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Marí-Gorreto J, San-Millán M, Carrera A, Tubbs RS, Iwanaga J, Cateura A, Acquabona L, Reina MA, Reina F. The anatomy of the tendon of abductor pollicis longus and its morphological variations: An anatomical approach emphasizing the clinical relevance. Ann Anat 2023; 247:152068. [PMID: 36754243 DOI: 10.1016/j.aanat.2023.152068] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Revised: 01/18/2023] [Accepted: 01/23/2023] [Indexed: 02/09/2023]
Abstract
PURPOSE The anatomical literature describes the abductor pollicis longus as a muscle with a single tendon inserting on the base of the first metacarpal bone, but investigations have shown that it often exhibits morphological variations. However, methodological approaches used to describe these variations have not been useful in a clinical context. Therefore, the purpose of this investigation was to study and relate such anatomical variations in a clinical context. BASIC PROCEDURES Thirty upper limbs from the body donation program were dissected using standard procedures to identify the number of abductor pollicis longus (APL) tendons, their position, site of insertion, length, width and thickness. The presence or absence of the extensor pollicis brevis muscle was also noted. Inter and intra-observer reliability was analysed. MAIN FINDINGS A total number of 71 tendons from the APL muscle were found in the thirty limbs. The most frequent distribution pattern was a main tendon inserted on the base of the first metacarpal and an accessory tendon inserted into the abductor pollicis brevis muscle. These tendons could divide into various tendinous slips that could insert in different locations. Also, clustering algorithms and classical statistical tests showed tendons inserting on the first metacarpal were longer than tendons not inserting on the first metacarpal (p = 0.03), while medial tendons and tendons from an APL muscle with supernumerary tendons were narrower (p < 0.001). The absence of the extensor pollicis brevis muscle was not related to the presence of supernumerary APL tendons. CONCLUSIONS Radiological and surgical implications of these results are important when examining this region of the hand and wrist. The pathophysiology and treatment of de Quervain's tenosynovitis, trapeziometacarpal arthritis and trapeziometacarpal subluxation or laxity could be influenced by the results of our findings.
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Affiliation(s)
- Jesús Marí-Gorreto
- Medical Sciences Department, Clinical Anatomy, Embryology and Neuroscience Research Group (NEOMA), Faculty of Medicine, University of Girona, Girona, Spain.
| | - Marta San-Millán
- Medical Sciences Department, Clinical Anatomy, Embryology and Neuroscience Research Group (NEOMA), Faculty of Medicine, University of Girona, Girona, Spain; EUSES University School of Health and Sports, University of Girona, Salt, Girona, Spain.
| | - Ana Carrera
- Medical Sciences Department, Clinical Anatomy, Embryology and Neuroscience Research Group (NEOMA), Faculty of Medicine, University of Girona, Girona, Spain.
| | - R Shane Tubbs
- Department of Neurosurgery, Tulane University School of Medicine, New Orleans, LA, USA; Department of Neurology, Tulane University School of Medicine, New Orleans, LA, USA; Department of Structural & Cellular Biology, Tulane University School of Medicine, New Orleans, LA, USA; Department of Surgery, Tulane University School of Medicine, New Orleans, LA, USA; Department of Anatomical Sciences, St. George's University, St. George's, Grenada; Department of Neurosurgery and Ochsner Neuroscience Institute, Ochsner Health System, New Orleans, LA, USA; University of Queensland, Brisbane, Australia.
| | - Joe Iwanaga
- Department of Neurosurgery, Tulane University School of Medicine, New Orleans, LA, USA; Department of Neurology, Tulane University School of Medicine, New Orleans, LA, USA; Department of Structural & Cellular Biology, Tulane University School of Medicine, New Orleans, LA, USA.
| | - Aïda Cateura
- Medical Sciences Department, Clinical Anatomy, Embryology and Neuroscience Research Group (NEOMA), Faculty of Medicine, University of Girona, Girona, Spain.
| | - Laura Acquabona
- Medical Sciences Department, Clinical Anatomy, Embryology and Neuroscience Research Group (NEOMA), Faculty of Medicine, University of Girona, Girona, Spain.
| | - Miguel A Reina
- CEU-San Pablo University School of Medicine. Department of Anesthesiology, Madrid-Montepríncipe University Hospital, Madrid, Spain; Departament of Anesthesiology, University of Florida College of Medicine, Gainesville, FL, USA.
| | - Francisco Reina
- Medical Sciences Department, Clinical Anatomy, Embryology and Neuroscience Research Group (NEOMA), Faculty of Medicine, University of Girona, Girona, Spain.
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Tonni G, Grisolia G, Bonasoni MP, Rizzo G, Werner H, Sepulveda W, Ruano R, Araujo Júnior E. Fetal Hands: A Comprehensive Review of Prenatal Assessment and Diagnosis Over the Past 40 Years. ULTRASOUND IN MEDICINE & BIOLOGY 2023; 49:657-676. [PMID: 36526543 DOI: 10.1016/j.ultrasmedbio.2022.09.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Revised: 09/16/2022] [Accepted: 09/30/2022] [Indexed: 06/17/2023]
Abstract
Fetal skeletal dysplasias involving limbs and hands are rare congenital malformations. Prenatal two-dimensional ultrasound diagnosis of fetal limb defects has a sensitivity of about 30%; however, an increased detection rate may be obtained using three-dimensional (3-D) ultrasound in the rendering mode. 3-D ultrasound may be used as a complementary method providing additional information. Currently, magnetic resonance imaging (MRI), with the emergence of ultrafast imaging techniques and new sequences, allows for better diagnosis of several fetal skeletal dysplasias such as limb reduction defects and neuromuscular disorders. 3-D volumetric images from ultrasound or MRI scan data allow 3-D ultrasound reconstructions of virtual/physical models, and virtual reality can help researchers to improve our understanding of both normal and abnormal fetal limb/hand anatomy. In this article, we review the embryological development of fetal hands and their main anomalies including prenatal diagnostic methods, genetic counseling, the role of orthopedic and plastic surgery reconstruction, and new perspectives in fetal surgery.
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Affiliation(s)
- Gabriele Tonni
- Prenatal Diagnostic Centre, Department of Obstetrics and Neonatology, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), AUSL Reggio Emilia, Italy.
| | - Gianpaolo Grisolia
- Prenatal Diagnostic Centre, Department of Obstetrics and Neonatology, Carlo Poma Hospital, Mantua, Italy
| | - Maria Paola Bonasoni
- Human Pathology, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), AUSL Reggio Emilia, Italy
| | - Giuseppe Rizzo
- Department of Obstetrics and Gynecology, Fondazione Policlinico Tor Vergata, University of Tor Vergata, Rome, Italy
| | - Heron Werner
- Department of Fetal Medicine, Clínica de Diagnóstico por Imagem (CDPI-DASA), Rio de Janeiro, Brazil
| | - Waldo Sepulveda
- FETALMED-Maternal-Fetal Diagnostic Center, Fetal Imaging Unit, Santiago, Chile
| | - Rodrigo Ruano
- Division of Maternal-Fetal Medicine, Department of Obstetrics, Gynecology & Reproductive Sciences, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Edward Araujo Júnior
- Department of Obstetrics, Paulista School of Medicine, Federal University of São Paulo (EPM-UNIFESP), São Paulo, Brazil
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Aparisi Gómez MP, Watkin S, Perry D, Simoni P, Trisolino G, Bazzocchi A. Anatomical Considerations of Embryology and Development of the Musculoskeletal System: Basic Notions for Musculoskeletal Radiologists. Semin Musculoskelet Radiol 2021; 25:3-21. [PMID: 34020465 DOI: 10.1055/s-0041-1723005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
The musculoskeletal (MSK) system begins to form in the third week of intrauterine development. Multiple genes are involved in the complex different processes to form the skeleton, muscles and joints. The embryonic period, from the third to the eighth week of development, is critical for normal development and therefore the time when most structural defects are induced. Many of these defects have a genetic origin, but environmental factors may also play a very important role. This review summarizes the embryology of the different components of the MSK system and their configuration as an organ-system, analyzes the clinical implications resulting from failures in the process of organogenesis, and describes the first approach to diagnosis of skeletal abnormalities using prenatal ultrasound.
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Affiliation(s)
- Maria Pilar Aparisi Gómez
- Department of Radiology, National Women's Ultrasound, Auckland City Hospital, Auckland, New Zealand.,Department of Radiology, Hospital Vithas Nueve de Octubre, Valencia, Spain
| | - Sheryl Watkin
- Department of Radiology, National Women's Ultrasound, Auckland City Hospital, Auckland, New Zealand
| | - David Perry
- Department of Radiology, National Women's Ultrasound, Auckland City Hospital, Auckland, New Zealand.,Department of Pediatric Radiology, Starship Children's Hospital, Auckland City Hospital, Auckland, New Zealand
| | - Paolo Simoni
- Diagnostic Imaging Department, Université Libre de Bruxelles, "Reine Fabiola" Children's University Hospital, Bruxelles, Belgium
| | - Giovanni Trisolino
- Pediatric Orthopedics and Traumatology, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Alberto Bazzocchi
- Diagnostic and Interventional Radiology, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
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Baken L, Benoit B, Koning AHJ, Willemsen SP, van der Spek PJ, Steegers-Theunissen RPM, Steegers EA, Exalto N. First-trimester hand measurements in euploid and aneuploid human fetuses using virtual reality. Prenat Diagn 2014; 34:961-9. [DOI: 10.1002/pd.4404] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2014] [Revised: 04/30/2014] [Accepted: 05/03/2014] [Indexed: 11/07/2022]
Affiliation(s)
- Leonie Baken
- Department of Obstetrics and Gynaecology, Division of Obstetrics and Prenatal Medicine; Erasmus MC University Medical Centre Rotterdam; Rotterdam The Netherlands
| | - Bernard Benoit
- Department of Obstetrics and Gynecology; Princess Grace Hospital; Monaco Monaco
| | - Anton H. J. Koning
- Department of Bioinformatics; Erasmus MC University Medical Centre Rotterdam; Rotterdam The Netherlands
| | - Sten P. Willemsen
- Department of Biostatistics; Erasmus MC University Medical Centre Rotterdam; Rotterdam The Netherlands
| | - Peter J. van der Spek
- Department of Bioinformatics; Erasmus MC University Medical Centre Rotterdam; Rotterdam The Netherlands
| | - Régine P. M. Steegers-Theunissen
- Department of Obstetrics and Gynaecology, Division of Obstetrics and Prenatal Medicine; Erasmus MC University Medical Centre Rotterdam; Rotterdam The Netherlands
| | - Eric A. P. Steegers
- Department of Obstetrics and Gynaecology, Division of Obstetrics and Prenatal Medicine; Erasmus MC University Medical Centre Rotterdam; Rotterdam The Netherlands
| | - Niek Exalto
- Department of Obstetrics and Gynaecology, Division of Obstetrics and Prenatal Medicine; Erasmus MC University Medical Centre Rotterdam; Rotterdam The Netherlands
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Hunter AGW, Seaver LH, Stevenson RE. Limb-body wall defect. Is there a defensible hypothesis and can it explain all the associated anomalies? Am J Med Genet A 2011; 155A:2045-59. [PMID: 21815262 DOI: 10.1002/ajmg.a.34161] [Citation(s) in RCA: 57] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2011] [Accepted: 05/21/2011] [Indexed: 11/06/2022]
Abstract
Aside from gastroschisis and omphalocele, major defects of the ventral body (thoracoabdominal) wall are relatively uncommon and almost universally lethal. They are most often associated with other anomalies including those of the limbs that may range from amelia to mild positional deformations, unusual craniofacial malformations, and a variety of visceral abnormalities that include the heart, lungs, genitourinary system, and gut. This complex of ventral wall anomalies has been discussed under a broad and changing nomenclature that has included amniotic band disruption complex, amnion rupture sequence, limb-body wall defect (or complex), and simply body wall complex. Three major theories have been suggested to explain this complex: early amnion rupture (operating through uterine pressure and/or disruption by amniotic bands), vascular compromise (primarily hypoperfusion), and an early intrinsic defect of the developing embryo. We present four patients that illustrate the spectrum of ventral body wall defects, and from there critique the current hypotheses of pathogenesis. We conclude that this association of malformations originates as early as the embryonic disc stage, and that some of the observed associated anomalies are secondary complications of the primary disturbance in embryogenesis. We propose a new explanation for the atypical facial clefts and cranial malformations that are often observed.
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Affiliation(s)
- Alasdair G W Hunter
- JC Self Research Institute, Greenwood Genetic Center, Greenwood, South Carolina, USA.
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Abstract
The various Wnt pathways that are related to upper limb anomalies are reviewed. Abnormalities in the Wnt7a pathway (located in the dorsal ectoderm) produce several clinically relevant conditions such as the palmar duplication syndrome, nail patella syndrome, ulnar ray deficiency, limb hypoplasia, polysyndactyly and the palmar nail syndrome. Abnormalities of the Wnt3/3a pathway (located in the apical ectodermal ridge) include tetra-amelia and loss of the distal phalanges/nails. Abnormalities of the Wnt5/5a pathway (located in the apical ectodermal ridge as well as in the mesoderm) will affect chondrogenesis of the developing limb and experimental Wnt5a(-/-) limbs have terminal adactyly. Chondrogenesis and limb muscle differentiation are both affected by several Wnt pathways and these will be reviewed in details. Abnormalities in LRP 5/6 (a co-receptor for Wnts) lead to congenital bone disease and Wnt4 is specifically involved in joint development. Finally, the relationship between the Wnt pathway and SALL4 (mutations of which cause Okihiro/Duane-radial ray deficiency in humans) are discussed.
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