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In vivo length and changes of ligaments stabilizing the thumb carpometacarpal joint
Jun Tan1, Jing Xu, Ren Guo Xie
1Department of Hand Surgery, Hand Surgery Research Center, Affiliated Hospital of Nantong University, Nantong, Jiangsu, China.
Purpose:
To investigate the lengths and changes of selected ligaments stabilizing the thumb carpometacarpal (CMC) joint during thumb motion in vivo.
Methods:
We obtained serial computed tomography scans of the thumb CMC joints of 6 healthy volunteers during thumb flexion, abduction, and opposition. We reconstructed the 3-dimensional structures of the bones of the thumb CMC joint using customized software and modeled the paths of fibers of 5 principal ligaments--deep anterior oblique (beak), dorsoradial, posterior oblique, intermetacarpal, and dorsal intermetacarpal--at each of the CMC joint positions studied. We estimated the virtual lengths of these ligaments in neutral position, flexion, abduction, and opposition of the CMC joint by measuring the distances between the origin and the insertion of individual ligaments, and statistically analyzed the length changes.
Results:
The estimated length of the CMC joint ligaments underwent significant changes during thumb motion in vivo. Thumb flexion led to the greatest changes in ligament lengths. During flexion, all the ligaments lengthened significantly (p < .05 or p < .01), except for the beak ligament, which shortened significantly (p < .001). The lengths of the ligaments changed similarly during thumb abduction and opposition, except for the dorsoradial ligament. In both motions, the posterior oblique and dorsal intermetacarpal ligaments lengthened and the beak ligament shortened significantly (p < .05 or p < .01). During the 3 thumb motions, the beak ligament underwent marked shortening, while the other measured ligaments lengthened to varied extent.
Conclusions:
The estimated lengths of principal ligaments stabilizing the CMC joint change substantially during thumb motions in vivo. Thumb flexion causes the greatest changes of the ligament lengths; abduction and opposition result in similar changes in the ligament lengths. The beak ligaments shorten while the other ligaments lengthen. This in vivo study suggests that thumb motions expose the CMC joint ligaments to different tensions at these thumb positions, and that the ligaments are under lower tension during thumb opposition and abduction than during flexion.
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