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At least 829 records · Page 46Linked to original sources

PubMed1999

Extra-articular synovial chondromatosis of the temporomandibular joint: pitfalls in diagnosis.

Synovial chondromatosis is a benign disease that only rarely affects the temporomandibular joint. When it does, disease is usually confined to the joint space itself but can occasionally extend beyond the joint capsule into the parotid gland, temporal bone, or cranium. The local clinical behavior, radiographic appearance, and histopathologic features can combine to create the appearance of a malignant lesion. We report a case of synovial chondromatosis that affected the temporomandibular joint and presented as an external auditory canal mass. The lesion was thought to be a chondrosarcoma prior to the definitive resection. Pitfalls in the diagnosis and management of synovial chondromatosis are discussed.

Chondromatosis, Synovial↗

PubMed2006

Improving human ankle joint position sense using an artificial tongue-placed tactile biofeedback.

Proprioception is comprised of sensory input from several sources including muscle spindles, joint capsule, ligaments and skin. The purpose of the present experiment was to investigate whether the central nervous system was able to integrate an artificial biofeedback delivered through electrotactile stimulation of the tongue to improve proprioceptive acuity at the ankle joint. To address this objective, nine young healthy adults were asked to perform an active ankle-matching task with and without biofeedback. The underlying principle of the biofeedback consisted of supplying subjects with supplementary information about the position of their matching ankle position relative to their reference ankle position through a tongue-placed tactile output device (Tongue Display Unit). Measures of the overall accuracy and the variability of the positioning were determined using the absolute error and the variable error, respectively. Results showed more accurate and more consistent matching performances with than without biofeedback, as indicated by decreased absolute and variable errors, respectively. These findings suggested that the central nervous system was able to take advantage of an artificial tongue-placed tactile biofeedback to improve the position sense at the ankle joint.

Adult↗

PubMed2002

Caudomedial approach for removal of an ununited anconeal process and assessment of the medial coronoid process of the ulna.

A caudomedial approach that allows the removal of an ununited anconeal process (UAP) is described. Intraoperative examination of the medial part of the joint to diagnose a fragmented coronoid process (FCP) is also possible using the same approach. Sixty-two joints (53 dogs) with UAP and various degrees of arthrosis were included in the study. In all joints the UAP could be removed via the caudomedial approach and the medial coronoid process could be inspected after extending the incision of the joint capsule distally. In eight cases a FCP was diagnosed and removed either by the caudomedial or by a medial approach. The results of the present study show that an UAP can occur simultaneously with a FCP in the same joint and that inspection of the medial part of the joint is useful.

Animals↗

PubMed1986

Arthroscopic surgery for osteochondral fractures of the proximal phalanx of the metacarpophalangeal and metatarsophalangeal (fetlock) joints in horses.

Arthroscopic surgery for osteochondral fractures of the proximal phalanx was performed on 74 fetlock joints of 63 horses for a total of 87 fractures during a 2-year period. The medial dorsal proximal aspect of the proximal phalanx of the forelimbs was most commonly involved (59 fractures), followed by the lateral aspect (26 fractures), and 2 fractures occurred in the fetlock joint of the right hindlimb. At surgery, 82 fragments were removed and 5 fragments that had healed or were embedded in the joint capsule were not removed. Of the fragments removed, 15 were fixed firmly to the proximal phalanx, 63 were easily movable by arthroscopic instruments (but had soft tissue attachments to the proximal phalanx), and 4 were floating free within the joint. Arthroscopic surgery allowed excellent visualization and appreciation of the attachments of fragments and their stage of healing. Horses returned to full race training at an average of 11 1/2 weeks (range, 6 to 24 weeks). Thirty eight of 46 horses (82.6%) with adequate postoperative follow-up returned to athletic performance at least equal to that before fetlock injury.

Animals↗

PubMed1987

[Temporomandibular arthrography].

Results of 104 arthrotomography scans with contrast of temporomandibular joints of 71 patients are used to define normal arthrography criteria (15.4% of cases). Reducible anterior displacements represented 28.8% of cases, non-reducible displacements 40.4%, perforations 12.5% (5.8% associated with a reducible luxation, 6.7% with a non-reducible luxation). The failure rate was 2.9%. Arthrography provides important information on articular morphology and dynamics, the state and position of the meniscus and of the posterior brake, and the state of the joint capsule. Performed by an experienced operator it possesses few complications.

Adult↗

PubMed1986

[Fragment dislocation and surgical indications in segmental fractures of the radial head].

The aim of this study was to evaluate the influence of primary displacement of fragments of the radial head on the clinical result after conservative therapy, also to see whether the extent of displacement could give valuable indications for operation. In non-displaced fractures the results are slightly but significantly better than in displaced fractures. On the other hand, the amount of displacement must be considered to be of minor importance. In 64 percent of conservatively treated patients the results were good despite displacement and the results were similar after primary open reduction. It has to be assumed that undiagnosed lesions of the joint capsule and ligaments are the most important cause of residual functional deficits.

Bone Screws↗

PubMed1994

Biomechanical comparison of methods of fixation of isolated osteotomies of the posterior acetabular column.

Ten fresh frozen specimens of a hemipelvis, including the hip joint, capsule and proximal femur, from elderly cadavers were used to evaluate three methods of internal fixation of isolated posterior column osteotomies. Intact and reconstructed specimens were tested at 30 degrees and 60 degrees of hip flexion in a specially designed joint simulator. The three methods of fixation used were a single 3.5 mm reconstruction plate, two such plates, and a 4.5 mm lag screw with a single plate. Motion at the fracture site in three orthogonal directions, and the overall stiffness of the construct, were recorded simultaneously. No significant differences were noted in stiffness for the three procedures and all retained 80% of the intact stiffness. At 60 degrees of flexion, smaller interfragmentary compliances were allowed by fixation with a lag screw and a neutralisation plate (p < 0.05). At 30 degrees, the position of the load plane relative to the fracture plane allowed less interfragmentary motion, so that no significant differences were found between the 3 methods.

Acetabulum↗

PubMed2007

Nociceptive nerve activity in an experimental model of knee joint osteoarthritis of the guinea pig: effect of intra-articular hyaluronan application.

Nociceptive impulse activity was recorded extracellularly from single A delta and C primary afferents of the guinea pig's medial articular nerve after induction of an experimental osteoarthritis in the knee joint by partial medial menisectomy and transection of the anterior cruciate ligament (PMM+TACL). Also, the analgesic effects of intra-articular hyaluronan solutions were evaluated. Healthy, PMM+TACL operated, sham-operated (opening of the joint capsule without PMM and TACL surgery) and acutely inflamed (intra-articular kaolin-carrageenan, K-C) animals were used. The stimulus protocol consisted of torque meter-controlled, standardized innocuous and noxious inward and outward rotations of the joint. This stimulus protocol of 50 s duration was repeated every 5 min for 70 min. One day, one week and three weeks after PMM+TACL, the movement-evoked discharges of A delta articular afferents were increased significantly over values found in sham-operated animals. The discharges of C fibers were significantly augmented only one week after PMM+TACL surgery. Filling of the joint cavity with a high viscosity hyaluronan solution (hylan G-F 20, Synvisc) immediately and three days after surgery reduced significantly the enhanced nerve activity observed in joint afferent fibers one day and one week after surgery. Augmentation of movement-evoked discharges in K-C acutely inflamed knee joints was similar to that observed one week after PMM+TACL. Our results indicate that in the PMM+TACL model of osteoarthritis in guinea pigs, enhancement of nociceptive responses to joint movement was primarily associated to post-surgical inflammation. Intra-articular injection of an elastoviscous hyaluronan solution reduced the augmented nerve activity.

Adjuvants, Immunologic↗

PubMed1984

[Arthrotomography of the normal temporomandibular joint. Anatomy, technic and complications. I].

Most abnormalities in the T.M. joint are due to pathological processes in the meniscus or joint capsule. They usually manifest themselves as an anterior luxation of the meniscus, which cannot be demonstrated by conventional radiological examination, even including tomography. In order to evaluate the meniscus, it is necessary to perform a contrast examination of the inferior joint space. The technique has proved valuable in 280 patients (308 arthrograms). The method is described and radiological anatomy is discussed. There were no significant complications in our series.

Humans↗

PubMed1987

The effect of acute joint distension on mechanoreceptor discharge in the knee of the cat.

Recordings were obtained from afferents travelling in the posterior articular nerve of the cat knee joint. These arose from tonically active slowly adapting mechanoreceptors which were located in the joint capsule and whose conduction velocities were in the group II range. Intraarticular fluid injection resulted in enhancement of receptor discharge. Both the static index (adapted discharge 2 s after ramp displacement) and the dynamic index (difference between peak discharge during joint displacement and that occurring 0.5 s later) increased after injection. However, whereas the dynamic index increased by three- to fivefold the static index never exceeded a twofold increase. Incremental rise of intra-articular volume resulted in progressive increase in both parameters at all angular velocities. Thus both position and velocity sensitivity are enhanced by the acute introduction of fluid into the synovial cavity.

Animals↗

PubMed1989

[The dorsal approach to the wrist joint and the distal radius].

The extensor retinaculum is divided between the 3rd and 4th extensor tendon compartment without opening the proper tendon sheaths. For partial wrist joint denervation the posterior interosseus nerve is resected routinely. The special anatomy of the joint capsule is emphasized. Careful preparation allows full protection of healthy structures, keeps their function intact and minimizes additional surgical damage.

Humans↗

PubMed1990

A radiographic and histologic study of the topographic relations in the temporomandibular joint region: implications for a nerve entrapment mechanism.

A radiographic and histologic investigation was performed in 18 temporomandibular joint (TMJ) autopsy specimens. Disc position was determined arthrotomographically. The pathway of the nerve branches in the vicinity of the joint was reconstructed from serial sagittal or frontal histologic sections. The relationship between the joint components and the different nerves running in the vicinity of the joint was studied. The results revealed the existence of topographical prerequisites for mechanical influence upon the nerve branches passing in the TMJ region. In two joints, both with a displaced disc, the auriculotemporal nerve trunk was almost in contact with the medial aspect of the condyle instead of having its normal sheltered course at the level of the condylar neck, thus exposing the nerve to the risk of mechanical irritation during condylar movements in an anteromedial direction. Two joints with normal disc position had an extension of the medial fossa wall in a caudal direction. In these joints the auriculotemporal nerve had its course between the condyle and the elongated fossa wall, exposing it to the risk of mechanical irritation during medial disc displacement. Compression of the masseteric nerve anterior to the TMJ was found in one joint with excessive condylar translation. The deep posterior temporal nerves may pass close to the anterior insertion of the joint capsule on the temporal bone, exposing them to the risk of mechanical irritation when there is condylar hypermobility. It was also found that the inferior alveolar and the lingual nerves may pass close to the medial part of the condyle. In joints with this nerve topography, a medially displaced disc could interfere mechanically with these nerves. These findings could offer an explanation for the sharp, shooting pain felt locally in the joint with jaw movements and the pain and other sensations projecting to the terminal area of distribution of the nerve branches in the vicinity of the TMJ such as the ear, temple, cheek, tongue, and teeth.

Aged↗

PubMed1988

[Rheumatoid arthritis: surgery of the metacarpophalangeal joints of the long fingers].

The author reviews the pathophysiological mechanisms of rheumatoid deformations of the long fingers' MP joint. He considers the different possibilities of surgical treatments; then focusing on arthroplasty, he compares and comments on technical points (incision, resection of the MP head, section of intrinsic muscles, size of the implant, joint capsule and ligament reconstruction, dressing, postoperative care) and results (mobility, implant fracture, ulnar deviation and palmar dislocation) achieved by various authors. He concludes that the Swanson implant remains at present the best therapeutic treatment of rheumatoid arthritis of the long fingers' MP joint. However, in order to improve the results obtained, and to avoid long term complications, research should be pushed until we can avail ourselves of a true prosthetic arthroplasty based on other principles and new materials.

Arthritis, Rheumatoid↗

PubMed2001

Sensorimotor control of knee stability. A review.

Traditionally, the concept of joint stability considered the displacement (or subluxation) of two bones relative to each other as the measurement index, and attributed the preservation of such stability in its physiologic range to the various ligaments associated with the joint. Although the ligaments are indeed the major restraints of any joint, the significant contribution of the musculature toward joint stability had been grossly overlooked or neglected until the last 15 years. The value and importance of muscular activity in that role becomes immediately apparent if one performs even a superficial functional comparison of muscles and ligaments. Ligaments are passive viscoelastic structures, whereas muscles are dynamic viscoelastic organs. The viscoelastic effects of the ligaments are activated and applied strictly upon the geometric and kinematic configuration of the joint traversing through its range of motion according to fixed force-displacement relationships. The musculature, however, can apply passive viscoelastic effects to the joint when not active (passive tone) and variable dynamic viscoelastic effects when contracting under voluntary or reflexive control, and at any desirable point in the range of motion and in response to joint speed, external load, gravity, pain, and so forth, while executing the functional objective of the movement set by the individual. Preservation of joint stability cannot be ascribed to the ligaments alone, but should be considered as a synergistic function in which bones, joint capsules, ligaments, muscles, tendons, and sensory receptors and their spinal and cortical neural projects and connections function in harmony. The objective of this report is to first review the anatomy and physiology of the various mechanoreceptors and their neural pathways about the joint, and describe some of the current concepts of the reflex arcs elicited by such receptors, with special emphasis on biomechanical outcomes relative to stability. The role of the musculature in maintaining stability while controlling joint motion is then reviewed, with data obtained from experiments performed on humans and animals. Finally, some clinical findings from patients with anterior cruciate ligament deficiency using a brace that simulates the ligament-muscle functions is described.

Anterior Cruciate Ligament Injuries↗

PubMed2003

Lateral atlantoaxial joint arthrography in atlantoaxial rotatory fixation.

There has been much debate about the pathogenesis of atlantoaxial rotatory fixation. Intraarticular abnormality has not been well documented thus far. This is the first case of chronic atlantoaxial rotatory fixation in which atlantoaxial joints were examined by consecutive arthrography. A 7-year-old girl was diagnosed with atlantoaxial rotatory fixation on a three-dimensional CT scan. Arthrography of the lateral atlantoaxial joints indicated a rupture of the joint capsule on the dislocated side at first, followed by a successful repair after 5 weeks' immobilization with a halo apparatus. Because torticollis recurred after taking off the halo vest, we performed surgery in which severe adhesion of the cartilage surface of facet joint was noted on the undislocated side and release of the adhesion was needed to mobilize the atlas. Atlantoaxial arthrodesis by screw fixation facilitated a solid fusion of the segment.

Arthrography↗

PubMed1975

Clinical kinesthetic experiments on the lateral pterygoid muscle and temporomandibular joint in man.

The possible kinesthetic function of proprioceptors in the lateral pterygoid muscle was clinically assessed after anesthesia of muscle and temporomandibular joint receptors, respectively. A mandibular posture was actively and repetitively produced with an average accuracy of 2.5 mm, while the accuracy decreased by about two-fold after narcotization. It is suggested that muscle spindles in the lateral pterygoid muscle as well as mechanoreceptors in the temporomandibular joint capsule are active in the perception and/or control of mandibular postures.

Adult↗

PubMedDate not supplied

The contribution of the glenohumeral ligaments to anterior stability of the shoulder joint.

The purpose of this study was to investigate the ligamentous stabilizing mechanisms preventing anterior instability in the glenohumeral joint. Six freshly thawed, unembalmed cadaveric shoulders were dissected, preserving the joint capsule and glenohumeral ligaments, the coracohumeral ligament, and the subscapularis tendon. Hall-effect strain transducers were placed on the superior, middle, and inferior glenohumeral ligaments. The humerus and scapula were fixed in a specifically designed mounting apparatus that allowed the glenohumeral joint to be placed in 0 degree, 45 degrees, or 90 degrees of abduction. The mounting apparatus was placed in a model TTC Instron Universal Testing Instrument, which applied an external rotation torque to the humerus. Strain produced in the three glenohumeral ligaments was recorded on a three-channel X-Y chart recorder. At 0 degree of abduction, the superior and middle glenohumeral ligaments developed the most strain. At 45 degrees of abduction, the inferior and middle glenohumeral ligaments developed the most strain, with considerable strain also being developed in the superior glenohumeral ligament. At 90 degrees of abduction, the inferior glenohumeral ligament developed the most strain, with strain also seen in the middle glenohumeral ligament.

Biomechanical Phenomena↗

PubMedDate not supplied

[The significance of inflammatory changes in the tarsometatarsal joints for development of rheumatic splayed foot: a radiologic follow-up].

The involvement of foot joints is a common finding in more than 90% of the patients with rheumatoid arthritis. The typical deformity of the forefoot is the splayfoot with hallux valgus or hallux rigidus and deformities of the lesser toes. 70 feet of 36 patients with rheumatoid arthritis were observed radiologically over a period between 5 years/1 month and 6 years/1 month. The x-rays were analyzed for arthritic changes of the various joints and changes of the foot statics. The question was whether the splay of the forefoot is caused by an arthritis of the metatarsophalangeal or tarsometatarsal joints with a consequent weakening of joint capsules and ligaments, or statistically by a flattening of the longitudinal arch owing to arthritic changes of the hindfoot. The statistic analysis showed that the splay of the forefoot appears between the first and second metatarsal bones. The arthritis of the tarsometatarsal joints II-IV could be identified as a statistically significant factor for the development of a splayfoot in rheumatoid arthritis. The influence of arthritic changes of the tarsometatarsal joints I and V was striking, but not statistically significant. The arthritis of the tarsometatarsal joints caused a flattening of the transverse arch already at an early stage. An arthritis of the metatarsophalangeal joints and the flattening of the longitudinal arch with arthritides of the rear foot had no statistically significant influence on the forefoot. From the results, we must draw the conclusions that orthopedic aids like shoe supports with retrocapital metatarsal bars should be recommended already at an early stage of the disease and that the support of the longitudinal arch is not sufficient to prevent a splayfoot.

Adult↗