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At least 217 records · Page 12Linked to original sources
PubMed2003

Complications of the treatment of the acromioclavicular and sternoclavicular joint injuries, including instability.

Treatment of AC joint injuries and SC joint injuries continues to evolve. The risk of complications of both the operative and nonoperative management of these injuries can be minimized by the treating physician if the physician thoroughly evaluates and understands the problem. Making an accurate diagnosis of the underlying pathology and then selecting the appropriate treatment for this will minimize the risk of an associated complication. Paying attention to detail and using the appropriate technique before any operative intervention is chosen will decrease the risk of failure and complication. Close follow-up and early detection of complications will lead to less severe sequelae. AC joint injuries are more common and operative management is accepted for specific indications. Most Orthopaedic Surgeons are comfortable treating these. SC joint injuries are less common and nonoperative treatment is the mainstay. As our approach to these complex problems evolves, we must keep a wary eye towards avoiding and minimizing the complications of the new techniques.

Acromioclavicular Joint↗
PubMed2005

[Open surgical treatment of recurrent anterior instability of the shoulder].

Recurrent anterior gleonohumeral instability is the most frequent joint instability of the body. Because of the complex stability mechanisms and diverse instability patterns of the glenohumeral joint, most cases present with more than one anatomic cause. Thus, the treatment of recurrent anterior instability of the shoulder should be designed to treat these pathologies. Although arthroscopic repair has outweighed the use of open surgical methods especially for the first dislocations, recurrent dislocations still require open repair techniques to overcome capsular laxity accompanying a Bankart lesion.

Humans↗
PubMed1995

Significance of the levels of carboxy terminal type II procollagen peptide, chondroitin sulfate isomers, tissue inhibitor of metalloproteinases, and metalloproteinases in osteoarthritis joint fluid.

The joint fluid levels of several molecules that reflect the anabolism and catabolism of cartilage matrix and its inflammation were quantitated in patients with primary osteoarthritis (OA) and traumatic arthritis. The carboxy terminal type II procollagen increased in primary OA and traumatic arthritis joint fluid and was thought to be a good marker of the repair response of chondrocytes. We found that the increase of this molecule in the joint correlated well with body mass index in primary OA and the degree of cartilage erosion caused by joint instability in traumatic arthritis. Chondroitin 6-sulfate, an integral part of human aggrecan, was also high in OA and traumatic arthritis joint fluids, and showed a similar distribution with keratan sulfate in each disease group. Stromelysin-1 and tissue inhibitor of metalloproteinases-1 levels in joint fluid were very high in RA, but levels in patients with OA were low. Carboxy terminal type II procollagen appeared most sensitive in the evaluation of risk factors of OA such as obesity and joint instability, compared to other markers tested.

Chondroitin Sulfates↗
PubMed1998

[The Donauspital-Stolzalpe concept (Danube Hospital, Vienna, Austria). Corrective osteotomy with selective labrum surgery following preoperative MRI arthrography].

Concomitant pathologies (labral lesions, intra-/extra-osseous ganglia and stress bone marrow edema) in adult residual hip dysplasia (RHD) might influence the outcome of conservative hip surgery. The aim of our prospective clinical study was to assess the value of preoperative MR arthrography in diagnosing concomitant lesions and in making surgical decisions in RHD. The first 37 consecutive patients with a minimum follow-up of 18 months have been analysed. All 37 patients presented RHD with the clinical symptomatology of labral lesions and underwent routine preoperative MRA. According to clinical, radiological and MR arthrographical criteria, these 37 patients were subdivided into four therapeutic subgroups: (1) reorientation of the acetabulum using the Tönnis triple pelvic osteotomy (TPO); (2) intertrochanteric varisation osteotomy (IVO); (3) palliative decompression with only symptomatic partial resection of the torn labrum (PALL); (4) primary total hip replacement (TEP). Based on the preliminary clinical and radiological outcomes of these four subgroups, the following conclusions can be drawn: labral lesions are considered to be a sign of chronic joint instability. Therefore, acetabular malorientation should be corrected by redirectional osteotomy of the acetabulum (TPO-subgroup) even in low grades of RHD if labral lesions are present. "Palliative" labral resections without corrective osteotomy (PALL subgroup) in secondary osteoarthritis due to RHD are definitively obsolete, because they rapidly progress to severe osteoarthritis due to surgically accelerated joint instability. In RHD with highly osteoarthritic hip joints and concomitant lesions, one should not hesitate to perform primary THR even in young patients.

Acetabulum↗
PubMed2003

Healing ligaments have decreased cyclic modulus compared to normal ligaments and immobilization further compromises healing ligament response to cyclic loading.

Ligaments help maintain joint stability by resisting excessive strain during the repetitive loading experienced during daily activity. Healing ligaments may be less able to fulfill this role, straining more under equivalent loading than normal ligaments. We examined the cyclic stress-strain response of normal and healing ligaments to repetitive low loads (<10% of the normal ligament failure strength). Rabbit medial collateral ligaments (MCLs) were surgically gapped in either a unilateral (right MCL; n=23) or bilateral (right and left MCLs; n=17) fashion with immobilization of the right hindlimb in the bilateral group. These MCL scars were allowed to heal for 3, 6, and 14 weeks and were cyclic creep tested at 2.2, 4.1, and 7.1 MPa, respectively. Creep test stresses were a constant 30% of the failure strength of non-immobilized scars at the different healing intervals. Normal MCLs were creep tested at 4.1 and 7.1 MPa (n=13). The cyclic modulus of the non-immobilized scars was less than that of normal ligaments. The percent increase in modulus during cycling was greater for scars than for normal ligaments, likely related to increased viscous dissipation or material inferiorities in scars. Furthermore, immobilization significantly decreased the ability of scars to resist strain, with a majority of immobilized scars failing during repetitive loading. Such failures were preceded by a reduction in cyclic modulus indicating damage to the healing ligaments that was predictive of eventual total failure. The implications of this study are that joints with healing ligaments may have increased strain in joint structures while they are under stress, potentially leading to joint instability. Although immobilization could be used temporarily to maintain joint stability, remobilization would likely lead to total failure of the healing ligament.

Animals↗
PubMedDate not supplied

The split peroneus longus lateral ankle stabilization procedure.

The authors present an interesting approach to lateral ankle stabilization using the peroneus longus tendon. The more commonly utilized procedures for instability of the ankle complex, rationale for use of the peroneus longus tendon, and the details of the split peroneus longus lateral ankle stabilization procedure are presented. When evaluating patients with lateral ankle joint instability, the subtalar joint (STJ) complex needs to be assessed. In addition, the role of STJ instability and its relationship to lateral ankle joint instability are discussed.

Adult↗
PubMed2003

Thumb deformity in the spastic hand: classification and surgical techniques.

Surgery based on an accurate determination of deforming forces, muscle weakness, and joint instability achieves reasonably predictable results in patients with cerebral palsy. Thumb deformities can be classified into those of mainly intrinsic nature, extrinsic nature, and those of a combined nature. This allows identification of which muscles are released most appropriately and which muscle function requires augmentation. Joint instability needs to be taken into consideration because tendon transfers across unstable joints will be ineffective. The various surgical procedures are outlined in the text. In 32 patients, application of these principles and techniques allowed removal of the thumb from the palm in 29 patients during fist formation. Lateral pinch was established in 26 thumbs, and functional assessment revealed improvement in one functional grade. Functional benefit may be determined by other factors beyond the control of the surgeon. Therefore, the decision to proceed to surgery may be undertaken only after detailed and repeated clinical examinations are conducted that are coordinated with the assessments of parents, caregivers, physicians, occupational and physical therapists, and social counselors.

Journal Article↗
PubMed1997

Intracapsular pressure in congenital dislocation of the hip.

Intracapsular hip joint pressure was measured in six infants with congenital dislocation of the hip (CDH) or acetabular dysplasia with hip joint instability diagnosed at an average of 4.3 months of age (range: 3-8 months). In the extension and neutral rotation position, the mean pressure was 8.9 mm Hg. After reduction, obtaining stability with the hip joints in the "frog-leg" position (i.e., maximum flexion around the axis of the neck of the femur), the mean pressure was 74.6 mm Hg. When obtaining stability with the hip joints in 20 degrees of flexion, abduction, and inward rotation, the mean pressure was 104 mm Hg, and in approximately 20 degrees of flexion, abduction, and forced inward rotation it was 160 mm Hg. We conclude that these rotational positions, often used to retain the joint in CDH or hip joint instability, induce intracapsular pressures that may cause occlusion of epiphyseal-physeal vessels and thus may be responsible for the avascular epiphyseal necrosis and growth disturbance seen in these patients.

Acetabulum↗
PubMed2006

Gait abnormalities caused by selective anesthesia of the suprascapular nerve in horses.

OBJECTIVE: To assess gait abnormalities associated with selective anesthesia of the suprascapular nerve (SSN) achieved by use of perineural catheterization and thereby determine the function of that nerve as it relates to gait in horses. ANIMALS: 3 adult horses with no preexisting clinically apparent lameness at a walk. PROCEDURE: Each horse was anesthetized; the right SSN was exposed surgically for placement of a perineural catheter to permit delivery of 1 mL of 2% mepivacaine hydrochloride. Six hours after recovery from anesthesia, each horse was videotaped while walking (50-step data acquisition period) before and after administration of mepivacaine. Videotapes were reviewed and the proportion of abnormal steps before and after selective SSN anesthesia was assessed. A step was considered abnormal if a marked amount of scapulohumeral joint instability (ie, lateral luxation of the proximal portion of the humerus) was observed during the weight-bearing phase of the stride. RESULTS: Clinically apparent gait dysfunction was detected in all 3 horses following perineural administration of the local anesthetic agent. Anesthesia of the SSN resulted in scapulohumeral joint instability as evidenced by consistent lateral excursion of the shoulder region during the weight-bearing phase of gait at a walk. The proportion of abnormal steps before and after SSN anesthesia was significantly different in all 3 horses. CONCLUSIONS AND CLINICAL RELEVANCE: These data support the role of the SSN in shoulder joint stability in horses and define SSN dysfunction as 1 mechanism by which the syndrome and gait dysfunction clinically referred to as sweeny may develop.

Anesthesia, Local↗
PubMed2003

Kinematics of ulnar head arthroplasty.

This in vitro study evaluated the performance of an ulnar head replacement. A joint simulator was employed that produced active forearm rotation in cadaveric specimens, with motion measured using an electromagnetic tracking system. The kinematics of the intact forearm were compared with a partial ulnar head replacement and a full replacement (with and without soft-tissue reconstruction) and a full excision of the ulnar head. There were no differences between intact kinematics and those following prosthetic reconstruction. However, ulnar head excision produced distal radioulnar joint instability in the form of radioulnar convergence and increased anteroposterior translations.

Arthroplasty↗
PubMed2006

Computed tomographic documentation of a comminuted fourth carpal bone fracture associated with carpal instability treated by partial carpal arthrodesis in an Arabian filly.

OBJECTIVE: To report treatment of a unilateral comminuted fourth carpal bone (C4) fracture associated with carpal instability by partial carpal arthrodesis (PCA) of the middle carpal joint (MCJ) and carpometacarpal joint (CMCJ). STUDY DESIGN: Case Report. ANIMALS: An 8-month-old Arabian filly. METHODS: A C4 slab fracture was diagnosed radiographically; however, fracture comminution was conclusively diagnosed after computed tomographic (CT) imaging. PCA of the MCJ and CMCJ was performed with 2 narrow dynamic compression plates. RESULTS: PCA provided appropriate carpal stability and correct limb alignment immediately after surgery. Complete bony fusion with substantial carpal flexion and no lameness at walk or light trot was observed 8 months after surgery. CONCLUSIONS: Carpal CT was successfully used to define fracture configuration after standard radiographic examination failed to delineate comminution. PCA was selected because of joint instability and lateral carpal collapse of MCJ and CMCJ and can be successfully used to treat comminuted C4 slab fractures associated with carpal instability. Moderate MCJ osteoarthritis without radiocarpal joint involvement allows pain-free, substantial carpal flexion and thus, return to low-level pleasure riding may be possible. CLINICAL RELEVANCE: CT imaging may more adequately characterize traumatic carpal bone injury, particularly, when carpal bone fracture configuration cannot be determined on standard radiographs. Early PCA of the MCJ and CMCJ is an useful alternative to treat comminuted C4 slab fractures that cannot be reconstructed.

Animals↗
PubMed2000

Thumb collateral ligament injuries. An anatomic basis for treatment.

This anatomic and clinical study leads to the following conclusions: 1. The ulnar and radial proper collateral ligaments are the critical lateral stabilizers of the thumb MP joint; both are highly vulnerable to complete disruption, with resultant disabling joint instability. 2. The intrinsic anatomy of the radial side of the MP joint is not a mirror image of the ulnar aspect. Significant anatomic differences account for distinctive patterns of instability. Whereas disruption of the ulnar collateral ligament in conjunction with dorsal capsular tears is apt to result in combined radiovolar subluxation, disruption of the radial collateral ligament, coupled with the unopposed dynamic force of the adductor pollicis, characteristically is prone to a rapid pathologic sequence of profound joint instability, with progressive ulnar and volar subluxation and, ultimately, degenerative joint disease. 3. Optimal management of the complete collateral ligament lesion requires prompt diagnosis, most accurately confirmed with physical and radiographic stress testing, and precise surgical repair. Immobilization alone is insufficient treatment for these serious ligament disruptions, characterized by considerable displacement with wide separation of torn ends. 4. Although early direct repair affords the best opportunity for restoration of joint integrity with a highly favorable functional recovery, secondary repair and free tendon grafting, prior to joint deformity, provide consistently successful options for chronic instability.

Athletic Injuries↗
PubMed1990

A finger function simulator and the laboratory testing of joint replacements.

The design of a metacarpophalangeal (MCP) joint function simulator was undertaken and resulted in a versatile machine which offers the facility to apply both dynamic and static loading to a joint, following closely the physiological levels and patterns imposed in vivo. An additional feature was the opportunity to investigate the effect of varying the degree of joint instability. Long-term tests performed on Swanson silastic implants have produced failures of the kind seen clinically, which is very encouraging since it would seem to validate the claim that the simulator successfully imitates the finger function.

Biomechanical Phenomena↗
PubMed1995

[Idiopathic arthritis of the finger joints].

Degenerative arthritis of the finger joints is a very common disease in middle-aged and elderly patients, in females more frequently than in males. Concerning differential diagnosis rheumatoid arthritis and related conditions, gout, calcinosis, tumors and tumor-like lesions must be considered. Therapy is not necessary in every case. Usually treatment is required if the disease causes pains, joint instability or disabling deformity. Conservative treatment such as diet, physiotherapy, orthotics, local physical and antiphlogistic drug treatment or systemic application of non-steroid antiphlogistics should be preferred. Operative procedures such as removal of osteophytes, arthrodesis or arthroplasty are indicated if conservative treatment fails.

Aged↗
PubMed1993

Joint hyperlaxity and its long-term effects on joints.

The range of movement at a joint varies between individuals. Reasons for this include inherited collagen structure in the joint capsule and ligaments, inherited shape of the bony articulating surfaces and neuromuscular tone which may be acquired and is modified by training. Methods for quantifying the range of movement at joints are described and compared, including the hyperextensometer and the Carter and Wilkinson score. Clinical patterns of joint hyperlaxity and their correlation with aetiology are discussed. Joint hyperlaxity may be advantageous in certain sports. Coaches need to be aware of optimum methods for improving it as well as for guarding against injury. Conversely, physiotherapists may learn from sports physiologists in the management of symptoms arising from patients who have hyperlax joints. Joint stability reduces the risk of injury. Joint hyperlaxity may also be associated with premature osteoarthritis but this is not always so. Joint instability may be the most potent cause though a radiological survey of retired teachers of physical education conducted by our Unit failed to show a higher incidence of osteoarthritis after a life spent in sport than in sedentary controls. However, certain factors that place some individuals at particular risk were identified.

Humans↗
PubMed1990

Traumatic disruption of the suspensory apparatus in foals.

Traumatic disruption of the suspensory apparatus is a catastrophic injury in the horse. Although this injury has been described in the adult, little information is available in the foal. This paper describes 3 foals with metacarpophalangeal joint instability caused by traumatic disruption of the suspensory apparatus. Two foals had biaxial proximal sesamoid fractures in a single forelimb, and 1 foal had avulsion of the distal sesamoidean ligaments in 1 forelimb plus biaxial proximal sesamoid fractures in the other forelimb. The foals with single forelimb involvement were managed with splints, and the foal with bilateral disruption of the suspensory apparatus was euthanatized. Both treated foals resumed natural exercise at pasture. Both continue to be pasture sound 2 and 3 years after injury and are to be used for breeding. Management of disruption of the suspensory apparatus causing metacarpophalangeal joint instability using external support was effective for salvage of these 2 valuable foals for breeding.

Animals↗
PubMed2003

[A bipolar radial head prosthesis after comminuted radial head fractures: indications, treatment and outcome after 5 years].

The treatment of comminuted fractures of the radial head with concomitant injuries of the ulnar complex by resection of the radial head usually does not provide satisfactory long-term results. Other than joint instability in the elbow and a limited range of motion, radius proximalisation in the sense of ulnocarpal impingement, osteoarthritis and pain in the elbow have been described. Between 1995 and 1997, 11 radial head prostheses were implanted in ten patients who had sustained a comminuted fracture of the radial head with concomitant injury to the ulnar complex. A follow-up survey was conducted with the patients on average 5 years after the injury. Eight patients with nine implants participated in the follow-up, one patient had died and another refused to participate but declared that he did not suffer from any impairment. According to the Morrey score, two of the results were found to be very good, five to be good, one to be fair and one to be poor. Despite the severe injuries sustained by the elbow, neither joint instability in the elbow nor proximalisation of the radius, cubitus valgus, ulnar nerve syndrome, nor loosening of the prosthesis were found in any of the patients. In the event of comminuted fractures of the radial head which are impossible to reconstruct by osteosynthesis and which occur with concomitant ulnar ligamentous or osseous injury, the implantation of a prosthesis is preferred over the resection of the head of the radius.

Adult↗