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Immunofluorescence analysis of sensory nerve endings in the periarticular tissue of the human elbow joint

  • Orthopaedic Surgery
  • Published:
Archives of Orthopaedic and Trauma Surgery Aims and scope Submit manuscript

Abstract

Introduction

To investigate the dynamic aspects of elbow stability, we aimed to analyze sensory nerve endings in the ligaments and the capsule of elbow joints.

Materials and methods

The capsule with its anterior (AJC) and posterior (PJC) parts, the radial collateral ligament (RCL), the annular ligament (AL), and the ulnar collateral ligament with its posterior (PUCL), transverse (TUCL) and anterior parts (AUCL) were dissected from eleven human cadaver elbow joints. Sensory nerve endings were analyzed in two levels per specimen as total cell amount/ cm2 after immunofluorescence staining with low-affinity neurotrophin receptor p75, protein gene product 9.5, S-100 protein and 4′,6-Diamidin-2-phenylindol, Carbonic anhydrase II and choline acetyltransferase on an Apotome microscope according to Freeman and Wyke’s classification.

Results

Free nerve endings were the predominant mechanoreceptor in all seven structures followed by Ruffini, unclassifiable, Golgi-like, and Pacini corpuscles (p ≤ 0.00001, respectively). Free nerve endings were observed significant more often in the AJC than in the RCL (p < 0.00002). A higher density of Ruffini endings than Golgi-like endings was observed in the PJC (p = 0.004). The RCL contained significant more Ruffini endings than Pacini corpuscles (p = 0.004). Carbonic anhydrase II was significantly more frequently positively immunoreactive than choline acetyltransferase in all sensory nerve endings (p < 0.05). Sensory nerve endings were significant more often epifascicular distributed in all structures (p < 0.006, respectively) except for the AJC, which had a pronounced equal distribution (p < 0.00005).

Conclusion

The high density of free nerve endings in the joint capsule indicates that it has pronounced nociceptive functions. Joint position sense is mainly detected by the RCL, AUCL, PUCL, and the PJC. Proprioceptive control of the elbow joint is mainly monitored by the joint capsule and the UCL, respectively. However, the extreme range of motion is primarily controlled by the RCL mediated by Golgi-like endings.

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Acknowledgements

We thank Manuel Llusa, MD, PhD (Department of Anatomy, University of Barcelona, Barcelona, Spain) for generous assistance in the laboratory work. We thank the BioImaging Core Facility BCF (http://www.maginlab.eu/home-bcf.html).

Funding

This study has been financially supported by Deutsche Gesetzliche Unfallversicherung, Sankt Augustin, Germany (grant number: FR-0272) and Bauerfeind AG, Zeulenroda-Triebes, Germany (grant number: 8344). The authors disclose any financial conflicts of interest that may influence interpretation of this study and/ or results.

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Authors and Affiliations

  1. Department of Plastic and Hand Surgery, Burn Unit, Hospital Sankt Georg, Delitzscher Straße 141, 04129, Leipzig, Germany

    Susanne Rein, Thomas Kremer & Paul Lühmann

  2. Martin-Luther-University Halle-Wittenberg, Halle (Saale), Germany

    Susanne Rein, Frank Siemers & Paul Lühmann

  3. Kaplan Hand Institute, Paseo de la Reina Elisenda 17, 08034, Barcelona, Spain

    Mireia Esplugas & Marc Garcia-Elias

  4. Department of Plastic and Hand Surgery, Burn Unit, Trauma Center Bergmannstrost, Merseburger Straße 165, 06112, Halle (Saale), Germany

    Frank Siemers

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All authors made substantive intellectual contributions to this study, in conception and design (SR, ME, MGE, FS), acquisition of data (SR, ME, MGE, PL), analysis and interpretation of data (SR, FS, PL), drafting and revising the manuscript (SR, ME, MGE, TK, FS, PL), as well as final approval of the version to be submitted (SR, ME, MGE, TK, FS, PL). All authors have read and approved the final submitted manuscript.

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Correspondence to Susanne Rein.

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The authors declare that they have no competing interests. This study has been financially supported by Deutsche Gesetzliche Unfallversicherung, Sankt Augustin, Germany (grant number: FR-0272) and Bauerfeind AG, Zeulenroda-Triebes, Germany (grant number: 8344). The authors disclose any financial conflicts of interest that may influence interpretation of this study and/ or results.

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All protocols in this study were approved by the local ethics committee review board (approval number 33/17).

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Rein, S., Esplugas, M., Garcia-Elias, M. et al. Immunofluorescence analysis of sensory nerve endings in the periarticular tissue of the human elbow joint. Arch Orthop Trauma Surg 143, 3779–3794 (2023). https://doi.org/10.1007/s00402-022-04604-0

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