Department of Plastic and Hand Surgery, Burn Unit, Hospital Sankt Georg, Delitzscher Straße 141, 04129, Leipzig, Germany.
Martin-Luther-University Halle-Wittenberg, Halle (Saale), Germany.
Arch Orthop Trauma Surg. 2023 Jul;143(7):3779-3794. doi: 10.1007/s00402-022-04604-0. Epub 2022 Sep 7.
To investigate the dynamic aspects of elbow stability, we aimed to analyze sensory nerve endings in the ligaments and the capsule of elbow joints.
The capsule with its anterior (AJC) and posterior (PJC) parts, the radial collateral ligament (RCL), the annular ligament (AL), and the ulnar collateral ligament with its posterior (PUCL), transverse (TUCL) and anterior parts (AUCL) were dissected from eleven human cadaver elbow joints. Sensory nerve endings were analyzed in two levels per specimen as total cell amount/ cm after immunofluorescence staining with low-affinity neurotrophin receptor p75, protein gene product 9.5, S-100 protein and 4',6-Diamidin-2-phenylindol, Carbonic anhydrase II and choline acetyltransferase on an Apotome microscope according to Freeman and Wyke's classification.
Free nerve endings were the predominant mechanoreceptor in all seven structures followed by Ruffini, unclassifiable, Golgi-like, and Pacini corpuscles (p ≤ 0.00001, respectively). Free nerve endings were observed significant more often in the AJC than in the RCL (p < 0.00002). A higher density of Ruffini endings than Golgi-like endings was observed in the PJC (p = 0.004). The RCL contained significant more Ruffini endings than Pacini corpuscles (p = 0.004). Carbonic anhydrase II was significantly more frequently positively immunoreactive than choline acetyltransferase in all sensory nerve endings (p < 0.05). Sensory nerve endings were significant more often epifascicular distributed in all structures (p < 0.006, respectively) except for the AJC, which had a pronounced equal distribution (p < 0.00005).
The high density of free nerve endings in the joint capsule indicates that it has pronounced nociceptive functions. Joint position sense is mainly detected by the RCL, AUCL, PUCL, and the PJC. Proprioceptive control of the elbow joint is mainly monitored by the joint capsule and the UCL, respectively. However, the extreme range of motion is primarily controlled by the RCL mediated by Golgi-like endings.
为了研究肘部稳定性的动态方面，我们旨在分析肘部关节韧带和囊中的感觉神经末梢。
从 11 个人体尸体肘部关节中解剖出囊及其前（AJC）和后（PJC）部分、桡侧副韧带（RCL）、环状韧带（AL）、尺侧副韧带及其后（PUCL）、横（TUCL）和前（AUCL）部分。用低亲和力神经营养素受体 p75、蛋白基因产物 9.5、S-100 蛋白和 4'，6-二脒基-2-苯基吲哚对每个标本的两个水平进行免疫荧光染色，根据 Freeman 和 Wyke 的分类分析感觉神经末梢，分析总细胞数/cm。
在所有 7 种结构中，游离神经末梢是主要的机械感受器，其次是 Ruffini 感受器、未分类感受器、Golgi 样感受器和 Pacini 小体（p ≤ 0.00001，分别）。在 AJC 中观察到的游离神经末梢明显多于 RCL（p < 0.00002）。在 PJC 中，Ruffini 感受器的密度明显高于 Golgi 样感受器（p = 0.004）。RCL 中 Ruffini 感受器的数量明显多于 Pacini 小体（p = 0.004）。在所有感觉神经末梢中，碳酸酐酶 II 的阳性免疫反应明显多于胆碱乙酰转移酶（p < 0.05）。在所有结构中，感觉神经末梢的神经束膜分布明显更为常见（p < 0.006，分别），除了 AJC，它具有明显的均等分布（p < 0.00005）。
关节囊中游离神经末梢的高密度表明其具有明显的痛觉功能。关节位置感主要由 RCL、AUCL、PUCL 和 PJC 检测。肘关节的本体感觉控制主要由关节囊和 UCL 分别监测。然而，极限运动范围主要由 RCL 通过 Golgi 样感受器介导控制。
