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At least 937 records · Page 52Linked to original sources

PubMed1990

Rapidly destructive coxarthrosis--a report of a patient with "strip-mining" and "interior crumbling" of bone architecture.

The pathomechanism of rapidly destructive coxarthrosis has not been clarified. Interesting findings were obtained in specimen from a 64-year-old male patient, i.e., the break-down (crumbling) of the internal structure of osteonal bone and superficial strip-mining of the femoral head. The detritic fragments and hydroxyapatite crystals were mainly deposited in the pocket of the joint capsule and some of them were embedded beneath the synovial membrane. We conjecture that apatite-associated destructive arthritis and/or detritic synovitis might accelerate the progression of rapidly destructive coxarthrosis.

Cartilage, Articular↗

PubMed1981

The ultrasonic image of the acetabular rim in infants. An experimental and clinical investigation.

We report about the possibilities to evaluate the fine structures of the area around the acetabular rim in infants using ultrasound. The identification of the rim within the joint capsule, limbus and cartilagineous preformed acetabular rim is explained by experimental investigations. The clinical use of ultrasound provides a diagnostic method which is painless, non invasive and especially avoids X-ray exposure. It also can be repeated as often as possible. First statements could be made about the above mentioned structures, not visible on the radiograph, according to routine ultrasonic examinations of infantile hip joints, performed to exclude a luxation. We also point out the prognostic value of the cartilagineous acetabular rim demonstrated by ultrasound.

Acetabulum↗

PubMed2003

Is the external laryngeal nerve an exclusively motor nerve? The cricothyroid connection branch.

OBJECTIVES: To obtain an accurate morphological description of the nerve that provides communication between the external laryngeal nerve and the recurrent laryngeal nerve in a large sample of human larynges. STUDY DESIGN: Morphological study of human larynges. METHODS: Microdissection of 103 human larynges obtained from necropsies was performed. Both the external laryngeal nerve and the recurrent laryngeal nerve were identified and dissected. The existence of a communication between the two nerves was evaluated. RESULTS: A neural communication between the external laryngeal nerve and the recurrent laryngeal nerve was found in 85% of the larynges studied (bilaterally in 44% and unilaterally in 41%). Two patterns of communication (with single or double branches) were found. The communication between the nerves can appear at different levels, giving off collateral branches to the cricothyroid muscle (23%), the cricothyroid joint capsule (49%), and the subglottic mucosa (50%). CONCLUSIONS: The nerve supply of the human larynx is more complex than classically considered. Our study does not support the classic neuroanatomical belief that the external laryngeal nerve is purely a motor nerve to the cricothyroid muscle. Our results reveal that it carries sensory and motor fibers on to other muscles (thyroarytenoid) or regions (subglottis mucosa and cricothyroid joint), as has been demonstrated in experimental studies in cats and dogs.

Adult↗

PubMed1985

Radiologic study of 42 cases of Wilson disease.

This paper reports 42 cases of bone and joint radiographic changes in hepatolenticular degeneration. The cases were proven clinically by ophthalmologic and laboratory study, and their radiographic and joint changes were divided into five groups: no abnormal findings, osteoporosis, osteomalacia (rickets), distinct changes, and miscellaneous. Distinct changes include marginal bone fragments, angulation of carpal bones, squaring of metacarpal heads, and calcification of the joint capsule or tendon insertion. The mechanism causing the bone changes in hepatolenticular degeneration is also discussed.

Adolescent↗

PubMed1979

Injury to the suprascapular nerve associated with anterior dislocation of the shoulder: case report and review of the literature.

A young man with persistent pain beginning 2 days following reduction of an anterior subcoracoid dislocation was found to have a suprascapular nerve injury. The patient described was felt to have a neurapraxia of the suprascapular nerve. Possible causes of post-reduction subluxation are interposition of the shoulder joint capsule or biceps tendon, or rupture of the rotator cuff. EMG in 3 weeks, followup examinations, and active assisted motion 4 to 6 weeks postinjury are recommended.

Adult↗

PubMed1984

Pressure-volume relationships and elastance in the knee joint of the dog.

This study has investigated changes in intra-articular hydrostatic pressure in the knee joints of normal dogs in response to continuous and stepwise infusions of fluids. The relationship between pressure and volume in the joint was examined over the pressure range of -8 to +50 mmHg, and also at much higher pressures often associated with joint disease or injury. The effects of joint angle and dog weight on the pressure-volume relationship and on elastance of the dogs' knees were also examined. With liquid paraffin B.P. the pressure was found to increase more with each unit volume infused at subatmospheric pressures than at pressures around atmospheric, and increased more again at higher pressures. The pressure-volume curve with saline infusions was affected by egress of fluid from the joint at supra-atmospheric pressure. Above +5 mmHg the rise in pressure per unit volume infused was less than that for paraffin at the same volume. Elastance and compliance of the normal joint capsule were calculated from the pressure-volume data. Elastance was high at subatmospheric pressures, decreased rapidly as atmospheric pressure was approached and rose as a linear function of pressure above 12 mmHg. The biphasic shape of the elastance-pressure curve is discussed, and explanations for the shape are suggested. After intra-articular pressure in the knee was raised by infusion of paraffin oil the joint was moved through the range of positions from 125 deg extension to 50 deg flexion. Intra-articular pressure did not change across the range 125-110 deg. However, increasing the angle of flexion from 110 to 50 deg resulted in a rise in pressure which became steeper for each volume increment. Increasing intra-articular fluid volume caused a decrease in the total range of movement of the joint. The pressure-volume curves measured at extended angles of 110, 125 and 140 deg, where the starting pressures were subatmospheric, were the same. At flexed joint positions of 80 and 50 deg, where the starting pressures were supra-atmospheric, the pressure-volume curves became steeper with greater flexion. Elastance of the joint tissues increased with flexion. The elastance at each joint angle depended also on the volume or pressure. Significant differences were found to exist between pressure-volume curves for three groups of animals of different weight.(ABSTRACT TRUNCATED AT 400 WORDS)

Animals↗

PubMed2005

Arthroscopic treatment of lateral epicondylitis: clinical and cadaveric studies.

Clinical and cadaveric studies were done to investigate the role of a degenerative fringe of the radiocapitellar complex subluxating in the radiocapitellar joint in patients with lateral epicondylitis. In the clinical study, arthroscopic resection of this capsular complex was done. Thirty patients with recalcitrant symptoms of lateral epicondylitis for a minimum of 9 months had surgery. In all patients at arthroscopy, a collar-like band of radiocapitellar capsular complex was found to impinge on the radial head and subluxate into the radiocapitellar joint with manipulation under direct vision. Histologic analyses of the resected tissue showed hyaline degeneration and fibrosis. There were no complications in this series. Twenty-eight patients had complete relief of symptoms by this procedure within 2 weeks of surgery. The average time until return to work was 7 days. Elbow arthroscopy was done in 34 cadaveric elbows to examine the relationship of the annular ligament, the lateral joint capsule, and the radial head. A degenerative capsular fold impinging on the radial head was seen in 15 elbows. A classification system, based on the relationship of the capsular fold to the radial head is described. In Type 1 (19 elbows), the radial head is completely exposed. In Type 2 (six elbows), there is partial coverage of the radial head by the capsuloligamentous complex without interposition into the joint in any position. In Type 3 elbows (six elbows), there is subluxation of the capsular edge into the joint, whereas in Type 4 elbows (three elbows), the radial head is completely obscured throughout the range of motion. The lesion was equally prevalent in men and women. The arthroscopic findings at the time of surgery in the clinical group were the same as the Grade 2 and Grade 3 changes that were seen in cadaveric specimens.

Aged↗

PubMed2003

The effect of impact angle on knee tolerance to rigid impacts.

While the number of deaths from vehicle accidents is declining, probably because of mandatory seat belt laws and air bags, a high frequency of lower extremity injuries from frontal crashes still occurs. For the years 1979-1995 the National Accident Sampling System (NASS) indicates that knee injuries (AIS 1-4) occur in approximately 10% of cases. Patella and femur fractures are the most frequent knee injuries. Current literature suggests that knee fractures occur in seated cadavers for knee impact forces of 7.3 to 21.0 kN. Experimental data shown in a study by Melvin et al. (1975) further suggests that fracture tolerance of the knee may be reduced for an impact directed obliquely to the axis of the femur. The current study hypothesized that the patella is more vulnerable to fracture from an oblique versus an axial impact (directed along the femoral axis), and that the fracture pattern would vary with impact direction. Isolated, 90 degrees flexed, paired human knee joints (73 -/+ 16.9 years) were impacted at sequentially higher loads either axially or obliquely from the medial aspect with a rigid interface on the patella. The peak load at fracture for each case was recorded, and a detailed description of the fracture pattern was documented. For axial impacts all nine knees failed by linear and comminuted patella fracture with an average peak load of 5.9 -/+ 1.4 kN. Seven of nine obliquely impacted knees also failed by linear and comminuted patella fracture with a significantly lower peak load of 3.5 -/+ 1.4 kN. The peak load data from fracture experiments for all knees showed a strong correlation with age and direction of the impact. Additionally, the fracture pattern for the axial impacts was generally oriented along a horizontal plane on the patella, while the fractures for oblique impacts were generally oriented along a vertical plane. In two oblique experiments patella fracture did not occur, as the patella dislocated at a load of 3.4 -/+ 0.2 kN. In one of these cases the medial aspect of the patello-femoral joint capsule was visibly torn, and in the other case surface damage was noted on the articular cartilage covering the lateral femoral condyle. In addition to the acute injuries described in this study, these data may suggest a potential for chronic diseases of the knee in cases where similar injuries are produced. Clinical studies have shown an increased risk of osteoarthritis in patients suffering patella fractures and damage to joint cartilage. Also, acute dislocation of the patella may cause soft tissue injury of the knee leading to chronic mal-tracking of the patella. These data may be particularly relevant in cases where occupants sit with abducted lower limbs prior to a frontal crash.

Journal Article↗

PubMedDate not supplied

Synovial hemangioma. Description of a case.

Intra-articular angioma, or vascular hamartoma, is a tumor-like lesion essentially made up of anomalous blood vessels localized in the joint capsule, in the synovial membrane, or in both structures. There are two anatomical varieties: one circumscribed localized and one extended. There seems to be predilection for the female sex, and age of onset ranges from birth to 20-30 years of age; it occurs more frequently in the knee, less in the elbow, in the wrist and in the ankle. Symptoms, which often begin after local trauma, include joint swelling and pain, both characterized by discontinuity and long duration. Sometimes there is an increase in swelling, repeated episodes of hemarthrosis (or hydrarthrosis), forced position and functional limitation of the joint, increase in skin temperature. Final diagnosis can only be obtained with histological examination, although MRI may be useful and arteriography clearly reveals it, if the harmatoma is extended enough and communicating with the circulation. Histological examination carried out on fragments of tissue taken in loco reveals a labyrinthine agglomerate of fissures and lengthening cavities, with walls that are generally thick and of a venous-like anomalous type. The course of the disease is slow, with periods of remission of local symptoms of varying duration. Treatment is surgical and it consists in complete removal when possible of the angiomas. The results, particularly in the localized form, are satisfactory; recurrence is infrequent and it is generally due to incomplete excision of the neoformation.

Hemangioma↗

PubMed1979

The influence of hydrostatic pressure on trans-synovial fluid movement and on capsular expansion in the rabbit knee.

1. The flow of Ringer solution or paraffin oil from an infusion reservoir into the cavity of the knee (stifle) joint was measured in anesthetized rabbits, as intraarticular pressure was progressively elevated from its intrinsic slightly subatmospheric value to +25 cm H2O. 2. Paraffin oil did not penetrate the tissues lining the joint cavity, yet a continuous flow of oil occurred into the joint at pressures over +2 cm H2O. It was concluded that the joint investment behaved as a visco-elastic tissue. 3. Trans-synovial flow of Ringer solution was calculated by correcting the observed inflow for visco-elastic expansion of the joint capsule. At intra-articular pressures +2 to +9 cm H2O, trans-synovial flow increased at an average rate of 0.49 microliter min-1.cm H2O-1. The hydraulic conductivity of the synovium was therefore similar to that of subcutaneous connective tissue. At around +9 cm H2O, the 'breaking pressure', the slope of the pressure-flow relationship increased by almost sixfold to 2.81 microliter min-1.cm H2O-1. 4. Changes in joint visco-elasticity, synovial surface area, blood pressure, colloid osmotic pressure of plasma and of joint fluid, and inflammation were excluded as explanations of the marked increase in rate of fluid absorption, which is tentatively attributed to increases in synovial hydraulic conductivity. Some physiological and clinical implications of the data are discussed.

Absorption↗

PubMed2003

Traumatic extensor tendon dislocation in a boxer: a case study.

An elite collegiate boxer developed extensor tendon subluxation in the small finger of his dominant right hand. He was thought to have a radial sagittal band disruption and was allowed to complete his season with custom padding. Surgical exploration revealed intact sagittal bands with divergent dislocation of the two extensor tendons to the small finger with underlying capsular rupture. These lesions were repaired and he successfully returned to boxing. Soft tissue injuries to the dorsal MCP joint may involve the collateral ligaments, the sagittal bands, the extensor tendons, or the joint capsule. Symptoms usually involve persistent pain, swelling, and tendon subluxation or dislocation. Accurate recognition and treatment is crucial as nonoperative treatment is generally unsuccessful and surgical reconstruction is required for optimal return to function.

Adult↗

PubMed2000

Non-inflammatory enthesopathies of the spine: a diagnostic approach.

Ankylosing vertebral hyperostosis, or hyperostotic disease, is an ossification of the entheses, the regions of insertion of tendons, ligaments or joint capsules into the bone. These ossifications create intervertebral bridges (ossifications of the common anterior, lateral and posterior intervertebral ligaments as well as of the ligamentum flavum), which are responsible for the potential signs of the disease: back and neck pain and stiffness, spinal cord compression at the cervical level and lumbar canal stenosis at the lumbar level. The bony epiphyses are the sites of bony appositions, or enthesophytes, which may compromise joint mobility and increase the risk of secondary osteoarthritis, causing hip and knee disorders in particular. These degenerative joint diseases may eventually necessitate total replacement. In this case, the risk of re-ossification around the prosthesis must be averted by the immediate postoperative prescription of anti-inflammatory medication for 1-2 weeks.

Adult↗

PubMed1992

Magnetic resonance spectroscopy of inflammation associated with the temporomandibular joint.

Noninvasive early recognition and treatment of temporomandibular joint dysfunction remains a diagnostic challenge. This pilot study evaluated the use of phosphorus 31 magnetic resonance spectroscopy with magnetic resonance imaging to measure alterations in pH and high-energy phosphate metabolite ratios of muscle that is adjacent to an inflamed temporomandibular joint. Ten New Zealand white rabbits were used in this study. Two animals were used to develop signal acquisition protocols and to ensure that stable baseline data could be measured. In each of the eight animals used in the experiment, one temporomandibular joint was injected with a suspension of silica particles and the contralateral joint served as a control. Data were collected from control and experimental joints on days 0, 7, 14, 21, and 28, after the injection. At the end of the study, temporomandibular joints were block resected and histologically examined to confirm the presence of an inflammatory response. Results indicated that pH and metabolite ratios could be obtained by 31P-magnetic resonance spectroscopy. Changes in pH and some metabolite ratios in experimental joints showed statistical significance (p < 0.001). Differences were seen on day 2 and day 7 (p = 0.040 and p = 0.008, respectively) in the phosphocreatine/alpha-adenosine triphosphate ratios. This contrasts with phosphocreatine/beta adenosine triphosphate ratios that showed significance that began at day 7 (p = 0.022) and continued to day 14 (p = 0.025). Histologic examination indicated that the tissue response within the joint capsule was less than the granulomatous reaction expected.(ABSTRACT TRUNCATED AT 250 WORDS)

Adenosine Triphosphate↗

PubMed2006

Histological evaluation of full thickness skin as an interpositional graft in the rabbit craniomandibular joint.

PURPOSE: The purpose of this study is to determine the histological fate of the full thickness skin graft when placed into the temporomandibular joint using a rabbit model. MATERIALS AND METHODS: Fourteen New Zealand white rabbits were used and divided into 3 groups. Two rabbits were used as controls (Group A) whereby a sham operation was undertaken with an incision made and immediately repaired without breaching the joint space of the left craniomandibular joint (CMJ). In 6 rabbits (Group B), the joint capsule of the left CMJ was surgically breached but the articular disc was preserved and the wound was repaired. The remaining 6 rabbits (Group C) also had the left CMJ surgically exposed with preservation of the articular disc and the interpositional placement of a full thickness skin graft that was taken from the skin of their necks. All grafts were placed above the articular disc and head of condyle in the superior joint space and firmly secured to the surrounding tissues with nonresorbable sutures. The rabbits were sacrificed at 1, 3, and 5 months after surgery and the left CMJs were histologically prepared and examined under light microscopy. RESULTS: The condylar head in the regions where the disc was present appeared to closely resemble that of the control rabbits. However, where the disc was breached by inadvertent surgical trauma (Group B), the underlying condyle showed an irregular outline with increased fibrosis and a marked reduction in mature cartilage. In the subarticular bone there was increased osteoblast and osteoclast activity reflecting high bone activity indicative of a remodeling rather than a degenerative process. The interpositional skin grafts in all experimental animals (Group C) were found adjacent to the condyle on the lateral aspect rather than above the condylar head where it was originally sutured in place. Significant atrophy and reduction in the number and size of the skin appendages such as sweat glands and hair follicles was found within the grafted skin of all experimental animals (Group C) compared with normal skin. All the grafts showed evidence of epidermoid inclusion cysts. CONCLUSIONS: The full thickness skin graft is not a suitable interpositional material for the TMJ because of the high risk of epidermoid cyst formation and the propensity for lateral displacement of the graft even when sutured into the appropriate intra-articular position.

Animals↗

PubMed1986

The locked metacarpophalangeal joint: diagnosis and treatment.

The locked metacarpophalangeal joint of a finger is an unusual condition frequently confused with a "trigger finger." The causes can be classified into degenerative and spontaneous groups. Ten cases are presented. The cause of locking of one patient in the degenerative group was gouty arthritis, a cause not previously reported in the literature. Although surgery is usually necessary, joint mobility was restored in 30% of the cases by distending the joint capsule with an intraarticular injection of a local anesthetic followed by gentle manipulation. In addition to routine x-ray films, arthrotomography was found to be a useful diagnostic technique in determining the cause of locking.

Adult↗

PubMedDate not supplied

Effects of exercise and polysulfated glycosaminoglycan on the development of osteoarthritis in equine carpal joints with osteochondral defects.

This study assessed the effects of postoperative exercise and intra-articular polysulfated glycosaminoglycan (PSGAG) on the repair of osteochondral defects in the carpal joints of ponies. Eighteen ponies with normal carpi had osteochondral defects (mean dimensions 2.4 cm x 0.9 cm) created arthroscopically on the dorsal aspect of the distal articular surface of the radial carpal bone. The ponies were randomized (while balancing for age [range, 2 to 15 years; median, 5.0 years]) to two groups--nine ponies were exercised and nine were stall confined. Beginning at surgery, six ponies in each group received five weekly intra-articular injections of PSGAG (250 mg) in one joint and lactated Ringer's solution in the contralateral joint; the remaining three ponies in each group received lactated Ringer's solution in both joints. The incremental exercise schedule on a circular, rotating walker was begun six days after surgery and occurred twice daily, reaching a maximum of 0.7 miles of walking and 2.7 miles of trotting by the third postoperative month. The effects of treatment on the joint tissues were determined by weekly lameness examinations and measurement of the range of carpal joint motion, carpal radiographs at six and 17 weeks after surgery, synovial fluid analysis, and cytologic evaluation of alcohol-fixed synovial fluid specimens at weeks 1 through 4 and week 17, and histology of the synovial membrane. Ultrasound images of the carpi were acquired before operation and at weeks 1, 2, 4, 8, 10, 13, and 17. Ponies were euthanatized 17 weeks after surgery. Exercise, without medication, caused more lameness throughout the study compared with no exercise. Exercised, nonmedicated ponies had the greatest limitation to carpal flexion (more painful joints), and nonexercised, nonmedicated (control) ponies had the least limitation to flexion. Radiographic scores indicated that the exercised, nonmedicated ponies had significantly (p < .05) more signs of osteoarthritis than exercised, medicated and control ponies. Ultrasonographic measurements indicated that exercise, without medication, caused the greatest increase in combined measurement of the joint capsule thickness and synovial fluid accumulation at all postoperative times. Synovial lining cell numbers in the synovial fluid from exercised ponies were significantly (p < .05) higher than in nonexercised ponies at week 1, and this trend continued at weeks 4 and 17 (p < .1). There were significantly (p < .05) more morphologic abnormalities in the synovial lining cells from exercised than from nonexercised ponies at week 17. Medication with PSGAG enabled exercised carpal joints to be flexed significantly further from weeks 2 through 6 compared with nonmedicated joints.(ABSTRACT TRUNCATED AT 400 WORDS)

Animals↗

PubMed1980

[Transient arthritis of the hip in childhood and Perthes disease (author's transl)].

The possibilities of the relationship between transient arthritis of the hip and Perthes disease have been analysed here. They pointed to the fact, that the intra-articular pressure is increased by the overproduction of the synovial fluid as a result of inflammation, and a continuously high pressure can lead to necrosis of the femoral of inflammation of the femoral capital epiphysis. Experiences are reported here, when an intertrochanteric osteotomy at the early stage of Perthes disease was performed with simultaneous fenestration of the joint capsule for decompression, and a great amount of synovial fluid was discharged under high pressure. They conclude therefore, that transient synovitis can not be regarded only as a harmless condition, but it can precede Perthes disease.

Arthritis, Rheumatoid↗

PubMedDate not supplied

Anatomy of the knee joint lateral retinaculum.

Dissections of the fiber orientation and interconnections of the lateral knee retinacula in 23 cadaver knees and one fresh knee demonstrate a superficial, oblique retinacular ligament running from fascia lata to patella. Deep to this structure are a separate distinct transverse band to the patella, an epicondylopatellar and a patellotibial band. Awareness of these distinct structures should be helpful to the surgeon performing a lateral retinacular release. The lateral knee retinaculum is oriented longitudinally with the knee extended. In view of this, there is little to support the lateral tibial plateau posteriorly once the anterior cruciate ligament has been torn. The fabellofibular ligament gives minimal supportive strength to the posterolateral corner. The lateral knee has two distinct functional layers. The outer layer consists of superficial and deep retinacular fibers, iliotibial band, lateral collateral, biceps tendon, and fabellofibular ligament; these are the main restaining, retinacular structures of the lateral knee. Deep to these structures lie the popliteus tendon, the true joint capsule, and synovium which have little ability to prevent anterolateral rotatory instability once the anterior cruciate ligament has been disrupted. The term "lateral capsular ligament" is anatomically incorrect, and specific retinacular structures should be designated in describing the lateral knee.

Autopsy↗