Saddle Joint Research Articles

Arthritis of the thumb (rhizarthrosis) in the elderly

Osteoarthritis of the base of the thumb is a common and painful condition, mostly observed in post menopausal women. This paper proposes a critical review of the recent papers in the point of view of geriatric medicine. The basal joint of the thumb is formed by the trapeziometacarpal joint and the carpometacarpal joint of the thumb. The trapeziometacarpal joint is a saddle joint with a wide mobility. The trapezium is most important bone which authorizes movement of rotation towards every finger of the hand. Carpometacarpal allows the strength of the hand. Antalgesic drugs are the first treatments. NSAIDs can be applied and reduced pain. Resting hand splint have a significant pain relief, without any side effects. This advantage is appropriate to treatment in elderly subjects. Flexible orthosis is adapted to maintaining activities of daily living in moderate pain. Chirurgical ligament reconstruction tendon interposition is the most common technics used. In elderly subject, trapeziectomy achieved pain relief and adapted to frail elderly.

The Design and Analysis of Saw-Milling Working Head for Special Shaped Stone

For a new type of saw-milling composite work-head, using the finite element method and modal analysis tests to get the dynamic characteristics analysis of the system. We have made dynamic parameters analyses which are mode shape, natural frequency and damping ratio of the whole machine and the piece structure of work-head, and identified the weak links of the machine. The research shows that: the composite work-head’ weaknesses are in the sliding saddle joint, and the vibration instability trend would drive the whole machine; the dynamic stiffness of spindle is lower in the low frequency band, and it causes a certain influence on the machining accuracy.

Edward Hallarran Bennett: Bennett's Fracture of the Base of the Thumb

Bennett's fracture involves part of the base of the metacarpal bone of the thumb. The fracture line runs obliquely and involves the joint between the first metacarpal and the adjacent carpal bone--the trapezium. The shaft of the metacarpal is pulled proximally by the action of the long muscles attached to the thumb, so a fracture-dislocation of the thumb carpo-metacarpal joint results. The injury occurs typically in young men as a result of a blow on the clenched fist, either in a fall or, very often, in landing a blow in boxing. Now this joint happens to be of extreme importance in fine movements of the thumb, because it is here that opposition of the thumb takes place. Look at your own hand; now put the tip of your thumb onto the tip of your index finger; this is opposition and only man and monkeys can carry out this action. It is this important movement that you use when writing, when holding a scissors or a scalpel. When you look at the two bones articulating together they resemble someone sitting on a saddle and the joint, the only one of its kind in your limbs, is appropriately called a 'saddle joint'.

Fixation of trapezial implants in a trapeziometacarpal total joint prosthesis tested in a model of porcine bone

High aseptic loosening rates have been reported in total joint prostheses of the carpometacarpal joint of the thumb, particularly in the trapezial component. The primary fixation of new implants may be tested in cadaver bones, but the anatomy of the pig is in many ways similar to that of the human, so we compared the central carpal bone from the forefoot of 6-month-old pigs, which has a saddle joint surface similar to the trapezium, to the trapezium in patients with carpometacarpal osteoarthritis. The mean (SD) bone mineral density of the 13 pig forefoot bones was 0.88 (0.12) g/cm2 compared with 0.63 (0.16) g/cm2 in the 31 human trapeziums. The measured size of the porcine bones was slightly larger than that of the human trapeziums. The similarity in form, size, and bone mineral density means that the central bone of the forefoot of 6-month-old pigs may be used for fixation tests in trapezial implants.

An effect on basic meat quality attributes of a balanced feed mixture with a 10 % share of flaxseed applied in goat kid feeding

Abstract. The objective of the study was to analyse the slaughter value and physico-chemical properties of goat kids slaughtered at 150 days of age. After weaning, at 60 days of age a balanced feed mixture with a 10 % share of flaxseed was applied in feeding. There was found a significant (P≤0.05) increase in slaughter performance (45.80 %) and primal cuts (leg, saddle joint) obtained in the experimental group. There was also found significantly (P≤0.05) less (by 1 %) fat in the carcass of the aforementioned group. In contrast, a percentage share of meat in the leg (70.60 %) and the carcass (60.71 %) was statistically insignificant although it was slightly higher in the experimental group. The meat of male kids fed flaxseed was darker, (L* 42.60) at P≤0.01, and contained more (P≤0.01) dry matter (24.32 %) and protein (20.97 %) but less (P≤0.05) fat (1.92 %). The sensory assessment revealed similar cooking usefulness of goat kid meat and no statistically significant differences between the groups studied.

Musculoskeletal structure of the feeding system and implications of snout elongation in Hippocampus reidi and Dunckerocampus dactyliophorus

A thorough morphological description of the feeding apparatus in Hippocampus reidi, a long-snouted seahorse, and Dunckerocampus dactyliophorus, an extremely long-snouted pipefish, revealed specialized features that might be associated with the fast and powerful suction feeding, like the two ligamentous connections between the lower jaw and the hyoid, the saddle joint of the latter with the suspensorium and the vertebro-pectoral fusion that articulates on three points with the cranium. Despite the conserved morphology of the feeding apparatus, it was found that in H. reidi the orientation of the occipital joint is ventrocaudal, the sternohyoideus and epaxial muscles are more bulky and both have a short tendon. In D. dactyliophorus, on the other hand, the protractor hyoidei muscle is enclosed by the mandibulo-hyoid ligament, the sternohyoideus and epaxial tendons are long and a sesamoid bone is present in the latter. These features were compared to other syngnathid species with different snout lengths to evaluate the implications of snout elongation on the musculoskeletal structure of the cranium. The arched path of the adductor mandibulae and the greater rigidity of the lower jaw might be related to elongation of the snout, as it yields an increased mechanical advantage of the lower jaw system and a reduced torque between the elements of the lower jaw during protractor hyoidei muscle contraction, respectively. Nevertheless, most observed features did not seem to be related to snout length, but might be associated with different force-generating strategies.

Blutegeltherapie bei symptomatischer Rhizarthrose

Leech therapy has been shown to be effective for symptomatic treatment of osteoarthritis of the knee. We aimed to investigate the effectiveness of leech therapy in another type of osteoarthritis. In this randomized controlled trial we evaluate the effectiveness of leech therapy in symptomatic osteoarthritis of the first carpometacarpal joint (thumb saddle joint). A single course of leech therapy is effective in relieving pain and improving disability for at least 2 months compared to topical diclofenac therapy. In conclusion, the leech therapy is another option for treatment of osteoarthritis of the first carpometacarpal joint.

Contribution to morphological knowledge of the development of the human incudo-mallear joint

Conclusion: At the time of birth, the incudo-mallear joint is completely developed. Objective. To study the development of the incudo-mallear joint in human embryos and fetuses. Materials and methods. In all, 46 temporal bones with ages between 9 mm and newborns were studied. The preparations were cut in a series and dyed using Martins’ trichrome technique. Results. The incudo-mallear joint acquires the characteristics of a saddle joint at 10 weeks of development. The cartilage that covers the articular surfaces is formed by different strata that develop successively: the superficial stratum at 14 weeks, the transitional between 15 and 19 weeks, and the radial from 20 weeks. The subchondral bone develops between weeks 25 and 28 by the mechanisms of apposition and extension of the periosteal and endosteal bones, but it is not until week 30 that it completely covers the articular surfaces, consisting of bone fascicles whereby the lines of force will be transmitted. The articular capsule is formed as from the inter-zone. The surface zone develops the capsular ligament, and the internal surface develops the synovial membrane. Even though it is not consistent, the primordium of the meniscus is seen at 18 weeks.

Effectiveness of leech therapy in women with symptomatic arthrosis of the first carpometacarpal joint: A randomized controlled trial

Leech therapy has been shown to be effective for symptomatic treatment of osteoarthritis of the knee. We aimed to investigate the effectiveness of leech therapy in another type of osteoarthritis, osteoarthritis of the first carpometacarpal joint (thumb saddle joint). Thirty-two women with symptomatic painful osteoarthritis of the first carpometacarpal joint and who scored > 40 mm on a 100 mm VAS pain scale were randomized to a single treatment with 2–3 locally applied leeches (leech group) or a 30-day course with topical diclofenac twice a day. Primary outcome measure was change of overall pain (mean of VAS for pain at rest, in motion, during grip) from baseline to day 7. Secondary outcomes were functional disability (DASH-questionnaire), quality of life (QoL, SF-36) and grip strength. Patients were examined baseline and at days 7, 30 and 60 after treatment. Overall pain score at day 7 was reduced from 59.6 ± 13.8 to 27.1 ± 20.6 in the leech group ( n = 16) and from 50.6 ± 13.3 to 46.9 ± 18.5 with diclofenac ( n = 16) (group difference −26.5, 95%CI −40.3; −12.7; p = 0.0003). Group differences for pain relief favoring the leech treatment increased at days 30 and 60. Significant treatment effects were also observed for the DASH score, QoL and grip. Results were not affected by outcome expectation or consumption of analgetics. A single course of leech therapy is effective in relieving pain, improving disability and QoL for at least 2 months. The potential of leech therapy for treatment of arthritic pain and underlying mechanisms should be further investigated.

Le premier rayon de la main et du pied chez les primates (I). Anatomie descriptive

Dissection of the first ray and the connecting structures of the hand and the foot of simian primates, conserved by freezing or embalming and observation of 325 skeletal pieces of specimens of the Museum of Natural History of Paris. The trapezometacarpal articulation is a saddle joint with a trapezial concavity according to its great oblique axis directed at 45 degrees with respect to a sagittal plan for the whole of the simian primates, with a trapezoidal concavity according to a great axis directed in a sagittal plan for the loridae, the galagonidae and the daubentonidae and with a counter fort supported by a mediopalmar apophysis or a sesamoid bone for the lemurpides. The whole of the mediopalmar ligaments is inserted distally on the medial tubercle at the basis of the first metacarpus. This insertion was fibrocartilaginous for the gorilla. The mediopalmar ligaments are very more developed than the laterodorsal ligaments in all the hominidae and the catarhinious. The both groups are equivalent for the platyrhinious and the prosimious. An intracapsular ligament may reinforce the laterodorsal by the lemoridae. The cuneometatarsal articulation presents a sagittal great axis. It was in fact a spiral trochoid joint with a cuneiform convexity in all the simian primates except for the humans. In this late case, the articular surface was less high, more narrow, with less marked relief. The form of this articulation is that of a saddle with a sagittal concavity in the prosimious with a strong lateral and palmar cuneiform tuberosity and a big lateral opposite apophysis at the basis of the first metatarsus. The tendon of the long lateral fibular muscle and one fascicle of the tendon of the anterior tibialis is fixed on the both side of the basis of the first metatarsus, except for human beings in which the tendon was undivided and was principally inserted of the navicular bone. The disposition of the cuneometatarsal ligaments is similar to that of the trapezometacarpal ligaments. The distal insertions of the lateral ligaments are fibrocarlilaginous in the cerpopithecidae. All the metacarpophalangeal and metatarsophalangeal are condylar, except for the metacarpophalangeal of the humans which looks like bicondylar; the interphalangeal articulations are bicondylar. The ligamentous devices include the glenoidal and collateral ligaments with their metacarpal- and metatarsophalangeal fascicles and their interphalangeal and phalangeoglenoidal fascicles.

Microstructural adaptation in trapezial bone due to subluxation of the thumb

Although the thumb saddle is one of the most common sites of degenerative osteoarthritis in the hand, little is known about the altered microstructure in osteoarthritic trapezial bones. External forces resulting from subluxation of the carpometacarpal joint of the thumb (CMC I) should provoke microstructural changes in the trapezium. The purpose of this study was to compare the regional differences of the microstructure between osteoarthritic and healthy trapezial bones. Fifteen trapezia harvested from female patients with radiologically and clinically diagnosed saddle joint osteoarthritis (OA) were compared with 15 unaffected controls. Microstructural parameters, such as bone volume ratio (BV/TV), three-dimensional connectivity (Conn.D), trabecular number (Tb.N), and trabecular thickness (Tb.Th) were studied using a microcomputed tomography (microCT) system. While the trapezial height in OA was 22% less, the sclerotic subchondral bone layer thickness was 50% higher in OA compared with the control group (p < 0.001). In the OA group there was a 42% higher bone volume ratio (p <or= 0.001), an 18% increase in Tb.Th (p = 0.006), and a 10% greater Tb.N (p = 0.034) compared with the control group. Although in both groups BV/TV was significantly lower in the radial region, the radial column showed the highest relative increase in bone volume and structure compared with the control group (+67% BV/TV, +20% Tb.Th, +23% Tb.N). The reinforcement of the bony microstructure in CMC I OA, especially at the radial side, is a sign for bone adaptation reacting to radially shifted joint forces. This has to be considered during the development of new prosthetic alternatives.

Comprehensive assessment of clinical outcome and quality of life after resection interposition arthroplasty of the thumb saddle joint

To explore the biometric and psychometric properties of clinical, generic, and condition-specific instruments and to assess quantitatively the outcome after resection interposition arthroplasty (RIAP) of the thumb saddle joint. One hundred three patients requiring 112 arthroplasties were assessed in a 4.5-7.7-year cross-sectional catamnesis by means of 4 widely used questionnaires and clinical and radiographic examinations. In all dimensions of the Short Form 36 (SF-36), the outcome was equal or significantly better than expected by the norm. The Disability of the Arm, Shoulder and Hand questionnaire (DASH) revealed some small, mainly functional limitations (mean score 78.4, norm 86.4). The SF-36, the DASH, and the Patient Related Wrist Evaluation form (PRWE) correlated highly and loaded on the same factor. The Hand Function Index was independent of the clinical measurements (range of motion, strength, etc. on the specially designed Custom Form) and of the self rating. Long-term followup of 112 RIAP patients showed excellent health and quality of life. A questionnaire set consisting of the SF-36, the DASH (or alternatively the short PRWE), and the Custom Form is proposed for the comprehensive and specific assessment of thumb joint conditions.

The carpometacarpal joint of the thumb: stability, deformity, and therapeutic intervention.

The carpometacarpal (CMC) of the thumb is a saddle joint that permits a wide range of motion and is largely responsible for the characteristic dexterity of human prehension. This joint, located at the very base of the thumb, is subject to large physical stresses throughout life. Osteoarthritis (posttraumatic or idiopathic), rheumatoid arthritis, and postmenopausal laxity of the capsular ligaments can predispose structural instability and impairment of this important joint. The instability is characterized by varying and often progressive dislocation of the joint surfaces, resulting in a displaced axis of rotation and abnormal actions of thumb muscles. The main consequence of the instability is most often pain and weakness, most notably during pinch and grasping actions. This paper is conceptually divided into 2 sections. The first section describes the anatomic structures that maintain stability in the normal CMC joint of the thumb and how disease or trauma can cause instability and ultimate deformity. The second section describes both nonsurgical and surgical interventions that are most often used to treat an unstable CMC joint. This paper is intended primarily as an overview for the physical therapist who does not specialize in the treatment of the hand, although desires basic information on this important topic.

An improved articulated model of the human hand

We present an improved anatomically based approach to modeling the human hand for use in the animation of American Sign Language. The joint rotations in the model are based on the bone and muscle configurations of the hand, and a forward kinematic solution is used to position the hand. In particular, we investigate the rotations of the base joint of the thumb. This joint is a saddle joint with non-trivial rotational axes and centers, and must be treated with care in such a model. We take advantage of several correlations between joint rotations in the hand to reduce the number of degrees of freedom in the model and provide a simple, intuitive and interactive interface for American Sign Language handshape transcription.

Primal joints and hind-leg cuts of entire and castrated Javan rusa ( Cervus timorensis russa) stags

The effects of castration on the primal joints and the cuts of the leg joint of Javan rusa ( Cervus timorensis russa) stag carcases was investigated at three slaughter ages (13, 19 and 25 months). Castration reduced the weights of some primal joints in the 19- and 25-months age groups, but not at 13 months. At 19 months, the neck, and neck plus chuck, were heavier by 35 and 17% respectively in entires ( P<0.05), and at 25 months entires had heavier carcases, shoulder, forequarter and hindquarter ( P<0.05). The leg and saddle joints were approximately 39 and 18% of the side, respectively, for both treatments and all ages. The proportions of the neck, and neck plus chuck, were higher ( P<0.05) in 19-month old entires than castrates. There were few significant differences between treatments in the weight or proportion of the hind leg cuts at any slaughter age, but in the 25-months group the silverside was 8% ( P<0.05) heavier in entires. In both castrates and entires, there appeared to be an increase in the percentage of the rump as the animals grew from 13 to 19 months of age.

Basisnahe Frakturen des ersten Mittelhandknochens - Untersuchungsergebnisse von 23 Patienten -

Dislozierte basisnahe Brüche des ersten Mittelhandknochens werden in der Regel osteosynthetisch versorgt mit dem Ziel, die Sattelgelenkfläche exakt wiederherzustellen, um eine posttraumatische Arthrose zu verhindern. Von Juli 1985 bis April 1996 wurden 38 Patienten operativ mit der Methode nach Iselin behandelt. 23 Patienten konnten durchschnittlich 53 Monate postoperativ nachuntersucht werden. In 21 Fällen fand sich ein gutes Ergebnis.

Daumenrekonstruktion durch kontinuierliche Verlängerung des ersten Mittelhandknochens

Reconstruction of the amputated thumb through continuous distraction with an Ilizarov ring fixator. Traumatic loss of thumb at the level of the proximal half of the proximal phalanx. Insufficient soft tissue coverage of stump. Stiff saddle joint. Tourniquet. Brachial plexus or general anaesthesia. Installation of a ring fixator. Incomplete osteotomy at mid shaft of first metacarpus with chisel and completion through osteoclasia by twisting the chisel. Preserve palmar periosteum. Deepening of first web space if necessary after removal of external fixator. Use of Z-plasty and proximal transfer of adductor pollicis insertion. After 1 week continuous lengthening 0.7 mm/day in 3 daily increments. After removal of fixator plaster cast for 2 weeks. Improper installation of fixator. Incomplete osteotomy. Too rapid or too slow distraction. Pin tract infection. Deep infection. Over a 2 year period 10 lengthenings. Average follow-up 23 months (10 to 36 months). Average gain in length 38.1 mm. Average length of treatment 163 days. Deepening of web space in 7 patients. Force of grasp 64% of opposite side. Pin tract infection: 4, too early removal of fixator: 1, revision of scar: 1 and correction of stump: 1. All patients were satisfied with the result but for scar at web space.

Arthrosis in the peritrapezial joints of the hand.

In the present study saddle joints of the thumb and neighboring joints of 100 anatomic specimens are examined with regard to radiological and macroscopic arthrotic alterations. Comparisons of radiological and macroscopic findings demonstrate that early arthrotic articular alterations cannot be diagnosed radiologically. Almost half of the hands examined displayed arthrotic lesions in the saddle joint of the thumb, whereas the trapezoido-scaphoidal and trapezio-scaphoidal joints are each affected in one third. Hands with manifest thumb saddle joint arthrosis are accompanied by arthrotic alterations of the joints between the scaphoid, trapezium and trapezoid in two-thirds of the cases. In the remaining radial intercarpal joints, no macroscopic evidence can be ascertained of arthrotic alterations. Among the processes discussed as causal factors of simultaneous incidence of scaphoidal and carpo-metacarpal arthroses, the architecture of the osseous carpus, the individual expression of the scaphoid bone and poly- or secondary arthrotic processes are important.

Dorsal connective tissue spaces of the thumb

Summary The clinical importance of the dorsal laminary connective tissue of the thumb is often emphasized with regard to spreading infectious inflammatory processes. The dorsal aponeurosis of the thumb contains connective tissue spaces, the function of which cannot simply be attributed to expanding the normal intercellular capillary spaces. These properties give the thumb a special status, separating it from the fingers motorically and morphologically. A plastic injection technique was used to display the various configurations of capillary spaces in the radio-dorsal region of fixed and unfixed hands and thumbs in order to describe them morphologically and topographically. Superficial, deep capillary and gliding spaces are structures limiting the mobility of the back of the thumb. They are topographically and functionally bound up with movements of the thumb saddle joint and carry the load of the radio-dorsal hand. The most exact reconstruction of the bordering elements of such functional spaces appears to be of special interest with regard to the complete restoration of thumb mobility.

Kinematics of the normal trapeziometacarpal joint.

Motion of the trapeziometacarpal joint was studied in 12 hands from fresh human cadavera. By use of a magnetic tracking system, a full range of motion of the first metacarpal was analyzed with respect to a defined trapezial coordinate system. The traces of the reference points on the head and base of the first metacarpal were monitored, and the instantaneous centers of rotation were calculated. During circumduction, the reference points on the head and base followed elliptical paths but in opposite directions. The average instantaneous center of circumduction was at approximately the center of the trapezial joint surface. In flexion-extension, the axis of rotation was located within the trapezium, and the path of the head was identical to the path of the base. In abduction-adduction, the axis of rotation was located distal to the trapezium within the base of the first metacarpal, and the base and head moved in opposite directions. There was no single center of rotation; rather, instantaneous motion occurred reciprocally between these centers of rotation within the trapezium and metacarpal base in the normal thumb. This changing instantaneous center of rotation results in a unique pattern of motion which is related to congruent, tightly constrained joint surfaces of two reciprocal saddle joints and to precisely positioned extraarticular ligaments.