3D modelling and tissue-level morphology of trapeziometacarpal joint

Al Harbi, Yasser (2016) 3D modelling and tissue-level morphology of trapeziometacarpal joint. PhD thesis, University of Glasgow.

Abstract

The ligaments of the trapeziometacarpal joint (TMC) are complex and highly varied. Several studies have reported different patterns of ligament arrangement. Which ligaments are responsible for governing the stability of the TMC is still a source of controversy; the very naming of some of the ligaments is also in dispute.
The overall aim of the experiments in this thesis is to explore the stabilization of the TMC ligaments during a specific positions (the neutral and full abduction positions), the mechanics of the attachment, the relaxing and stretching of the TMC ligaments, and the responsibilities of the TMC ligaments to prevent the TMC joint subluxations such as dorsal subluxation, palmar subluxation, and lateral subluxation. An additional aim is to describe the orientation of the TMC ligaments (origin, insertion) and the ligament fibres’ directions.
The study used development devices to render the TMC ligaments into 2D reconstruction and 3D modelling in the 3D virtual environment such as Rhinoceros V5, 3D Landmark software, and 3D Amira software. Length, width, area, volume, thickness, and cross-sectional measurements were assessed in the neutral and full abduction positions. The ligament stretcher was designed to stretch the TMC ligaments after the ligaments were cut away from the joint. Also used in the thesis is a new technique to develop staining procedures by combining two different stains with accurate timing and re-timing the procedures of the Miller’s Elastin Staining protocol. Also, the entheses investigations have been applied on the attachments of the TMC ligaments with trapezuim and first metacarpal bones (proximal and distal).
Moreover, the technique of the high resolution episcopic microscopy (HREM) was used to identify the relation of the TMC ligaments fibres to the flexor retinaculum, especially at dorso-ulnar trapeziometacarpal ligament (DUTML). The layers of the palmar trapeziometacarpal ligament (PTML) were also investigated to identify the nature of this ligament. The osteological descriptions were noted for the first metacarpal and trapezium bones, the geometrical measurement experiments on the articular surface of both bones allowed for a description of the effects of the degenerative disease, especially osteioarthritis disease (OA), and comparisons between both genders, the right and left specimens, embalmed and fresh cadavers were investigated to achieve the most accurate and precise results. The index procedures against the third metacarpal assisted in describing the relation between the actual reading and index reading.
Seven ligaments were shown in the 3D virtual environment: radial trapeziometacarpal ligament (RTML), superficial palmar trapeziometacarpal ligament (sPTML), deep palmar trapeziometacarpal ligament (dPTML), palmo-ulnar trapeziometacarpal ligament (PUTML), dorso-ulnar trapeziometacarpal ligament (DUTML), palmar intermetacarpal ligament (PIML), and dorsal intermetacarpal ligament (DIML). Also, the results revealed that the PIML and DIML were the main stabilizers through the experiments, and the DUTML and PUTML served as associated ligaments to prevent TMC joint dislocation. The RTML prevented radial subluxation, while the superficial and deep layers of the PTML acted as a pivot for the movement of the TMC joint and assisted in preventing a palmar subluxation. In addition, there were no significant differences (p>0.05) between embalmed and fresh cadavers, but there were significant differences (p<0.05) between male and female cadavers as well as between the right and left hands, especially in the measurement investigations.
Moreover, the TMC ligament attachments were found to be of the fibrocartilagenous type; this was found at both attachments, proximal and distal. The combination beginning with Miller Elastin stain (ME) was better than that starting with Modified Masson Trichrome stain (MME) and the colours were nearer to those of the MMT results; however, the MMT alone was clearest. Also, a re-timing of the ME stain revealed that the experiment involving 2.5 hours of Miller’s Elastin and 15 seconds of Van Gieson Solution was the best of all experiments. The HREM technique revealed no connection between the collagen fibres of both the DUTML and the flexor retinaculum. The single coordination points of each of the first metacarpal (1st MC) and trapezium (TM) bones revealed varieties of prominences and declines in the bones’ surfaces, especially the articular surface.

New names of the TMC ligaments as following:
Old Name New Name
Ulnar collateral ligament (UCL). Radial trapeziometacarpal ligament (RTML).
Superficial anterior oblique ligament (sAOL). Superficial palmar trapeziometacarpal ligament (sPTML).
Deep anterior oblique ligament (dAOL). Deep palmar trapeziometacarpal ligament (dPTML).
Posterior oblique ligament (POL). Palmo-ulnar trapeziometacarpal ligament (PUTML).
Dorso-radial ligament (DRL). Dorso-ulnar trapeziometacarpal ligament (DUTML).

New osteological definitions were noted, such as the distal border of the 1st MC facet, the distal and proximal ridge of the palmar surface of the1st MC, and eminences of the trapezial ridge of TM.
Overall, the results of my studies suggested that the importance of the PIML, DIML, and RTML should be considered when planning surgeries involving ligament reconstruction of the TMC joint.

• Item Type: Thesis (PhD)
• Qualification Level: Doctoral
• Subjects: R Medicine > R Medicine (General); R Medicine > RZ Other systems of medicine
• Colleges/Schools: College of Medical Veterinary and Life Sciences
• Supervisor's Name: Cushely, Prof. Willam
• Date of Award: 2016
• Depositing User: Dr Yasser Al Harbi
• Unique ID: glathesis:2016-7148
• Copyright: Copyright of this thesis is held by the author.
• Date Deposited: 22 Apr 2016 08:57
• Last Modified: 05 Mar 2018 13:39
• URI: https://theses.gla.ac.uk/id/eprint/7148