Elisabet Hagert

Elisabet Hagert
Aspetar - Qatar Orthopaedic and Sports Medicine Hospital | aspetar

MD PhD

About

71
Publications
46,676
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1,554
Citations
Additional affiliations
September 2014 - present
Karolinska Institutet
Position
  • Professor (Associate)
January 2011 - December 2012
Stanford University
January 2004 - December 2012
Karolinska Institutet

Publications

Publications (71)
Article
Background Palmer type 1B triangular fibrocartilage complex (TFCC) tears are a common cause of distal radioulnar joint (DRUJ) instability. Unfortunately, the best surgical technique for TFCC reinsertion is still unknown, and up to a quarter of patients report instability after repair. The purpose of this systematic review of cadaver studies was to...
Article
Hace más de una década, un grupo de amigos interesados en la anatomía y la biomecánica de la muñeca empezamos a pasar horas en los departamentos de Anatomía de las dos universidades más importantes de Barcelona sin esperar otra recompensa que aprender y saciar nuestras inquietudes. Aprovechando el lanzamiento de la Revista de Cirugía de Mano y Micr...
Article
The technical simplicity of the Darrach procedure may explain why it has been so popular. Excising the distal ulna, however, may have potentially undesired consequences to the biomechanics in two areas: the distal radioulnar and the ulno-carpal joints. These conjointly define the radio-ulno-carpal joint (RUCJ). The RUCJ is not a small and irrelevan...
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Full-text available
Objective Focal cartilage injuries, and posttraumatic osteoarthritis (OA) in the wrist are likely common and a cause of wrist pain. To estimate the incidence of cartilage lesions and to understand the pathomechanisms leading to wrist cartilage injuries and OA, a literature review on the subject was performed combined with a presentation of one of t...
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Full-text available
Introduction Traumatic injuries of the triangular fibrocartilage complex (TFCC) are frequent reasons for ulnar wrist pain. The assessment of the extent of articular disc (AD) degeneration is important for the differentiation of acute injuries versus chronic lesions. Materials and methods The AD of the TFCC of eleven human cadaver wrists was dissec...
Article
PurposeLigamento-muscular reflex pattern following stimulation of the anterior talofibular ligament (ATFL) was examined.Methods The peroneus longus (PL), the tibialis anterior (TA), and tibialis posterior (TP) muscles were investigated in sixteen patients with functional ankle instability (FAI) and 16 age- and gender-matched controls. The ATFL was...
Article
Introduction Due to the complex shape of the carpometacarpal (CMC) joint, a fixed joint collapse deformity of the thumb CMC (CMC1) and metacarpophalangeal (MCP1) joint can present in the advanced stages of CMC1 osteoarthritis (OA), resulting in adduction of the first metacarpal (MC) and hyperextension of the MCP1. The aim of this study was to deter...
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Full-text available
Study Design Descriptive reliability study. Introduction A well-functioning wrist requires sufficient range of motion accompanied by adequate strength in every movement and direction—factors that are not regularly measured simultaneously in patients with wrist problems today. The ISOmetric Power device (ISOP) is a new instrument that measures isom...
Article
Dorsoradial and anterior oblique ligaments were harvested during surgery in 13 patients with symptomatic trapeziometacarpal osteoarthritis, which had been graded preoperatively by a modified Eaton-Littler radiographic grading. Ligaments, including the periligamentous synovium, were stained with S100 protein, neurotrophic receptor p75, protein gene...
Article
Backround: Some children with obstetric brachial plexus palsy (OBPP) present later on with an ulnarly deviated wrist. The aim of this study was to present a retrospective analysis of a subgroup of OBPP children with ulnarly deviated wrists and to describe their morphologic wrist deformity in terms of clinical and radiological appearance. Methods:...
Article
Background: Forearm peak pronation and supination torque measurements are reduced up to 30% in patients with triangular fibrocartilage complex (TFCC) 1B injuries with concomitant distal radioulnar joint (DRUJ) instability. The aim of our study was to evaluate whether patients with TFCC 1B injuries, with concomitant DRUJ instability, improve in for...
Article
Purpose: The dorsoradial ligament (DRL) is essential for stability of the first carpometacarpal joint (CMC1) and is innervated with nerve endings and mechanoreceptors known to contribute to joint proprioception. The influence of these nerve endings on the neuromuscular stability of CMC1 is not yet known. This study investigated whether a ligamento...
Article
Introduction: Many people with chronic spinal cord injury (SCI) develop shoulder pain, which can adversely impact transfers and independence. Yet effective treatments remain elusive. Case presentation: This report presents two patients with tetraplegia who had long-standing shoulder pain. Our exam showed muscle weakness and point tenderness, sug...
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Full-text available
Purpose In the presence of early osteoarthritis, changes to the trapeziometacarpal joint (TMJ) often result in pain and is associated with joint instability and a tendency of dorsoradial subluxation. In these instances, arthroscopy may be indicated to: (1) assess the extent of cartilage disease and the laxity of ligaments and to (2) treat TMJ insta...
Article
The morphological structure of the seven components of triangular fibrocartilage complexes of 11 cadaver wrists of elderly people was assessed microscopically, after staining with Hematoxylin-Eosin and Elastica van Gieson. The articular disc consisted of tight interlaced fibrocartilage without blood vessels except in its ulnar part. Volar and dorsa...
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Purpose The purpose was to investigate whether surgical repair earlier or later than 3 months after injury may result in similar outcomes and patient satisfaction. Methods Seventy-three patients (75 shoulders, 58 males, mean age 59) who had undergone surgical intervention for traumatic rotator cuff tears from 1999 to 2011 were assessed by MRI, clin...
Article
Aim and Hypothesis: The aim of this study was to evaluate the reliability of ISOP, a new portable isometric power device (Medical Control Group Inc., Malmo, Sweden), with regard to evaluating isometric muscle force in the three planes of wrist motion. The hypothesis was as follows: Is there a significant difference in isometric power when repeated...
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Full-text available
Purpose The population of mechanoreceptors in patients with osteoarthritis (OA) lacks detailed characterization. In this study, we examined the distribution and type of mechanoreceptors of two principal ligaments in surgical subjects with OA of the first carpometacarpal joint (CMC1). Methods We harvested two ligaments from the CMC1 of eleven subjec...
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Full-text available
Stability of the thumb carpometacarpal joint relies upon equilibrium between its ligaments, muscular support and joint congruity. We wanted to identify the muscles important in preventing or increasing dorsoradial subluxation of this joint. In ten cadaveric hands, a Fastrak(®) motion tracking device was used to assess the effects of individual isom...
Article
Carpal stability has traditionally been defined as dependent on the articular congruity of joint surfaces, the static stability maintained by intact ligaments, and the dynamic stability caused by muscle contractions resulting in a compression of joint surfaces. In the past decade, a fourth factor in carpal stability has been proposed, involving the...
Article
Full-text available
The triangular fibrocartilage complex is the main stabilizer of the distal radioulnar joint. While static joint stability is constituted by osseous and ligamentous integrity, the dynamic aspects of joint stability chiefly concern proprioceptive control of the compressive and directional muscular forces acting on the joint. Therefore, an investigati...
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Full-text available
Articular joint congruity, static stability secondary to ligament integrity and dynamic joint surface compression due to muscular contraction have been defined classically as the key for carpal stability. Recetly, a fourth factor in carpal stability has been proposed, involving the neuromuscular and propioceptive control of joints. Propioception of...
Article
Paper written in Spanish Articular joint congruity, static stability secondary to ligament integrity and dynamic joint surface compression due to muscular contraction have been deined classically as the key for carpal stability. Recently, a fourth factor in carpal stability has been proposed, involving the neuromuscular and proprioceptive control o...
Article
Full-text available
Articular joint congruity, static stability secondary to ligament integrity and dynamic joint surface compression due to muscular contraction have been deined classically as the key for carpal stability. Recently, a fourth factor in carpal stability has been proposed, involving the neuromuscular and proprioceptive control of joints. Proprioception...
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Full-text available
Introduction Palmar midcarpal instability (PMCI) is a painful condition characterized by a kinematic dysfunction of the proximal carpal row (PCR). Although its etiology is still poorly understood, it is believed to be due to congenital (or traumatic) laxity of the ligaments that stabilize the PCR, primarily, the dorsal radiotriquetral (DRT) ligamen...
Article
The epinephrine myth originated in the 1940s, when acidic (pH 1) procaine-epinephrine was injected into fingers, causing finger necrosis. Today, level 1 evidence exists for the safe use of epinephrine in fingers. The ability to use lidocaine-epinephrine in hand surgery and orthopedics eliminates the need for a tourniquet, or »bloodless field«. Surg...
Article
Full-text available
The epinephrine myth originated in the 1940s, when acidic (pH 1) procaine-epinephrine was injected into fingers, causing finger necrosis. Today, level 1 evidence exists for the safe use of epinephrine in fingers. The ability to use lidocaine-epinephrine in hand surgery and orthopedics eliminates the need for a tourniquet, or »bloodless field«. Surg...
Article
Various ankle ligaments have different structural composition. The aim of this study was to analyze the morphological structure of ankle ligaments to further understand their function in ankle stability. One hundred forty ligaments from 10 fresh-frozen cadaver ankle joints were dissected: the calcaneofibular, anterior, and posterior talofibular lig...
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Full-text available
Background: The paradoxical demands of stability and mobility reflect the purpose and function of the human thumb. Its functional importance is underscored when a thumb is congenitally absent, injured, or afflicted with degenerative arthritis. Prevailing literature and teaching implicate the unique shape of the thumb carpometacarpal (CMC) joint, a...
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Where Are We Now?The development of the thumb is considered an important development in human evolution. The evolution of the opposable thumb facilitated reach-grasp functions and allowed for the advanced handling of tools. The thumb’s complexities and apparent contradictions — such as the disparate functions of fine motor skills and power grip — c...
Article
Non-traumatic pain in the shoulder, arm and hand (brachialgia) is a common complaint in the field of musculoskeletal disorders, where nerve entrapment constitutes a possible cause. The effect of nerve compression is dose-dependent; hence a low-level compression will only result in decreased endoneurial circulation, neural edema and a Seddon's grade...
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Full-text available
Background: The complex configuration of the thumb carpometacarpal (CMC-1) joint relies on musculotendinous and ligamentous support for precise circumduction. Ligament innervation contributes to joint stability and proprioception. Evidence suggests abnormal ligament innervation is associated with osteoarthritis (OA) in large joints; however, littl...
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Full-text available
From a kinetic point of view, the wrist is considered stable when it is capable of resisting load without suffering injury. Several prerequisites are necessary for the wrist to be kinetically stable: bone morphology, normal articulating surfaces, ligaments, the sensorimotor system, the muscles crossing the wrist, and all nerves connecting to ligame...
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Background: The aim of this study was to analyze the inter-, intraligamentous, and side-related patterns of sensory nerve endings in ankle ligaments. Methods: A total of 140 ligaments from 10 cadaver feet were harvested. Lateral: calcaneofibular, anterior-, posterior talofibular; sinus tarsi: lateral- (IERL), intermediate-, medial-roots inferior...
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Full-text available
Although there are many surgical options to treat thumb carpometacarpal (CMC) arthritis, a precise etiology for this common disorder remains obscure. To better understand the physiology of the thumb CMC joint and treat pathology, it is helpful to examine the biomechanics, hormonal influences, and available surgical treatment options, along with the...
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Full-text available
Purpose We propose to identify and correlate arthroscopic internal ligaments with external ligaments, providing an accurate roadmap for arthroscopic ligament and joint anatomy. Ligamentous laxity is considered an important risk factor in developing the common basilar arthritis of the thumb. Controversy exists as to the precise ligamentous anatomy o...
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Background: Proximal median nerve entrapment (PMNE, or pronator syndrome) at the elbow has traditionally been considered an elusive and rare diagnosis, as it is seldom detectable using electrophysiological techniques. In this paper, the clinical manifestations, physical diagnosis, surgical technique, and results of surgical treatment of PMNE are p...
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Full-text available
Recent research in the field of joint osteoarthritis (OA) indicates that osteoarthritis is in fact not a disease of joint cartilage. Rather, the cartilage wear seen in OA should be regarded as the end-stage of a disease that originates in the tissues supporting the joint. Therefore, it has been suggested that the joint should be viewed as a "synovi...
Data
Recent research in the field of joint osteoarthritis (OA) indicates that osteoarthritis is in fact not a disease of joint cartilage. Rather, the cartilage wear seen in OA should be regarded as the end-stage of a disease that originates in the tissues supporting the joint. Therefore, it has been suggested that the joint should be viewed as a "synovi...
Article
Background: The aim of this study was to analyze the pattern and types of sensory nerve endings in ankle ligaments using immunohistochemical techniques, in order to gain more insight into functional ankle stability. Methods: One hundred forty ligaments from 10 cadaver feet were included: the calcaneofibular and anterior/posterior talofibular lig...
Article
Stability and mobility represent the paradoxical demands of the human thumb carpometacarpal joint, yet the structural origin of each functional demand is poorly defined. As many as sixteen and as few as four ligaments have been described as primary stabilizers, but controversy exists as to which ligaments are most important. We hypothesized that a...
Article
Full-text available
The wide-awake approach to hand surgery entails the use of local infiltration anesthesia using lidocaine with epinephrine and no tourniquet. The technique provides practitioners with an option to perform advanced hand surgical care in an ambulatory setting, without the need for general or regional anesthetics. We present our results using wide-awak...
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Full-text available
The images (►Fig. 1a, b) illustrate the components of dynamic joint stability, here visualized in an anatomical study of the volar DRUJ. Tensegrity—ultimate stability through a combination of compressive and tensile forces— is achieved through compression of normal joint surfaces, the passive tension achieved through ligaments stabilizing the joint...
Article
The human thumb trapeziometacarpal (TM) joint is a unique articulation that allows stability during pinch and grip and great degrees of mobility. Because the saddle-shaped articulating surfaces of the TM joint are inherently unstable, joint congruity depends on the action of restraining ligaments and periarticular muscles. From other joints, it is...
Article
Full-text available
Ligament innervation purportedly plays a critical role in stability, proprioception and pathology of joints with minimal bony constraints. The human thumb carpometacarpal (CMC) joint is such a joint: with a complex saddle configuration and wide circumduction, its constraint is primarily ligamentous and it is prone to osteoarthritis. CMC reconstruct...
Article
Background Massive degenerative rotator cuff tears are a considerable problem in the elderly. It is known that about one third of surgical repairs of damaged rotator cuffs result in re-tear. The most common reason for this failure is poor quality of the cuff due to degenerative changes. The aim of our study was to see if Artelon Tissue Reinforcemen...
Article
The authors describe the anatomy of the distal radioulnar joint (DRUJ) and delineate the importance of viewing this joint as part of the whole forearm. The osseous congruity and ligamentous integrity is of essence for the stability of the DRUJ, according to the principles of tensegrity. The neuromuscular control and possible proprioceptive function...
Article
For the distal radioulnar joint (DRUJ) to be stable, not only do the articulating surfaces need to be congruent and well aligned but also the capsule and ligaments need to be mechanically and sensorially competent. According to recent investigations, ligaments should not be regarded as simple static structures maintaining articular alignment but as...
Article
Surgical approaches to the wrist joint have traditionally been focused on providing wide exposure to allow adequate access to the carpus. In light of recent investigations on the innervation and proprioception of the wrist joint, one should also take into consideration not to denervate the wrist capsule and ligaments. In this manuscript, we propose...
Article
The presence of wrist proprioceptive reflexes after stimulation of the dorsal scapholunate interosseous ligament has previously been described. Because this ligament is primarily innervated by the posterior interosseous nerve (PIN) we hypothesized altered ligamento-muscular reflex patterns following desensitization of the PIN. Eight volunteers (3 w...
Article
Study design: Narrative review. Recent years have brought new research findings on the subject of wrist joint proprioception, which entails an understanding of the wrist as part of a sensorimotor system where afferent information from nerve endings in the wrist joint affects the neuromuscular control of the joint. An understanding of proprioceptio...
Article
Recent publications on the sensory innervation of wrist ligaments have challenged our understanding of ligaments as mere passive restraints in wrist stability. Mechanoreceptors in ligaments have a role in signaling joint perturbations, in which the afferent information is believed to influence periarticular muscles. The scapholunate interosseous li...
Article
To analyze ligament innervation and the structural composition of wrist ligaments to investigate the potential differences in sensory and biomechanical functions. The ligaments analyzed were the dorsal radiocarpal, dorsal intercarpal, scaphotriquetral, dorsal scapholunate interosseous, scaphotrapeziotrapezoid, radioscaphoid, scaphocapitate, radiosc...
Article
The purpose of this study was to analyze human wrist ligaments with regard to presence of general innervation and mechanoreceptors. The ligaments studied were: dorsal radiocarpal (DRC), dorsal intercarpal (DIC), long radiolunate (LRL), radioscaphocapitate (RSC), ulnocarpal (UC), scapholunate interosseous (SLI) and lunotriquetral interosseous (LTI)...
Article
The scapholunate interosseous ligament (SLIL) is biomechanically important in maintaining wrist motion and grip strength in the hand, but its possible sensory role in the dynamic muscular stability of the wrist joint has not been examined. The aim of this study was to use immunohistochemical methods to analyze the general innervation and the possib...

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Projects (3)
Project
Check mechanoreceptors and other neural fibers in Interosseous membrane, annular ligaments of the radius, DRUJ capsule, inter carpal ligaments and elbow ligaments.
Project
Deciphering the contributing factors to development of thumb carpometacarpal (CMC) osteoarthritis: abnormal kinematics (motion), proprioception, and wear patterns