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At least 793 records · Page 44Linked to original sources

PubMed1997

[Menisci and synovial folds of the metacarpophalangeal joint of the thumb].

The inner surface of 25 thumb metacarpophalangeal joints were investigated and the arrangement and structure of different folds protruding into the joint cavity at the level of the joint cleft studied. At the ulnar and radial sides, compact wedgeshaped folds are found consisting of collagenous fibres, which connect with the fibrous layer of the joint capsule. The circularly arranged fibrous tissue is covered by a thin layer of cartilaginous cells. From a structural and functional point of view they are comparable to the menisci of the knee joint. In contrast, a different kind of tissue is found at the palmar and dorsal circumference of the joint cleft: typical synovial folds, consisting of loose connective tissue and small fat lobules. These are suggested not to fulfill a particular mechanical function but to act as a malleable spacer which is able to conform to the requirements of joint mobility.

Cartilage, Articular↗

PubMed1995

Partial trapeziectomy and interpositional arthroplasty for trapeziometacarpal osteoarthritis of the thumb.

Partial excision including the articular surface of the trapezium and interpositional arthroplasty using one half of the flexor carpi radialis tendon was done in 36 hands. The joint capsule was reattached to the trapezium and the thumb immobilized for 4 weeks post-operatively. No ligament reconstruction was done. 30 hands (83.6%) had complete relief of pain. The average post-operative pinch strength was 11 lb. Three patients who complained of weakness of pinch had hyperextension of the MP joint. Correction of MP hyperextension is recommended to improve pinch strength. The outcome of this operation is comparable to any of the techniques described in the literature. The technique is simple and easy to perform. Since the capsule is closed the operation is truly an interpositional arthroplasty.

Aged↗

PubMed1998

Superior-inferior stability of the shoulder: role of the coracohumeral ligament and the rotator interval capsule.

OBJECTIVE: To study the superior-inferior stabilizing functions of the coracohumeral ligament (CHL) and the rotator interval capsule (RIC) with use of a material testing machine. MATERIAL AND METHODS: The axial translations of the humerus with the superior-inferior translation force of 30 N applied were recorded under the following joint capsule conditions: (1) intact, (2) vented, (3) the CHL sectioned, and (4) the RIC incised in six cadaver shoulders. The order of sectioning was changed for conditions 3 and 4 in six other cadaver shoulders. RESULTS: With the arm in internal and neutral rotations, venting the capsule significantly increased the superior-inferior translation, which was unaffected by further sectioning of the CHL and the RIC. With the arm in external rotation, only the CHL contributed significantly to inferior stability, whereas both this ligament and the RIC contributed to superior stability to a lesser degree. CONCLUSION: The CHL is a stabilizer in superior inferior directions with the arm in external rotation, and the intra-articular pressure that is maintained by the intact RIC is a stabilizer in superior-inferior directions with the arm in internal and neutral rotations. These findings may provide a scientific background to support closure of the interval space to stabilize the shoulder and may explain part of the superior instability observed in shoulders with rotator cuff tears.

Aged↗

PubMed1989

[Dislocations of the carpometacarpal joint of the thumb--results of follow-up].

This report deals with twenty-nine dislocations of the carpometacarpal joint of the thumb--twenty-five closed and four compound dislocations, three of which were part of complex injuries of the hand--treated during the period 1957 to 1983. The closed dislocations comprised eighteen dorsal, three dorsal-ulnar, two dorsal-radial, one palmar, and one palmar-ulnar. The compound dislocations comprised one radial (isolated), one palmar-radial, one dorsal-radial, and one palmar-ulnar; the last three occurring together with complex injuries. Eleven patients were followed up after an average period of about eleven years. Closed dislocations including those with minor tears of ligaments and/or the joint capsule do not require operative treatment. Reduction and immobilization for four weeks in a plaster splint with inclusion of the thumb were sufficient; recurrence of the dislocations did not occur. The compound dislocations required temporary transarticular Kirschner wire fixation as the ligament and the capsule were completely torn.

Adolescent↗

PubMed1987

The frozen shoulder. Diagnosis and management.

The differentiation between the stiff and painful shoulder without any joint capsule involvement and with capsule involvement (true adhesive capsulitis) must be established before a rational treatment can be prescribed. Arthrography establishes the correct diagnosis of adhesive capsulitis. Treatment of the stiff and painful shoulder is through prevention and exercise. The treatment of adhesive capsulitis includes prevention, exercises, manipulation, and capsulotomy. Each treatment method is determined by specific criteria. Arthroscopy is not useful for either diagnosis or treatment of adhesive capsulitis but may be useful for recognition of the four stages of the disease.

Female↗

PubMed1982

The role of the meniscus in an instability model for osteoarthritis in the rabbit knee.

After division of the cruciate ligaments and one meniscus in the knee joint of the rabbit, degenerative changes were observed in both the articular cartilage and bone. This was more apparent on the tibial plateau in which the meniscus had been removed, progressive changes occurring from 3 to 16 weeks after trauma. A parallel in vitro experiment, involving measuring the lateral displacement of the tibia in the rabbit knee during medial-lateral leading, was performed before and after transverse division of the meniscus alone. The resulting displacements during medial-lateral shear loading approximately doubled after meniscectomy in the mechanical tests, the apparent clinical stability still being provided after meniscus division by the collateral ligaments, joint capsule, cruciates and bone geometry.

Animals↗

PubMed1994

The shoulder-hand syndrome after stroke: a prospective clinical trial.

Shoulder-hand syndrome developed in 36 (27%) of 132 hemiplegic patients in a prospective study. Subluxation, paresis of the shoulder girdle, moderate spasticity, and deficits in confrontation visual field testing were the major risk factors. In a placebo-controlled, nonblinded trial, 31 of the 36 patients became almost symptom free within 10 days' treatment with low doses of oral corticosteroids. Shoulder joint capsules taken at autopsy of 7 patients showed signs of previous trauma of the affected shoulder. In the second part of this study on another 86 patients, early awareness of potential injuries to shoulder joint structures reduced the frequency of shoulder-hand syndrome from 27 to 8%. These clinical findings suggest that shoulder-hand syndrome in hemiplegia is initiated by peripheral lesions. A self-perpetuating vicious cycle may be established, followed by the clinical picture of a "reflex sympathetic dystrophy." In the majority of stroke patients, this clinical phenomenon seems to be preventable by avoiding shoulder trauma.

Adrenal Cortex Hormones↗

PubMed1983

Dissection of gas into an intraspinal synovial cyst from contiguous vacuum facet.

Intraspinal synovial cysts probably originate from herniation of synovium through a weakened facet joint capsule. The computed tomographic (CT) findings of such lesions were recently reported. An additional characteristic is gas within the cyst as demonstrated by CT. We postulate the source to be an adjacent diseased facet joint with a vacuum cleft with consequent dissection of gas into the cyst.

Female↗

PubMed1984

Response of slowly adapting articular mechanoreceptors in the cat knee joint to alterations in intra-articular volume.

Recordings were obtained from slowly adapting mechanoreceptors innervating the posterior aspect of the cat knee joint capsule. It was observed that, with rising intra-articular volume, initially both intra-articular pressure and the neural discharge increased. This increase was dependent on the rate of fluid accumulation within the joint. However, the joint nerve discharge invariably levelled out despite increasing intra-articular volume and pressure. This suggests that there exists some limit to capsular distension in the posterior joint region beyond which fluid is diverted to other areas of the knee joint.

Action Potentials↗

PubMed1995

[Bone hypertrophy as a results of training].

It is well known that adaptational processes following athletic training affect not only muscles and tendons, but also the skeletal system of the athlete. Functional adaptation of the bone is shown by an increase in cortical thickness, frequent development of bony spurs at the insertion of tendons and joint capsules, an increase of density of the bone substance, and bony changes as a reaction to increased mobility of bony junctions such as the symphysis of the pubic bones of the sacro-iliac joints. Recently, in an investigation involving 20 professional tennis players, we demonstrated that--in addition to the adaptational processes mentioned above--stimulation of longitudinal bone growth and widening of the joint space (cartilage hypertrophy) occur. The possibility of bony hypertrophy as a result of athletic training, especially with regard to increases in of bone density and bone diameter, should lead to incorporation of sports medical considerations into the prophylaxis and therapy of osteoporosis.

Adaptation, Physiological↗

PubMed1998

[Clenched fist injuries from teeth: not to be disregarded].

During the delivery of a blow to the jaw, two men, 33 and 34 years of age, suffered an injury at the level of the right metacarpophalangeal joint in, respectively, the 4th and 3rd digit. In both cases, purulent arthritis and destruction of the MCP-joint developed. Clenched-fist injuries are known for their severe complications such as septic arthritis, osteomyelitis and persistent infection leading to amputation. These complications are due to the easy perforation of the MCP-joint capsule and the fact that the patients do not seek medical treatment until a significant inflammatory process has developed. Exploration of the wound on a flexed hand is crucial to exclude perforation of tendon, joint and bone. The wound should be left open to avoid infections. In case of infections, which can be caused by a variety of aerobic and anaerobic bacteria, the recommended treatment is immediate debridement and administration of broad-spectrum antibiotics.

Adult↗

PubMed1995

Temporomandibular disorders after early Class II treatment with bionators and headgears: results from a randomized controlled trial.

Symptoms and signs of temporomandibular disorders were assessed in children enrolled in a randomized controlled trial of early treatment for Class II malocclusion. Children (mean age of 9.8 years) were assigned to a treatment protocol (bionator, n = 60; observation, n = 60; headgear/bite plane, n = 71) using randomized block stratification. Temporomandibular joint (TMJ) sounds, joint capsule pain to palpation, and muscle pain to palpation were scored as binary responses (present/absent in a subject). Determinations were made by blinded, calibrated examiners initially (DC1) and after a Class I molar correction was achieved or 2 years had elapsed (DC3). Univariate relationships among explanatory factors (group assignment, gender, age, time interval between DC1 and DC3, Class II severity, mandibular plane angle, preparatory treatment, whether Class I molar relation was achieved) and binary responses were explored using Chi square tables and ANOVA methods. Logistic regression modeled the relationship between binary responses and the explanatory variables. At DC1, the 3 groups were equivalent in the explanatory variables (P > .05). Subjects with a TMJ sound, joint pain, and/or muscle pain at follow-up were more likely those who had the sign at baseline (P < .01). Early treatment with bionators and headgear/bite planes did not place healthy children without these signs at risk for developing these signs. Only increasing age (for the development of sounds, P < .04) and failure to achieve a Class I molar relation (for development of muscle pain, P < .04) placed sign-free children at greater risk. Subjects with TMJ pain at baseline were 7 times more likely to have pain at follow-up if they had been treated with a headgear/bite plane or observed than if they had been treated with a bionator (P = .007). We conclude that an immediate benefit or risk for children receiving early Class II treatment with bionators and headgear/bite planes with respect to temporomandibular joint function does not exist with the prospect that Class II children with TMJ capsule pain may benefit from bionator therapy.

Activator Appliances↗

PubMed1984

Rotatory instability of cadaver knees after transection of collateral ligaments and capsule.

The importance of the medial and lateral compartment ligaments of the knee in relation to valgus-varus and axial rotation instability was investigated. Mobility patterns were drawn from 20 osteoligamentous knee preparations after successive transections of the structures. Cutting of the medial collateral ligament resulted only in slight valgus instability and modest anteromedial instability. When the medial posterior joint capsule was also cut, both types of instability increased, and moreover, the knee became posteromedially unstable. Cutting of the lateral collateral ligament produced only a little varus instability and anterolateral rotatory instability, but varus instability increased considerably when the posterior lateral capsule was also transected. In this latter situation, even marked posterolateral rotatory instability was found. Isolated transection of the medial or lateral collateral ligament did not cause any major valgus or varus instability, but when the posterior capsule was also transected, a considerable degree rotatory instability could be found even though the cruciate ligaments were intact.

Biomechanical Phenomena↗

PubMed1981

Chronic boutonniere deformity--an anatomic reconstruction.

Restoration of motion and appearance of the chronic boutonniere deformity is often accomplished by splinting. If the deformity persists following appropriate splinting, and if a full passive range of motion of the proximal interphalangeal joint is present, surgery may be recommended. Thirteen patients had surgical reconstruction over a 10-year period, with satisfactory improvement in all but one. This operation involves release of the transverse retinacular ligaments and reconstruction of the damaged central slip by using the local joint capsule and synovium attached to the base of the proximal phalanx.

Adult↗

PubMed1997

Rupture of flexor tendons due to pisotriquetral osteoarthritis.

We are reporting a case of a flexor profundus tendon rupture of the little finger due to pisotriquetral osteoarthrosis. Resection of the pisiform bone and resurfacing of the carpal tunnel with the joint capsule was performed for the osteoarthrosis and free tendon grafting for the tendon rupture. The tendon grafting and a subsequent tenolysis restored the function of the little finger. Other than radiological changes in the pisotriquetral joint, the diagnostic value of preoperative radiocarpal arthrography was emphasized in this rare complication of pisotriquetral arthrosis.

Aged↗

PubMed1986

Sonography, arthroscopy, and intracapsular pressure in juvenile chronic arthritis of the hip.

Sonography was used in the preoperative evaluation of the hip joint in 14 patients with juvenile chronic arthritis (JCA). The joint capsule distension found at sonography and the intracapsular pressure were increased in patients with severe synovitis revealed at arthroscopy. Sonography and intracapsular pressure-recording can be recommended for assessments of synovitis of the hip joint in JCA.

Adolescent↗

PubMed2003

Voltage-gated calcium channels may be involved in the regulation of the mechanosensitivity of slowly conducting knee joint afferents in rat.

Voltage-gated Ca(2+) channels play an important role in the central processing of nociceptive information. Recently, it has been shown that L- and N-type voltage-gated Ca(2+) channels are also present on peptidergic, fine afferent nerve fibers in the knee joint capsule. Therefore, the influence of specific blockers for L-type (verapamil) or N-type (omega-conotoxin GVIA) Ca(2+) channels on the mechanosensitivity of slowly conducting afferents was tested in the rat knee joint. Topical application of 100 microM verapamil onto the receptive field reduced the mean response to knee joint rotation to 67+/-8% (SEM, n=12), obtained by outward rotations with a torque of 10 mNm above the mechanical threshold and compared with control movements. In the presence of 50 microM omega-conotoxin GVIA, the mean response decreased to 44+/-5% ( n=12), a reduction that was also observed during rotations of other intensities. Simultaneous application of both substances further reduced the response to 25+/-11% ( n=6). In additional experiments it was shown that L- and N-type voltage-gated Ca(2+) channels do not influence activity-dependent changes of the mechanical excitability. In conclusion, the data of the present study indicate that voltage-gated Ca(2+) channels may also be involved in the regulation of the mechanosensitivity of nociceptive nerve fiber endings.

Afferent Pathways↗

PubMed1996

Direct measurement of hoop strains in the intact and torn human medial meniscus.

OBJECTIVE: To measure the circumferential or hoop strains generated in the medial meniscus during loading of the knee joint and to examine the effect of longitudinal and radial tears in the meniscus on these strain values. DESIGN: An in vitro investigation measuring the circumferential strains in the medial menisci of cadaveric human knees as they were loaded in a materials testing machine. BACKGROUND: The menisci transmit approximately 50% of the load through the knee, the rest being transmitted by direct contact of the articular cartilage. Damage to the menisci will alter the pattern of load transmission as will meniscectomy. This study examined the changes in the mechanics of the meniscus in situ as a result of simulated tears to assess the effect of its load carrying capacity and the implications of surgery to remove part or all of a damaged meniscus. METHODS: Nineteen human cadaveric knees were tested. Windows were made in the joint capsule and strain gauges inserted into the anterior, middle and posterior sections of the medial meniscus. The knees were then loaded to three times body weight at speeds of 50 and 500 mm/min, with the knee joint at 0 degrees and 30 degrees of flexion. The tests were repeated following the creation of a longitudinal or a radial tear in the meniscus. RESULTS: The intact menisci showed significantly less strain in the posterior section compared to the anterior and middle sections (P < 0.003, with strains of 1.54%, 2.86% and 2.65% respectively). With a longitudinal tear this pattern changed with strains decreasing anteriorly and increasing posteriorly. There were also significant differences at different angles of knee joint flexion not seen in the intact meniscus. 50% radial tears reduced the strains anteriorly whilst a complete radial tear completely defunctioned the meniscus. CONCLUSIONS: This study has shown that there are significantly different hoop strains produced in different sections of the medial meniscus under load and the patterns of strain distribution are disturbed by meniscal tears. RELEVANCE: These results provide important data for mathematical models which must include non-uniform behaviour. They also have implications for the surgical management of torn menisci. Undamaged portions should be preserved and the integrity of the circumferential fibres maintained to ensure the menisci retain a load bearing capability.

Journal Article↗