Skip to main content
SpringerLink
Log in

Ultrastructure and Innervation of Thumb Carpometacarpal Ligaments in Surgical Patients With Osteoarthritis

  • Symposium: Thumb Carpometacarpal Arthritis
  • Published:
Clinical Orthopaedics and Related Research®

Abstract

Background

The complex configuration of the thumb carpometacarpal (CMC-1) joint relies on musculotendinous and ligamentous support for precise circumduction. Ligament innervation contributes to joint stability and proprioception. Evidence suggests abnormal ligament innervation is associated with osteoarthritis (OA) in large joints; however, little is known about CMC-1 ligament innervation characteristics in patients with OA. We studied the dorsal radial ligament (DRL) and the anterior oblique ligament (AOL), ligaments with a reported divergent presence of mechanoreceptors in nonosteoarthritic joints.

Questions/purposes

This study’s purposes were (1) to examine the ultrastructural architecture of CMC-1 ligaments in surgical patients with OA; (2) to describe innervation, specifically looking at mechanoreceptors, of these ligaments using immunohistochemical techniques and compare the AOL and DRL in terms of innervation; and (3) to determine whether there is a correlation between age and mechanoreceptor density.

Methods

The AOL and DRL were harvested from 11 patients with OA during trapeziectomy (10 women, one man; mean age, 67 years). The 22 ligaments were sectioned in paraffin and analyzed using immunoflourescent triple staining microscopy.

Results

In contrast to the organized collagen bundles of the DRL, the AOL appeared to be composed of disorganized connective tissue with few collagen fibers and little innervation. Mechanoreceptors were identified in CMC-1 ligaments of all patients with OA. The DRL was significantly more innervated than the AOL. There was no significant correlation between innervation of the DRL and AOL and patient age.

Conclusions

The dense collagen structure and rich innervation of the DRL in patients with OA suggest that the DRL has an important proprioceptive and stabilizing role.

Clinical Relevance

Ligament innervation may correlate with proprioceptive and neuromuscular changes in OA pathophysiology and consequently support further investigation of innervation in disease prevention and treatment strategies.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1A–B
Fig. 2A–D
Fig. 3
Fig. 4A–D
Fig. 5
Fig. 6

Similar content being viewed by others

References

  1. Bettinger PC, Linscheid RL, Berger RA, Cooney WP 3rd, An KN. An anatomic study of the stabilizing ligaments of the trapezium and trapeziometacarpal joint. J Hand Surg Am. 1999;24:786–798.

    Article  PubMed  CAS  Google Scholar 

  2. Bettinger PC, Smutz WP, Linscheid RL, Cooney WP 3rd, An KN. Material properties of the trapezial and trapeziometacarpal ligaments. J Hand Surg Am. 2000;25:1085–1095.

    Article  PubMed  CAS  Google Scholar 

  3. Bosmans B, Verhofstad MH, Gosens T. Traumatic thumb carpometacarpal joint dislocations. J Hand Surg Am. 2008;33:438–441.

    Article  PubMed  CAS  Google Scholar 

  4. Brandt KD, Dieppe P, Radin E. Etiopathogenesis of osteoarthritis. Med Clin North Am. 2009;93:1–24, xv.

    Google Scholar 

  5. Colman M, Mass DP, Draganich LF. Effects of the deep anterior oblique and dorsoradial ligaments on trapeziometacarpal joint stability. J Hand Surg Am. 2007;32:310–317.

    Article  PubMed  Google Scholar 

  6. Cooney WP 3rd, Lucca MJ, Chao EY, Linscheid RL. The kinesiology of the thumb trapeziometacarpal joint. J Bone Joint Surg Am. 1981;63:1371–1381.

    PubMed  Google Scholar 

  7. Diederichsen LP, Norregaard J, Krogsgaard M, Fischer-Rasmussen T, Dyhre-Poulsen P. Reflexes in the shoulder muscles elicited from the human coracoacromial ligament. J Orthop Res. 2004;22:976–983.

    Article  PubMed  Google Scholar 

  8. Doerschuk SH, Hicks DG, Chinchilli VM, Pellegrini VD Jr. Histopathology of the palmar beak ligament in trapeziometacarpal osteoarthritis. J Hand Surg Am. 1999;24:496–504.

    Article  PubMed  CAS  Google Scholar 

  9. Eaton RG, Glickel SZ. Trapeziometacarpal osteoarthritis. Staging as a rationale for treatment. Hand Clin. 1987;3:455–471.

    PubMed  CAS  Google Scholar 

  10. Fick A. [The Joint With Saddle Shaped Surface] [in German]. Heidelberg, Germany: Adademische Verlagshandlung; 1854:314–321.

  11. Freeman MA, Wyke B. Articular reflexes at the ankle joint: an electromyographic study of normal and abnormal influences of ankle-joint mechanoreceptors upon reflex activity in the leg muscles. Br J Surg. 1967;54:990–1001.

    Article  PubMed  CAS  Google Scholar 

  12. Hagert E. Wrist Ligaments—Innervation Patterns and Ligamento-muscular Reflexes. PhD thesis, Department of Clinical Science and Education, Section of Hand Surgery. Stockholm, Sweden: Karolinska Institutet; 2008:1–51.

  13. Hagert E. Proprioception of the wrist following posterior interosseous sensory neurectomy. J Hand Surg Am. 2010;35:690–691; author reply 691.

    Google Scholar 

  14. Hagert E, Forsgren S, Ljung BO. Differences in the presence of mechanoreceptors and nerve structures between wrist ligaments may imply differential roles in wrist stabilization. J Orthop Res. 2005;23:757–763.

    Article  PubMed  Google Scholar 

  15. Hagert E, Garcia-Elias M, Forsgren S, Ljung BO. Immunohistochemical analysis of wrist ligament innervation in relation to their structural composition. J Hand Surg Am. 2007;32:30–36.

    Article  PubMed  Google Scholar 

  16. Hagert E, Lee J, Ladd AL. Innervation patterns of thumb trapeziometacarpal joint ligaments. J Hand Surg Am. 2012;37:706–714.e701.

    Google Scholar 

  17. Hagert E, Ljung BO, Forsgren S. General innervation pattern and sensory corpuscles in the scapholunate interosseous ligament. Cells Tissues Organs. 2004;177:47–54.

    Article  PubMed  CAS  Google Scholar 

  18. Hagert E, Persson JK, Werner M, Ljung BO. Evidence of wrist proprioceptive reflexes elicited after stimulation of the scapholunate interosseous ligament. J Hand Surg Am. 2009;34:642–651.

    Article  PubMed  Google Scholar 

  19. Hunter DJ, Zhang Y, Sokolove J, Niu J, Aliabadi P, Felson DT. Trapeziometacarpal subluxation predisposes to incident trapeziometacarpal osteoarthritis (OA): the Framingham Study. Osteoarthritis Cartilage. 2005;13:953–957.

    Article  PubMed  CAS  Google Scholar 

  20. Hurley MV. The role of muscle weakness in the pathogenesis of osteoarthritis. Rheum Dis Clin North Am. 1999;25:283–298, vi.

    Google Scholar 

  21. Imaeda T, An KN, Cooney WP 3rd, Linscheid R. Anatomy of trapeziometacarpal ligaments. J Hand Surg Am. 1993;18:226–231.

    Article  PubMed  CAS  Google Scholar 

  22. Konttinen YT, Tiainen VM, Gomez-Barrena E, Hukkanen M, Salo J. Innervation of the joint and role of neuropeptides. Ann N Y Acad Sci. 2006;1069:149–154.

    Article  PubMed  Google Scholar 

  23. Kwan MM, Close JC, Wong AK, Lord SR. Falls incidence, risk factors, and consequences in Chinese older people: a systematic review. J Am Geriatr Soc. 2011;59:536–543.

    Article  PubMed  Google Scholar 

  24. Ladd AL, Lee J, Hagert E. Macroscopic and microscopic analysis of the thumb carpometacarpal ligaments: a cadaveric study of ligament anatomy and histology. J Bone Joint Surg Am. 2012;94:1468–1477.

    Article  PubMed Central  PubMed  Google Scholar 

  25. Lee HM, Cheng CK, Liau JJ. Correlation between proprioception, muscle strength, knee laxity, and dynamic standing balance in patients with chronic anterior cruciate ligament deficiency. Knee. 2009;16:387–391.

    Article  PubMed  Google Scholar 

  26. Lee J, Ladd A, Hagert E. Immunofluorescent triple-staining technique to identify sensory nerve endings in human thumb ligaments. Cells Tissues Organs. 2012;195:456–464.

    Article  PubMed  CAS  Google Scholar 

  27. Lephart SM, Fu FH Proprioception and Neuromuscular Control in Joint Stability; Introduction to the Sensorimotor System. Champaign, IL, USA: Human Kinetics; 2000.

    Google Scholar 

  28. McGonagle D, Tan AL, Carey J, Benjamin M. The anatomical basis for a novel classification of osteoarthritis and allied disorders. J Anat. 2010;216:279–291.

    Article  PubMed Central  PubMed  Google Scholar 

  29. Napier JR. The form and function of the carpo-metacarpal joint of the thumb. J Anat. 1955;89:362–369.

    PubMed Central  PubMed  CAS  Google Scholar 

  30. Palmer I. Pathophysiology of the medical ligament of the knee joint. Acta Chir Scand. 1958;115:312–318.

    PubMed  CAS  Google Scholar 

  31. Pellegrini VD Jr. Osteoarthritis of the trapeziometacarpal joint: the pathophysiology of articular cartilage degeneration. I. Anatomy and pathology of the aging joint. J Hand Surg Am. 1991;16:967–974.

    Article  PubMed  Google Scholar 

  32. Pellegrini VD Jr. The ABJS 2005 Nicolas Andry Award: osteoarthritis and injury at the base of the human thumb: survival of the fittest? Clin Orthop Relat Res. 2005;438:266–276.

    Article  PubMed  Google Scholar 

  33. Phillips D, Petrie S, Solomonow M, Zhou BH, Guanche C, D’Ambrosia R. Ligamentomuscular protective reflex in the elbow. J Hand Surg Am. 1997;22:473–478.

    Article  PubMed  CAS  Google Scholar 

  34. Riemann BL, Lephart SM. The sensorimotor system, part I: the physiologic basis of functional joint stability. J Athl Train. 2002;37:71–79.

    PubMed Central  PubMed  Google Scholar 

  35. Riemann BL, Lephart SM. The sensorimotor system, part II: the role of proprioception in motor control and functional joint stability. J Athl Train. 2002;37:80–84.

    PubMed Central  PubMed  Google Scholar 

  36. Salo P. The role of joint innervation in the pathogenesis of arthritis. Can J Surg. 1999;42:91–100.

    PubMed Central  PubMed  CAS  Google Scholar 

  37. Salo PT, Hogervorst T, Seerattan RA, Rucker D, Bray RC. Selective joint denervation promotes knee osteoarthritis in the aging rat. J Orthop Res. 2002;20:1256–1264.

    Article  PubMed  Google Scholar 

  38. Salo PT, Seeratten RA, Erwin WM, Bray RC. Evidence for a neuropathic contribution to the development of spontaneous knee osteoarthrosis in a mouse model. Acta Orthop Scand. 2002;73:77–84.

    Article  PubMed  Google Scholar 

  39. Sharma L. Proprioceptive impairment in knee osteoarthritis. Rheum Dis Clin North Am. 1999;25:299–314, vi.

    Google Scholar 

  40. Skinner HB, Barrack RL, Cook SD. Age-related decline in proprioception. Clin Orthop Relat Res. 1984;184:208–211.

    PubMed  Google Scholar 

  41. Slaoui M, Fiette L. Histopathology procedures: from tissue sampling to histopathological evaluation. Methods Mol Biol. 2011;691:69–82.

    Article  PubMed  Google Scholar 

  42. Strauch RJ, Behrman MJ, Rosenwasser MP. Acute dislocation of the carpometacarpal joint of the thumb: an anatomic and cadaver study. J Hand Surg Am. 1994;19:93–98.

    Article  PubMed  CAS  Google Scholar 

  43. Tan AL, Toumi H, Benjamin M, Grainger AJ, Tanner SF, Emery P, McGonagle D. Combined high-resolution magnetic resonance imaging and histological examination to explore the role of ligaments and tendons in the phenotypic expression of early hand osteoarthritis. Ann Rheum Dis. 2006;65:1267–1272.

    Article  PubMed Central  PubMed  CAS  Google Scholar 

  44. Tomita K, Berger EJ, Berger RA, Kraisarin J, An KN. Distribution of nerve endings in the human dorsal radiocarpal ligament. J Hand Surg Am. 2007;32:466–473.

    Article  PubMed  Google Scholar 

  45. Van Brenk B, Richards RR, Mackay MB, Boynton EL. A biomechanical assessment of ligaments preventing dorsoradial subluxation of the trapeziometacarpal joint. J Hand Surg Am. 1998;23:607–611.

    Article  PubMed  Google Scholar 

  46. Weerakkody NS, Blouin JS, Taylor JL, Gandevia SC. Local subcutaneous and muscle pain impairs detection of passive movements at the human thumb. J Physiol. 2008;586:3183–3193.

    Article  PubMed Central  PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Clinical Science and Education, Karolinska Institute, Sjukhusbacken 10, 118 83, Stockholm, Sweden

    Nathalie Mobargha MD & Elisabet Hagert MD, PhD

  2. Department of Orthopaedic Surgery, Stanford University School of Medicine, Stanford University, Stanford, CA, USA

    Cassie Ludwig BS

  3. Department of Orthopaedic Surgery, Robert A. Chase Hand & Upper Limb Center, Stanford University, Stanford, CA, USA

    Amy L. Ladd MD

  4. Hand & Foot Surgery Center, Stockholm, Sweden

    Elisabet Hagert MD, PhD

Authors
  1. Nathalie Mobargha MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Cassie Ludwig BS
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Amy L. Ladd MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Elisabet Hagert MD, PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Nathalie Mobargha MD.

Additional information

One of the authors (NM) was supported by Karolinska Institute to cover travel expenses.

All ICMJE Conflict of Interest Forms for authors and Clinical Orthopaedics and Related Research editors and board members are on file with the publication and can be viewed on request.

Clinical Orthopaedics and Related Research neither advocates nor endorses the use of any treatment, drug, or device. Readers are encouraged to always seek additional information, including FDA-approval status, of any drug or device prior to clinical use.

Each author certifies that his or her institution approved the human protocol for this investigation, that all investigations were conducted in conformity with ethical principles of research, and that informed consent for participation in the study was obtained.

This investigation was performed at the Robert A. Chase Hand & Upper Limb Center, Department of Orthopedic Surgery and Division of Clinical Anatomy, Stanford University, Stanford, CA, USA.

About this article

Cite this article

Mobargha, N., Ludwig, C., Ladd, A.L. et al. Ultrastructure and Innervation of Thumb Carpometacarpal Ligaments in Surgical Patients With Osteoarthritis. Clin Orthop Relat Res 472, 1146–1154 (2014). https://doi.org/10.1007/s11999-013-3083-7

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11999-013-3083-7

Keywords

Search

Navigation