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At least 739 records · Page 41Linked to original sources
PubMed2001

360 degrees arthroscopic capsular release in patients with adhesive capsulitis of the glenohumeral joint--indication, surgical technique, results.

Adhesive capsulitis of the glenohumeral joint is said to be a self-limiting process. However, in some patients the disease can last much longer than 1 year, which may lead patients to more invasive treatment than merely undergoing physiotherapy. Other patients do not accept this severe limitation and choose treatment options that restore the range of motion (ROM) more rapidly. Conventional open release techniques generally improve motion but involve extensive dissection. The purpose of this study was to develop a safe and reproducible technique of arthroscopic capsular release (ACR) and to present the results of this technique in the clinical situation. The technique for ACR was first defined in a cadaver study and then applied in 28 patients with primary adhesive capsulitis of the glenohumeral joint. The patients were selected for the arthroscopic release when conservative therapy had failed for at least 6 months. All of the patients had a global loss of shoulder motion and had motion restored with a combined anterior, posterior, superior, and inferior release of the of the capsule (360 degrees release). Additionally, in all patients synovectomy with electrocautery was performed. We documented the ROM in the different planes as well as the Constant score. The Constant score improved a mean of 41 points. Range of motion for all planes significantly improved (P < 0.01). Abduction improved from 75 degrees preoperatively to 165 degrees intraoperatively; 6 weeks after surgery, mean abduction was 168 degrees and at the time of follow-up it was 167 degrees. Mean external rotation in adduction improved from 3 degrees preoperatively to 75 degrees intraoperatively. After 6 weeks, the mean external rotation in adduction was 72 degrees and at the time of follow-up the external rotation reached 76 degrees. Mean external rotation in abduction improved from 4 degrees preoperatively to 81 degrees intraoperatively, 80 degrees after 6 weeks and 85 degrees at the time of the last follow-up. Internal rotation in abduction was 17 degrees preoperatively. Intraoperatively, mean internal rotation was 59 degrees. An angle of 58 degrees was documented at 6 weeks follow-up, and at the last follow-up an angle of 63 degrees was documented. No postoperative lesion of the axillary nerve was present. We concluded that arthroscopic capsular release is a reliable method for restoring motion with minimum morbidity in carefully selected patients. When performing an ACR the incision of the glenohumeral joint capsule should be undertaken at the glenoidal insertion in the abducted and external rotated shoulder.

Adult↗
PubMed1999

Insertion of the abductor hallucis muscle in feet with and without hallux valgus.

Textbooks of human anatomy present different opinions on the insertion of the abductor hallucis muscle which is concerned in etiology as well as in therapy of hallux valgus. In plastic and reconstructive surgery the muscle is taken as a graft for flap-surgery. In this study 109 feet (58 right, 51 left) were examined, 18 of these with clinical hallux valgus. The tendon of the muscle may attach to the tendon of the medial head of the short flexor hallucis muscle where a subtendineous bursa can be found. At the head of the first metatarsal bone the joint capsule is reinforced by fibres arising from the medial sesamoid bone which may be called "medial sesamoidal ligament." The tendon passes the first metatarsophalangeal joint plantarily to its transverse axis. Three types of insertion could be distinguished: type A, insertion at the proximal phalanx (N = 42); type B, insertion at the medial sesamoid ligament and at the medial sesamoid bone (N = 65); type C, insertion at the medial sesamoid bone (N = 2). In all types superficial fibres of the tendon extended to the medial and plantar sides of the base of the proximal phalanx, running in a plantar to dorsal direction. Statistical analysis exposed neither significant differences between both sides nor significant difference between normal feet and feet with hallux valgus. Therefore, a specific pattern of insertion of the abductor hallucis muscle in hallux valgus cannot be stated.

Foot↗
PubMed1995

Extension creep in the lumbar spine.

This in vitro study was designed to examine extension creep of the lumbar spine under conditions of sustained loading. By means of a weight and pulley circuit, loads simulating lumbar extension and flexion were applied to 25 male lumbar spines removed at postmortem. Sagittal ranges of movement and the amount of creep occurring in a 20-min period at the limit of extension were recorded. The data were classified into three age group categories representing young adults, the middle-aged and the elderly. The results indicated that extension creep behaviour was similar to that of flexion creep previously reported. The elderly lumbar spines appeared to have a greater range of extension creep than those of the young and middle-aged groups, but analysis of variance showed that the difference in creep between age groups was not significant. The viscoelastic behaviour of the spinal ligaments, zygapophyseal joint capsules and intervertebral discs during extension are sufficient to produce a characteristic creep-recovery curve, but perhaps the important role that the zygapophyseal joints play in limiting extension is sufficient to prevent significant change in creep behaviour with increasing age. RELEVANCE:--This study provides information on the biomechanical responses of the lumbar spine to sustained end range extension loading. Results suggest that in the living, even brief periods of sustained extension loading may cause significant extension creep.

Journal Article↗
PubMed2000

[Standardized sonographic examination of the hip joint].

AIM: We demonstrate a technique for examining the hip joint sonographically in a standardised way using sectional planes corresponding to the guidelines provided by the work group "Sonography of the Musculo-Skeletal System" of the German Society of Ultrasound (DEGUM). MRT-scans were used as a comparative standard. METHOD: The ultrasound examination was performed in the following standardised way: a transversal and longitudinal scan were done in the ventral region and additionally a longitudinal scan in the lateral region. In cases without pathological findings two standardised planes should be documented. In the case of pathological findings the picture should be documented in two standardised planes and compared to the corresponding contralateral site. An ultrasound examination standardised in this way facilitates a precise assessment of the ventral joint capsule, the bone structures, the ventral and lateral aspects of the glenoid cavity and the peri-articular soft tissue structures of the hip joint. RESULTS: An examination technique is presented which offers additional pictorial information, saves costs and is not harmful to the patient. CONCLUSION: The ultrasound examination of the hip joint can supply additional information about diseases and traumatic changes in this region. In paediatric hip disorders such as transient synovitis, septic arthritis, juvenile arthritis, Leg-Calvé-Perthes disease and slipped femoral epiphysis, the ultrasound examination can provide important additional information for the initial differential diagnosis and during follow-up.

Germany↗
PubMed1995

Recombinant OspA protects dogs against infection and disease caused by Borrelia burgdorferi.

Twenty-two specific-pathogen-free beagles were vaccinated with recombinant OspA (ospA gene derived from Borrelia burgdorferi B31) alone or with adjuvant (QuilA, Montanide ISA25, or aluminum hydroxide) at 6 weeks of age. Thirteen dogs were used as nonvaccinated controls with or without adjuvant. Three dogs were kept as contact controls and received neither vaccine nor challenge. Six weeks or 6 months after the first vaccination, the vaccinated (20 of 22) and nonvaccinated dogs (13) were challenged by exposure to adult ticks (Ixodes scapularis) naturally that were infected with B. burgdorferi (tick infection rate, > or = 60%) and that were collected from Westchester County, N.Y. Protection from infection was evaluated by culture for B. burgdorferi from skin biopsies taken near the sites of tick bites. Skin biopsies were taken at monthly intervals for 3 months. B. burgdorferi was not isolated from any of the vaccinated dogs. In contrast, 12 of 13 control dogs challenged by exposure to the ticks were culture positive. The histopathology of the joint capsules 3 months after the challenge was used to evaluate protection from arthritis. Eight of 13 control dogs showed synovitis in single or multiple joints, while only 1 of the 22 vaccinated dogs had a single focus of mild inflammation in a single joint. At the time of the challenge, the vaccinated dogs had antibody to B. burgdorferi, which was demonstrable by kinetic enzyme-linked immunosorbent assay, Western blotting (immunoblotting), and a serum growth inhibition assay. The vaccinal antibody declined gradually after the challenge, especially in dogs vaccinated with OspA without adjuvants. Antibodies in the challenge control dogs were only detectable by 4 to 6 weeks after the challenge and remained at high levels until the termination of the study. Contact control dogs showed no antibody responses or histopathologic lesions and were culture negative. By Western blot analysis, antibodies to OspA first appeared in the sera of vaccinated dogs 3 weeks after the first vaccination. The absence of additional bands after the challenge suggests that infection in vaccinated dogs was blocked. Results from this study show that vaccination with recombinant OspA protected dogs against infection and disease after an experimental challenge with B. burgdorferi by exposure to ticks.

Animals↗
PubMed2002

[Vertebral joint meniscoids in the norm and in functional blocking of the vertebral segment].

Meniscoids have been studied of the intervertebral joints in normal subjects and in blocking of the vertebral locomotory segment. Development of changes in meniscoids in functional blocking of the vertebral segment is shown as is in different degrees of incomplete dislocation in the intervertebral joint. In an unremoved blocking of the vertebral segment the soft tissues of the joint gradually undergo accelerated dystrophy (the joint capsule, meniscoid, articular cartilage). In the early periods of blocking meniscoid becomes hyperplastic (edema), it comes to be wedged in the cavity of the joint rendering it immobile. The findings secured are helpful when it comes to choosing between different policies of managing vertebrogenic disorders and to administering prophylaxis thereof.

Animals↗
PubMed1987

Functional anatomy of the carpometacarpal joint of the thumb.

The first carpometacarpal joint is formed by the proximal joint facet of the first metacarpal and the distal joint on the trapezium. The morphologic features of these facets, together with a lax but strong joint capsule, give the thumb great mobility and play a major role in the opposition of the thumb. Based on the kinematic behavior of the joint, it was given the functional status of a ball-and-socket joint. To analyze the motion patterns of the first metacarpal with regard to the trapezium, models were proposed based on the principles of regularly curved joint surfaces. However, it has been acknowledged that irregularly curved surfaces attuned to a specifically shaped ligamentous system offer the morphologic basis for understanding mobility at the base of the thumb. The stability of the first carpometacarpal joint is not guaranteed by joint surfaces and ligaments alone because differences in mobility between the anatomic bone-ligament specimen and the joint in vivo are conspicuous. The function of muscles crossing the joint is essential. The close structural relation between the tendon of the abductor pollicis longus and the first carpometacarpal joint was observed. Five distinguishable tendons of this muscle end at different parts of the joint. The interweaving of some of the tendons with the ligamentous system undoubtedly influences the restraining and directing function of the ligamentous system.

Carpal Bones↗
PubMed1982

Developing coxal joint of the dog: gross morphometric and pathologic observations.

The growth and development of the proximal parts of femurs and the acetabula were studied in 32 English Pointers. The dogs were allotted to 8 age groups, birth through 9 months of age. Dogs were euthanatized, and at necropsy, 6 linear measurements were made on the proximal part of each femur: the cranial-caudal and the dorsal-ventral diameters of the femoral head, and the widths of the articular surface of the head from the center of the fovea to the cranial, caudal, dorsal, and ventral articular margins. Also 7 linear measurements were made on each acetabulum, including the cranial-caudal and the dorsal-ventral diameters, the length and width of the acetabular fossa, and the width of the lunate surface from the acetabular lip to the acetabular fossa in 3 places. All of the linear values increased rapidly during the first 4 weeks of life and slowly thereafter, and most of them increased simultaneously and proportionately. By 9 months of age, average body weight had increased by a factor of 52 (from initial 0.4 kg to 20.9 kg) and the diameter of the femoral heads and acetabula had increased by a factor of 4.5. Other coxal joint features were also evaluated, including the relative thickness of the joint capsule, the presence of fraying or disruption of the ligament of the femoral head, and the smoothness and regularity of the articular surfaces. Coxal joints in the younger dogs were free of grossly detectable pathologic changes. However, abnormalities of various joint components were present in 1 of the 6 dogs in the 5-month age group, in 2 of the 6 dogs in the 7-month age group, and in 4 of the 6 dogs in the 9-month age group.

Acetabulum↗
PubMed1990

Histologic, biochemical, and ion analysis of tissue and fluids retrieved during total hip arthroplasty.

Large amounts of metal and polyethylene debris and high ion readings are found in capsule and fibrous membranes of both loose titanium and cobalt-chromium stems. Prostaglandin E2, interleukin-1, and collagenase levels are elevated when compared to control values with collagenase having the highest and most consistent elevations. Synovial fluid and blood ion readings were elevated in loose cemented and cementless stems made from both materials. Blood ion readings were not elevated in fixed stems. Fixed stems had much less particulate debris in soft tissues. The data showed that failure of most metal hip stems was initially due to a mechanical cause, with high debris and ion counts occurring secondarily in capsule and fibrous membranes. Particulate debris and high ion readings are primarily a focal problem contained by the periprosthetic fibrous connective-tissue encapsulation within the femoral canal and joint capsules. No systemic problems were manifest in any of the patients examined and followed in this study.

Aluminum↗
PubMed1994

Case report 818: Pericapsular desmoid tumor of the knee.

A case of pericapsular desmoid tumor is presented. The MR features of signal hypointensity and association with the joint capsule suggested the diagnosis of focal PVNS or giant cell tumor of tendon sheath. Arguing against the diagnosis of PVNS were the absence of significant joint effusion, the unifocality of a fairly large lesion, and the absence of bony erosion. While nonspecific, the MR features in some cases of desmoid tumor may help to suggest the correct diagnosis.

Diagnosis, Differential↗
PubMed1996

Swelling of the knee joint: effects of exercise on quadriceps muscle strength.

OBJECTIVE: To investigate the effects of excessive fluid in the knee joint on the performance of the quadriceps muscles and to determine whether quadriceps muscle performance can be altered by exercising the swollen joint. DESIGN AND SETTING: A before-after trial design was used, and the procedures were performed in a laboratory setting. SUBJECTS: A random sample of 27 adult men with no musculoskeletal problems was divided into intervention and control groups. INTERVENTION: First, in all groups, torque generated by the quadriceps muscle was examined by isokinetic muscle testing undertaken at a joint angular velocity of 120 degrees/sec over a range of motion from 5 degrees to 80 degrees flexion. After this initial test, in group 1, 60mL saline and dextrose was injected into the knee joint and subjects repeated the maximal effort procedure. Subjects then performed submaximal exercise for 3 to 4 minutes, after which maximal effort testing was undertaken again. In group 2, subjects received no injection of fluid, undertook 2 maximum effort tests, then performed submaximal exercise for 3 to 4 minutes, after which maximum effort testing was undertaken again. In group 3 (control group), subjects undertook three maximum effort tests over a time period similar to that for the other groups. MAIN OUTCOME MEASURE: Quadriceps muscle torque generated at 60 degrees from full knee extension. RESULTS: Torque decreased (p < .05) 30% immediately after the injection of fluid. However, torque returned to preinjection levels after submaximal exercise (p > .05). These findings were related to joint capsule compliance and fluid movement. No significant changes (p > .05) in torque were observed for the other two groups. CONCLUSION: Submaximal exercise of swollen knee joints can decrease artificially induced quadriceps muscle inhibition. These findings may have implications for patients with perennial effusions who at times undertake gait activities.

Adult↗
PubMed1986

Amyloid deposits in the knee joint at autopsy.

Joint capsule, meniscus, and cartilage from the patella and medial femoral condyle from 30 non-selected autopsies have been investigated for amyloid deposits with light and electron microscopy. Both right and left knee joints from 28 of the 30 autopsy specimens contained amyloid deposits (93%). The amyloid characteristically showed green dichroism in polarised light after staining with alkaline Congo red. The ultrastructural features were also characteristic of amyloid. Amyloid in capsule tissue was found in a subsynovial location, as well as deeper in the capsule tissue, while in the cartilage amyloid was localised along the surface. The meniscus tissue, in particular, contained heavy deposits of amyloid--mainly along the inner margin. Osteoarthritic changes, with fibrillation of the cartilage, were significantly related to amyloid deposition. No pathogenetic correlation between the osteoarthritic changes and amyloid deposition could be shown in the present investigation.

Age Factors↗
PubMed1987

[Functional anatomy of the knee joint].

Detailed and comprehensive knowledge of the knee joint's anatomy is an essential prerequisite for understanding of the joint's function and its pathophysiology, for precise diagnosis, and for satisfactory treatment of lesions of the joint capsule and ligaments. Thus, anatomy represents "the key to the knee".

Biomechanical Phenomena↗
PubMed1998

Glenohumeral joint: comparison of shoulder positions at MR arthrography.

PURPOSE: To compare neutral, external rotation, and abduction external rotation positions of the glenohumeral joint during magnetic resonance (MR) arthrography in the assessment of the joint capsule, biceps-labral complex, and glenohumeral ligaments. MATERIALS AND METHODS: MR imaging with intraarticular administration of gadopentetate dimeglumine was performed in 10 adult cadaveric glenohumeral joints. Fat-suppressed oblique coronal, oblique sagittal, and axial. T1-weighted spin-echo imaging and axial three-dimensional spoiled gradient-recalled imaging were performed with each shoulder in the neutral, external rotation, and abduction external rotation positions. Shoulders were sectioned in the planes that yielded optimal MR images. Anatomic and MR imaging findings were correlated. RESULTS: The biceps-labral complex was best visualized on oblique coronal and axial images obtained in external rotation. Oblique axial abduction external rotation imaging best delineated the inferior glenohumeral ligament but did not improve assessment of the superior and middle glenohumeral ligaments in comparison with findings in neutral and external rotation. CONCLUSION: Although MR arthrography of the glenohumeral joint clearly delineates the biceps-labral complex and glenohumeral ligaments, external rotation of the shoulder optimizes visualization of the former structures. Abduction external rotation is the best position for evaluation of the inferior glenohumeral ligament and anterior capsular attachment.

Adult↗
PubMed1981

Collateral ligaments of the canine stifle joint: anatomic and functional analysis.

The anatomic features and functions of the collateral ligaments of the canine stifle joint were investigated, using cadaver specimens. The structure of the collateral ligaments was examined by dissection, with attention given to the spatial relationships existing between the collateral ligaments and their neighboring structures, such as the menisci and joint capsule. The relative tension of the ligaments was determined by identifying the points of attachment with lead markers and taking a series of radiographs of the joint throughout its range of motion. The distance between the points was measured, and the change in length was determined as a function of joint position. Measurements of internal and external rotation, varus angulation, and valgus angulation were made before and after severance of one or both ligaments. The medial collateral ligament was taut in extension, with only the caudal portion of the ligament becoming lax in flexion. The lateral collateral ligament was also taut in extension; however, its entire bulk because lax as the joint was flexed. In extension, the ligaments were primary restraints preventing varus and valgus angulation, and they functioned to limit internal and external rotation of the tibia. In flexion, the cranial portion of the medial collateral ligament remained taut and prevented external rotation of the tibia, whereas the relaxation of the lateral collateral ligament allowed the tibia to rotate internally, with further rotation limited by the cruciate ligaments.U

Animals↗
PubMed1983

Pathologic ligamentous constraint of the hip.

A mathematic model of the hip capsule and lower extremity musculature was utilized to predict the forces present in the hip ligaments during locomotion. The results demonstrate principles and trends (rather than absolute results) in hip mechanics, the details of which are affected by the associated modeling assumptions. The active stretching of a hip joint capsule tightened by scarring or surgical transfer may appreciably increase the hip contact force. Capsular elements that prevent hip flexion and adduction play a major role in hip contact force exaggeration during common activities. The positive effect of maintaining the hip capsule to reduce total hip component dislocation contrasts with the potential negative effects of restricting joint motion and increasing the joint contact force. Increased joint loading due to capsular restriction may contribute to prosthetic component loosening.

Hip Joint↗