Abstract
The distribution of neural elements in the triangular fibrocartilage complex (TFCC) of the human wrists was studied via immunohistochemical staining of protein gene product (PGP) 9.5 and calcitonin gene-related peptide (CGRP). Articular branches projecting to the TFCC arose from the dorsal branch of the ulnar nerve in all wrists examined. The TFCC is subdivided into the following six regions: the articular disc proper (ADP), meniscus homolog (MH), radio-ulnar ligament (RUL), loose part of ulnar collateral ligament (lUCL), dense part of ulnar collateral ligament (dUCL), and internal portion (IP). The IP consists of a mixture of dense and loose connective tissues enclosed by the ADP, MH, RUL, and UCL, and resides deep in the prestyloid recess, which is a pit in the MH. The densities of PGP 9.5-positive neural elements, including free nerve endings, single nerve fibers, nerve fascicles, and perivascular neural nets, were significantly higher in the IP than in other regions. Some of the neural elements except for the perivascular neural nets were positive for CGRP. The high density of neural elements in the IP suggests that sensory nerves projecting to the TFCC enter into the IP and from there distribute to adjacent regions such as the MH and RUL. Free nerve endings are responsible for pain transmission. The high density of free nerve endings in the IP suggests that the IP is a source of ulnar side wrist pain.
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References
Benjamin M, Evans EJ, Pemberton DJ (1990) Histological studies on the triangular fibrocartilage complex of the wrist. J Anat 172, 59–67.
Bolton CF, Winkelmann RK, Dyck PJ (1966) A quantitative study of Meissner’s corpuscules in man. Neurology 16, 1–9.
Cauna N (1960) The effect of aging on the receptor organs of the human dermis. In: Advances in Biology of Skin, Vol. 1 (Montsagna W, ed.). Pergamon Press, Oxford, 63–93.
Cavalcante MLC, Rodrigues CJ, Mattar R Jr (2004) Mechanoreceptors and nerve endings of the triangular fibrocartilage in the human wrist. J Hand Surg [Am] 29, 432–5.
Fukumoto K, Kojima T, Kinoshita Y et al. (1991) An anatomical study of the innervation of the triangular fibrocartilage complex. J Jpn Soc Surg Hand 8, 598–601 (in Japanese with English abstract).
Garcia-Elias M, Domenech-Mateu JM (1987) The articular disc of the wrist. Limits and relations. Acta Anat (Basel) 128, 51–4.
Gupta R, Nelson SD, Baker J et al. (2001) The innervation of the triangular fibrocartilage complex: Nitric acid maceration rediscovered. Plast Reconstr Surg 107, 135–9.
Ishida-Yamamoto A, Tohyama M (1989) Calcitonin gene-related peptide in the nervous tissue. Prog Neurobiol 33, 335–86.
Ju G, Hokfelt T, Brodin E et al. (1987) Primary sensory neurons of the rat showing calcitonin gene-related peptide immunoreactivity and their relation to substance P-, somatostatin-, galanin-, vasoactive intestinal polypeptide- and cholecystokinin-immunoreactive ganglion cells. Cell Tissue Res 247, 417–31.
Kauer JM (1975) The articular disc of the hand. Acta Anat (Basel) 93, 590–605.
Lewis OJ, Hamshere RJ, Bucknill TM (1970) The anatomy of the wrist joint. J Anat 106, 539–52.
Li Y, Hsieh ST, Chien HF et al. (1997) Sensory and motor denervation influence epidermal thickness in rat foot glabrous skin. Exp Neurol 147, 452–62.
Maeda T, Iwanaga T, Fujita T et al. (1985) Immunohistochemical demonstration of the nerves in human dental pulp with antisera against neurofilament protein and glia-specific S-100 protein. Arch Histol Jpn 48, 123–9 (in Japanese with English abstract).
Merida-Velasco JA, Garcia-Garcia JD, Espin-Ferra J, Sanchez-Montesinos I (1996). Development of the human wrist joint ligaments. Anat Rec 245, 114–21.
Nakamura T (1995) Triangular fibrocartilage complex: Functional anatomy and histology. Nippon Seikeigeka Gakkai Zasshi 69, 168–80 (in Japanese with English abstract).
Nakamura T, Yabe Y (2000) Histological anatomy of the triangular fibrocartilage complex of the human wrist. Ann Anat 182, 567–72.
Nakamura T, Yabe Y, Horiuchi Y (1996) Functional anatomy of the triangular fibrocartilage complex. J Hand Surg [Br] 21, 581–6.
Nakamura T, Takayama S, Horiuchi Y et al. (2001) Origins and insertions of the triangular fibrocartilage complex: A histological study. J Hand Surg [Br] 26, 446–54.
Ohmori M, Azuma H (1998) Morphology and distribution of nerve endings in the human triangular fibrocartilage complex. J Hand Surg [Br] 23, 522–5.
Palmer AK, Werner FW (1981) The triangular fibrocartilage complex of the wrist-anatomy and function. J Hand Surg [Am] 6, 153–62.
Taleisnik J (1976) The ligaments of the wrist. J Hand Surg [Am] 1, 110–18.
Thompson RJ, Doran JF, Jackson P et al. (1983) PGP 9.5: a new marker for vertebrate neurons and neuroendocrine cells. Brain Res 278, 224–8.
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Shigemitsu, T., Tobe, M., Mizutani, K. et al. Innervation of the triangular fibrocartilage complex of the human wrist: Quantitative immunohistochemical study. Anato Sci Int 82, 127–132 (2007). https://doi.org/10.1111/j.1447-073X.2007.00173.x
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DOI: https://doi.org/10.1111/j.1447-073X.2007.00173.x