Vascular supply of the metacarpophalangeal joints and cartilaginous covering of the metacarpal heads with special emphasis on ultrasonographic imaging
Baksa Gábor
Surgical Medicine Division
Dr. Szijártó Attila
SE Elméleti Orvostudományi Központ, Beznák Aladár terem
2025-05-26 14:00:00
Physiology and Pathology of the Musculoskeletal System
Dr. Szőke György
Dr. Bálint Péter Vince
Dr. Heinzlmann Andrea
Dr. Kaszap Balázs
Dr. Szendrői Miklós
Dr. Pálinkás Márton
Dr. Zachar Gergely
Vascular changes in various rheumatological issues e.g. RA are generally known diagnostic signs in different phases of diseases. Imaging of the circulation in the small joints may add to both the early recognition of disease onset and the follow-up of the applied therapy, presumably mitigating the chronic complications of RMDs.
In our investigations we described the entire arterial anatomy of the 2nd to 5th MCP joints. A relative constant vascular pattern was revealed. The in vivo Doppler US of healthy subjects verified significantly higher detectability of vascular signals on the 2nd and 3rd joints, which are even more frequently involved in RA than the other two. However, due to several factors, neither our anatomical nor our US measurements provided reliable data concerning the normal size (diameter) of these joint supplying branches. Among others, the clear ultrasonographical differentiation of veins and arteries and the validated calibration of US equipment for small vessel circulation are still missing. Anatomically, the ex vivo conditions together with different preparation techniques and lack of investigation of venous branches could lead to a possible false assessment of vessel sizes. Based on our creditable description about the localization of joint arteries, multicenter US studies with a considerably higher number of participants are needed to adopt this knowledge to daily clinical routine.
Since cartilage loss in chronic RA is regarded as the most relevant cause for severe pain and working disability, we performed investigations on the 2nd to 5th metacarpal heads’ cartilages. Our paper was the first to correlate US cartilage measurements with anatomical data, both collected in cadaveric specimens. To prove the reliability of US by a gold standard method, both in and ex situ US measurements were validated using conventional histology. We found the investigated cartilages to be inhomogeneous in their thickness and confirmed the phenomenon published on other joints’ cartilages that the US is only able to detect the non-calcified cartilages. Subsequential 3D thickness mapping of the entire cartilaginous covering showed a defined pattern of cartilage morphology with certain differences among finger rays. We obtained valuable results in this field, however, the low number of specimens position them to be a plausible research model without current statistical relevance. A significantly higher number of specimens can fortify our findings in future investigations.
