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PubMedDate not supplied

Diagnostic and surgical arthroscopy of the equine shoulder joint.

An arthroscopic technique for examination and surgical treatment of conditions of the shoulder joint was evaluated in eight normal horses and two horses with osteochondrosis lesions. A single arthroscope entry point caudal to the infraspinatus tendon allowed inspection of the cranial, lateral, and caudal surfaces of the shoulder joint. With the humeral head and glenoid cavity distracted by a curved forceps, the entire cartilage surface of the shoulder could be examined. The caudomedial portion of the humeral head was seen better with a 70 degree angled arthroscope. Instruments for intra-articular manipulation were introduced through a separate skin incision 2 to 4 cm caudal to the arthroscope entry point. Two horses with osteochondrosis lesions of the shoulder were examined arthroscopically and debrided with instrument triangulation. Five normal horses and both horses with osteochondrosis lesions were euthanized immediately after the procedure and a necropsy was performed. Minor iatrogenic damage to the cartilage surfaces and joint capsule resulted from the technique. Three horses recovered from anesthesia and were killed 3, 30, or 60 days after surgery. Subcutaneous fluid that accumulated during surgery had resorbed by 3 days and lameness was evident for 12 to 24 hours. Gross examination and histopathologic findings of specimens collected at 30 and 60 days showed several small nonhealing partial-thickness cartilage defects attributed to instrument insertion. Arthroscopy is a satisfactory method to examine the joint surfaces and to evaluate and treat osteochondrosis lesions of the shoulder joint in horses.

Animals↗

PubMed2005

Bilateral facet dislocation on L4-L5 without neurologic deficit.

We present a case of traumatic bilateral facet dislocation of L4-L5 without neurologic deficit in a 47-year-old woman after a motor vehicle accident. We considered that the mechanism of injury was the composition of hyperflexion, distraction, and rotation. Open reduction was easily performed when the obstacles consisting of the disrupted joint capsule and synovial membrane were completely removed. Also, posterior interbody and posterolateral fusion and pedicle screw augmentation are recommended because of surgeon familiarity, the absence of additional injury for unstable injury, and the safety of this treatment.

Decompression, Surgical↗

PubMed2003

Fluordeoxyglucose positron emission tomography detection of inflammatory reactions due to polyethylene wear in total hip arthroplasty.

A patient experienced chronic pain 8 years after total hip arthroplasty. Radiology and bone scanning showed no signs of aseptic loosening, but fluorine-18 fluorodeoxyglucose positron-emission tomography ((18)F-FDG-PET) showed intensive glucose metabolism in the joint capsule and around the prosthesis neck. The surgical intervention revealed soft tissue reaction in this area. Histologic examination showed a granulomatous foreign body reaction against polyethylene debris particles. Infection and rheumatoid arthritis could be excluded clinically, histologically, microbiologically, and with the bone scan. Therefore, FDG-PET detected inflammatory reaction caused by polyethylene wear in total hip arthroplasty and allowed clinicians to decide on interventions, including removal of granulomatous tissue and the replacement of worn artificial joint components to prevent aseptic loosening.

Fluorodeoxyglucose F18↗

PubMed1987

[Origin, diagnosis and treatment of sternoclavicular joint dislocation].

Traumatic dislocation of the sternoclavicular joint is very uncommon (1,5% of all dislocation, 10% of all dislocations in clavicular joints; ratio acromioclavicular dislocations: sternoclavicular dislocations = 5-10:1). The functional importance of this joint requires open reduction with reconstruction of its ruptured ligaments and the disc. The sternoclavicular joint can be dislocated in association with congential, developmental, degenerative and inflammatory processes (M. Friedrich, rheumatoid arthritis). Epiphyseal separations or fractures of the medial end of the clavicle can usually be treated conservatively, but interposition of the joint capsule between the fragments may cause the dislocation to be irreducible. In addition to clinical examination and anteroposterior of oblique posteroanterior X-rays, tomography, computed tomography and arthrography can be of help in diagnosis. Additional special X-ray pictures as suggested by Heinig, Hobbs and Kattan are very helpful in determining the degree of dislocation (Allman). If open reduction is necessary, the functional importance of the disc and the angle of inclination of the joint socket must be taken into consideration.

Biomechanical Phenomena↗

PubMed2004

[Herniation of the soft tissue of the temporomandibular joint into the external auditory canal].

The bone between the external auditory meatus and temporomandibular joint may be destroyed as a result of canaloplasty or malignant otitis externa. This may lead to herniation of the joint capsule into the external auditory canal. Spontaneous herniation through a foramen of Huschke (bony dehiscence in the anterior wall of the tympanic bone) is rare. We present a case of spontaneous herniation with otorrhea.

Cerebrospinal Fluid Otorrhea↗

PubMed2006

[Imaging methods in rheumatology: imaging in psoriasis arthritis (PsA)].

Conventional radiography is still the standard method of imaging in PsA since it displays many joints at the same time, thereby allowing different types of joint involvement to be recognized. Moreover, thanks to the high resolution of radiography, bony changes in a single joint are depicted in a brilliant way. Several features of psoriatic arthritis allow the distinction from rheumatoid arthritis, including the frequent involvement of the distal interphalangeal joints, asymmetry of joint involvement, axial involvement of finger joints, oligoarticular involvement; however, symmetric polyarthritis is also possible. At the level of the single joint, there are signs of severe destructive changes potentially leading to mutilation and at the same time signs of periostal bone proliferation and ankylosis may be present. Bony proliferation and/or osteolysis are not restricted to the joint region but can affect also the total phalanx with bone apposition or concentric osteolysis which may lead to a complete disappearance of phalanxes. For purposes of quantification of radiographic changes scoring methods are used that were originally developed for rheumatoid arthritis. So far, there is only one validated scoring method that was specifically designed for PsA and that takes into account both features of PsA, damage as well as proliferation of bone. In contrast to conventional radiography, MRI and sonography are able to visualize inflammatory processes within the soft tissue (joint capsules, tendon sheaths, tendon insertions, etc.), allowing an estimation of disease activity. Scintigraphy is nonspecific and can only be used to detect clinically silent inflammatory spots. The relatively frequent spinal (axial) involvement is similar to that seen in ankylosing spondylitis. However, unilateral sacroiliitis, asymmetry of syndesmophytes and development of parsyndesmophytes may distinguish PsA from ankylosing spondylitis. While conventional radiography demonstrates the bony consequences of inflammation in the spine, MRI also shows the active inflammatory changes in sacroiliacal joints and vertebrae.

Arthritis, Psoriatic↗

PubMed1986

Segond tibial condyle fracture: lateral capsular ligament avulsion.

Avulsion fractures in the appendicular skeleton are a result of stress on a specific structure that is firmly attached to bone. A small avulsion fracture from the directly lateral surface of the lateral tibial condyle results from excessive tension on the lateral capsular ligament of the knee joint. Recognition of this fracture on an anteroposterior radiograph of a traumatized knee represents substantial evidence of major injury to the lateral joint capsule. This fracture also has a strong association with rupture of the anterior cruciate ligament. The avulsed tibial fragment is remarkably constant in site and appearance. The typical fragment is isolated by a longitudinal fracture line separating a small piece of bone from the lateral tibia. It is elliptical in outline (10 X 3 mm), with its proximal border lying 4 mm distal to the subarticular cortex of the lateral tibial condyle. A hemarthrosis of the knee joint is consistently visible.

Adolescent↗

PubMed2000

Nerve distribution to the human knee joint: anatomical and immunohistochemical study.

The nerve distribution to the knee joints was analyzed in 5 cadavers and 10 joint capsules specimens were resected during total knee arthroplasty. We found nerve fibers immunoreactive for anti-substance P antibody in the articular capsule. By confocal laser scanning microscopy, we evaluated the three-dimensional structures of the Ruffini's corpuscles and the free nerve endings, both of which were immunoreactive for anti-protein gene product 9.5.

Arthroplasty, Replacement, Knee↗

PubMed1985

Bursae and abscess cavities communicating with the hip. Diagnosis using arthrography and CT.

Bursae or abscess cavities communicating with the hip joint were demonstrated by hip arthrography or by computed tomography (CT) in 40 cases. The bursae or abscess cavities were associated with underlying abnormalities in the hip, including painful hip prostheses, infection, and inflammatory or degenerative arthritis. Structures communicating with the joint capsule included iliopsoas bursae (13 cases), bursae associated with the greater trochanter (21 cases), ischiotrochanteric bursae created by abnormal articulation between the ischium and lesser trochanter (two cases), and abscess cavities not associated with a bursa (four cases). Symptoms may be produced directly as a result of infection or indirectly as a result of inflammation or pressure on adjacent structures. In cases of suspected infection, direct puncture and aspiration of the bursa or abscess cavity, in addition to joint aspiration, may be necessary to obtain organisms for culture as joint aspiration may not yield fluid. Hip arthrography can confirm a diagnosis of bursae and abscess cavities communicating with the hip joint in patients with hip pain or soft-tissue masses around the groin. Differentiation of enlarged bursae from other abnormalities is important to avoid unnecessary or incorrect surgery.

Abscess↗

PubMed1992

MRI of the shoulder.

MR imaging of the shoulder has become an important imaging modality for that joint. Excellent soft tissue contrast and multiplanar acquisition provide optimal assessment of muscle, tendons, hyaline and fibrous cartilage, joint capsules, fat, bursae and bone marrow. The most common indications for shoulder MRI are suspected rotator cuff tear, shoulder instability, osteonecrosis, neoplasm and infection. In this article we describe MR technique, special anatomy of the shoulder, and diagnostic MR criteria of common pathologic conditions.

Humans↗

PubMed1981

Extraskeletal calcified synoviobursitis.

A large synoviobursitis calcified mass is not commonly seen in the digits of the foot. After injury, effusion subcutaneous hemorrhage and synovitis may occur with a fluctuating edema over the inflamed parts. In the later stages, a nodular type of increase in soft tissue density within the confines of the joint capsule may be the result of tumor formation. The mass may develop beyond capsular tissue and may resemble a synoviobursitis calcified mass. This must be considered in a differential diagnosis to rule out any malignant manifestation.

Bursitis↗

PubMed1996

The inferiorly based rectus abdominis island flap for the treatment of complex hip wounds.

Complex wounds in the hip region often result from complications of orthopedic procedures performed in this region such as total hip arthroplasty, ORIF procedures, tumor ablation, and/or radiation therapy. Exposure of bone, joint capsule, prostheses, and other hardware often results with these wounds. Salvage of these exposed and/or infected essential elements and providing soft-tissue coverage are difficult and challenging problems for the orthopedic and plastic surgeon. To provide coverage for such situations, we have developed an aggressive strategy of thorough debridement, systemic antibiotics, and well-vascularized soft-tissue coverage utilizing an inferiorly based rectus abdominis island flap. This technique was utilized in five patients with all wounds and joints remaining stable at follow-up periods ranging from 2 to 7 years.

Adult↗

PubMed1998

Iatrogenic posterior tibial nerve division during ankle arthroscopy.

Ankle arthroscopy has been increasingly applied to the diagnostic and therapeutic treatment of ankle disorders. Owing to the complex cutaneous anatomy of the ankle, neurological injuries are a potential complication of this procedure. All reports of neurological complications resulting from ankle arthroscopy have attributed them to use of a distractor pin or to portal placement. Several authors have noted the possibility of damage to the deep peroneal nerve from the use of motorized arthroscopic tools within the anterior ankle joint capsule. We present what we believe to be the first reported case of complete division of the posterior tibial nerve resulting from an apparently overaggressive intra-articular manipulation during ankle arthroscopy performed for loose body removal.

Ankle Injuries↗

PubMed1988

Pitfalls in MR imaging of the knee.

Discrepancies between the findings of magnetic resonance (MR) imaging and those of arthroscopy were reviewed retrospectively in 52 knee examinations. Some of the discrepancies between MR imaging and arthroscopy were caused by errors in interpretation of MR images due to normal structures that mimicked meniscal tears. The transverse ligament and the lateral inferior genicular artery can produce the appearance of tears in the anterior horns of the medial and lateral menisci, respectively. The popliteus tendon may be mistaken for a tear in the posterior horn of the lateral meniscus. The normal concavity at the outer edge of the meniscus can create a volume-averaging artifact, which mimics a horizontal tear in the meniscus. Tears of the meniscus and separations of the meniscus from the joint capsule were not seen or were underestimated when the tears were oriented parallel to the plane of the image. An awareness of these pitfalls may improve the accuracy of the interpretation of MR images of the knee.

Adolescent↗

PubMed2002

Ultrasonographic investigation of the atlanto-occipital articulation in the horse.

The purpose of this study was to evaluate ultrasonographic imaging as a means of easy and noninvasive diagnosis of articular and periarticular structures of the atlanto-occipital articulation in the horse; and to find a safe approach to the atlanto-occipital joint. Ultrasonographic investigations were performed on 6 healthy horses and 16 specimens from horses humanely destroyed age 2-17 years (mean 9.56 years). Preliminary examinations included anatomical studies and preparation of cross-sections. On 4 horse specimens, puncture of the atlanto-occipital joint under ultrasonographic guidance was performed and a new lateral approach undertaken. For ultrasonographic investigations, the neck was divided into 4 zones according to anatomical and clinical modalities: 1) insertion of the funiculus nuchae; 2) tuberculum dorsale of the atlas; 3) atlanto-occipital joint and 4) region above the foramen alare. Each zone was examined in transverse and longitudinal planes proceeding from cranial to caudal. Ultrasonography was found to be useful for soft tissue imaging of this region and was performed down to the atlanto-occipital joint of which the joint surfaces, joint capsule and collateral ligament could be delineated in both planes. We conclude that ultrasonography of the neck is a useful technique, representing an easy to use and safe method. However, further studies are indicated which should be performed on live subjects.

Animals↗

PubMed1982

Unstable fracture-dislocations of the forearm (Monteggia and Galeazzi lesions).

Forty-nine Monteggia and forty-seven Galeazzi lesions were treated over a twenty-five-year period. I used Bado's criteria to evaluate the results in the Monteggia lesions. In all of the children in the series either closed or open reduction yielded good results, while the results of treatment of the Monteggia fractures in the adults in the study varied. The best results were obtained in Type-I lesions treated by open anatomical reduction, internal stabilization of the ulnar fracture, and closed reduction of the radial head. Factors leading to poor results in Type-I lesions were failure to obtain anatomical reduction of the ulna, heterotopic ossification including synostosis of the proximal parts of the radius and ulna, and persistence or recurrence of dislocation of the radial head. In patients in whom the radial head could not be reduced by closed methods, the radial head was buttonholed through the joint capsule and the annular ligament was displaced but not ruptured. I have not found that reconstruction of the annular ligament is necessary in the treatment of acute Monteggia fractures. In the Type-II, III, and IV lesions in this series, fair results were the rule. The results of closed reduction of the classic Galeazzi fractures in the adults in this series were not good, due to malunion of the radius and persistent derangement of the distal radio-ulnar joint. The seventeen patients who were treated with accurate reduction and internal fixation of the fractured radius and immobilization of the forearm in full supination for six to eight weeks obtained good results.

Adult↗

PubMed1983

Stressing on the human femoro-patellar joint. I. Components of a vertical and horizontal tensile bracing system.

Horizontal and vertical tensions act on the femoropatellar joint. In both knee joints of 60 human corpses the muscles and ligaments participating in the tensile bracing of the knee joint were studied macroscopically. While the structures acting in the vertical direction are very constant, the components participating in horizontal tensile bracing show large variations. Components of vertical tensile bracing are the quadriceps femoris muscle, the ligamentum patellae as well as the vertical patellar retinacula. The active part of horizontal tensile bracing consists of the medial and lateral vastus muscles. The passive components of this system are arranged in three layers. The superficial layer is formed by the fascia lata. The middle layer consists of the horizontal retinacula. A medial horizontal retinaculum was present in one third of our cases. It passes from the medial margin of the patella towards the medial femoral epicondyle. A lateral horizontal retinaculum is demonstrable in all cases studied. It passes horizontally from the lateral margin of the patella and inserts into the deep layer of the iliotibial tract. Insertion of the lateral horizontal retinaculum into the lateral femoral epicondyle was not observed in our material. The third layer is formed by ligaments supporting the joint capsule. These originate from the medial and lateral margin of the patella and pass towards their respective meniscus as well as variably towards the femoral or tibial condyle. These structures are found both medially and laterally in two thirds of the cases studied.

Adult↗

PubMed1996

Neurofibroma in the articular disc of the temporomandibular joint: a case report.

In classical Von Recklinghausen neurofibromatosis (Type I), skeletal defects occur as a result of abnormalities of derivatives of the neuroectoderm and mesoderm. Temporomandibular joint (TMJ) disorders caused by neurofibroma in the joint capsule or disc have not been reported previously in the English language literature. A case of neurofibroma in the TMJ articular disc in a 29-year-old woman with neurofibromatosis Type I is presented.

Adult↗