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Immunhistochemical Analysis of Sensory Nerve Endings in the Triangular Fibrocartilage Complex in Humans
Susanne Rein, MD, PhD1; Manuel Semisch1; Marc Garcia-Elias, MD, PhD2; Alex Lluch, MD2; Hans Zwipp, MD, PhD3; Elisabet Hagert, MD, PhD4
1University Hospital "Carl Gustav Carus", Germany; 2Institut Kaplan, Germany; 3University Hospital, Germany; 4Karolinska Institutet, Germany

Background:The aim of this study was to analyze the pattern and types of sensory nerve endings in the triangular fibrocartilage complex (TFCC) using immunohistochemical techniques, in order to gain more insight into the proprioceptive function of the distal radioulnar joint (DRUJ).
Methods: TFCC of eleven human cadaver wrists were included: the subsheat of the extensor carpi ulnaris tendon, the meniscoid, the triangular disc, the radioulnar dorsal and volar ligaments as well as the ulnolunate and ulnotriquetral ligaments have been investigated. Sensory nerve endings were classified according to Freeman and Wyke after staining with hematoxylin-eosin, low-affinity neurotrophin receptor p75, protein gene product 9.5, and S-100 protein. Ruffini, Pacini, Golgi-like, and free nerve endings as well as unclassifiable corpuscles were counted in 5 levels per specimen with respect of the total cell count per section.
Results: Preliminary results show that free nerve endings were the predominant sensory endings in all specimens, particularly found in the ulnotriquetral ligament and the meniscoid. Ruffini endings have been found in all specimens except the triangular disc and the ulnolunate ligament. Pacini corpuscles were only seen in the volar and dorsal radioulnar ligaments.
Conclusions: Free nerve endings were the predominant receptor type, followed by Ruffini endings, indicating that nociception and joint position have primary importance in DRUJ proprioception. The volar and dorsal radioulnar ligaments were the only ligaments with Ruffini, Pacini and free nerve endings. The ulnolunate ligament and the triangular disc are rarely innervated, which implies less proprioceptive and rather static function in the TFCC. Key words: Immunohistochemistry, Mechanoreceptors, Proprioception, triangular fibrocartilage complex, Wrist


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