Efectos predecibles del acortamiento metacarpiano en la función del músculo interóseo.
Matthew J. Meunier, MD a * [MEDLINE LOOKUP] Eric Hentzen, MD, PhD a [MEDLINE LOOKUP] Michael Ryan a [MEDLINE LOOKUP] Alexander Y. Shin, MD b [MEDLINE LOOKUP] Richard L. Lieber, PhD a [MEDLINE LOOKUP]
Purpose Metacarpal fractures are common in hand surgery. Metacarpal shortening ranging from 2 mm to as much as 10 mm has been deemed acceptable in the literature. We examined the effect of metacarpal shortening on interosseous muscle architecture and predicted force production capacity based on the standard muscle length-tension curve (commonly known as the Blix curve). Methods The dorsal interosseous muscles between the middle and ring finger metacarpals from 9 adult human cadaver hands were exposed and studied. The ring finger metacarpal was translated proximally in 2-mm increments in relation to a stationary middle finger metacarpal. Digital images were obtained and analyzed to define the length and orientation of individual muscle fibers with each incremental change in position. Results Interosseous muscle fiber length increased and pennation angle decreased uniformly with increasing proximal translation of the ring finger metacarpal. At 10 mm of shortening the fiber length had increased to 20.8 ± 1.8 mm, or to approximately 125% of optimum fiber length, and the pennation angle had decreased to 6.7° ± 2.2° or by approximately 50%. Conclusions The interosseous muscles have been shown to have a high fiber-to-muscle length ratio. This ratio indicates that these muscles function optimally over a short range of lengths, leaving them vulnerable to derangement in function owing to alteration in the surrounding bony architecture. Based on the standard muscle length-tension relationship we had predicted a steady linear decrease in interosseous power with proximal translation of the metacarpal. The results indicate an initial linear progression with a plateau at approximately 8 mm of shortening. At 2 mm of shortening there is an approximately 8% loss of power generation, at 10 mm of metacarpal shortening we predict the interosseous muscle to be capable of only approximately 55% of its optimum power compared with the resting position.
The Journal of Hand Surgery. July 2004. Volume 29.Number 4.