Radial Collateral Research Articles

Músculos cráneo-laterales del antebrazo del mapache cangrejero (Procyon cancrivorus) y una revisión comparativa con otros carnívoros

ABSTRACT The crab-eating raccoon Procyon cancrivorus (Cuvier, 1798) is a species of the order Carnivora and family Procyonidae with a geographical distribution in Central and South America. Although crab-eating raccoons use scansorial locomotion, they also have aquatic habits, displaying greatly developed skills when handling their food. This species can frequently be found in wildlife care centers due to injuries caused by domestic dogs, humans, and car collisions. Having knowledge of the species’ gross anatomy and anatomical bases is imperative to perform the most appropriate medical and surgical procedures. Thus, the objective of this investigation was to analyze the interspecific and intraspecific differences of the craniolateral forearm muscles of Procyon cancrivorus. Gross dissections were performed in four specimens describing the origin, insertion, shape, innervation, and arterial supply of the craniolateral forearm muscles. There is a constant and well development of brachioradialis muscle comparatively to that described in strictly cursorial species; the extensor carpi radialis muscle has two bellies that are fused proximally; the extensor digitorum communis muscle can also extend the tendon to the digit I as an anatomical variant, and the extensor digiti I and II muscle also extends the tendon to digit III. All are innervated by the deep branch of the radial nerve, and their arterial supply is mainly by the radial collateral, cubital transverse, and cranial interosseous arteries. The anatomical characteristics observed in this study complement the previous descriptions for Procyon cancrivorus, and the anatomical variants found in this species can also be in other carnivorans. Thus, the intraspecific anatomical variations of the digital extensor muscles in P. cancrivorus are phylogenetic traits that can occur as a common pattern or as anatomical variants in other species of the order Carnivora.

Acute Ligament Injuries of the Elbow.

Ulnar collateral, radial collateral, lateral ulnar collateral, and annular ligaments can be injured in an acute trauma, such as valgus stress in athletes and elbow dislocation. Recognizing normal anatomy in magnetic resonance imaging and ultrasonography studies is important to identify ligamentous abnormalities in these imaging modalities.

The lateral collateral ligament complex of the elbow: quantitative anatomic analysis of the lateral ulnar collateral, radial collateral, and annular ligaments

Injury to the lateral ulnar collateral ligament (LUCL) complex of the elbow often results in posterolateral rotatory instability. Although surgical reconstruction of the LUCL is often required, gaps in our understanding of the LUCL complex remain. The purpose of this study was to provide a robust and accurate characterization of the lateral elbow ligamentous complex. The LUCLs, radial collateral ligaments, and annular ligaments in 10 cadaveric elbows were 3-dimensionally digitized and reconstructed using computed tomography. Surface areas, origin and insertion footprint areas, distances between perceived footprint centers and geometric footprint centroids, distances to key landmarks, and ligament isometry were measured. The mean surface area of the LUCL was 229.3 mm2. The mean origin and insertion footprint areas were 26.0 mm2 and 22.9 mm2, respectively. The mean distance between the apparent centers and the geometric centroids of the footprints was 1 mm. The center of the LUCL origin was 10.7 mm distal to the lateral epicondyle and 8.2 mm from the capitellar articular margin. The center of the LUCL insertion was 3.3 mm distal to the apex of the supinator crest. The LUCL showed anisometric properties as elbow flexion increased (P < .001). The LUCL origin center was 10.7 mm from the lateral epicondyle, whereas the insertion center was 3.3 mm from the apex of the supinator crest. The visually estimated footprint centers were generally within 1 mm of the geometric centroid. These geometries and distances to key landmarks will be informative for surgeons seeking to perform anatomic ligament reconstruction procedures.

Vascularized Composite Allotransplantation of the Elbow Joint: A Cadaveric Study.

Surgical options for the unreconstructable elbow are limited to arthrodesis, total arthroplasty, or osteoarticular allograft reconstruction. Each of these options is limited by severe functional impairment and/or high complication rates. Vascularized allotransplantation of the elbow joint has the potential to mitigate these complications. In this study, we describe our technique for harvesting the elbow for vascularized joint transplantation and demonstrate the flap's vascularity using contrast angiography. Anatomical studies were used to design and harvest a vascularized elbow joint flap pedicled on the brachial vessels in 10 cadaveric arms. Diaphyseal blood supply is provided by 3 nutrient arteries, and periarticular supply arises from the various collateral arteries of the arm and recurrent arteries of the forearm. The brachialis and supinator, and their respective nerves, were included as functional muscles because of their intimate association with critical vasculature. Tendinous insertions of the biceps and triceps, as well as the flexor/pronator and extensor origins, were preserved for repair in the transplant recipient. Both lateral arm and radial forearm flaps were preserved to aid in soft tissue inset as well as vascular/immunologic monitoring. Contrast angiography of each dissected specimen was performed to assess the location of the nutrient vessels and assess flap vascularity, as indicated by filling of the critical extraosseous and endosteal vessels. Angiographic imaging of 10 specimens demonstrated that this flap dissection preserves the nutrient endosteal supply to the humeral, radial, and ulnar diaphysis, in addition to the critical extraosseous arterial structures perfusing the elbow joint and periarticular tissues. From proximal to distal, these arteries are the musculoperiosteal radial, posterior branch of the radial collateral, inferior ulnar collateral, recurrent interosseous, radial recurrent, and the anterior and the posterior ulnar recurrent. Vascularized composite allotransplantation of the elbow joint holds promise as a motion and function preserving option for young, high-demand patients with a sensate and functional hand, who would otherwise be limited by the restrictions of total elbow arthroplasty or fusion. In this study, we propose a flap design and technique for harvest and also offered vascular imaging-based evidence that this flap is adequately vascularized.

The Abnormal Origin, Course and the Distribution of the Arteries of the Upper Limb: A Case Report

The knowledge on the arterial variations in the arm is of importance for a clinician, as it is a frequent site of injury and as it is also involved in many surgical and invasive procedures. During the routine dissection classes for medical students, we came across the multiple arterial variations in the right upper limb of an approximately 45-year-old male cadaver.The brachial artery was very short, and it terminated by dividing into the radial and the ulnar arteries in the upper part of the arm. The radial collateral, the middle collateral and the superior ulnar collateral arteries arose from a common trunk. This common trunk originated from the proximal part of the brachial artery. The ulnar artery was the lateral branch and the radial artery was the medial branch of the brachial artery at their point of origin. The radial artery had a tortuous course, and it crossed the ulnar artery from the medial to the lateral side in the middle third of the arm. The ulnar artery gave anterior and posterior interosseous arteries and a common trunk that divided into the anterior and the posterior ulnar recurrent arteries in the cubital fossa.The knowledge on these variations is very useful for radiologists and surgeons.

An Unusual Branching Pattern of the Axillary Artery

During routine dissection of a female cadaver, an unusual branching pattern of right axillary artery was observed. It was seen that second part of axillary artery gave only one branch i.e. the thoracoacromial artery. While its third part gave two branches namely, the anterior circumflex humeral and subscapular. The subscapular artery (with its usual branches) also gave origin to the lateral thoracic and the posterior circumflex humeral branch. It furthur continued as brachial artery from which arose anterior and posterior descending (radial collateral) arteries (branches of profunda), which coursed through the lower triangular space along with the radial nerve.Grant Funding Source: University

HS03 STABILITY OF THE WRIST AND THE RADIAL (LATERAL) COLLATERAL LIGAMENT

Purpose: Most textbooks, including “Terminology for Surgery of the Hand” name this ligament. Ingenious diagrams demonstrate its role in stabilizing the wrist in extreme ulnar deviation. The present study aims to verify this assumption.Methods: Eight embalmed cadaveric specimens, dissected to expose the fibrous apparatus on the radial side of the wrist joint were fixed to a stand by the radius and ulna. Constant traction of 2 kg in the ulnar direction was exerted through the base of the third metacarpal. The fibrous elements on the radial side of the joint, ie. the capsule and the strong fibrous sheaths of the tendons of Extensor Pollicis Longus (EPL), Extensor Carpi Radialis Longus (ECRL) and Brevis (ECRB), and of the Abductor Pollicis Longus (APL) and Extensor Pollicis Brevis (EPB) were divided in different sequences.Results: No real radial (lateral) collateral ligament of the wrist, capable of stabilising it in extreme ulnar inclination was found. Stability was due to the strong fibrous sheaths of ECRL, ECRB, and especially that of APL and EPB.Conclusion: This raises questions about the aetiology of de Quervin's disease.

Stress And Strain At The Lateral Collateral Ligament Complex Of The Elbow Joint

Background: The radial collateral ligament was previously believed to be the only ligament existing at the lateral aspect of the elbow joint until Morrey and An (1976) classified the ligaments to include radial collateral (RCL) and lateral ulnar collateral ligaments (LUCL). There is therefore the need to assess the impact these ligaments in elbow joint stability.&#x0D; &#x0D; Objective: To investigate how the RCL and LUCL are affected by stress and strain in both routine and forceful movements of the limb.&#x0D; &#x0D; Materials and Methods: Eight (8) embalmed upper extremities were used for this investigation. The elbow joint was dissected with care taken to preserve the lateral ulnar collateral ligament seen in seven of the limbs. Qualitative assessment of ligament tension was made under valgus and varus stresses. The angles at which stress was applied were 450, 700, 750, 900, 1100, 1200 and full extension. These angles were chosen partly because most movements during racket sporting activities take place at higher angles (Regan et al 1991). The angles were determined by hand held goniometer while the arm was firmly held in a retort stand. &#x0D; &#x0D; Results: The RCL is more able to absorb stress and strain because of its greater flexibility enhanced by its attachment at the annular ligament. However, LUCL a thickened mass, in both valgus and varus stresses was taut throughout most of the entire arc of flexion. It is a much stronger ligament that effectively stabilizes elbow joint in both routine and forceful movement. &#x0D; &#x0D; Conclusion: This study has been able to establish that LUCL is more prone to stress and strain. Being attached from bone to bone, it equally provides greater stability at the lateral aspect of elbow joint.&#x0D; &#x0D; KEY WORDS: Elbow joint; Ulna and Radial Collateral Ligament; stress and strain.

The effect of arthroscopic sectioning of the lateral ligament complex of the elbow on posterolateral rotatory stability

This study evaluates the relative roles of the radial collateral ligament, the lateral ulnar collateral ligament, and the overlying musculature in posterolateral rotatory instability of the elbow. Fourteen cadaveric upper limbs underwent sequential arthroscopic sectioning of the lateral collateral ligament complex. After sectioning, arthroscopic and fluoroscopic evaluation of a lateral pivot shift test was done. Minimal instability was noted after the first section, but no difference between radial collateral or lateral ulnar collateral ligament sectioning was found. A greater degree of instability was seen between the first and second cut ( P = .0001), but no significant difference was seen between sectioning the 2 groups ( P = .61). Complete instability occurred only after sectioning the overlying musculature. On the basis of this study, injury to both the radial collateral and lateral ulnar collateral ligaments is necessary to cause significant posterolateral rotatory instability of the elbow. Furthermore, the overlying musculature plays an important role in overall stability.

Single-strand reconstruction of the lateral ulnar collateral ligament restores varus and posterolateral rotatory stability of the elbow

Because of a lack of biomechanical studies of lateral elbow ligament reconstruction in the literature, the initial stability afforded by 3 different techniques of lateral ulnar collateral ligament reconstruction was evaluated in 8 cadaveric elbows. The arm was mounted in a testing apparatus, and passive flexion was performed with the arm in varus and valgus orientations. A pivot shift test was performed with the arm in the vertical orientation. An electromagnetic tracking device was used to quantify motion pathways. After intact testing, each specimen underwent sectioning of the radial collateral and lateral ulnar collateral ligaments from the lateral epicondyle. Reconstruction of the lateral ulnar collateral ligament was performed in a randomized sequence, consisting of proximal single-strand, distal single-strand, and double-strand tendon grafts. Division of the radial collateral and lateral ulnar collateral ligaments from the lateral epicondyle caused a significant decrease in rotational stability when the pivot shift test was being performed (P <.0001). Varus-valgus stability also decreased after transection of the radial collateral and lateral ulnar collateral ligaments (P <.0001). Reconstruction of the lateral ulnar collateral ligament restored elbow stability to that of the intact state. There was no significant difference in stability between the single- and double-strand repair techniques (P >.05). This study demonstrates that both single- and double-strand reconstructions restore varus and posterolateral elbow stability and may be considered appropriate reconstructive procedures in patients with symptomatic insufficiency of the lateral ligaments of the elbow. (J Shoulder Elbow Surg 2002;11:60-4.)

Ligamentous stabilizers against posterolateral rotatory instability of the elbow.

The lateral ulnar collateral ligament, the entire lateral collateral ligament complex, and the overlying extensor muscles have all been suggested as key stabilizers against posterolateral rotatory instability of the elbow. The purpose of this investigation was to determine whether either an intact radial collateral ligament alone or an intact lateral ulnar collateral ligament alone is sufficient to prevent posterolateral rotatory instability when the annular ligament is intact. Sequential sectioning of the radial collateral and lateral ulnar collateral ligaments was performed in twelve fresh-frozen cadaveric upper extremities. At each stage of the sectioning protocol, a pivot shift test was performed with the arm in a vertical position. Passive elbow flexion was performed with the forearm maintained in either pronation or supination and the arm in the varus and valgus gravity-loaded orientations. An electromagnetic tracking device was used to quantify the internal-external rotation and varus-valgus angulation of the ulna with respect to the humerus. Compared with the intact elbow, no differences in the magnitude of internal-external rotation or maximum varus-valgus laxity of the ulna were detected with only the radial collateral or lateral ulnar collateral ligament intact (p > 0.05). However, once the entire lateral collateral ligament was transected, significant increases in internal-external rotation (p = 0.0007) and maximum varus-valgus laxity (p < 0.0001) were measured. None of the pivot shift tests had a clinically positive result until the entire lateral collateral ligament was sectioned. This study suggests that, when the annular ligament is intact, either the radial collateral ligament or the lateral ulnar collateral ligament can be transected without inducing posterolateral rotatory instability of the elbow.

ANATOMY OF THE RADIAL BRANCHES OF THE PALMAR ARCH

In this study, the authors present the results of the investigation of arteries that replace digital collaterals of the radial side of the hand when the superficial palmar arch (SPA) does not develop completely. The replacement occurs with the first interosseous dorsal and the first interosseous palmar arteries. The former takes place through the middle developed branch that issues the radial collateral of the thumb and the ulnar collateral of the little finger whereas the latter takes place in three cases: a) presence of a branch entering into the retroadductor space and finishing like the previously mentioned; b) the origin of the trunk of the ulnar collateral of the thumb finger and the radial collateral of the index finger; c) due to the origin of both collaterals of the thumb finger. In cases when the SPA does not issue the fourth palmar collateral, this one is replaced by the second palmar interosseous artery, a branch of the deep palmar arch. These three arteries are combined to form three different basic kinds of arterial replacement that are described, adding a fourth group of exceptions that does not fit into any of the categories mentioned previously.

The extraosseous and intraosseous arterial anatomy of the adult elbow.

We investigated the extraosseous and intraosseous arterial anatomy of the human adult elbow. Twenty-two fresh adult cadaveric upper extremities were studied with a technique of combined India-ink and latex injection followed by chemical débridement. The intraosseous vascularity of twelve extremities was then evaluated with a rapid Spalteholz clearing technique. Our findings demonstrated consistent patterns of extraosseous and intraosseous vascular anatomy, which were organized into three vascular arcades: medial, lateral, and posterior. The medial arcade was formed by the superior and inferior ulnar collateral arteries and the posterior ulnar recurrent artery. The lateral arcade was formed by the radial and middle collateral, radial recurrent, and interosseous recurrent arteries. The posterior arcade was formed by the medial and lateral arcades and the middle collateral artery. The intraosseous circulation of the elbow, which was segmental in organization, appeared to be dependent on the local blood supply. The capitellum and the lateral aspect of the trochlea were supplied by posterior perforating vessels arising from the radial recurrent, radial collateral, and interosseous recurrent arteries. The medial aspect of the trochlea was supplied by a circumferential vascular ring originating from the inferior ulnar collateral artery. Watershed areas were apparent between the blood supplies to the medial and lateral aspects of the distal end of the humerus. The olecranon was richly supplied by vessels coursing along its medial aspect from the posterior ulnar recurrent artery and along its lateral aspect from the interosseous recurrent artery. The radial head had a dual extraosseous blood supply from a single branch of the radial recurrent artery, which supplied the head directly, and from additional vessels from both the radial and the interosseous recurrent artery, which penetrated the capsular insertion at the neck of the radius. Our findings demonstrate that arterial contributions to the intraosseous circulation of the elbow are more specific than previously appreciated. The intraosseous circulation of the elbow is derived mainly from perforating vessels that arise from neighboring extraosseous arteries. These perforating arteries may be damaged by trauma or by extensile dissection during reconstruction of the elbow. An understanding of the extraosseous and intraosseous circulation of the elbow may help to avoid iatrogenic injury to the intraosseous circulation.

Free tendon grafting to repair the metacarpophalangeal joint of the thumb. Surgical techniques and a review of 70 patients

We report the use of a free tendon graft in 70 patients to repair lesions of the capsuloligamentous complex of the metacarpophalangeal joint of the thumb. Of these 37 had a lesion of the ulnar collateral ligament, 18 of the radial collateral and 11 of the volar plate. Four patients had combined lesions. We outline our techniques and review 51 of the patients. Of those 47 (92%) were satisfied, and all but one had regained full stability. Pinch grip strength was normal in 48. About one-third of the patients had some loss of flexion/extension; this was seldom noticed by the patients and caused no significant disability. Free tendon graft reconstruction is indicated for severe fresh lesions, for old lesions with chronic disability and for lesions which have not responded to conservative management.