Contributions of the Third and Fourth Digits and the Second and Fifth Digits of the Flexor Digitorum Superficialis Muscle to Elbow Valgus Stability

BACKGROUND: Thiel cadavers have been reported to have lifelike flexibility and mechanical properties, but whether they are useful for measurement of the ulnohumeral joint space (JS) is unclear. The contributions of the third and fourth digits and the second and fifth digits of the flexor digitorum superficialis (FDS) to elbow valgus stability are also unknown. PURPOSE: To (1) clarify whether Thiel cadavers can be used for JS measurement on ultrasound and (2) identify the contributions to valgus stability of the third and fourth digits and the second and fifth digits of the FDS. STUDY DESIGN: Descriptive laboratory study. METHODS: In experiment 1 (12 elbows from human volunteers and 12 elbows from Thiel cadavers), valgus stress was increased gradually from 0 to 30 to 60 N, and the JS was compared on ultrasound between groups at each load. In experiment 2 (13 elbows from Thiel cadavers), specimens were divided into 2 groups, and the JS was measured for group 1 with the FDS intact, with tendinous insertions of the third and fourth digits cut (3/4-cut state), and with tendinous insertions of all fingers cut (all-cut state); and for group 2 at intact FDS, with tendinous insertions of the second and fifth digits cut (2/5-cut state), and at all-cut. RESULTS: In experiment 1, the rate of change of the JS increased significantly with elbow valgus stress in both humans and Thiel cadavers, with no significant difference between groups. In experiment 2, the JS was significantly greater in the 3/4- and 2/5-cut states compared with the intact state at both 30 N (Δ(3/4-cut vs intact) = 0.23 mm [P = .01]; Δ(2/5-cut vs intact) = 0.32 mm [P = .02]) and 60 N (Δ(3/4-cut vs intact) = 0.33 mm [P = .002]; Δ(2/5-cut vs intact) = 0.37 mm [P = .04]). There was no significant difference in JS measurements between the 3/4- and 2/5-cut states at any load. CONCLUSION: Thiel cadavers showed JS changes similar to those of humans when valgus stress was applied. The third and fourth digits and the second and fifth digits of the FDS were involved in valgus stability, and there was no difference in their respective contributions. CLINICAL RELEVANCE: This study may help in identifying function of the FDS based on structure.