographic findings in cadavers.

OBJECTIVE: To demonstrate the normal anatomy of the metatarsophalangeal (MTP) joint of the great toe with MR imaging, MR arthrography, and MR bursography. MATERIALS AND METHODS: MR images of 12 cadaveric MTP joints of the great toe were obtained before and after arthrography, busography, or both. The MR appearances of all articular and periarticular structures were analyzed and correlated with those seen on anatomic sections. RESULTS: The sesamoid bones and ligaments, the deep transverse metatarsal ligament, and the tendon attachments of the abductor and adductor hallucis muscles were seen best in the coronal plane. The sagittal plane was best for evaluating the plantar plate, the articular cartilage, and the tendon attachments of the flexor and extensor hallucis brevis muscles. The main collateral ligaments were evaluated best in the axial plane. MR arthrography improved the visualization of all articular and periarticular structures except the collateral ligament complexes. MR bursography did not enhance the visualization of these structures. CONCLUSIONS: MR imaging and MR arthrography allow accurate visualization of the important anatomic structures in and about the MTP joint of the great toe.

Aged↗