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PubMed2004

Immunohistochemistry of the enthesis organ of the human Achilles tendon.

BACKGROUND: The insertional region of the Achilles tendon includes: the fibrocartilage of the enthesis at the tendon-bone junction, the sesamoid fibrocartilage in the deep surface of the tendon, and the periosteal fibrocartilage covering the superior tuberosity of the calcaneus. The mechanism by which compressive stress and low oxygen concentration modulate the phenotypical expression of cartilaginous cells in mesenchymal tissue is still unknown. Tenascin-C isoform, with its anti-adhesive properties, has been hypothesized to have a role in cellular adaptation to compression. The purpose of this study was to define the immunohistochemical localization of tenascin-C in the enthesis organ of the Achilles insertion in man. METHODS: Five specimens of Achilles tendon and its insertion were obtained from adult patients during below-knee amputation surgery. To determine the histochemistry, for light microscopy, specimens were stained with hematoxylin-eosin, safranin-O, Verhoeff, alcian blue methods. For immunohistochemistry, the following antibodies were used: anti-S-100 protein; anti-chondroitin sulfate; anti-types I and II collagen, anti-type IV collagen, anti-type X collagen, and anti-tenascin-C. RESULTS: The enthesis, sesamoid, and periosteal fibrocartilages have been defined by a separate region of immunohistochemical labeling for S-100 antibody and type II collagen and chondroitin-sulfate. The sesamoid and periosteal fibrocartilages stained for tenascin-C, which in cartilaginous areas was closely associated with rounded cells in the extracellular matrix. CONCLUSION: By showing a relationship between chondrocyte-like cells and immunolabeling for tenascin-C in periosteal and sesamoid fibrocartilage, the present data suggest a role in the dynamic equilibrium in the formation of fibrocartilaginous foci in tendon areas exposed to compressive stress. CLINICAL RELEVANCE: The data support the surgical practice of the resection of the diseased tendinous portion in case of chronic Achilles tendinitis. The decompression removed the enthesis organ that in an inflammatory environment could be altered and would not contribute to the distribution of the tensive load. After the decompression, it was hypothesized that in tendon areas exposed to compressive stress there was restoration of the fibrocartilaginous foci that constitute the enthesis organ.

Achilles Tendon↗
PubMedDate not supplied

Osteonecrosis of the tibial and fibular sesamoids in an aerobics instructor.

Osteonecrosis of the sesamoids is a fairly uncommon clinical entity. The development of this condition involving both sesamoids has never been presented in the American literature. After extirpation of the sesamoids and interdigital fusion, the patient returned to her regular activities, including dance.

Adult↗
PubMed1982

An automated technique for the radiographic determination of bone age.

We have developed an automated procedure for determining bone-age in the monkey, Macaca fascicularis. The status of epiphysial junctions and sesamoids were determined from radiographs. Epiphyses were scored as either open or closed, and sesamoids were scored as either present or absent. Bone-age was calculated by a computer program that stored and used a data base of probabilities for epiphysial closure and sesamoid appearance. The simplicity of scoring, combined with the speed and accuracy of the calculations, make this technique potentially adaptable for use in a variety of primate species.

Age Determination by Skeleton↗
PubMed2006

Comparison of bone scintigraphy with serum tumor markers of CA 15-3 and carcinoembryonic antigen in patients with breast carcinoma.

OBJECTIVE: To compare the bone scintigraphy findings with a carcinoembryonic antigen (CEA) and cancer antigen 15-3 (CA 15-3) levels in breast carcinoma patients. We also investigated the relationship between anatomical bone type and its effect on tumor marker levels. METHODS: The study was consisted of retrospective evaluation of 120 bone scans of patients with breast carcinoma admitted to the Nuclear Medicine Department, Medical Faculty, Hacettepe University, Ankara, Turkey between January 2003 and December 2004. The mean age of the patients was 54.7 years. We grouped the results of the bone scans into 3 as normal, equivocal and metastatic. Carcinoembryonic antigen and CA 15-3 levels were recorded from the files of the patients. Upper cut levels of 4.8 U/ml for CEA and 38 U/ml for CA 15-3 was accepted. Metastatic bone areas were distributed according to their anatomical location as long, short, flat, irregular and sesamoid and effect of bone type on tumor marker was investigated. RESULTS: In 16 of the patients, bone scintigraphy revealed metastases. Sixty-one patients had normal scans and in 47 patients metastases could not be ruled out. In patients with metastases, CA 15-3 was elevated in 8 and CEA was higher than the upper limit in 6. For CEA and CA 15-3, the anatomical type of bone has no any effect on serum tumor marker concentration between patients with normal and elevated levels of tumor markers in metastatic patients. CONCLUSION: Tumor markers are not solely enough in predicting bone metastases. Bone scintigraphy and tumor markers should be both used in management of patients with breast carcinoma. The anatomical type of bone has no any effect on elevation of serum tumor marker concentration.

Adult↗
PubMed1980

Fractured fibular sesamoid: a case report.

Dr. Glass believes fracture of the fibular sesamoid to be quite uncommon, and he discusses its occurrence in the absence of direct trauma to the foot. A fractured sesamoid may be distinguished from a bipartite or tripartite sesamoid by the absence or presence of pain, which occurs with a fractured sesamoid but not with a bipartite or tripartite sesamoid. The appearance of the line of division and the absence or presence of a periosteal reaction are also helpful in diagnosis.

Adult↗
PubMedDate not supplied

The microvasculature of the sesamoid complex: its clinical significance.

The microvascular anatomy of the sesamoid complex was investigated in 15 cadaver specimens using histology and tissue clearing (Spalteholz) techniques. It was found that both sesamoids appeared equally well vascularized and the vascular supply to each sesamoid originated from two major sources (proximal and plantar) and one minor source (distal). Proximally, vessels originating from the first plantar metatarsal artery enter the sesamoid at its attachment to the flexor hallucis brevis. In addition, vessels enter the plantar surface of the sesamoid near the midline and arborize throughout the bone, anastamosing with the proximal vessels. The distal vascular supply to the sesamoids originates from its distal capsular attachment and appears to contribute minimally to the overall vascular scheme. The lateral attachments of the sesamoids to the plantar plate and joint capsule were relatively avascular. In two bipartite specimens examined, the major blood supply originated from the proximal and distal poles of the sesamoid. No vessels were observed entering the plantar surface of these specimens. The results of this study suggest that injury to the proximal or plantar aspects of the sesamoids could disrupt the vascular supply to these bones. These areas should, therefore, be avoided during the surgical approach to the sesamoids.

Hallux↗
PubMed2006

Postcranial skeleton of Shinisaurus crocodilurus (Squamata: Anguimorpha).

The postcranial skeleton is poorly known for Shinisaurus crocodilurus, the Chinese crocodile lizard. Discrepancies exist between published accounts of Shinisaurus; moreover, comparisons with complete specimens show important differences from the published descriptions. Contrary to some publications, the axial skeleton variably consists of 26 or 27 presacral vertebrae, including eight cervical vertebrae. Humeral entepicondylar and ectepicondylar foramina are present, as are an epipubis and hypoischium, and the post-tubercular portion of the pubis is subequal in length to the proximal portion. Sesamoids are present in the knee, elbow, and between the penultimate phalanges and unguals. A cartilaginous strut joins the clavicles and interclavicle. Comparative investigation of extant anguimorphs add context to these observations and support the conclusion that Mosasauroidea possessed eight or more (rather than seven) cervical vertebrae. Overall, the postcranium of Shinisaurus is relatively unspecialized for Anguimorpha, although it may be diagnosed accurately by a combination of character states.

Animals↗
PubMed1986

Diagnostic dilemmas in foot and ankle injuries.

Differential diagnosis of foot and ankle injuries should include stress fractures of the great toe sesamoids, the shaft of the fifth metatarsal, and the tarsal navicular bone; transchondral talar-dome fractures; fractures of the os trigonum; and dislocating peroneal tendons. Diagnosis of these injuries is challenging because the initial roentgenograms often are normal, and special clinical tests and ancillary studies are required.

Ankle Injuries↗
PubMed1990

Traumatic disruption of the suspensory apparatus in foals.

Traumatic disruption of the suspensory apparatus is a catastrophic injury in the horse. Although this injury has been described in the adult, little information is available in the foal. This paper describes 3 foals with metacarpophalangeal joint instability caused by traumatic disruption of the suspensory apparatus. Two foals had biaxial proximal sesamoid fractures in a single forelimb, and 1 foal had avulsion of the distal sesamoidean ligaments in 1 forelimb plus biaxial proximal sesamoid fractures in the other forelimb. The foals with single forelimb involvement were managed with splints, and the foal with bilateral disruption of the suspensory apparatus was euthanatized. Both treated foals resumed natural exercise at pasture. Both continue to be pasture sound 2 and 3 years after injury and are to be used for breeding. Management of disruption of the suspensory apparatus causing metacarpophalangeal joint instability using external support was effective for salvage of these 2 valuable foals for breeding.

Animals↗
PubMed2000

[The metacarpal ligament of the thumb. Topography and functional significance of a heretofore unknown fiber tract of the thumb and its anatomic relationship to the internal interosseus muscle].

During cadaver dissections of the thenar muscles of 81 human hands, we found a distinct ligament at the palmar side of the first metacarpal in 58% ([symbol: see text] 47 hands). This not previously described ligament crosses the princeps pollicis artery regularly. The ligament arises from the base of the first metacarpal bone in 83%. Sometimes (in 15%) it arises from the trapezium or from the middle portion of the first metacarpal bone in one case. The primary insertion of this ligament is the ulnar sesamoid. We have named these fibres "metacarpal ligament of the thumb". It could be classified into five different types. We think that this ligament is helpful in the stabilisation of the ulnar sesamoid. Besides it fixes the princeps pollicis artery to the metacarpal bone and therefore it is possible that it could compress the artery. Maybe the "metacarpal ligament of the thumb" is a rudiment of the interosseous muscles of the thumb or of the deep head of the flexor pollicis brevis muscle or of the oblique head of the adductor pollicis muscle. There is a very close topographic relationship between this ligament and the "internal interosseous muscle" of the thumb which was described by Schmidt and Lanz (1992) and which was mentioned by Henle (1858), who named it "M. interosseus volaris primus" for the first time. We could isolate this muscle in 69%.

Aged↗
PubMed2002

[Piso-triquetral osteoarthritis. Thirteen case reports and review of the literature].

Piso-triquetral osteoarthritis (OA) is an infrequent cause of ulnar wrist compartment pain. Specific clinical manoeuvres may help for diagnosis. If this aetiology is suspected, a 30 degrees oblique wrist X-ray in supination and sometimes a CT scan with transverse cuts should be performed demonstrating a joint narrowing and osteophytes formation. The FCU-pisiform biomechanical unit transfers the wrist flexion forces. A series of 13 cases of piso-triquetral OA is presented in 12 patients (six females and six men) treated between 1990 and 1997. Mean age was 52.7 y. Pain at resisted motion in flexion and ulnar deviation and strength decrease was always present at clinical examination. Subperiosteal pisiform excision has been constantly performed. Continuity of FCU insertions and its distal ligamentous extensions has been preserved. Mean F-up was 18.1 months (3-57). Pain has disappeared in seven cases and significantly decreased in five. NSD was present in one case. Range of motion and strength was normal in all cases. Ulnar nerve paresthesias has always disappeared. The pisiform bone is not a sesamoid: a true joint with the triquetrum exists. From the phylogenetic point of view, three theories have been proposed: (a) in some species, pisiform is fused with adjacent bones or metacarpals; (b) pisiform is a remnant of a polydactyly hand; (c) pisiform is a remnant of the carpal central row.

Biomechanical Phenomena↗
PubMed1998

Review of radiographic measurements following Austin bunionectomy.

This study compared preoperative and postoperative results for selected radiographic measurements of 30 patients undergoing the modified Austin bunionectomy procedure for the correction of hallux abducto valgus. Significant reductions in all postoperative radiographic values were demonstrated, including hallux abductus angle, metatarsus primus adductus angle, tibial sesamoid position, and first metatarsal protrusion distance.

Adult↗