Ulnar collateral ligament injuries of the thumb: phalangeal translation during valgus stress in human cadavera

BACKGROUND: The clinical diagnosis of thumb ulnar collateral ligament disruption has been based on joint angulation during valgus stress testing. This report describes a definitive method of distinguishing between complete and partial ulnar collateral ligament injuries by quantifying translation of the proximal phalanx on the metacarpal head during valgus stress testing. METHODS: Sixty-two cadaveric thumbs underwent standardized valgus stress testing under fluoroscopy with the ulnar collateral ligament intact, following an isolated release of the proper ulnar collateral ligament, and following a combined release of both the proper and the accessory ulnar collateral ligament (complete ulnar collateral ligament release). Following complete ulnar collateral ligament release, the final thirty-seven thumbs were also analyzed after the application of a valgus force sufficient to cause 45° of valgus angulation at the metacarpophalangeal joint to model more severe soft-tissue injury. Two independent reviewers measured coronal plane joint angulation (in degrees), ulnar joint line gap formation (in millimeters), and radial translation of the proximal phalanx on the metacarpal head (in millimeters) on digital fluoroscopic images that had been randomized. RESULTS: Coronal angulation across the stressed metacarpophalangeal joint progressively increased through the stages of the testing protocol: ulnar collateral ligament intact (average [and standard deviation], 20° ± 8.1°), release of the proper ulnar collateral ligament (average, 23° ± 8.3°), and complete ulnar collateral ligament release (average, 30° ± 8.9°) (p < 0.01 for each comparison). Similarly, gap formation increased from the measurement in the intact state (5.1 ± 1.3 mm), to that following proper ulnar collateral ligament release (5.7 ± 1.5 mm), to that following complete ulnar collateral ligament release (7.2 ± 1.5 mm) (p < 0.01 for each comparison). Radial translation of the proximal phalanx on the metacarpal head did not increase after isolated release of the proper ulnar collateral ligament (1.6 ± 0.8 mm vs. 1.5 ± 0.9 mm in the intact state). There was a significant increase in translation following release of the complete ulnar collateral ligament complex (3.0 ± 0.9 mm; p < 0.01) and an additional increase after forcible angulation of the joint to 45° (4.1 ± 0.9 mm; p < 0.01). Translation 2 mm greater than that in the stressed control was 100% specific for complete disruption of the ulnar collateral ligament complex. CONCLUSIONS: While transection of the proper ulnar collateral ligament leads to an increase in metacarpophalangeal joint angulation and gapping on stress fluoroscopic evaluation, only release of both the accessory and the proper ulnar collateral ligament significantly increases translation of the proximal phalanx on the metacarpal head. CLINICAL RELEVANCE: A finding of phalangeal translation on a stress fluoroscopic image distinguishes partial from complete tears of the thumb ulnar collateral ligament

Duplicated Palmaris Longus Muscle With Insertion Onto The Transverse Carpal Ligament: A Case Report

The palmaris longus muscle is one of the most anatomically variable muscles in the human body, with incidence ranging from 0-63.9%.&nbsp; While these anatomical variations are typically benign, they are of clinical importance as they can contribute to neurovascular and biomechanical dysfunction.&nbsp; We report here a duplicated palmaris longus muscle with an insertion onto the transverse carpal ligament found during cadaveric dissection in a graduate anatomy course for physical and occupational therapy students.&nbsp

Flexor Carpi Radialis Brevis: A Case Report

The flexor carpi radialis brevis is a rare anomalous muscle, with incidence ranging from 1.6-7.5%.&nbsp; While this anatomical variation is typically benign, it is of clinical importance as it can contribute to neurovascular and musculoskeletal dysfunction.&nbsp; Surgeons should be made aware of this variation during distal radius volar plating procedures and carpal tunnel releases.&nbsp; The flexor carpi radialis brevis muscle may also cause confusion when interpreting imaging results.&nbsp; We report here a rare case of bilateral flexor carpi radialis brevis muscles that travel through the carpal tunnel found during cadaveric dissection in a graduate course for physical therapy students.&nbsp; To our knowledge, this is the second published example of a flexor carpi radialis brevis muscle traveling through the carpal tunnel

Vascular anatomy of the tibiofibular syndesmosis

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A Communicating Branch Between the Musculocutaneous Nerve and the Median Nerve: A Case Report

Anatomical variations of peripheral nerves are commonly reported in the literature.&nbsp; While typically benign, they are of clinical importance as they can contribute to atypical clinical presentations, cause difficulty with imaging and nerve conduction studies, and lead to surgical challenges for surgeons.&nbsp; We report here a communicating branch between the musculocutaneous nerve and median nerve found during cadaveric dissection in a Doctor of Nursing Practice course in the Department of Nurse Anesthesia at Samford University.&nbsp; Although the case described here is among the most common anatomical variations of the peripheral nerves, there are classification systems for this variation that need to be recognized and applied by anatomists, clinicians, and surgeons

Bilateral Long Head of the Triceps Brachii Muscle Innervation via Axillary Nerve: A Case Report

The radial nerve has traditionally been considered the innervation of the long head of the triceps brachii (LHT). However, cadaveric studies have discovered LHT innervation via the axillary nerve in roughly 6-15 % of shoulders. A cadaver with exclusive axillary nerve innervation to the LHT bilaterally was discovered during cadaveric dissection in a graduate course at Samford University. This anatomical variation may have clinical implications for surgeries, shoulder dislocations, and quadrilateral space syndrome. Axillary nerve injuries may additionally present with shoulder extension and elbow extension weakness if this variation is present.&nbsp

Exploring the nature of stigmatising beliefs about depression and help-seeking: Implications for reducing stigma

<p>Abstract</p> <p>Background</p> <p>In-depth and structured evaluation of the stigma associated with depression has been lacking. This study aimed to inform the design of interventions to reduce stigma by systematically investigating community perceptions of beliefs about depression according to theorised dimensional components of stigma.</p> <p>Methods</p> <p>Focus group discussions were held with a total of 23 adults with personal experience of depression. The discussions were taped, transcribed and thematically analysed.</p> <p>Results</p> <p>Participants typically reported experiencing considerable stigma, particularly that others believe depressed people are responsible for their own condition, are undesirable to be around, and may be a threat. Participants expressed particular concerns about help-seeking in the workplace and from mental health professionals.</p> <p>Conclusion</p> <p>Findings indicate that interventions to reduce the stigma of depression should target attributions of blame; reduce avoidance of depressed people; label depression as a 'health condition' rather than 'mental illness'; and improve responses of help-sources (i.e. via informing professionals of client fears).</p