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Two-dimensional rigid-body kinematics using image contour registration.

A method for calculating two-dimensional rigid-body kinematic parameters using shape features is presented. Proposed applications include the noninvasive quantification of planar joint motion in vivo. By using digitized images (computed tomographs, radiographs, etc.) of a bone contour at two positions, the contour curvatures can be 'best-fit' to obtain a one-to-one mapping or registration of the bone images. This produces a dense field of displacement vectors from which planar rigid-body kinematic parameters can be estimated. Accuracy was studied using radiographic images of cadaveric femoral bone. The two motions of pure rotation with a fixed center of rotation and of pure translation were simulated. For pure rotation, error in rotation was independent of the rotation magnitude, with an average (n = 10) error of 0.3 +/- 0.8 degrees. The translation error averaged 0.9 +/- 0.5 mm. For pure translation, the error in rotation was -0.01 +/- 0.69 degrees and the error in translation was -0.62 +/- 0.98 mm (n = 10). This novel method has broad applications in the field of planar kinematics, especially in cases for which marker fixation is neither possible nor practical.

Algorithms↗

Evaluation of impairment of the upper extremity.

Evaluation of impairment of the upper extremity is the product of a team effort by the physician, occupational therapist, physical therapist, and rehabilitation counselor. A careful recording of the anatomic impairment should be made because this is critical in determining the subsequent functional activities of the extremity. The measurement criteria for clinical and functional evaluation includes condition assessment instruments. Some assess the neurovascular system, others assess movements including the monitoring of articular motion and musculotendinous function. Sensibility assessment instruments measure sympathetic response and detect single joint stimulus, discrimination, quantification, and recognition abilities. A detailed description of each assessment is recorded and physical capacity evaluation is only one component of the entire vocational evaluation. This evaluation answers questions regarding the injured worker's ability to return to his previous job. The work simulator is a useful instrument that allows rehabilitation and testing of the injured upper extremity. Job site evaluation includes assessment criteria for work performance, work behavior, and work environment.

Arm↗

Rheumatoid hand joint synovitis: gray-scale and power Doppler US quantifications following anti-tumor necrosis factor-alpha treatment: pilot study.

PURPOSE: To evaluate by using B-mode and power Doppler ultrasonography (US) and clinical assessment the response of hand joint synovitis in patients with active rheumatoid arthritis (RA) to treatment with the anti-tumor necrosis factor-alpha agent infliximab. MATERIALS AND METHODS: Wrists, metacarpophalangeal (MCP) joints, and proximal interphalangeal (PIP) joints in 11 patients with active RA were assessed before and 6 weeks after three infliximab infusions. US assessment was performed at a single site in the MCP and PIP joints and at two sites (radiocarpal and intercarpal) in the wrists. Twenty measurements were performed in the wrists; 110 measurements, in the MCP joints; and 103 measurements, in the PIP joints. Two wrists and seven PIP joints were excluded owing to complete joint destruction. US parameters (synovial thickness, number of US-positive joints [ie, with synovial thickness > or = 1 mm], cumulative synovial thickness index, and presence of Doppler signal) and clinical parameters (swollen joint count) were independently assessed and compared with baseline values by using the McNemar chi2 and paired Student t tests. RESULTS: After infliximab treatment, there was a significant decrease in the mean numbers of swollen and US-positive joints and in the cumulative synovial thickness (P <.05). The mean synovial thickness decreased in all joints swollen at baseline and in the MCP and PIP joints not swollen at baseline (P <.01). Change from baseline cumulative synovial thickness correlated significantly with change in disease activity score (r = 0.69, P <.05). The number of positive Doppler US signals decreased significantly (in 13 US-positive joints at baseline, in five after treatment; P <.05). CONCLUSION: US is a feasible imaging modality for measurement of the response of RA small-joint synovitis to therapy.

Adult↗

Quantification of the volume of articular cartilage in the metacarpophalangeal joints of the hand: accuracy and precision of three-dimensional MR imaging.

OBJECTIVE: Cartilage loss is central to the development of joint failure in arthritis. However, radiographic assessment of cartilage loss is highly unreliable. This study examined the accuracy and reproducibility of a noninvasive technique for quantifying the volume of articular cartilage in the metacarpophalangeal joints of the hand by use of three-dimensional (3D) MR imaging. SUBJECTS AND METHODS: Eight metacarpophalangeal joints (four normal, one rheumatoid arthritic, and three normal cadaveric) each were imaged three times with a 1.5-T clinical MR imaging scanner with a small partial volume coil and a fat-saturated 3D spoiled gradient-echo sequence optimized for delineating articular cartilage. The volumes of cartilage over the metacarpal and phalangeal surfaces were quantified by summing the voxels within segmented 3D reconstructions of the images. Cartilage volumes in the three cadaver joints also were estimated by scraping cartilage off the articular surfaces and measuring water displacement in graduated cylinders. These values were used as the gold standard for assessing the accuracy of cartilage volume quantification by MR imaging. RESULTS: The fat-saturated sequence discriminated the articular cartilage from adjacent joint structures with high contrast and high spatial resolution. Cartilage volumes determined by MR imaging for the different subjects ranged from 115 microliters to 222 microliters for metacarpal cartilage and from 34 microliters to 86 microliters for proximal phalangeal cartilage. Accuracy errors for quantifying cartilage volume by MR imaging were -1.8% (95% confidence interval, -3.5% to -0.7%) for metacarpal cartilage and 9.1% (4.3% to 14.7%) for proximal phalangeal cartilage. Reproducibility errors were 5.2% (95% confidence interval, 2.9% to 7.6%) and 9.9% (5.4% to 15.1%), respectively. CONCLUSION: Fat-suppressed T1-weighted 3D MR imaging provides sufficient contrast and spatial resolution to allow accurate and reproducible quantification of articular cartilage volume in the metacarpophalangeal joints of the hand. This technique may be useful for monitoring cartilage loss in patients with arthritis.

Adult↗

Increased concentrations of bone sialoprotein in joint fluid after knee injury.

OBJECTIVE: To detect evidence for localised changes in bone matrix metabolism after joint trauma and in post-traumatic osteoarthritis by quantification of bone sialoprotein in joint fluid and serum after knee injury in a cross sectional study. METHODS: Samples of knee joint fluid and serum were obtained from volunteers with normal knees (n = 19), patients with rupture of the anterior cruciate ligament isolated or combined with tear of a meniscus (n = 114), and patients with isolated meniscus lesions (n = 80). Concentrations of bone sialoprotein were determined by ELISA. Concentrations of other markers of joint tissue metabolism in these samples were determined in previous investigations. RESULTS: The median concentrations of bone sialoprotein in joint fluid from healthy volunteers was 122 ng ml-1 (range 41 to 183). Concentrations of bone sialoprotein were increased in both injury groups compared with the reference group (median for cruciate ligament injury 146 ng ml-1, range 72 to 339; median for meniscus injury 166 ng ml-1, range 75 to 376). After injury, bone sialoprotein increased quickly and remained increased for six months. Bone sialoprotein in joint fluid was increased only in samples from joints with normal or nearly normal (fibrillated) cartilage, and was within reference range in joints with radiographic signs of osteoarthritis. Bone sialoprotein concentrations in joints with cruciate ligament injury were positively correlated with levels of aggrecan and cartilage oligomeric matrix protein fragments, and with levels of stromelysin-1 and tissue inhibitor of metalloproteinase-1. The ratios between the concentrations of bone sialoprotein in joint fluid and serum were > 1 in the majority of the cruciate ligament injury cases. CONCLUSIONS: The release of significant amounts of bone sialoprotein into joint fluid in connection with acute joint trauma may be associated with injury to, and active remodelling of, the cartilage-bone interface and subchondral bone. The findings are consistent with dramatic shifts in cartilage, bone, and synovial metabolism following joint injury. Bone sialoprotein concentrations in synovial fluid may be a useful marker of subchondral injury and remodelling following joint injury.

Adolescent↗

A literature review of midtarsal joint function.

This article focuses on nearly 50 years of research by various authors documenting function and motion of the midtarsal joint. Subtalar joint control of the midtarsal joint, axes of motion, and quantification of range of motion are examined. The evolution of the joint from primates to man and the associated changes in functional requirements are considered.

Animals↗

Quantification of translational and gliding components in human temporomandibular joint during mouth opening.

OBJECTIVE: In humans, the opening movement of the mouth requires a complex combination of rotation in the lower temporomandibular joint compartment and of translation in the upper compartment. The aim of the current study was to quantitatively assess the percentage contribution of rotation and translation movements of the mandible at maximum mouth opening in normal, healthy individuals. DESIGN: Free, habitual movements of mouth opening were recorded in 12 men and 15 women aged 19-30 years using an optoelectronic three-dimensional motion analyser. All subjects had a sound, complete, permanent dentitions with Angle Class I jaw relationships, without cast restorations or cuspal coverage, TMJ or craniocervical disorders. For each subject, the mandibular movements at the interincisor point (occlusal plane) were reconstructed, and, using suitable mathematical algorithms, divided into their rotation and gliding components. The relative contribution of the two components to the total movement was calculated for each frame of motion. In particular, the situation at maximum opening was assessed. RESULTS: At maximum mouth opening, on average, men had significantly larger displacement of the mandibular interincisor point (56 mm versus 46 mm) and angle of rotation (34 degrees versus 32 degrees), than women. The percentage of mandibular movement explained by rotation at maximum mouth opening (77%) was not influenced by sex. The degree of rotation was significantly related to the displacement of the interincisor point: in women r2 = 87%, in men, r2 = 45%. CONCLUSIONS: Overall, in normal subjects with a healthy stomatognathic apparatus, mouth opening was more determined by mandibular rotation than by translation.

Adult↗

Effects of abnormal posture on capsular ligament elongations in a computational model subjected to whiplash loading.

Although considerable biomechanical investigations have been conducted to understand the response of the cervical spine under whiplash (rear impact-induced postero-anterior loading to the thorax), studies delineating the effects of initial spinal curvature are limited. This study advanced the hypothesis that abnormal curvatures (straight or kyphotic) of the cervical column affect spinal kinematics during whiplash loading. Specifically, compared to the normal lordotic curvature, abnormal curvatures altered facet joint ligament elongations. The quantifications of these elongations were accomplished using a validated mathematical model of the human head-neck complex that simulated three curvatures. The model was validated using companion experiments conducted in our laboratory that provided facet joint kinematics as a function of cervical spinal level. Regional facet joint ligament elongations were investigated as a function of whiplash loading in the four local anatomic regions of each joint. Under the normal posture, greatest elongations occurred in the dorsal anatomic region at the C2-C3 level and in the lateral anatomic region from C3-C4 to C6-C7 levels. Abnormal postures increased elongation magnitudes in these regions by up to 70%. Excessive ligament elongations induce laxity to the facet joint, particularly at the local regions of the anatomy in the abnormal kyphotic posture. Increased laxity may predispose the cervical spine to accelerated degenerative changes over time and lead to instability. Results from the present study, while providing quantified level- and region-specific kinematic data, concur with clinical findings that abnormal spinal curvatures enhance the likelihood of whiplash injury and may have long-term clinical and biomechanical implications.

Cervical Vertebrae↗

Doppler imaging of vibrations as a tool for quantifying first tarsometatarsal joint stiffness.

OBJECTIVE: To assess whether first tarsometatarsal joint stiffness can be measured by Doppler imaging of vibrations and if so, to assess reference values. DESIGN: Repeated in vivo Doppler imaging of vibrations measurements at the first tarsometatarsal joint in healthy persons. BACKGROUND: Clinical hypermobility of the first tarsometatarsal joint is an important factor in a hallux valgus deformity. No objective and non-invasive test is available to quantify first tarsometatarsal joint mobility. Doppler imaging of vibrations, a technique recently developed to measure joint stiffness, might be an effective tool to quantify stiffness of this joint. METHODS: Vibrations were applied to the head of the first metatarsal in 46 feet of 23 healthy subjects and picked up by a transducer at both sides of the first tarsometatarsal joint. A pilot study was performed on three patients with hypermobility of the first tarsometatarsal joint. Measurements are expressed in threshold units related to colour Doppler imaging. RESULTS: The values of the threshold units were found to be very similar in healthy persons, with a good repeatibility; 95% of the healthy persons had a threshold unit below 3.4. No significant difference was found between the left and right foot, or between male and female subjects. Also there was no significant correlation with age or weight of the subjects. In the three patients with first tarsometatarsal hypermobility we found threshold units above 5. CONCLUSIONS: With Doppler imaging of vibrations first tarsometatarsal joint stiffness can be measured in healthy persons in a non-invasive and objective way. In a pilot study, three patients with first tarsometatarsal hypermobility showed lower stiffness values than the healthy subjects. Relevance This study presents a new method for quantification of first tarsometatarsal joint stiffness and provides reference values in healthy persons. First measurements on patients gave promising results to future use of this method for assessment of clinical hypermobility in hallux valgus patients.

Adolescent↗

Interobserver reliability in quantitative MRI assessment of temporomandibular joint disk status.

OBJECTIVE: The purpose of this study was to investigate interobserver reliability of a new technique for quantification of magnetic resonance images of temporomandibular joint disk status. STUDY DESIGN: Sixty magnetic resonance images of adolescent temporomandibular joints were randomly drawn for analysis. Four experienced observers traced the articular disk and osseous structures on sagittal magnetic resonance slice images. Quantitative measurements of disk length and disk displacement were recorded for each slice of 57 joints traced by each observer through use of a new quantification technique. Intraclass correlation coefficients were computed to assess interobserver agreement in the tracing of joint structures. RESULTS: The calculated intraclass correlation coefficient was 0.681 for disk length and 0.830 for disk displacement. In addition, the mean variability among observers was 1.041 mm for measurement of disk length and 0.972 mm for measurement of disk displacement. CONCLUSIONS: Interobserver agreement is high when the new quantification technique is used to interpret magnetic resonance images.

Adolescent↗

Joint synchrony of reciprocal hormonal signaling in human paradigms of both ACTH excess and cortisol depletion.

The hypothalamo-pituitary-adrenal axis is a stress-adaptive neuroendocrine ensemble, in which adrenocorticotropin (ACTH) drives cortisol secretion (feedforward) and cortisol restrains ACTH outflow (feedback). Quantifying direction- and pathway-specific adjustments within this and other interlinked systems by noninvasive means remains difficult. The present study tests the hypothesis that forward and reverse cross-approximate entropy (X-ApEn), a lag-, scale-, and model-independent measure of two-signal synchrony, would allow quantifiable discrimination of feedforward (ACTH --> cortisol) and feedback (cortisol --> ACTH) control. To this end, forward X-ApEn was defined by employing serial ACTH concentrations as a template to appraise pair-wise synchrony with cortisol secretion rates and vice versa for reverse X-ApEn. Coupled hormone profiles included normal ACTH-normal cortisol, high ACTH-high cortisol, and high ACTH-low cortisol concentrations in 35 healthy subjects, 21 patients with tumoral ACTH secretion, and 9 volunteers given placebo and a steroidogenic inhibitor, respectively. We used forward and reverse X-ApEn analyses to identify marked and equivalent losses of feedforward and feedback linkages (both P < 0.001) in patients with tumoral ACTH secretion. An identical analytical strategy revealed that ACTH --> cortisol feedforward synchrony decreases (P < 0.001), whereas cortisol --> ACTH feedback synchrony increases (P < 0.001), in response to hypocortisolemia. The collective outcomes establish precedence for pathway-specific adaptations in a major neurohormonal system. Thus quantification of directionally defined joint synchrony of biologically coupled signals offers a noninvasive strategy to dissect feedforward- and feedback-selective adaptations in an interactive axis.

Adolescent↗

Ultrastructural quantification of collagen in the articular disc of the temporomandibular joint of the rabbit.

Collagen fibril diameters were quantified in two regions of the articular disc of this joint. One region was the thinner, translucent central part of the disc; the other was from the thicker, opaque peripheral part more anteriorly. Mean collagen fibril diameters in the thicker zone were small and had a unimodal distribution. In contrast, mean collagen fibril diameters in the thinner central region were larger and with a much wider range of values, as indicated by the larger standard deviations. It was concluded that regional variations exist in the collagen of the rabbit articular disc and may reflect the mechanical loads to which the disc is subjected.

Actin Cytoskeleton↗

A technique for 3D in vivo quantification of proton density and magnetization transfer coefficients of knee joint cartilage.

OBJECTIVE: To develop an MR-based method for the in vivo evaluation of the structural composition of articular cartilage. DESIGN: Five sagittal magnetic resonance imaging (MRI) protocols were acquired throughout the knee joint of 15 healthy volunteers and the boundaries of the cartilage segmented from a previously validated sequence with high contrast between cartilage and surrounding tissue. The other sequences were matched to these data, using a 3D least-squares fit algorithm to exclude motion artefacts. In this way secondary images were computed that included information about the proton density (interstitial water content) and the magnetization transfer coefficient (macromolecules, collagen). The average signal intensities of the 3D cartilage plates were extracted from these data sets and related to a phantom. RESULTS: The signal intensity data showed a high interindividual variability for the proton density (patella 31%, lateral tibia 36%, medial tibia 29%); the patella displaying higher values than the tibia (P< 0.001). There were high correlations between the three plates. The magnetization transfer coefficient also showed high variability (patella 25%, lateral tibia 32%, medial tibia 30%) with the lowest values in the medial tibia (P< 0.01) and lower correlations between the plates. The slice-to-slice variation (medial to lateral) ranged from 9% to 24%. CONCLUSION: An MR-based method has been developed for evaluating the proton density and magnetization transfer of articular cartilage in vivo and observing systematic differences between knee joint cartilage plates. The technique has the potential to supply information about the water content and collagen of articular cartilage, in particular at the early state of osteoarthritic degeneration.

Adult↗

Quantification of skin displacement near the carpal, tarsal and fetlock joints of the walking horse.

A technique enabling simultaneous visualisation of skin and underlying bony structures in the walking horse was used to quantify skin displacements on the lateral surface of carpal, tarsal and fetlock joints. The technique employed implanted light-emitting-diodes (LEDs) for marking the bone, and self adhesive spot labels for marking the overlying skin. Photographic recordings were made. Skin displacement was measured in six Dutch Warmblood horses. Mean total displacements and mean displacement per degree of change of joint angle were calculated. Displacements at the level of the fetlock joints appeared to be generally small (less than or equal to 2 mm), but displacements up to 2 cm were measured in the distal tibia. Displacements of this magnitude are of importance for the interpretation of results obtained by modern gait analysis techniques.

Animals↗

In vivo quantification of capsular end-point in the nonimpaired glenohumeral joint using an instrumented measurement system.

STUDY DESIGN: Single-group factorial. OBJECTIVES: Quantify glenohumeral joint translations as a function of force using an instrumented measurement system. Our first specific aim was to compare the magnitude of force (N) required to reach capsular end-point between the anterior, posterior, and inferior directions. Our second specific aim was to compare the magnitude of translation (mm) at capsular end-point between the anterior, posterior, and inferior directions. BACKGROUND: Manual force-displacement techniques are subjective in nature, and the clinician must rely on "feel" to determine capsular end-point. Several investigators have attempted to utilize more objective measures at the glenohumeral joint, however none have quantified the force or displacements necessary to achieve a true capsular end-point. METHODS AND MEASURES: An arthrometric technique was used to measure anterior, posterior, and inferior glenohumeral translations in 20 nonimpaired shoulders (11 women and 9 men with a mean age of 20.9 +/- 3.6 years). RESULTS: The magnitude of applied force required to reach capsular end-point was significantly different between directions of translations. Anterior-directed translations required a significantly greater magnitude of applied force to reach capsular end-point than inferior-directed translations. The magnitude of translation was not significantly different between directions at capsular end-point. CONCLUSIONS: Applied forces in the range of 181 to 203 N are necessary to reach capsular end-point in subjects with nonimpaired shoulders. Anterior translation required significantly higher forces (203.1 +/- 13.1 N) to reach capsular end-point than inferior translation (181.4 +/- 31.9 N).

Adult↗

Arthritic temporomandibular joint: correlation of macromolecular contrast-enhanced MR imaging parameters and histopathologic findings.

PURPOSE: To assess the utility of macromolecular contrast material-enhanced magnetic resonance (MR) imaging parameters for determining the histopathologic severity of temporomandibular joint (TMJ) arthritis. MATERIALS AND METHODS: Ovalbumin was used to induce arthritis in the TMJs of 10 previously sensitized adult white rabbits. Five rabbits composed the sham-treated control group. Dynamic spin-echo imaging was performed immediately before and for 30 minutes after injection of macromolecular contrast medium. Histologic specimens of TMJ were assessed quantitatively for arthritis. Changes in MR signal intensity were derived from the synovial and subsynovial tissues of the TMJ, and plasma volume (PV) and permeability surface area product (PS) were calculated. These MR parameters and the arthritic scores were compared between sham-treated and antigen-challenged TMJs. The relationships between MR parameters and histopathologic indexes were also determined. RESULTS: Arthritic TMJs showed marked enhancement of the synovial and subsynovial tissues over the imaging period. PS and all histopathologic indexes of arthritis were significantly greater (P < .005) in antigen-challenged than in sham-treated TMJs. PS demonstrated strong positive relationships with all histologic parameters of arthritis, indicating its utility for assessing the severity of joint inflammation. CONCLUSION: Macromolecular contrast-enhanced MR imaging enables quantification of PS and PV in inflamed joints. This technique may provide insights into the pathogenesis of joint inflammation and noninvasive monitoring of disease severity and treatment response in arthritis.

Albumins↗

Regional quantification of cartilage type II collagen and aggrecan messenger RNA in joints with early experimental osteoarthritis.

OBJECTIVE: Accurate assessment of chondrocyte metabolism is a potentially valuable indicator of cartilage health in osteoarthritis (OA). This study was conducted to explore the anabolic metabolism of chondrocytes early in the natural history of an experimental canine model of OA. METHODS: Competitive reverse transcription-polymerase chain reaction was used to calculate the copy number of type II collagen and the messenger RNA (mRNA) levels of aggrecan core protein in articular cartilage samples obtained from different regions of the femorotibial joint 12 and 39 weeks after cruciate transection. RESULTS: Gene expression of both type II collagen and aggrecan in cartilage samples obtained from experimental joints at both intervals after surgery was elevated significantly compared with that in samples from contralateral control joints. The number of mRNA copies per microgram of DNA of aggrecan exceeded that of type II collagen in control cartilage, but the copy number of type II collagen mRNA exceeded that of aggrecan in OA cartilage. Thus, the ratio of type II collagen-to-aggrecan mRNA copy number (normalized to DNA) was shown to be characteristically altered in cartilage with experimental OA. CONCLUSION: Accurate assessment of multiple gene products in small samples of cartilage taken from focal areas of a joint can be used diagnostically for monitoring chondrocyte metabolism and possibly for staging at least the early phases of this joint disease.

Aggrecans↗