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Examination of Pediatric Elbow
Published in Nirmal Raj Gopinathan, Clinical Orthopedic Examination of a Child, 2021
Karthick Rangasamy, Nirmal Raj Gopinathan, Pebam Sudesh
The lateral collateral ligament (Figure 6.2) includes three parts, namely the annular ligament, lateral ulnar collateral ligament, and radial collateral ligament. It provides posterolateral rotational stability and protects against varus stress on the elbow.5The lateral ulnar collateral ligament is the major stabilizer extending from the humeral lateral epicondyle to the supinator crest on the ulna.The radial collateral ligament originates from the lateral humeral epicondyle and inserts on the annular ligament.The annular ligament has its origin and insertion at the sigmoid notch of the ulna and it wraps around the radial neck. It stabilizes the proximal radioulnar joint.The accessory lateral collateral ligament begins at the annular ligament and inserts at the supinator crest on the ulna. It reinforces the annular ligament.
A to Z Entries
Published in Clare E. Milner, Functional Anatomy for Sport and Exercise, 2019
There are several ligaments that limit movement of the wrist, in addition to the joint capsule. The posterior radiocarpal ligament runs diagonally across the posterior aspect of the wrist from the distal end of the radius to the triquetral and hamate carpal bones on the ulnar side of the wrist. This ligament limits flexion of the wrist. The anterior radiocarpal ligament runs from the anterior aspect of the distal end of the radius to the scaphoid, lunate and capitate bones of the wrist. This ligament limits extension of the wrist. The collateral ligaments of the wrist run along the sides of the joint to limit frontal plane motion. The ulnar collateral ligament, running from the styloid process of the ulna to the triquetral, limits abduction of the wrist. The radial collateral ligament, from the styloid process of the radius to the scaphoid bone, limits adduction of the wrist. Minimal movement occurs between the carpal bones themselves; they are held together by the anterior, posterior and interosseous carpal ligaments. The interlocking structure of the carpal bones also provides support for the wrist, in addition to the support provided by these ligaments.
Test Paper 3
Published in Teck Yew Chin, Susan Cheng Shelmerdine, Akash Ganguly, Chinedum Anosike, Get Through, 2017
Teck Yew Chin, Susan Cheng Shelmerdine, Akash Ganguly, Chinedum Anosike
A 15-year-old man patient presents with pain on the medial aspect of the right elbow. MRI shows no joint effusion or signal change. The medial collateral ligament is lax, ill-defined, and irregular in appearance. Which of the following is the most likely diagnosis? Acute partial ulnar collateral ligament tearAcute partial radial collateral tearChronic ulnar collateral ligament injuryChronic radial collateral ligament injuryChronic lateral ulnar collateral ligament injury
A new assessment tool for ulnar drift in patients with rheumatoid arthritis using pathophysiological parameters of the metacarpophalangeal joint
Published in Modern Rheumatology, 2019
Shogo Toyama, Ryo Oda, Daisaku Tokunaga, Daigo Taniguchi, Satoru Nakamura, Maki Asada, Hiroyoshi Fujiwara, Toshikazu Kubo
UD is the most common and difficult to manage deformity in the rheumatoid hand [8]; it is reported that 44% of patients develop UD within the first 10 years [6]. For UD to emerge, several factors are present in normal hands while others are present only in the arthritic joints of patients with adult-onset RA. Several common activities increase ulnar deviation force, such as turning a key, lifting a mug by the handle, and cutting food with a knife [9,10]. In addition, in the normal hand, the radial collateral ligament of the MP joint is longer than the ulnar collateral ligament, so arthritis at the MP joint initially elongates the radial collateral ligament [11–13]. Meanwhile, in arthritic joints, synovitis due to RA at the wrist joint induces radial rotation of the carpal bones [14] and carpometacarpal joint descent of the fourth and fifth metacarpal bones (so-called ‘metacarpal-descent’), and sagittal band loosening at the MP joint, in particular, induces extensor tendon dislocation at the MP joint level and dysfunction of the intrinsic muscles [15–17].
A rare case of thumb polydactyly with metacarpophalangeal joint synostosis
Published in Case Reports in Plastic Surgery and Hand Surgery, 2019
Michael Finsterwald, Sebastian Guenkel
During surgery (Figure 3) the hypoplastic bony radial component was resected with an oscillating saw cutting from distal to proximal at the level of the metacarpophalangeal joint and the metacarpal head reduced to match the proximal ulnar phalanx. Flexor and Extensor pollicis longus and brevis tendons of the radial component were dissected proximal of the metacarpophalangeal joint as far as the incision allowed. Careful subperiostal dissection proximally and preservation of the radial collateral ligament and metacarpophalangeal joint capsule distally allowed an anatomic transosseus reinsertion through drill holes with non-absorbable sutures into the distal first metacarpal to stabilise the metacarpal joint against radial stress. In order to avoid a painful neuroma the remaining nerves of the removed radial component were dissected, crushed and buried into an intraosseus drillhole. Clinical examination showed a stable metacarpophalangeal joint with a good range of motion. Postoperatively the thumb was immobilised in a cast for eight weeks. At three months and one year follow-up the patient showed no metacarpophalangeal joint instability, a satisfying motion of the thumb (Figure 4) as well as intact sensation. He was pain free and very pleased with the result. Postoperative and follow-up X-Rays revealed a normal joint alignment.