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Mireia Esplugas

Universitat de Barcelona, Obstetrícia i Ginecologia, Pediatria, Radiologia i Anatomia, Graduate Student

Universitat Autònoma de Barcelona, Anatomía y biomecánica, Department Member

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Dedicated for more than 30 years, to the surgical treatment of patients affected by Traumatic, Degenerative and Inflammatory diseases of the Hand and Wrist. Expert in opened and arthroscopic repair surgery.
I currently combine my clinical practice with the carpal biomechanics research in the Department of Biomechanics attached to the Department of Anatomy in the University Autónoma of Barcelona. Our work on "Muscle control of the trapeziometacarpal joint" was awarded with the Kaplan Award for Anatomical Excellence granted during the Congress of the American Society of Hand Surgery 2015 by the New York Society of Hand Surgery.My actual research work is the basis of my PhD on "The influence of pronosupination of the forearm on the scapholunate stability" that I am about to read at the University of Barcelona.
I dedicate a great part of my free time to write all the communications that I am asked to give in different National and International Congresses of Surgery and Wrist Arthroscopy.
Extreme outdoor sportswoman, I also take advantage of my leisure time to use sport as a modulator of daily stress while allowing me to continue organizing time effectively, accompanied by my family and friends.
The daily work always bears some fruits: my daily work for many years and the National and International awards received for him, are giving great fruits now that I wish to share!

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Papers by Mireia Esplugas

Kinetic dysfunction of the wrist with chronic scapholunate dissociation. A cadaver study

Clinical Biomechanics

Immunofluorescence analysis of sensory nerve endings in the interosseous membrane of the forearm

Journal of Anatomy

¿Cómo han influido las investigaciones básicas en propiocepción y control neuro-muscular del carpo, en la toma de decisiones terapéuticas del día a día?

Revista Iberoamericana de Cirugía de la Mano

Role of muscles in the stabilization of ligament-deficient wrists

Journal of Hand Therapy, 2016

This article reviews the results of a series of cadaver investigations aimed at clarifying the ro... more This article reviews the results of a series of cadaver investigations aimed at clarifying the role of muscles in the stabilization of ligament-deficient wrists. According to these studies, isometric contraction of some forearm muscles induces midcarpal (MC) supination (ie, the abductor pollicis longus, extensor carpi radialis longus, and flexor carpi ulnaris), whereas other muscles induce MC pronation (ie, the extensor carpi ulnaris). Because MC supination implies tightening of the volar scaphoid-distal row ligaments, the MC supination muscles are likely to prevent scaphoid collapse of wrists with scapholunate ligament insufficiency. MC pronator muscles, by contrast, would be beneficial in stabilizing wrists with ulnar-sided ligament deficiencies owing to their ability to tighten the triquetrum-distal row ligaments. Should these laboratory findings be validated by additional clinical research, proprioceptive reeducation of selected muscles could become an important tool for the treatment of dynamic carpal instabilities.

Extensor Mechanism of the Fingers: MR Imaging–Anatomic Correlation1

Radiographics a Review Publication of the Radiological Society of North America Inc, May 1, 2003

Extension of the fingers is a complex function carried out by simultaneous action of extrinsic an... more Extension of the fingers is a complex function carried out by simultaneous action of extrinsic and intrinsic muscles, as well as retinacular structures in the dorsum of the wrist, hand, and fingers that support and coordinate the action of the muscles. The extensor mechanism of the fingers is divided into topographic zones, which extend from the forearm to the distal phalanx. Magnetic resonance (MR) imaging shows in detail the musculotendinous and retinacular structures of the extensor apparatus. In the different extensor zones, MR imaging findings are similar to those seen macroscopically in anatomic sections. Understanding of and familiarity with the extensor anatomy of the hand and fingers by the radiologist is crucial for better assessment of pathologic conditions with MR imaging and optimization of this modality as a diagnostic tool. Extensor tendon injuries and tenosynovitis represent clinical situations in which knowledge of this anatomy is useful for the clinical radiologist.

[Subacute subdural hematoma after cranioencephalic trauma in an alcoholic patient]

Revista espanola de anestesiologia y reanimacion

Proprioception and neuromuscular control in carpal instabilities

Paper written in Spanish Articular joint congruity, static stability secondary to ligament integr... more Paper written in Spanish Articular joint congruity, static stability secondary to ligament integrity and dynamic joint surface compression due to muscular contraction have been deined classically as the key for carpal stability. Recently, a fourth factor in carpal stability has been proposed, involving the neuromuscular and proprioceptive control of joints. Proprioception of the wrist starts in sensory end organs located in ligaments and joint capsules (mechanoreceptors). When mechanoreceptors are stimulated, an afferent signal causes an involuntary spinal relex that induces a selective muscular contraction in order to protect from ligament injury. The aim of this review is to provide an understanding of the role of proprioception and neuromuscular control in carpal instabilities, as well as descriptions of potential clinical applications. © 2015, SECMA. Published by Elsevier España, S.L.U. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/lice...

[Late extrapyramidal syndrome with low doses of droperidol]

Revista española de anestesiología y reanimación

Extensor Mechanism of the Fingers: MR Imaging–Anatomic Correlation1

…, 2003

Extension of the fingers is a complex function carried out by simultaneous action of extrinsic an... more Extension of the fingers is a complex function carried out by simultaneous action of extrinsic and intrinsic muscles, as well as retinacular structures in the dorsum of the wrist, hand, and fingers that support and coordinate the action of the muscles. The extensor mechanism of the fingers is divided into topographic zones, which extend from the forearm to the distal phalanx. Magnetic resonance (MR) imaging shows in detail the musculotendinous and retinacular structures of the extensor apparatus. In the different extensor zones, MR imaging findings are similar to those seen macroscopically in anatomic sections. Understanding of and familiarity with the extensor anatomy of the hand and fingers by the radiologist is crucial for better assessment of pathologic conditions with MR imaging and optimization of this modality as a diagnostic tool. Extensor tendon injuries and tenosynovitis represent clinical situations in which knowledge of this anatomy is useful for the clinical radiologist.

Muscle Control of the First Carpometacarpal Joint

The Journal of Hand Surgery, 2014

Análisis de las complicaciones de la artroscopia de muñeca sufridas durante la curva de aprendizaje de la técnica

resumen: objetivo: Describir las complicaciones sufridas durante las primeras artroscopias de muñ... more resumen: objetivo: Describir las complicaciones sufridas durante las primeras artroscopias de muñeca realizadas por la autora y cómo evitarlas, tras analizar la anatomía. Material y método: Definimos como complicación, los efectos adversos directamente relacionados con la técnica artros-cópica. Valoramos retrospectivamente una serie de cincuenta artroscopias realizadas en tres años (2008-2011): indicacio-nes y procedimientos realizados. Analizamos las nueve complicaciones recogidas: su pico de incidencia, su relación con el procedimiento terapéutico y con la anatomía. Resultados: Se recogieron: un caso de rotura del tendón eDM, tres casos de dolor por los nudos del anclaje periférico del fibrocartílago triangular (FCT) y cinco casos de lesión de la rama sensitiva dorsal del nervio cubital (RSDnC). el mayor índice de complicaciones apareció durante el segundo año de la práctica artroscópica. Conclusión: la artroscopia de muñeca ha experimentado un considerable auge en los últimos años. Abundan los cursos para aprender la técnica. Poco se habla en ellos de complicaciones lo que puede sugerir que es una técnica inocua y sen-cilla. Pero las complicaciones existen y pueden comportar importante iatrogenia. Tras la detección y análisis de las compli-caciones acaecidas durante la curva de aprendizaje (2008-2011) y tras realizar estudios anatómicos específicos, la autora ha modificado su técnica artroscópica. la incidencia de complicaciones desde el 2011 es prácticamente nula. Palabras clave: Complicación, Artroscopia de muñeca, Curva de aprendizaje, Rama sensitiva dorsal del nervio cubital, tendón extensor Digiti Minimi, Fibrocartílago triangular (FCT). abstract: objective: To describe the complications suffered during the first 50 wrist arthroscopies performed by the author and how to avoid them after analyzing the anatomy. Material and Method: We define as a complication the adverse effect directly related to the technique We retrospectively assess 50 arthroscopies performed in 3 years (2008-2011): indications, procedures performed. We analyze the 9 complications collected and their relation to the technique and the anatomy. Results: We found: 1 case of eDM tendon rupture, 3 cases of pain due to the knots of the peripheral TFCC tears sutures and 5 cases of injuries to the dorsal sensory branch of the ulnar nerve (DSbun). Complications mainly occurred during the second year of the arthroscopic practice. Conclusion:. Wrist arthroscopy has experienced a considerable boom in recent years. There are plenty of courses to learn the technique. little is said in them about complications: this may suggest that the technique is safe and simple. but complications exist and they may incur in significant injuries. Following the detection and analysis of the complications that appeared during the learning curve(2008-2011) and following specific anatomical studies, the authors have modified their arthroscopic technique. The complication rate since 2011 is practically zero.

El papel de la propiocepción y el control neuromuscular en las inestabilidades del carpo

by E. Hagert, M. Llusà, and Mireia Esplugas

Revista Iberoamericana de Cirugía de la Mano, 2015

Recibido el 15 de abril de 2015. Aceptado el 16 de abril de 2015.

Trapeziometacarpal Ligaments Biomechanical Study: Implications in Arthroscopy

by Mireia Esplugas and M. Garciaelias

Purpose In the presence of early osteoarthritis, changes to the trapeziometacarpal joint (TMJ) of... more Purpose In the presence of early osteoarthritis, changes to the trapeziometacarpal joint (TMJ) often result in pain and is associated with joint instability and a tendency of dorsoradial subluxation. In these instances, arthroscopy may be indicated to: (1) assess the extent of cartilage disease and the laxity of ligaments and to (2) treat TMJ instability. The purpose of our study was to biomechanically analyze which ligaments are the primary stabilizers of the TMJ. Methods Overall, 11 fresh-frozen human cadaver specimens were dissected and attached to a testing device with the thumb positioned in neutral abduction, neutral flexion, and neutral opposition. The four extrinsic and five intrinsic muscle tendons acting on the TMJ were simultaneously loaded with weights proportional to their physiological cross-sectional area. The dorsal, volar, and ulnar groups of ligaments were dissected. A motion-tracking device, FasTrak (Polhemus Inc., Colchester, VT), was used to study the spatial position of the base of the first metacarpal bone (MC1), before and after random sectioning of each of the ligaments. Statistical analysis of the MC1 translation along the transverse XY plane was performed using one-way analysis of variance and a paired t-test, with a significance level of p < 0.05. Results After isolated sectioning of the volar or the ulnar ligaments, the MC1 moved dorsoradially with an average of 0.150 mm (standard deviation [SD]: 0.072) and 0.064 mm (SD: 0.301), respectively. By contrast, the destabilization of the MC1 after sectioning of the dorsal ligaments was substantially larger (0.523 mm; SD: 0.0512; p ¼ 0.004). Conclusions Sectioning of the dorsal ligament group resulted in the greatest dorsor-adial translation of the MC1. Consequently, the dorsal ligaments may be regarded as the primary TMJ stabilizers. Clinical Relevance This study suggests that stabilizing arthroscopic shrinkage of the TMJ should be targeted toward the dorsal TMJ ligaments.

Role of muscles in the stabilization of ligament-deficient wrists

This article reviews the results of a series of cadaver investigations aimed at clarifying the ro... more This article reviews the results of a series of cadaver investigations aimed at clarifying the role of muscles in the stabilization of ligament-deficient wrists. According to these studies, isometric contraction of some forearm muscles induces midcarpal (MC) supination (ie, the abductor pollicis longus, extensor carpi radialis longus, and flexor carpi ulnaris), whereas other muscles induce MC pronation (ie, the extensor carpi ulnaris). Because MC supination implies tightening of the volar scaphoid-distal row ligaments, the MC supination muscles are likely to prevent scaphoid collapse of wrists with scapholunate ligament insufficiency. MC pronator muscles, by contrast, would be beneficial in stabilizing wrists with ulnar-sided ligament deficiencies owing to their ability to tighten the triquetrum-distal row ligaments. Should these laboratory findings be validated by additional clinical research, proprioceptive reeducation of selected muscles could become an important tool for the treatment of dynamic carpal instabilities.

The effect of individual isometric muscle loading on the alignment of the base of the thumb metacarpal: a cadaveric study

by E. Hagert, Nathalie Mobargha, and Mireia Esplugas

Journal of Hand Surgery (European Volume), 2015

Stability of the thumb carpometacarpal joint relies upon equilibrium between its ligaments, muscu... more Stability of the thumb carpometacarpal joint relies upon equilibrium between its ligaments, muscular support and joint congruity. We wanted to identify the muscles important in preventing or increasing dorsoradial subluxation of this joint. In ten cadaveric hands, a Fastrak ® motion tracking device was used to assess the effects of individual isometric muscle loading on the base of the thumb metacarpal relative to the radius and to the base of the middle finger metacarpal. We found that the first dorsal interosseous muscle caused the least dorsoradial translation and highest distal migration of the base of the first metacarpal, whereas abductor pollicis longus was the primary destabilizer, increasing dorsoradial misalignment. The findings show different impacts of these muscles on joint alignment and stability, which suggests that treatment should be targeted to enhance the action of the primary stabilizing muscle, the first dorsal interosseous muscle.

Reinserción capsular y reanclaje a la fóvea del complejo del fibrocartílago triangular de la muñeca. Videotécnica

Revista Española de Artroscopia y Cirugía Articular, 2015

r e v e s p a r t r o s c c i r a r t i c u l . 2 0 1 4;2 1(2):120 w w w . e l s e v i e r . e s ... more

Lesiones del complejo del fibrocartílago triangular. Tipos de reparación

Revista Española de Artroscopia y Cirugía Articular, 2014

How to Avoid Ulnar Nerve Injury When Setting the 6U Wrist Arthroscopy Portal

Journal of Wrist Surgery, 2014

Although wrist arthroscopy without traction has been described, 1 most of the procedures use a tr... more Although wrist arthroscopy without traction has been described, 1 most of the procedures use a traction tower. In some of these traction systems, finger traps suspend the hand and the forearm is secured in neutral rotation to a post by Velcro strap. In such cases, forearm rotation is very restricted and the hand and wrist are free to supinate or pronate around the forearm axis (►Fig. 1). The 6U portal is established just palmar to the anterior margin of the extensor carpi ulnaris (ECU) tendon and proximal to the medial prominence of the triquetrum.

MR Imaging of Ligament and Tendon Injuries of the Fingers1

by Xavier Alomar and Mireia Esplugas

RadioGraphics, 2002

Magnetic resonance (MR) imaging can provide important information for diagnosis and evaluation of... more Magnetic resonance (MR) imaging can provide important information for diagnosis and evaluation of soft-tissue trauma in the fingers. An optimal imaging technique should include proper positioning, dedicated surface coils, and specific protocols for the suspected abnormalities. Familiarity with the fine anatomy of the normal finger is crucial for identifying pathologic entities. MR imaging is a powerful method for evaluating acute and chronic lesions of the stabilizing articular elements (volar plate and collateral ligaments) of the fingers and thumbs, particularly in the frequently affected proximal interphalangeal and metacarpophalangeal joints. As in other body regions, MR imaging is also useful for depicting traumatic conditions of the extensor and flexor tendons, including injuries to the pulley system. In general, normal ligaments and tendons have low signal intensity on MR images, whereas disruption manifests as increased signal intensity. Radiologists need to understand the full spectrum of finger abnormalities and associated MR imaging findings.

Extensor mechanism of the fingers: MR imaging-anatomic correlation

by Xavier Alomar, Oscar Fariñas, and Mireia Esplugas

Radiographics : a review publication of the Radiological Society of North America, Inc

Extension of the fingers is a complex function carried out by simultaneous action of extrinsic an... more Extension of the fingers is a complex function carried out by simultaneous action of extrinsic and intrinsic muscles, as well as retinacular structures in the dorsum of the wrist, hand, and fingers that support and coordinate the action of the muscles. The extensor mechanism of the fingers is divided into topographic zones, which extend from the forearm to the distal phalanx. Magnetic resonance (MR) imaging shows in detail the musculotendinous and retinacular structures of the extensor apparatus. In the different extensor zones, MR imaging findings are similar to those seen macroscopically in anatomic sections. Understanding of and familiarity with the extensor anatomy of the hand and fingers by the radiologist is crucial for better assessment of pathologic conditions with MR imaging and optimization of this modality as a diagnostic tool. Extensor tendon injuries and tenosynovitis represent clinical situations in which knowledge of this anatomy is useful for the clinical radiologist.

Kinetic dysfunction of the wrist with chronic scapholunate dissociation. A cadaver study

Clinical Biomechanics

Immunofluorescence analysis of sensory nerve endings in the interosseous membrane of the forearm

Journal of Anatomy

¿Cómo han influido las investigaciones básicas en propiocepción y control neuro-muscular del carpo, en la toma de decisiones terapéuticas del día a día?

Revista Iberoamericana de Cirugía de la Mano

Role of muscles in the stabilization of ligament-deficient wrists

Journal of Hand Therapy, 2016

This article reviews the results of a series of cadaver investigations aimed at clarifying the ro... more This article reviews the results of a series of cadaver investigations aimed at clarifying the role of muscles in the stabilization of ligament-deficient wrists. According to these studies, isometric contraction of some forearm muscles induces midcarpal (MC) supination (ie, the abductor pollicis longus, extensor carpi radialis longus, and flexor carpi ulnaris), whereas other muscles induce MC pronation (ie, the extensor carpi ulnaris). Because MC supination implies tightening of the volar scaphoid-distal row ligaments, the MC supination muscles are likely to prevent scaphoid collapse of wrists with scapholunate ligament insufficiency. MC pronator muscles, by contrast, would be beneficial in stabilizing wrists with ulnar-sided ligament deficiencies owing to their ability to tighten the triquetrum-distal row ligaments. Should these laboratory findings be validated by additional clinical research, proprioceptive reeducation of selected muscles could become an important tool for the treatment of dynamic carpal instabilities.

Extensor Mechanism of the Fingers: MR Imaging–Anatomic Correlation1

Radiographics a Review Publication of the Radiological Society of North America Inc, May 1, 2003

Extension of the fingers is a complex function carried out by simultaneous action of extrinsic an... more Extension of the fingers is a complex function carried out by simultaneous action of extrinsic and intrinsic muscles, as well as retinacular structures in the dorsum of the wrist, hand, and fingers that support and coordinate the action of the muscles. The extensor mechanism of the fingers is divided into topographic zones, which extend from the forearm to the distal phalanx. Magnetic resonance (MR) imaging shows in detail the musculotendinous and retinacular structures of the extensor apparatus. In the different extensor zones, MR imaging findings are similar to those seen macroscopically in anatomic sections. Understanding of and familiarity with the extensor anatomy of the hand and fingers by the radiologist is crucial for better assessment of pathologic conditions with MR imaging and optimization of this modality as a diagnostic tool. Extensor tendon injuries and tenosynovitis represent clinical situations in which knowledge of this anatomy is useful for the clinical radiologist.

[Subacute subdural hematoma after cranioencephalic trauma in an alcoholic patient]

Revista espanola de anestesiologia y reanimacion

Proprioception and neuromuscular control in carpal instabilities

Paper written in Spanish Articular joint congruity, static stability secondary to ligament integr... more Paper written in Spanish Articular joint congruity, static stability secondary to ligament integrity and dynamic joint surface compression due to muscular contraction have been deined classically as the key for carpal stability. Recently, a fourth factor in carpal stability has been proposed, involving the neuromuscular and proprioceptive control of joints. Proprioception of the wrist starts in sensory end organs located in ligaments and joint capsules (mechanoreceptors). When mechanoreceptors are stimulated, an afferent signal causes an involuntary spinal relex that induces a selective muscular contraction in order to protect from ligament injury. The aim of this review is to provide an understanding of the role of proprioception and neuromuscular control in carpal instabilities, as well as descriptions of potential clinical applications. © 2015, SECMA. Published by Elsevier España, S.L.U. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/lice...

[Late extrapyramidal syndrome with low doses of droperidol]

Revista española de anestesiología y reanimación

Extensor Mechanism of the Fingers: MR Imaging–Anatomic Correlation1

…, 2003

Extension of the fingers is a complex function carried out by simultaneous action of extrinsic an... more Extension of the fingers is a complex function carried out by simultaneous action of extrinsic and intrinsic muscles, as well as retinacular structures in the dorsum of the wrist, hand, and fingers that support and coordinate the action of the muscles. The extensor mechanism of the fingers is divided into topographic zones, which extend from the forearm to the distal phalanx. Magnetic resonance (MR) imaging shows in detail the musculotendinous and retinacular structures of the extensor apparatus. In the different extensor zones, MR imaging findings are similar to those seen macroscopically in anatomic sections. Understanding of and familiarity with the extensor anatomy of the hand and fingers by the radiologist is crucial for better assessment of pathologic conditions with MR imaging and optimization of this modality as a diagnostic tool. Extensor tendon injuries and tenosynovitis represent clinical situations in which knowledge of this anatomy is useful for the clinical radiologist.

Muscle Control of the First Carpometacarpal Joint

The Journal of Hand Surgery, 2014

Análisis de las complicaciones de la artroscopia de muñeca sufridas durante la curva de aprendizaje de la técnica

resumen: objetivo: Describir las complicaciones sufridas durante las primeras artroscopias de muñ... more resumen: objetivo: Describir las complicaciones sufridas durante las primeras artroscopias de muñeca realizadas por la autora y cómo evitarlas, tras analizar la anatomía. Material y método: Definimos como complicación, los efectos adversos directamente relacionados con la técnica artros-cópica. Valoramos retrospectivamente una serie de cincuenta artroscopias realizadas en tres años (2008-2011): indicacio-nes y procedimientos realizados. Analizamos las nueve complicaciones recogidas: su pico de incidencia, su relación con el procedimiento terapéutico y con la anatomía. Resultados: Se recogieron: un caso de rotura del tendón eDM, tres casos de dolor por los nudos del anclaje periférico del fibrocartílago triangular (FCT) y cinco casos de lesión de la rama sensitiva dorsal del nervio cubital (RSDnC). el mayor índice de complicaciones apareció durante el segundo año de la práctica artroscópica. Conclusión: la artroscopia de muñeca ha experimentado un considerable auge en los últimos años. Abundan los cursos para aprender la técnica. Poco se habla en ellos de complicaciones lo que puede sugerir que es una técnica inocua y sen-cilla. Pero las complicaciones existen y pueden comportar importante iatrogenia. Tras la detección y análisis de las compli-caciones acaecidas durante la curva de aprendizaje (2008-2011) y tras realizar estudios anatómicos específicos, la autora ha modificado su técnica artroscópica. la incidencia de complicaciones desde el 2011 es prácticamente nula. Palabras clave: Complicación, Artroscopia de muñeca, Curva de aprendizaje, Rama sensitiva dorsal del nervio cubital, tendón extensor Digiti Minimi, Fibrocartílago triangular (FCT). abstract: objective: To describe the complications suffered during the first 50 wrist arthroscopies performed by the author and how to avoid them after analyzing the anatomy. Material and Method: We define as a complication the adverse effect directly related to the technique We retrospectively assess 50 arthroscopies performed in 3 years (2008-2011): indications, procedures performed. We analyze the 9 complications collected and their relation to the technique and the anatomy. Results: We found: 1 case of eDM tendon rupture, 3 cases of pain due to the knots of the peripheral TFCC tears sutures and 5 cases of injuries to the dorsal sensory branch of the ulnar nerve (DSbun). Complications mainly occurred during the second year of the arthroscopic practice. Conclusion:. Wrist arthroscopy has experienced a considerable boom in recent years. There are plenty of courses to learn the technique. little is said in them about complications: this may suggest that the technique is safe and simple. but complications exist and they may incur in significant injuries. Following the detection and analysis of the complications that appeared during the learning curve(2008-2011) and following specific anatomical studies, the authors have modified their arthroscopic technique. The complication rate since 2011 is practically zero.

El papel de la propiocepción y el control neuromuscular en las inestabilidades del carpo

by E. Hagert, M. Llusà, and Mireia Esplugas

Revista Iberoamericana de Cirugía de la Mano, 2015

Recibido el 15 de abril de 2015. Aceptado el 16 de abril de 2015.

Trapeziometacarpal Ligaments Biomechanical Study: Implications in Arthroscopy

by Mireia Esplugas and M. Garciaelias

Purpose In the presence of early osteoarthritis, changes to the trapeziometacarpal joint (TMJ) of... more Purpose In the presence of early osteoarthritis, changes to the trapeziometacarpal joint (TMJ) often result in pain and is associated with joint instability and a tendency of dorsoradial subluxation. In these instances, arthroscopy may be indicated to: (1) assess the extent of cartilage disease and the laxity of ligaments and to (2) treat TMJ instability. The purpose of our study was to biomechanically analyze which ligaments are the primary stabilizers of the TMJ. Methods Overall, 11 fresh-frozen human cadaver specimens were dissected and attached to a testing device with the thumb positioned in neutral abduction, neutral flexion, and neutral opposition. The four extrinsic and five intrinsic muscle tendons acting on the TMJ were simultaneously loaded with weights proportional to their physiological cross-sectional area. The dorsal, volar, and ulnar groups of ligaments were dissected. A motion-tracking device, FasTrak (Polhemus Inc., Colchester, VT), was used to study the spatial position of the base of the first metacarpal bone (MC1), before and after random sectioning of each of the ligaments. Statistical analysis of the MC1 translation along the transverse XY plane was performed using one-way analysis of variance and a paired t-test, with a significance level of p < 0.05. Results After isolated sectioning of the volar or the ulnar ligaments, the MC1 moved dorsoradially with an average of 0.150 mm (standard deviation [SD]: 0.072) and 0.064 mm (SD: 0.301), respectively. By contrast, the destabilization of the MC1 after sectioning of the dorsal ligaments was substantially larger (0.523 mm; SD: 0.0512; p ¼ 0.004). Conclusions Sectioning of the dorsal ligament group resulted in the greatest dorsor-adial translation of the MC1. Consequently, the dorsal ligaments may be regarded as the primary TMJ stabilizers. Clinical Relevance This study suggests that stabilizing arthroscopic shrinkage of the TMJ should be targeted toward the dorsal TMJ ligaments.

Role of muscles in the stabilization of ligament-deficient wrists

This article reviews the results of a series of cadaver investigations aimed at clarifying the ro... more This article reviews the results of a series of cadaver investigations aimed at clarifying the role of muscles in the stabilization of ligament-deficient wrists. According to these studies, isometric contraction of some forearm muscles induces midcarpal (MC) supination (ie, the abductor pollicis longus, extensor carpi radialis longus, and flexor carpi ulnaris), whereas other muscles induce MC pronation (ie, the extensor carpi ulnaris). Because MC supination implies tightening of the volar scaphoid-distal row ligaments, the MC supination muscles are likely to prevent scaphoid collapse of wrists with scapholunate ligament insufficiency. MC pronator muscles, by contrast, would be beneficial in stabilizing wrists with ulnar-sided ligament deficiencies owing to their ability to tighten the triquetrum-distal row ligaments. Should these laboratory findings be validated by additional clinical research, proprioceptive reeducation of selected muscles could become an important tool for the treatment of dynamic carpal instabilities.

The effect of individual isometric muscle loading on the alignment of the base of the thumb metacarpal: a cadaveric study

by E. Hagert, Nathalie Mobargha, and Mireia Esplugas

Journal of Hand Surgery (European Volume), 2015

Stability of the thumb carpometacarpal joint relies upon equilibrium between its ligaments, muscu... more Stability of the thumb carpometacarpal joint relies upon equilibrium between its ligaments, muscular support and joint congruity. We wanted to identify the muscles important in preventing or increasing dorsoradial subluxation of this joint. In ten cadaveric hands, a Fastrak ® motion tracking device was used to assess the effects of individual isometric muscle loading on the base of the thumb metacarpal relative to the radius and to the base of the middle finger metacarpal. We found that the first dorsal interosseous muscle caused the least dorsoradial translation and highest distal migration of the base of the first metacarpal, whereas abductor pollicis longus was the primary destabilizer, increasing dorsoradial misalignment. The findings show different impacts of these muscles on joint alignment and stability, which suggests that treatment should be targeted to enhance the action of the primary stabilizing muscle, the first dorsal interosseous muscle.

Reinserción capsular y reanclaje a la fóvea del complejo del fibrocartílago triangular de la muñeca. Videotécnica

Revista Española de Artroscopia y Cirugía Articular, 2015

r e v e s p a r t r o s c c i r a r t i c u l . 2 0 1 4;2 1(2):120 w w w . e l s e v i e r . e s ... more

Lesiones del complejo del fibrocartílago triangular. Tipos de reparación

Revista Española de Artroscopia y Cirugía Articular, 2014

How to Avoid Ulnar Nerve Injury When Setting the 6U Wrist Arthroscopy Portal

Journal of Wrist Surgery, 2014

Although wrist arthroscopy without traction has been described, 1 most of the procedures use a tr... more Although wrist arthroscopy without traction has been described, 1 most of the procedures use a traction tower. In some of these traction systems, finger traps suspend the hand and the forearm is secured in neutral rotation to a post by Velcro strap. In such cases, forearm rotation is very restricted and the hand and wrist are free to supinate or pronate around the forearm axis (►Fig. 1). The 6U portal is established just palmar to the anterior margin of the extensor carpi ulnaris (ECU) tendon and proximal to the medial prominence of the triquetrum.

MR Imaging of Ligament and Tendon Injuries of the Fingers1

by Xavier Alomar and Mireia Esplugas

RadioGraphics, 2002

Magnetic resonance (MR) imaging can provide important information for diagnosis and evaluation of... more Magnetic resonance (MR) imaging can provide important information for diagnosis and evaluation of soft-tissue trauma in the fingers. An optimal imaging technique should include proper positioning, dedicated surface coils, and specific protocols for the suspected abnormalities. Familiarity with the fine anatomy of the normal finger is crucial for identifying pathologic entities. MR imaging is a powerful method for evaluating acute and chronic lesions of the stabilizing articular elements (volar plate and collateral ligaments) of the fingers and thumbs, particularly in the frequently affected proximal interphalangeal and metacarpophalangeal joints. As in other body regions, MR imaging is also useful for depicting traumatic conditions of the extensor and flexor tendons, including injuries to the pulley system. In general, normal ligaments and tendons have low signal intensity on MR images, whereas disruption manifests as increased signal intensity. Radiologists need to understand the full spectrum of finger abnormalities and associated MR imaging findings.

Extensor mechanism of the fingers: MR imaging-anatomic correlation

by Xavier Alomar, Oscar Fariñas, and Mireia Esplugas

Radiographics : a review publication of the Radiological Society of North America, Inc

Extension of the fingers is a complex function carried out by simultaneous action of extrinsic an... more Extension of the fingers is a complex function carried out by simultaneous action of extrinsic and intrinsic muscles, as well as retinacular structures in the dorsum of the wrist, hand, and fingers that support and coordinate the action of the muscles. The extensor mechanism of the fingers is divided into topographic zones, which extend from the forearm to the distal phalanx. Magnetic resonance (MR) imaging shows in detail the musculotendinous and retinacular structures of the extensor apparatus. In the different extensor zones, MR imaging findings are similar to those seen macroscopically in anatomic sections. Understanding of and familiarity with the extensor anatomy of the hand and fingers by the radiologist is crucial for better assessment of pathologic conditions with MR imaging and optimization of this modality as a diagnostic tool. Extensor tendon injuries and tenosynovitis represent clinical situations in which knowledge of this anatomy is useful for the clinical radiologist.