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At least 991 records · Page 55Linked to original sources

PubMed2004

Assessment of the efficacy of joint lavage versus joint lavage plus corticoids in patients with osteoarthritis of the knee.

PURPOSE: Joint lavage (JL), involves the passage of cold sterile 0.9% saline through the knee joint in order to have the fluid reach the inside of the joint capsule. This technique was evaluated as a local treatment for osteoarthritis (OA) of the knee alone (JL) and in combination with intra-articular infiltration with glucocorticoids (JLC). PATIENTS AND METHODS: An overall 299 knees belonging to 205 patients (22% males, 78% females) with a mean age of 67 +/- 8 years and osteoarthritis of the knee of radiological grade II or III on the Kellgren scale were randomised in the ratio of 1:4 into two therapeutic groups, namely: JL (n = 62) and JLC (n = 237). All patients received joint lavage on day 0; in those of the JLC group, joint lavage was followed by infiltration of 40 mg of triamcinolone acetonide. The efficacy of both treatments was assessed by recording the corresponding values for the following variables: pain strength as measured by a visual analogy scale (VAS), effusion, crepitation, restricted motion, of osteoarthritis of the knee. spontaneous pain, pain on pressure, pain on passive motion and pain on active motion; all of these were recorded at the onset of the study, and after 1 and 3 months. RESULTS: There were no significant differences in the values of the variables at the different followup times. Also, pain severity was similar in both treatment groups. Thus, VAS for pain was 7.3 +/- 0.3 for the JL group and 7.1 +/- 0.2 for the JLC group at the onset, and decreased to 3.0 +/- 0.3 in the former and 2.8 +/- 0.2 in the latter after 1 month; the decrease was statistically significant in both cases. After 3 months, the JL and JLC groups had a VAS of 3.5 +/- 0.3 and 3.8 +/- 0.2, respectively. CONCLUSIONS: The results of this work suggest the absence of significant differences between the two treatments, such that both joint lavage alone and with infiltration with corticoids can be concluded as similarly effective for the symptomatic management

Adrenal Cortex Hormones↗

PubMed2003

High occurrence of a basicranial feature in Homo erectus: anatomical description of the preglenoid tubercle.

The degree of differentiation between Western and Eastern Early Middle Pleistocene hominids (Homo erectus) is still under debate. On the one hand, the two populations are believed by some to belong to two separate taxonomic categories possessing their own exclusive features. On the other hand, they are considered by others to belong to a single but ubiquitous global population with regional specificities that are mainly due to variations in the frequency of certain features. In this context, an additional trait, the preglenoid tubercle (tuberculum anterius fossae mandibularis), may well shed light on the matter. The tubercle is often present on the anterior part of the fossa mandibularis at the anterior extent of the joint capsule and articular tubercle (tuber articulare) of fossils usually assigned to Homo erectus. This study describes the anatomy of the preglenoid tubercle, to indicate its occurrence and to try to improve its use in taxonomy and phylogeny, although its origin and functional significance have not yet been clarified.

Animals↗

PubMed1974

A study of single axons in the cat's medial lemniscus.

1. A method was developed for locating the rostral part of the medial lemniscus in anaesthetized cats and then exploring it with a micro-electrode selective for single axons. Records were made from 165 axons, all shown histologically to lie in the lemniscus.2. Almost all lemniscal axons responded at short latency to a shock through surface electrodes over the dorsal columns at C2. The great majority probably belonged to the dorsal column-lemniscal system, though some may have belonged to other (e.g. spinocervicothalamic) systems.3. Resting discharge was seen in almost all axons in the absence of any stimulation, and must have been generated almost entirely in the relevant relay nuclei, particularly since in many axons it was easily depressed or totally inhibited by appropriately placed mechanical stimulation of skin or a shock to the dorsal columns.4. For each fibre held for an adequate length of time, the receptive field, if accessible, was classified as accurately as possible. Fifty-two axons were precisely categorized in this way: many more were studied for long enough to yield useful information.5. One half (twenty-six) of the best categorized axons had receptive fields suggesting excitation by only one type of receptor: fifteen by tylotrich hairs, four by rapidly adapting tactile foot pad receptors, two by claw movement, two by cutaneous touch corpuscles and three by Type II cutaneous receptors. Rigidly held probes driven by electromechanical transducers were used to establish stimulus/response relations. Adjacent or surround inhibition was seen in nearly all these fields, except for the Type II category.6. The other half (twenty-six) of the best categorized axons showed various degrees of inter-receptive excitatory convergence. Five responded to all types of hair, twelve to hair movement and foot-pad displacement, and nine to hair movement combined with inputs from a variety of slowly adapting receptors in skin or deep tissues, thresholds for the latter ranging from light contact to noxious pressure.7. Forty axons responded with a slowly adapting discharge to joint movement, some with properties suggesting that their receptors did not lie in the joint capsule itself. The high threshold of most of these axons to dorsal column stimulation suggested that the relevant primary axons lay either deep in the dorsal column or in some other tract.8. Of axons whose receptive fields were accurately located, 88% lay in forelimb or upper trunk - the remainder in lower trunk, hind limb or tail. The forepaw accounted for 41% of the former group. Axons with receptively ;pure' properties tended to lie in central or deep parts of the main lemniscal mass at the level studied. Axons responding to joint movement tended to lie deep in the main mass and in the ventromedial lemniscal bundle. There was some clustering of axons with identical receptive properties.

Action Potentials↗

PubMed1995

Considerations about a unique clinical pattern: flexion block of the shoulder.

Frozen shoulder is a well-defined nosologic entity characterized by retraction of the anterior portion of the glenohumeral joint capsule. When clinical findings are inconclusive, arthrography can differentiate a frozen shoulder from a stiff and painful shoulder. We report three cases of stiffness of the shoulder that we believe was due to a unique pathological process. Flexion was restricted to 120 degrees and a sensation suggestive of mechanical blockage was felt upon passive flexion. Medical rotation was restricted and painful, whereas lateral rotation with the elbow held against the torso was normal. Findings upon arthrography or magnetic resonance imaging were normal, with no evidence of capsulitis or chronic rotator cuff lesions. Our pathogenic hypotheses include a lesion of the proximal portion of the long head of the biceps brachii or a focal ligamentous lesion. Treatment should consist of specific physical therapy and, in refractory forms, gentle mobilization under general anesthesia.

Adult↗

PubMed1977

[Ganglion recidives of the knee joint. Arthrography and clinic (author's transl)].

56 patients with 59 operated popliteal cysts were controlled clinically and by arthrography. In 14.3% (8 knee-joints) a recidive was found. In 64% the arthrogram showed a tout outline of the joint-capsule. In 30% a small and big bursa was seen. Recessus with long narrow handle can be a potential recidive of ganglion. Clinic and arthrogram allow to make a difference between "recidive" and "ganglion". The clinical recidive may be a new "ganglion".

Adult↗

PubMedDate not supplied

Acquired valgus instability after knee replacement.

Four cases of acquired valgus instability occurred after knee resurfacing operations; all four were initially stable. Three cases originally had a varus deformity which required extensive releases for its correction. All of these patients fell, disrupting the medial joint capsule and medial collateral ligament. This complication in the two early cases could have been prevented by adequate bracing until full recovery of the quadriceps had occurred. In one case, attribution due to projection medially of the tibial component may have played a role. In the fourth case, the tibial component was inserted with the tibia in external rotation, thus advancing the tibial attachment of the medial collateral ligament, which was disrupted during manipulation to gain flexion. The simplest treatment for this complication is probably to brace the knee until the joint reaction settles and then revise to a fully constrained prosthesis.

Aged↗

PubMed1975

[Proximal interphalangeal articulation in man].

A report is presented on microdissections of the proximal interphalangeal joint, in particular the proximal attachments of volar plate and tendon sheath. The proximal anchorage of the joint capsule is assured by three components, occurring bilaterally. A. Laterobasal and retrochlear fibres. B. An internal cord which inserts along the inner side of the line of attachment of the osteofibrous sheath of phalanx I; C. The cruciform ligament of the sheath which is inserted at the outer side of the osteofibrous sheath of phalanx I.

Connective Tissue↗

PubMed1993

Extra-articular augmentation for residual hip dysplasia. Radiological assessment after Chiari osteotomies and shelf procedures.

The Chiari osteotomy and various shelf procedures are used to augment the weight-bearing area in dysplastic acetabula. The new articular surface derives by metaplasia from the acetabular rim and joint capsule, and is therefore of poorer quality than congruous hyaline cartilage. We reviewed 32 patients after augmentation procedures, using conventional radiographs and three-dimensional reconstruction from CT scans. We showed that Chiari osteotomy and shelf procedures generally achieve less than complete cover, especially over the posterolateral quadrant of the femoral head. Our results suggest that alternative methods which reorientate the whole of the acetabulum are the treatment of choice. Augmentation procedures remain as a salvage option when reorientation is inappropriate or the original hyaline cartilage surface is absent, as in subluxed joints with a secondary acetabulum. Computerised assessment is recommended before operation to assess existing cover and the possible extent of provision of new cover.

Adolescent↗

PubMed1977

[Etiology and pathogenesis of neurological symptoms in low bite].

50 patients were subjected to complex examination. In bite lowering the head of the condyle is displaced backwards and upwards into the depth of the glenoid fossa. The pressure of the displaced mandibular joints upon the arterial cord and the tympanic vein as well as upon the venous network around the mandibular joint capsule may produce disturbed blood supply to the mucosa of the middle ear and of the auditory tube, and finally, obstruction of the auditory tube. Disturbances in the blood supply of the middle ear irritate the tympanic cord and tympanic plexus, which causes burning of the tongue, taste and salivation troubles, and also ear complaints. Since the sympathetic fibres of the tympanic plexus and of the eye are closely interrelated, this leads also to an irritation of the dilator muscle of the pupil. The reflectory irradiations from the tympanic plexus and mandibular joint explain many other neurologic symptoms. In bite lowering these symptoms are not always associated with joint disturbances.

Adult↗

PubMed1995

Tophaceous pseudogout (tumoral calcium pyrophosphate dihydrate crystal deposition disease).

Most cases of calcium deposition seen radiologically in soft tissues are caused by calcium hydroxyapatite and occur either as a complication of trauma with associated necrosis (eg, fat necrosis), generalized connective tissue diseases (eg, scleroderma), metabolic disturbances (eg, hyperparathyroidism, familial hyperphosphatemia), sarcoidosis, myeloma, or metastases. Hydroxyapatite deposits are seen at many soft tissue sites, including joint capsules, ligaments, blood vessels, dermis, etc. On the other hand, deposits of calcium pyrophosphate are seen typically in the meniscus, articular cartilage, ligamentum flavum, and intervertebral disc. They usually are punctate or linear in distribution within the meniscus or parallel to the subchondral bone end plate. We report seven cases of massive focal calcium pyrophosphate dihydrate (CPPD) crystal deposition disease (tophaceous pseudogout) that occurred in atypical locations for CPPD. The ages of the patients ranged from 31 to 86 years (average, 60.7 years). One patient was male and six were female. The temporomandibular joint was involved in three patients and the metatarsophalangeal joint of the great toe was involved in two patients. The hip joint and cervical spine were involved in one patient each. A mass or swelling with or without pain was a common symptom. None of the patients in our series had clinical or radiographic evidence of CPPD crystal deposition disease in any other joints. Roentgenograms showed calcified lesions with a granular or fluffy pattern. Histologically, the lesions showed small or large deposits of intensely basophilic calcified material containing needle shaped and rhomboid crystals with weakly positive birefringence characteristic of CPPD. Foreign body granulomatous reaction to the CPPD deposition was constantly found. Chondroid metaplasia around and in the areas of CPPD deposition was observed commonly. Some of the chondroid areas showed cellular atypia in chondrocytes suggestive of a malignant cartilage tumor. It is important to recognize this rare form of CPPD crystal deposition disease and to identify the CPPD crystals in the calcified deposits, thus avoiding the misdiagnosis of benign or malignant cartilaginous lesions.

Adult↗

PubMed1999

Cartilage and synovium of the peroneocuboid joint: an anatomic and histological study.

The surface area, thickness, and composition of the articular cartilage of the peroneocuboid articulation and the location of the synovium were investigated in 15 cadaver foot specimens. The articulations of the medial side of the peroneus longus tendon and lateral side of the cuboid were covered with fibrous and hyaline cartilages, respectively. On the lateral tuberosity of the cuboid, there is a facet that has 79.37+/-20.24 mm2 articular cartilage area with an oval shape to conform to that of the articular surface of the peroneus longus tendon (articular cartilage area, 67.35+/-28.53 mm2) with which it articulates. The mean thickness of the articular cartilage of the peroneus longus tendon and cuboid was 0.34+/-0.08 and 0.52+/-0.07 mm, respectively. The peroneocuboid joint has its own joint capsule. The synovial cavity does not communicate with the sheath of the peroneus longus tendon. Synovial membranes were attached to the margins of the articular surfaces of the cuboid immediately peripheral to the cartilage region.

Adult↗

PubMed1986

Computed tomography and ultrasonography for diagnosis of hip joint effusion in children.

Nineteen consecutive children with transient synovitis of the hip were examined for intracapsular joint effusion using computed tomography (CT) and ultrasonography (US). The two techniques were highly correlated in measurements of the anterior displacement of the joint capsule, indicating both to be reliable diagnostic tools. Such an effusion is clinically important because of the increase in intracapsular pressure with ensuing disturbance in the vascular supply to the proximal femoral epiphysis, as demonstrated experimentally and clinically in transient synovitis.

Child↗

PubMed1993

Acute injury of the neck: anatomical and pathological basis of pain.

Headache, upper torso and upper limb pain can all originate in lesions of the cervical spine. The pain distribution is similar whether the cause is traumatic or degenerative. Nociceptive fibres are present in many cervical spine structures including the disc annulus, facet joint capsules, muscles, meninges, arteries, nerve roots and dorsal root ganglia. Such nerves are not present in the disc nucleus, facet articular cartilages and the ligamentum flavum. Central nervous connections between the trigeminal nucleus and upper cervical sensory input provide an explanation for some forms of headache and facial pain. This paper focuses on neck sprain from road traffic accidents as a cause of pain. Similar lesions are seen in the cervical spines of those who die immediately and survivors who die some years after a neck injury, from unrelated causes. Both discs and facet joints are injured. The common disc injury is a "rim lesion" or transverse tear near the anterior vertebral rim. It is caused by distraction and shearing in sudden extension. Both the posterior disc and the facets are compressed, causing disc contusion or herniation, facet haemarthroses, bruising around the C2 nerve, or fractures of articular processes. Suboccipital vascular congestion and annulus calcification are also seen in the "survivors". Chronic pain develops in 20-40% of the "survivors". The reasons include altered spinal mechanics, neural damage and vascular changes. Management must always start with an accurate diagnosis based on a history and physical examination. Simple investigations such as extension X-rays may reveal vacuum clefts in the same anatomical position as rim lesions. Nuclear scans detect increased uptake at damaged end plates or facet fractures.(ABSTRACT TRUNCATED AT 250 WORDS)

Accidents, Traffic↗

PubMed1997

Symptomatic herniation pits of the femoral neck: anatomic and clinical study.

OBJECTIVE: The purpose of this study was to investigate the pathogenesis of herniation pits of the femoral neck, which are frequently considered a normal variant, and to describe the imaging abnormalities of such pits in three symptomatic patients. CONCLUSION: The changing relationship between the joint capsule and the iliopsoas muscle appears to be important in the pathogenesis of the herniation pit, especially in athletic persons. In some cases, these pits may enlarge, the overlying cortex may fracture, and significant clinical manifestations may be apparent.

Adult↗

PubMed1989

[Temporomandibular joint dysfunction and neurofibromatosis. Apropos of a case].

The authors report one case of Von Recklinghausen's disease localized to the temporomandibular joint capsule and unilaterally associated with other cephalic manifestations. Although no other study, notably a CAT-scan, showed this tumor localization, surgical exploration was imperative and led to exeresis of the lesion which proved to be the treatment of choice.

Adult↗

PubMed2004

The cannabinomimetic arachidonyl-2-chloroethylamide (ACEA) acts on capsaicin-sensitive TRPV1 receptors but not cannabinoid receptors in rat joints.

The vasoactive effects of the synthetic cannabinoid (CB) arachidonyl-2-chloroethylamide (ACEA) was tested in the knee joints of urethane-anaesthetised rats. Experiments were also performed to determine whether these vasomotor responses could be blocked by the selective CB(1) receptor antagonists AM251 (N-(piperidin-1-yl)-5-(4-iodophenyl)-1-(2,4-dichlorophenyl)-4-methyl-1H-pyrazole-3-carboxamide) (10(-9) mol) and AM281 (1-(2,4-dichlorophenyl)-5-(4-iodophenyl)-4-methyl-N-4-morpholinyl-1H-pyrazole-3-carboxamide) (10(-8) mol), as well as the selective CB(2) receptor antagonist AM630 (6-iodo-2-methyl-1-[2-4(morpholinyl)ethyl]-[1H-indol-3-yl](4-methoxyphenyl)methanone) (10(-8) mol). Peripheral application of ACEA (10(-14)-10(-9) mol) onto the exposed surface of the knee joint capsule caused a dose-dependent increase in synovial blood flow. The dilator action of the CB occurred within 1 min after drug administration and rapidly returned to control levels shortly thereafter. The maximal vasodilator effect of ACEA corresponded to a 30% increase in articular perfusion compared to control levels. The hyperaemic action of ACEA was not significantly altered by coadministration of AM251, AM281 or AM630 (P>0.05; two-way ANOVA). The transient receptor potential channel vanilloid receptor 1 (TRPV(1)) antagonist capsazepine (10(-6) mol) significantly reduced the vasodilator effect of ACEA on joint blood vessels (P=0.002). Furthermore, destruction of unmyelinated and thinly myelinated joint sensory nerves by capsaicin (8-methyl-N-vanillyl-6-nonenamide) treatment also attenuated ACEA responses (P<0.0005). These data clearly demonstrate a vasodilator effect of the cannabinomimetic ACEA on knee joint perfusion. Rather than a classic CB receptor pathway, ACEA exerts its vasomotor influence by acting via TRPV(1) receptors located on the terminal branches of capsaicin-sensitive afferent nerves innervating the joint.

Animals↗

PubMed1976

Plantar aponeurosis and internal architecture of the ball of the foot.

On the basis of its internal structure, the ball of the foot can be divided into three transverse areas, each with a different mechanical function: (1) an area proximal to the heads of the metatarsals in which the retinacula cutis are developed into a series of transverse bands, and in which the deep fibres of the plantar aponeurosis form ten sagittal septa connected to the deep transverse metatarsal ligament and through this the proximal phalanges of the toes, (2) an area below the heads of the metatarsals in which vertical fibres from the joint capsules and the sides of the fibrous flexor sheaths form a cushion below each metatarsal head, and in which fat bodies cover the digital nerves and vessels in their passage between the cushions, and (3) a distal area which comprises the interdigital web. The superficial fibres of the plantar aponeurosis are inserted into the skin of this distal area, and deep to them the plantar interdigital ligament forms a series of transverse lamellae connected to the proximal phalanges by a mooring ligament which arches from one fibrous flexor sheath to the next. When the metatarsophalangeal joints are extended, the fibres of the three areas are tensed and the skin is anchored firmly to the skeleton. The direction of the fibres in the distal and proximal area promotes the transfer of forces exerted on the skin during push-off and braking respectively, while the intermediate area is adapted to bear the weight of the body. A concentration of Pacinian corpuscles is found along the digital nerves in the weight-bearing area below the transverse metatarsal ligament. The nerves for the second, and especially for the third, interstice are close to or in contact with the sharp proximal edges of the sagittal septa.

Connective Tissue↗

PubMed1982

Performing shoulder arthrography without image converters in the field of orthopedic accident surgery.

This paper describes a method by which a shoulder arthrography may be carried out without the aid of fluoroscopy. To provide all patients with the best therapy possible, one should be able to perform arthrographies without having to own an image intensifier. The process of mixing a radiopaque substance with a local anesthetic agent combined with air will in itself dissolve existing adhesions during the tapping of the joint, as a result of which this diagnostic procedure will turn into therapy. In cases of extensive lacerations of the joint capsule, it is not possible to obtain a clear outline of the intra-articular structures, but on the other hand we shall frequently meet with a diffuse outflow of the mixture into the surrounding musculature. No allergic reactions to the radiopaque substance were observed.

Adolescent↗