Faes Kerkhof

Comparison of the Anatomical Dimensions and Mechanical Properties of the Dorsoradial and Anterior Oblique Ligaments of the Trapeziometacarpal Joint

PURPOSE The respective roles of the dorsoradial (DRL) and anterior oblique (AOL) ligaments in stability of the highly mobile trapeziometacarpal (TMC) joint remain disputed. Earlier publications have pointed to the AOL as the key stabilizing structure; yet, more recent publications have challenged the stabilizing role of the AOL, favoring the DRL as the main TMC joint stabilizer. We executed an anatomical study of the ligaments, including detailed dissection to quantify the length, width, and thickness of the AOL and DRL and tested the material properties of these ligaments. METHODS Thirteen fresh frozen cadaveric thumbs from 9 specimens were used. Length, width, and thickness of the AOL and DRL were measured on magnetic resonance imaging and/or after dissection. Next, the first metacarpal and trapezium were isolated together with both ligaments, and both bones were cut sagittally to isolate a first metacarpal-AOL-trapezium and first metacarpal-DRL-trapezium complex from each thumb. These samples were subjected to cyclic loading in displacement-controlled tests. The obtained force-displacement curves were used to calculate stiffness and hysteresis of each sample. RESULTS Our results showed that the DRL is significantly shorter and thicker than the AOL, which is thin and ill-defined. Our results also indicate that the DRL has a higher stiffness than the AOL, making it a more likely candidate to provide joint stability. CONCLUSIONS Although the AOL has been asserted to be the primary restraint to dorsoradial subluxation, this view has been challenged over the past 10 years by several studies. These studies have shown the AOL to be relatively weak and compliant compared with the intermetacarpal and dorsoradial ligaments and have demonstrated that the DRL is the strongest and stiffest ligament of the TMC joint. Our studies confirm these findings. CLINICAL RELEVANCE This study indicates that the DRL is relatively stiff and thick, suggesting it should be repaired or reconstructed when disrupted to restore stability of the TMC joint.

Quantifying thumb opposition kinematics using dynamic computed tomography

Current motion capture techniques all have shortcomings when applied to the 3D quantitative evaluation of thumb base motion. Dynamic CT might overcome these shortcomings but, so far, robustness of this technique in more than one specimen has not yet been demonstrated. The aim of the current study is to further evaluate the use of dynamic CT for quantification of thumb motion in a larger cadaveric study using a protocol which is feasible in a clinical context. A dynamic CT scan was acquired from six cadaveric human forearms, while a motion simulator imposed thumb opposition. After image acquisition and segmentation, carpal bone motion was quantified using helical axes. To enable comparisons between specimens, intersection points of the instantaneous helical axis with an anatomically defined plane were determined. Precision of the dynamic CT method, measured as variation in distances between silicon nitride beads between frames of a dynamic scan, was 0.43mm (+/-0.09mm) when fixed to the skin and 0.13mm (+/-0.04mm) when embedded into the bone. Absolute deviation between known and measured distances were not larger than 0.34mm. We could demonstrate and quantify that thumb opposition is associated with motion at the trapeziometacarpal and scaphotrapezotrapezoidal joints. High consistency in motion patterns between specimen were found, while the radiation dose was limited. We conclude that dynamic CT can be used to visualize and quantify 3D thumb kinematics, making it a promising method to explore kinematics in vivo.

In vivo kinematics of the thumb during flexion and adduction motion: Evidence for a screw‐home mechanism

The thumb plays a crucial role in basic hand function. However, the kinematics of its entire articular chain have not yet been quantified. Such investigation is essential to improve our understanding of thumb function and to develop better strategies to treat thumb joint pathologies. The primary objective of this study is to quantify the in vivo kinematics of the trapeziometacarpal (TMC) and scaphotrapezial (ST) joints during flexion and adduction of the thumb. In addition, we want to evaluate the potential coupling between the TMC and ST joints during these tasks. The hand of 16 asymptomatic women without signs of thumb osteoarthritis were CT scanned in positions of maximal thumb extension, flexion, abduction, and adduction. The CT images were segmented and three‐dimensional surface models of the radius, scaphoid, trapezium, and the first metacarpal were created for each thumb motion. The corresponding rotations angles, translations, and helical axes were calculated for each sequence. The analysis shows that flexion and adduction of the thumb result in a three‐dimensional rotation and translation of the entire articular chain, including the trapezium and scaphoid. A wider range of motion is observed for the first metacarpal, which displays a clear axial rotation. The coupling of axial rotation of the first metacarpal with flexion and abduction during thumb flexion supports the existence of a screw‐home mechanism in the TMC joint. In addition, our results point to a potential motion coupling between the TMC and ST joints and underline the complexity of thumb kinematics.

In vivo contact biomechanics in the trapeziometacarpal joint using finite deformation biphasic theory and mathematical modelling

The assessment of the contact biomechanics in the trapeziometacarpal (TMC) joint during functional tasks represents a relevant way to obtain a better understanding of the onset of osteoarthritis (OA). CT scans of the hand region of 20 female volunteers were taken in relaxed neutral, lateral key pinch and power grasp configuration. 3D models of the first metacarpal (MC1) and the trapezium were created. The articular area of each bone was quantified and a mathematical model was developed in Matlab to evaluate the projected contact area and stress distribution of each bone. The articular areas of the MC1 and the trapezium presented no significant difference. A slightly smaller projected contact area was calculated for the trapezium compared to the MC1. Similar amounts of stress were reported in the neutral and lateral pinch configurations. The highest stress levels were observed during power grasp. Very consistent results for high stress location on the volar/radial articular sub-region were found in the neutral and power grasp configurations. More variation was reported during lateral pinch. The mathematical model presented in this paper offers the possibility to predict contact patterns within the TMC joint based on in vivo CT images.

In vivo biomechanical behavior of the trapeziometacarpal joint in healthy and osteoarthritic subjects

Background: The contact biomechanics of the trapeziometacarpal joint have been investigated in several studies. However, these led to conflicting results and were mostly performed in vitro. The purpose of this study was to provide further insight on the contact biomechanics of the trapeziometacarpal joint by in vivo assessment of healthy and osteoarthritic subjects. Methods: The hands of 16 healthy women and 6 women with trapeziometacarpal osteoarthritis were scanned in positions of maximal thumb extension, flexion, abduction and adduction during three isometric tasks (lateral key pinch, power grasp and jar twist) and in thumb rest posture (relaxed neutral). Three‐dimensional surface models of the trapezium and first metacarpal were created for each thumb configuration. The articular surface of each bone was measured in the neutral posture. A computed tomography‐based proximity mapping algorithm was developed to calculate the distance between opposing joint surfaces, which was used as a surrogate for intra‐articular stress. Findings: Distinct proximity patterns were observed across tasks with a recurrent pattern reported on the volar aspect of the first metacarpal. The comparison between healthy and arthritic subjects showed a significantly larger articular area, in parallel with a significant joint space narrowing and an increase in proximity area in arthritic subjects. We also observed severe articular deformations in subjects with late stage osteoarthritis. Interpretation: This study has increased our insight in the contact biomechanics of the trapeziometacarpal joint during tasks and positions of daily life in healthy and arthritic subjects, which might contribute to a better understanding of the occurrence mechanisms of degenerative diseases such as osteoarthritis. HIGHLIGHTSAn approach based on joint proximity is proposed to assess the contact biomechanics of the thumb.Proximity patterns of healthy and late stage osteoarthritic subjects were compared.Healthy group: distinct proximity patterns were observed between tasks.Osteoarthritic group: severe morphological changes were observed.Findings suggest an association between proximity patterns and osteoarthritis development.

Segmentation of 4D CT bone images by sequential registration

The introduction of 4D image acquisition techniques has made it possible to analyse anatomical motion in vivo. With 4D computed tomography (CT), it is now possible to study the motion of joints leading to a deeper understanding of the role of morphology on joint motion and a better assessment of pathologies. Although 4D CT shows a lot of opportunities, the workload to process these 4D acquisitions has increased dramatically. A major part of this process is segmentation, the delineation of the objects of interest within the image volume. This paper presents an algorithm to accelerate this step by registering the segmentation of one frame onto the others. This results in a fast segmentation of the whole 4D dataset, all identical in shape. We show that the proposed algorithm is able to segment two carpal bones, the trapezoid and the scaphoid, with results close to a manual segmentation in less than 5% of the processing time.

Trapeziometacarpal stabilization through dorsoradial ligament reconstruction: An early post-surgery in vivo biomechanical analyses: TRAPEZIOMETACARPAL STABILIZATION THROUGH DORSORADIAL LIGAMENT

Ligament reconstruction can provide pain relief in patients with a painful, unstable, pre‐arthritic trapeziometacarpal (TMC) joint. Imbrication of the dorsoradial ligament (DRL) has been proposed as a minimal invasive stabilization technique. It requires less invasive surgery than an Eaton‐Littler technique and shows promising long‐term clinical outcome. We used dynamic CT to objectively review the effects of the imbrication. Four patients with pain and laxity at the TMC joint, but without radiographic signs of osteoarthritis, were recruited. Dynamic CT scans were made during active thumb abduction‐adduction, flexion‐extension, and two functional grip tasks using a radiolucent jig. Scans of the patients were acquired before and 3 to 6 months after DRL reconstruction. Motion of each bone in the articular chain of the thumb was quantified. In addition, we mapped changes in the contact patterns between the articular facets during the entire thumb motion. After DRL imbrication, we found no overall decrease in MC1 movement in three out of four patients. Furthermore, no increase in TMC joint congruency, defined as proximity area size, was found for three out of four patients. Pre‐ and post‐operative differences in congruency across different tasks were patient‐dependent and relatively small. We demonstrated that, from a biomechanical perspective, there is high variability in post‐operative outcome between patients that undergo identical surgical procedures performed by the same surgeon. A post‐operative decrease in range of motion, increase in joint congruency or decrease in proximity area shift during thumb motion is not omnipresent.

Insights into the musculature of the bonobo hand

The human hand is well known for its unique dexterity which is largely facilitated by a highly mobile, long and powerful thumb that enables both tool manufacturing and use, a key component of human evolution. The bonobo (Pan paniscus), the closest extant relative to modern humans together with the chimpanzee (Pan troglodytes), also possesses good manipulative capabilities but with a lower level of dexterity compared with modern humans. Despite the close phylogenetic relationship between bonobos and humans, detailed quantitative data of the bonobo forelimb musculature remains largely lacking. To understand how morphology may influence dexterity, we investigated the functional anatomy of the bonobo hand using a unique sample of eight bonobo cadavers, along with one chimpanzee and one human (Homo sapiens) cadaver. We performed detailed dissections of unembalmed specimens to collect quantitative datasets of the extrinsic and intrinsic hand musculature, in addition to qualitative descriptions of the forelimb muscle configurations, allowing estimation of force‐generating capacities for each functional group. Furthermore, we used medical imaging to quantify the articular surface of the trapeziometacarpal joint to estimate the intra‐articular pressure. Our results show that the force‐generating capacity for most functional groups of the extrinsic and intrinsic hand muscles in bonobos is largely similar to that of humans, with differences in relative importance of the extensors and rotators. The bonobo thumb musculature has a lower force‐generating capacity than observed in the human specimen, but the estimated maximal intra‐articular pressure is higher in bonobos. Most importantly, bonobos show a higher degree of functional coupling between the muscles of the thumb, index and lateral fingers than observed in humans. It is conceivable that differentiation and individualization of the hand muscles rather than relative muscle development explain the higher level of dexterity of humans compared with that of bonobos.

The digital human forearm and hand

How changes in anatomy affect joint biomechanics can be studied using musculoskeletal modelling, making it a valuable tool to explore joint function in healthy and pathological joints. However, gathering the anatomical, geometrical and physiological data necessary to create a model can be challenging. Very few integrated datasets exist and even less raw data is openly available to create new models. Therefore, the goal of the present study is to create an integrated digital forearm and make the raw data available via an open‐access database. An un‐embalmed cadaveric arm was digitized using 7T MRI and CT scans. 3D geometrical models of bones, cartilage, muscle and muscle pathways were created. After MRI and CT scanning, physiological muscle parameters (e.g. muscle volume, mass, length, pennation angle, physiological cross‐sectional area, tendon length) were obtained via detailed dissection. After dissection, muscle biopsies were fixated and confocal microscopy was used to visualize and measure sarcomere lengths. This study provides an integrated anatomical dataset on which complete and accurate musculoskeletal models of the hand can be based. By creating a 3D digital human forearm, including all relevant anatomical parameters, a more realistic musculoskeletal model can be created. Furthermore, open access to the anatomical dataset makes it possible for other researchers to use these data in the development of a musculoskeletal model of the hand.

Subject-specific thumb muscle activity during functional tasks of daily life.

BACKGROUND The trapeziometacarpal joint is subjected to high compressive forces during powerful pinch and grasp tasks due to muscle loading. In addition, muscle contraction is important for stability of the joint. The aim of the present study is to explore if different muscle activation patterns can be found between three functional tasks. METHODS Isometric forces and fine-wire electromyographic (fEMG) activity produced by three intrinsic and four extrinsic thumb muscles were measured in 10 healthy female volunteers. The participants performed isometric contractions in a lateral key pinch, a power grasp and a jar twist task. The tasks were executed with and without EMG recording to verify if electrode placement influenced force production. RESULTS A subject-specific muscle recruitment was found which remained largely unchanged across tasks. Extrinsic thumb muscles were significantly more active than intrinsic muscles in all tasks. Insertion of the fEMG electrodes decreased force production significantly in all tasks. CONCLUSION The thumb muscles display a high variability in muscle activity during functional tasks of daily life. The results of this study suggest that to produce a substantial amount of force, a well-integrated, but subject-specific, co-contraction between the intrinsic and extrinsic thumb muscles is necessary.