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PubMed1991

[Innervation of the sacroiliac joint. Macroscopical and histological studies].

Macroscopical and histological studies were carried out to clarify nerve innervation of the sacroiliac joint which is believed to have a role in the development of low back pain. Eighteen Japanese adult cadavers were used for gross anatomical examination and six for histological examination of the nerve supply to the joint. The results were as follows: 1) It is suggested by the gross examination that the upper ventral portion of the joint is mainly innervated by the ventral ramus of the 5th lumber nerve. 2) The lower ventral portion of the joint was mainly supplied by the ramus of the 2nd sacral nerve or branches from the sacral plexus. 3) Lateral branches of the dorsal ramus of the 5th lumber nerve were considered to be the main nerves which innervated the upper dorsal portion of the joint. 4) The lower dorsal portion was innervated by nerves arising from a plexus composed of lateral branches of the dorsal rami of the sacral nerves. 5) The nerves which innervate the joint range in diameter from 0.292 mm to 0.997 mm, and no difference was found among those in the four subdivisions of the joint. 6) Histological examination revealed that nerve fibers and the terminals were present in the joint capsule and adjoining ligaments. The nerve fibers varied from 0.2 micron to 2.5 microns in diameter and ended with five morphologically different terminals.

Adult↗

PubMed2004

Does the fabella contribute to the reinforcement of the posterolateral corner of the knee by inducing the development of associated ligaments?

The fabellofibular (FF) and arcuate ligaments are closely colocated at the posterolateral corner of the knee. However, a bony fabella is often absent in Japanese subjects. We investigated these structures morphometrically using 212 knees. A thick FF ligament was found in 38.1% (40/105) of knees with a hard fabella. When identified histologically, a bony fabella accompanied a thick FF in 82.8% (24/29). Conversely, a thin or indefinite FF ligament and an elastic-textured fabella co-existed in 77.9% (60/70) of knees. There were no strong correlations between the morphology of the fabella and the arcuate ligament. Thus, a hard or bony fabella seemed to relate to thickening of the FF ligament. In contrast, the thicknesses of the FF and arcuate ligaments were negatively correlated. When the FF ligament was more than 5 mm thick, indicating that it was as strong as the lateral collateral ligament, no arcuate ligament could be identified. Conversely, a thin or indefinite FF ligament often accompanied a well-developed arcuate ligament (61.9%, 96/155). Our observations suggest that these ligaments act in a complementary manner to stabilize the posterolateral corner. A possible common function is fixation of the popliteal tendon on the joint capsule and lateral meniscus, rather than direct stabilization against rotation stress.

Aged↗

PubMed1992

[MR tomography versus CT arthrography in glenohumeral instabilities].

In a prospective study the diagnostic value of MRI compared to CT arthrography (CT-A) was evaluated in 26 patients with 27 instable shoulder joints. Surgical and/or arthroscopic correlation was available in all cases. Both methods showed a high accuracy (96% CT-A, 94% MRI) in the evaluation of the glenoid labrum. CT-A was significantly superior to MRI in the detection of capsular lesions (sensitivity 96% vs. 44%, accuracy 96% vs. 72%, negative predictive value 96% vs. 67%). CT-A and MRI results regarding humeral head fractures were similar; fractures of the glenoid rim were better detected by CT-A, the difference, however, was statistically not significant. Overall, CT-A proved to be superior to MRI, as lesions of the joint capsule were shown with greater certainty.

Adolescent↗

PubMed1995

The pain threshold in juvenile chronic arthritis.

An algometer was used to study the pain threshold (PT) on pressure at the joint capsules of the wrists, elbows, knees, ankles and at paravertebral soft tissues in 57 patients with juvenile chronic arthritis (JCA) and 69 healthy controls, aged 6-17 yr. The PTs were correlated to visual analogue scales (VAS) and values of articular disease activity, to define their relation with pain perception and joint inflammation. The PTs in JCA patients were significantly lower than in their healthy peers, both in children with active inflammation as well as in children without detectable inflammation. The JCA group with active inflammation showed significant lower PTs than without detectable inflammation. Disease activity and VAS correlated significantly with PT (r = -0.5). There is an enhanced sensitivity to noxious stimuli in all measured body areas, suggesting a change in the pain processing system in JCA. The sensitivity endures in JCA patients without clinically active disease, probably due to prolonged central sensitization after periods of active disease.

Adolescent↗

PubMed1998

Multiple ligamentous injuries of the canine stifle joint: a study of 12 cases.

Multiple ligamentous injuries of the canine stifle are uncommon. In this study, they affected mainly adult, male, working or sporting dogs and occurred secondary to severe trauma, or where chronic joint infection had weakened the supporting structures. Rupture of the cranial cruciate, caudal cruciate and lateral collateral ligaments was the most common injury observed and this occurred after catching the limb in a fence or gate. Reconstruction of the collateral and cranial cruciate ligaments, and careful repair of damaged menisci and joint capsule, was an effective method of treatment for medium- and large-size dogs. Reconstruction of the caudal cruciate ligament and postoperative limb support was not found to be essential. All dogs with subluxated stifles had good to excellent limb function with minimal loss of mid-thigh circumference or stifle joint range of motion at follow-up. Less favourable results were achieved where there was stifle joint luxation with extensive disruption to secondary joint restraints.

Animals↗

PubMed1988

Arthrotomography of the unstable shoulder.

Thirty-seven patients suffering from clinically verified subluxation of the shoulder joint underwent double-contrast arthrotomography. Sixteen of these patients were operated on, 4 of whom after arthroscopy, and 1 patient had only arthroscopy. Arthrotomography readily revealed lesions of the glenoid labrum, most of them small, and also redundancy of the anterior joint capsule. The method can be recommended in the examination of the glenoid labrum in patients suffering from anterior subluxation of the shoulder.

Adolescent↗

PubMed1989

Interactions between jaw-muscle recruitment and jaw-joint forces in Canis familiaris.

Electromyographic activity from the jaw-adductor muscles was recorded during mastication and bone crushing in domestic dogs (Canis familiaris). During mastication, balancing-side temporalis electromyographic activity was much less than that of the working side while masseter muscle electromyographic activities were of similar amplitude. Despite the large bite forces that were produced during bone crushing, balancing-side masseter and temporalis electromyographic activities were always smaller than the working-side electromyographic amplitudes. Based upon geometric modelling, it is proposed that balancing-side muscle activity is reduced because of its tendency to produce mechanically disadvantageous jaw-joint forces. This hypothesis was tested by correlating bone strain adjacent to the jaw joint measured during manipulations of the mandibular condyle with bone strain recorded during the simulation and stimulation of jaw-adductor muscle activity. Working-side muscle activity produced bone strain that correlated with a compressive joint loading, while balancing-side muscle activity, with an occlusal fulcrum at the carnassial teeth, produced bone strain indicative of an anteroventral movement of the working-side mandibular condyle which eventually ruptured the joint capsule. When the temporalis and masseter muscles were stimulated bilaterally with a carnassial bite point, bone strain indicative of a ventrally directed and potentially damaging condylar movement was produced. It is proposed that working-side muscle activity exceeds balancing-side muscle activity during carnassial biting to maintain jaw-joint stability.

Animals↗

PubMed1988

A new periacetabular osteotomy for the treatment of hip dysplasias. Technique and preliminary results.

A new periacetabular osteotomy of the pelvis has been used for the treatment of residual hip dysplasias in adolescents and adults. The identification of the joint capsule is performed through a Smith-Petersen approach, which also permits all osteotomies to be performed about the acetabulum. This osteotomy does not change the diameter of the true pelvis, but allows an extensive acetabular reorientation including medial and lateral displacement. Preparations and injections of the vessels of the hip joint on cadavers have shown that the osteotomized fragment perfusion after correction is sufficient. Because the posterior pillar stays mechanically intact the acetabular fragment can be stabilized sufficiently using two screws. This stability allows patients to partially bear weight after osteotomy without immobilization. Since 1984, 75 periacetabular osteotomies of the hip have been performed. The corrections are 31 degrees for the vertical center-edge (VCE) angle of Wiberg and 26 degrees for the corresponding angle of Lequesne and de Seze in the sagittal plane. Complications have included two intraarticular osteotomies, a femoral nerve palsy that resolved, one nonunion, and ectopic bone formation in four patients prior to the prophylactic use of indomethacin. Thirteen patients required screw removal. There was no evidence of vascular impairment of the osteotomized fragment.

Acetabulum↗

PubMed2005

The entheses: histology, pathology, and pathophysiology.

The entheses are the sites of attachment of ligaments, tendons, and joint capsules to bone. Their ubiquitous distribution throughout the body explains the considerable clinical and radiological polymorphism of entheseal diseases. In addition to aging and mechanical factors, many disorders related to a vast array of pathophysiological mechanisms can produce entheseal disease. The spondyloarthropathies provide the most striking examples of entheseal involvement in inflammatory joint disease. Over the last few decades, major advances have shed light on the biochemical composition of the entheses, their histological features, their mechanical role, and their evaluation by ultrasonography and magnetic resonance imaging. These new insights have generated valuable hypotheses about the pathogenesis of spondyloarthropathies.

Humans↗

PubMed2000

Unique gradual and sustained vasodilator response to substance P in the rabbit knee joint.

The effects of substance P on blood flow, plasma extravasation, and knee joint sizes in the rabbit were investigated. Topical bolus application of substance P (1 nmol) onto the exposed rabbit knee joint capsule increased its blood flow from 15 min onwards and reached a peak of 46% at 90 min compared to saline administration. However, administration by the same route and the same dose of the NK(1) receptor agonist [Sar(9), Met (O(2))(11)]substance P produced no change on the knee joint blood flow compared to the saline control. The NK(1) receptor antagonist N(2)-[(4R)-4-hydroxy-1-(1-methyl-1H-indol-3-yl)carbonyl-L-prolyl]-N-m ethyl-N-phenylmethyl-3-(2-naphthyl)-L-alaninamide (FK888) and the NK(2) receptor antagonist (S)-N-methyl-N-[4-acetylamino-4-phenylpiperidino)-2-(3, 4-dichlorophenyl)-butyl] benzamide (SR48968), at 2x1 nmol and 2x10 nmol, had no effect on the substance P-induced response, which however was reduced by pyrilamine, cimetidine, and flurbiprofen (all at 2x10 nmol). N(G)-nitro-L-arginine methyl ester (L-NAME) and N(G)-nitro-D-arginine methyl ester (D-NAME), both at 2x100 nmol, did not significantly affect the substance P-induced response. Unilateral intra-articular administration of substance P (1 nmol) into synovial cavities of the rabbit knee joint increased basal blood flow of the ipsilateral joint at 4 h post-injection, and bilateral increase of basal blood flow was observed at 24 h. Plasma extravasation was significantly higher in the substance P-injected knee compared to the contralateral saline-injected knee at 4 h after intra-articular administrations, but not at 24 h. Knee joint sizes were not affected at both time points. The present study is the first to demonstrate that substance P possesses a gradual and persistent vasorelaxant action in the rabbit knee joint. This novel action of substance P is not mediated by NK(1) or NK(2) receptors, but involves histamine and prostaglandins. The degree of plasma extravasation elicited by substance P in the rabbit knee joint is small and short-lived, and with no concurrent oedema of the joint. These results suggest that substance P can evoke acute inflammatory responses in the rabbit knee joint, but on its own, it is unlikely to cause chronic joint inflammation in this species.

Administration, Topical↗

PubMed1998

Masticatory muscle responses associated with unloading of biting force during food crushing.

The aim of this study was to evaluate masticatory muscle responses during food crushing. Electromyograms were recorded simultaneously with mandibular movement and the sound of food fracture in eight healthy adult males at the superior and inferior heads of the lateral pterygoid muscles, the anterior belly of the digastric muscle, the temporal muscle, and the masseter muscle. After fracture of the food, silent periods of the elevator muscles and excitatory responses of the depressor muscles were observed. The latency and duration of the silent periods increased significantly with increasing incisal velocity after fracture. The mean latency of the excitatory responses of the depressor muscle was stable. After the application of anaesthetic into the temporomandibular joint capsule, the excitatory response disappeared, whereas the silent period was partly maintained. These findings suggest that the excitatory response of the depressor muscle occurs via a polysynaptic reflex arc, and that several reflex arcs are involved in the development of the silent period during food crushing. An important role for the temporomandibular joint receptors is implied.

Adult↗

PubMedDate not supplied

Symptomatic herniation pit of the femoral neck: a case report.

OBJECTIVE: To discuss herniation pits of the femoral neck as a possible source of hip pain in a young athletic population. CLINICAL FEATURES: A 25-year-old former varsity volleyball player sought treatment for recurrent episodes of sharp left hip pain after intense physical activity. Radiographs revealed a small, oval, lobulated radiolucency with a thin sclerotic border in the superolateral aspect of the left femoral neck. Passive internal rotation of the left hip reproduced the complaint. Iliopsoas tendinitis/bursitis tests did not reproduce the complaint. INTERVENTION AND OUTCOME: The patient reported no significant reduction of hip pain after a variety of conservative therapies including soft tissue therapy, stretching, interferential current, and long-axis distraction. CONCLUSION: There is evidence to suggest that herniation pits of the femoral neck are a result of mechanical stress from the overlying joint capsule and iliopsoas tendon. Herniation pits of the femoral neck should be considered a potential cause of hip pain, particularly if the patient is physically active.

Adult↗

PubMed1993

Joint laxity and hip rotation in normal children and in those with congenital dislocation of the hip.

We measured the range of rotation in both hips of 397 normal children and in the unaffected hip of 135 children with unilateral congenital dislocation of the hip. Both groups were assessed for generalised joint laxity. Joint laxity was more common in normal children with an internally centred arc of hip rotation than in normal children with a neutral or an externally rotated arc. The children with congenitally dislocated hips had significantly more joint laxity than did the control group and significantly more of them had an internally centred arc of hip rotation. We suggest that the lax joint capsule fails to mould away the neonatal anteversion of the femoral neck during the first few months of life.

Adolescent↗

PubMed2001

Ganglion of the distal interphalangeal joint (myxoid cyst): therapy by identification and repair of the leak of joint fluid.

BACKGROUND: Digital myxoid cysts are a relatively common pathology in the skin, representing a ganglion of the adjacent distal interphalangeal joint. Success of treatment is largely proportional to the destructiveness of the therapy and postoperative morbidity. We studied an effective, minimally traumatic surgical treatment in which tissue is not removed and morbidity is low. DESIGN: Open, nonrandomized trial of therapy. Methylene blue dye was injected into the distal interphalangeal joint. A skin flap was designed around the cyst and raised to identify the dye-filled communication between joint and cyst. The communication was sutured and the flap was replaced with no tissue excision. SETTING: Two university dermatology departments. PATIENTS: Fifty-four subjects with 47 cysts involving fingers or thumbs and 7 involving toes. Previous therapies in 37 patients had resulted in relapse. MAIN OUTCOME MEASURES: Clinical assessment at 2 and 8 months. RESULTS: We treated 34 women and 20 men (mean age, 60.4 years; range, 45-83 years). Communication between cyst and joint was identified by means of methylene blue injection in 48 patients (89%). At 8 months, 48 patients remained cured with no visible scarring. Of these, nail dystrophy associated with the cyst preoperatively (n = 35) resolved in all but 1 patient (97%). Six patients had relapses (5 within 4 months). Of these, 3 were on the toes. Cure rate on toes was 4 of 7 (57%) and on fingers, 44 of 47 (94%). In 2 patients, pain persisted for 4 months and then resolved. Limitation of joint mobility resolved after 2 months in 1 subject. CONCLUSIONS: Ligature of myxoid cyst origin at the joint capsule is an effective treatment and does not require excision. Myxoid cysts on toes are more likely to relapse than those on fingers.

Aged↗

PubMed1993

Joint hypermobility in pediatric practice--a review.

It has been well established that joint hypermobility may predispose children to the development of joint pain. Joint hypermobility represents an extreme variation of normal joint mobility with no underlying connective tissue diseases. Its prevalence among children varies from series to series. Evidence that there are differences between races and sexes exist. Joint hypermobility diminishes markedly throughout childhood and then more slowly during adult life. Although quantitative measurements in the assessment of joint hypermobility have been described, the criteria defined by Carter and Bird are preferred. Any subject who is able to perform 3 or more of the 5 maneuvers devised by these criteria was considered to have joint hypermobility. The mechanism in which joint symptoms develop is not well understood. Excessive motion or inappropriate physical activities that hyperextend the joint capsule, the ligaments and soft tissue constituent causing injury. These injuries are manifested by pain. The clinical features, prognosis and relevance to pediatric practice are discussed.

Child↗

PubMed1990

Neural influences on synovial mast cell density in rat.

The mast cell, an immunocompetent cell that contributes to neurogenic inflammation in a variety of tissues, including synovium, is found in close proximity to peripheral terminals of unmyelinated primary afferents and sympathetic postganglionic nerve terminals. In this study we evaluated the hypothesis that the density of mast cells in synovial tissue is dependent on the neural innervation. In normal rats, we found that the density of mast cells in the ankle joint capsule, which is heavily innervated, is greater than in the capsule of the knee, which is less densely innervated. Selective lesions of unmyelinated primary afferents with capsaicin, or of sympathetic postganglionic neurons with guanethidine, produced a significant decrease in mast cells; surgical removal of the parasympathetic ganglia did not significantly affect mast cell density. Finally, the number of mast cells in the synovial joint of spontaneously hypertensive rats, which have increased sympathetic activity, was significantly greater than in normotensive control rats. These observations support the hypothesis that the innervation in the synovial joint of the rat, by unmyelinated afferents and sympathetic efferents, exerts a trophic effect on mast cell density.

Animals↗

PubMed2001

The anatomy of the ligaments of the wrist and distal radioulnar joints.

The ligaments of the wrist are responsible for guiding and constraining the complex motion of the carpal bones relative to the forearm bones, the metacarpals, and contiguous carpal bones. The majority of wrist ligaments are found within the joint capsule as organized thickenings composed of parallel collagen fascicles, small caliber nerves and blood vessels, and lined on their deep surfaces by synoviocytes. The palmar radiocarpal ligament complex is composed of the radioscaphocapitate, long radiolunate, radioscapholunate and short radiolunate ligaments. The ulnocarpal ligaments include the ulnolunate, ulnotriquetral and ulnocapitate ligaments. Dorsally, the radiocarpal joint is spanned by the dorsal radiocarpal ligament. Palmar ligaments connecting the proximal and distal carpal rows include the scaphotrapeziotrapezoid, scaphocapitate, triquetrocapitate and triquetrohamate ligaments. Within each row are interosseous ligaments connecting adjacent carpal bones, each divisible into dorsal and palmar components. There are unique regions within some of the ligaments, such as a zone of fibrocartilage in the proximal regions of the scapholunate and lunotriquetral interosseous ligaments, and strong deep regions connecting the trapezoid, capitate, and hamate. The distal radioulnar joint is connected by the triangular fibrocartilage complex, composed of a fibrocartilaginous disc and the palmar and dorsal radioulnar ligaments. The ulnocarpal ligaments attach to the palmar radioulnar ligament rather than directly to the ulna, allowing increased independence between wrist and forearm motion.

Forearm↗

PubMed1994

Preoperative staging of osteosarcoma: efficacy of MR imaging in detecting joint involvement.

OBJECTIVE: Selecting the appropriate surgical procedure for treatment of patients with osteosarcoma requires accurate preoperative evaluation of tumor extent. Establishing the presence or absence of joint involvement is particularly important. Accordingly, we studied the efficacy of MR imaging for detecting joint involvement in 46 patients with osteosarcoma around joint spaces. SUBJECTS AND METHODS: Preoperative MR examinations were performed in 46 consecutive patients with osteosarcoma whose tumors were located around the knee (n = 33), the hip (n = 8), or the shoulder (n = 5). T2-weighted and unenhanced and contrast-enhanced T1-weighted spin-echo MR images were obtained for all patients. We assessed the presence or absence of tumor invasion of the intracapsular-intrasynovial joint space, either by disruption of the joint capsule or by intraarticular destruction of the cortical bone and articular cartilage or the intracapsular-extrasynovial cruciate ligaments of the knee. All patients subsequently had surgery. The MR findings were correlated with findings from macroscopic and microscopic pathologic examinations. RESULTS: All 10 patients who subsequently proved to have tumor involvement of the joint were correctly identified (sensitivity, 100%). The tumor involved the knee joint in seven patients, the hip joint in two, and the shoulder joint in one. However, the MR diagnosis was false-positive in another 11 patients who did not have joint involvement at surgery (specificity, 69%). In the knee, MR imaging was more accurate in identifying tumor extension to the cruciate ligaments than to the intrasynovial joint space. Post-contrast T1-weighted images were most useful in detecting joint involvement. CONCLUSION: MR imaging is highly sensitive for detecting joint invasion of osteosarcoma. However, false-positive diagnoses may lead to overstaging of tumor and result in unnecessarily radical surgical procedures.

Adolescent↗