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Physiological characteristics of low-threshold mechanoreceptors in joints, muscle and skin in human subjects.

1. The development of microneurography, in which an insulated tungsten microelectrode is inserted into an accessible peripheral or cranial nerve in awake human subjects, has allowed detailed analyses of the signalling capacities of single mechanoreceptive afferents from the skin, muscles and joints. For example, we know much about how the two classes of rapidly adapting (Meissner and Pacinian) and two classes of slowly adapting (Merkel and Ruffini) cutaneous mechanoreceptors encode forces applied normal or tangential to the skin of the hand and the similarities and differences in glabrous versus non-glabrous skin (and receptors associated with hairs). We also know about stretch- and force-sensitive endings in muscle (the muscle spindle and Golgi tendon organ, respectively) and how they behave during passive or active movements or during isometric contractions. In addition, we have characterized the firing properties of mechanoreceptors in the joint capsules of the fingers. However, we know little about sensory nerves in the periosteum, other than that nociceptors and Pacinian corpuscles exist. 2. In addition to studies on the physiology of sensory endings in human subjects, microstimulation through the recording microelectrode has revealed how the brain deals with the sensory information conveyed by a single afferent. From this work, we know that there is specificity in the sensory channels: electrical stimulation of a single Meissner or Pacinian corpuscle generates frequency dependent illusions of 'flutter' or 'vibration', whereas microstimulation of a single Merkel afferent can produce a percept of 'pressure' and stimulation of a single joint afferent can evoke a sensation of 'joint rotation'. Interestingly, the input from a single Ruffini ending in the skin cannot be perceived and the same is true of muscle spindle afferents. So, where does this leave us with osseoperception from the mouth? Given that the periodontal receptors in the vicinity have been lost, which mechanoreceptive endings could encode forces applied to a bone-implanted prosthesis? 3. Meissner and Merkel endings have very small receptive fields and respond only to local forces. Pacinian corpuscles have an exquisite sensitivity to brisk mechanical events and could respond to such stimuli transmitted through the bone to a remote receptor, but would not be able to encode sustained forces. Ruffini endings also respond to forces applied remote to the receptive field and, unlike the Pacinian corpuscles, respond in a sustained fashion, but would their signals be perceived? Like muscle spindles, it is possible that the coactivation of many Ruffini endings could provide meaningful information. Finally, as we have seen, the input from a single joint receptor can be perceived, but they mostly respond at the limits of joint rotation, so it is unlikely that any associated with the temporomandibular joint could contribute to osseoperception.

Animals↗

Roentgen anatomy of the posterior horn of the lateral meniscus.

The roentgen anatomy of the posterior horn of the lateral meniscus of the knee is presented with particular attention to the relationships between the popliteus tendon, joint capsule and meniscus. The popliteus tendon creates a tunnel as it passes obliquely through the posterior half of the meniscus creating two walls (medial and lateral) and a roof (superior attachment) and a floor (inferior attachment). The boundaries are readily visible on the double-contrast knee arthrogram. Familiarity with these relationships aids in the diagnosis of meniscal injuries.

Humans↗

Therapies for psoriatic enthesopathy. A systematic review.

Enthesitis is defined as inflammation at sites of tendon, ligament, joint capsule, or fascia insertion sites to bone, and is a hallmark feature of psoriatic arthritis. Several outcome measures have been developed to assess enthesitis, but none have been validated in psoriatic arthritis. In this evidence-based review, we assess the limited data on treatments for enthesitis and make recommendations for further studies in psoriatic enthesitis.

Antirheumatic Agents↗

Conscious neurosensory mapping of the internal structures of the human knee without intraarticular anesthesia.

The conscious neurosensory characteristics of the internal components of the human knee were documented by instrumented arthroscopic palpation without intraarticular anesthesia. With only local anesthesia injected at the portal sites, the first author (SFD) had both knees inspected arthroscopically. Subjectively, he graded the sensation from no sensation (0) to severe pain (4), with a modifier of either accurate spatial localization (A) or poor spatial localization (B). The nature of the intraarticular sensation was variable, ranging from 0 on the patellar articular cartilage to 4A on the anterior synovium, fat pad, and joint capsule. The sensation arising from the cruciate ligaments ranged from 1 to 2B in the midportion, and from 3 to 4B at the insertion sites. The sensation from the meniscal cartilages ranged from 1B on the inner rim to 3B near the capsular margin. Innervation of most intraarticular components of the knee is probably crucial for tissue homeostasis. Failure of current intraarticular soft tissue reconstructions of the knee may be due, in part, to the lack of neurosensory restoration. Research studies of the knee designed to delineate factors that restore neurosensory characteristics of the musculoskeletal system may lead to techniques that result in true restoration of joint homeostasis and function.

Anesthesia, Local↗

Repair of the ligaments about the knee.

The evolution of techniques used to repair torn ligaments about the knee is described. A combination of repairs of the anterior cruciate ligament, medial collateral ligament, and posterior joint capsule along with transfer of the medial half of the semimembranosus tendon and transfer of the pes anserinus is described. The surgical procedures have been evolved over a three year period in an orthopedic practice in a skiing and resort community. These combinations of surgical techniques can insure stable knees for active persons without the need to resort to more formal and more extensive surgical procedures. It is also thought that repair of both fresh and old ligament tears in the manner described gives the athletic individual a better chance for continuing in recreational and competitive sports, as well as reducing the possibility of lateral degenerative joint changes.

Athletic Injuries↗

The quantitative morphology of interstitial tissue channels in some tissues of the rat and rabbit.

The water-rich phase (tissue channels) of the intersititial tissue in rat ileum, knee joint capsules, kidneys, and implanted Guyton's capsules was examined electron microscopically by the SEM of plastic injection models, and by TEM and HVEM of ferrocyanide and ferritin as tracers. It was shown that the channels do in fact exist, and are not just vacuoles. Quantitative estimations of their numbers and diameters were made. These agreed well with estimates made by other methods.

Animals↗

Intra-articular pressure measurements in patients with suddenly developing, severely limited mouth opening.

A condition of sudden, severe, and persistent limited mouth opening, which readily responds to arthrocentesis, is postulated to be the effect of a vacuum between disc and fossa in the upper compartment of the temporomandibular joint. In 16 patients with this condition, the negative intra-articular pressure was found to be significantly lower (mean, -82.6 +/- 25.4 mm Hg) than in the control group (mean, -7.7 +/- 2.5 mm Hg) (P less than .0001). It is suggested that the process underlying the vacuum effect starts with persistent pressure (eg, clenching) resulting in the viscoelastic disc being pressed flat against the fossa. Immediately on cessation of the pressure, the disc resumes its natural biconcave shape, but its rims remain fastened to the fossa. The consequent increased negative pressure in the closed space created firmly anchors the disc to the fossa and any attempt to elicit condyle and disc sliding will only stretch the joint capsule and cause pain. This, in turn, will reflexly prevent the pterygoid muscle from exerting sufficient force to pull the disc and thus release the vacuum. This chain of events may account for the severe and persistent limitation in jaw movement and for the easy reversal of the condition by simple nonsurgical treatment.

Adolescent↗

The subscapular and subcoracoid bursae: descriptive and functional anatomy.

The subscapularis and subcoracoid bursae, as well as the subscapularis muscle, were studied in 42 fresh cadaveric shoulders. Fibrous bands were found in the medial part of the muscle; they were intercalated with the distal tendon-like bands. The superior distal fibrous band was always found to be thicker than the others. Strong fibrous attachments of the subscapularis muscle were found along the lateral border of the scapula as well as along the medial third of the bony crests in the subscapular fossa. Between the crests, the muscle bundles were directly attached to the bone. In the lateral part of the scapula, the subscapularis muscle had only weak connective links with the bone. The subscapularis bursa was found in all cases as a pouch strongly attached to the scapular neck and the adjacent part of the joint capsule. The top of the bursa was linked to the coracoid process by a fibrous attachment called the suspensory ligament. The subcoracoid bursa had only weak connective links with the coracoid process. In 28% of cases, the subscapularis and subcoracoid bursae merged into a unique wide bursa. The subscapular bursa had two types of links with the muscle: (1). weak connective links with the superficial muscle bundles and (2). at least 2 fibrous arcs joining the lateral tendon-like bands, the bursa, and bony crests of the subscapularis fossa. These arcs allow the bursa to follow the course of the muscle exactly. During movements of the glenohumeral joint, the subscapularis muscle sustains huge changes of orientation, particularly the upper part of the muscle that coils around the coracoid process. The strong superior fibrous band enables the muscle to maintain contact with the coracoid process. It is the function of the subscapularis and subcoracoid bursae to manage the friction of the superficial fibers against the scapular neck, the humeral head, and the coracoid process.

Aged↗

Morphology of the musculus articularis genus in dog with description of ectopic muscle spindles.

The gross morphology of the musculus articularis genus and the location of muscle spindles at its point of insertion were studied in 18 adult dogs. The m. articularis genus was usually small and bipartite. From its originate on the cranial surface of the distal femur, it passed distally to terminate at the femoropatellar-joint capsule surface and extend into the synovial membrane. Although the m. articularis genus was usually composed of two parts, only a medial part was present in some dogs and was entirely absent in one specimen. Innervation to the m. articularis genus was provided by a branch of the femoral nerve. Muscle spindles were abundant in the termination of the muscle. spindles were abundant in the termination of the muscle. Frequently, the spindles were not in contact with muscle fibers (dissociated). Muscle spindles were located in close proximity to the surface of the synovial membrane. Morphological adaptations of the m. articularis genus support its potential function as a monitor of joint movement rather than an extensor of the stifle joint.

Animals↗

[Technical aspects and value of arthrosonography in rheumatologic diagnosis. 4: Ultrasound of the elbow].

Musculoskeletal ultrasonography is an important imaging technique in the diagnosis of rheumatic diseases especially for early manifestation. It allows sensitive detection of small joint fluid collections as well as differentiation of soft tissue lesions and bone lesions. The following standard scans are suggested for sonographic evaluation of the elbow: 1) anterior humeroradial longitudinal scan, 2) anterior humeroulnar longitudinal scan to detect effusions, synovial proliferation, loose joint bodies, bone lesions (osteoarthritis/arthritis), 3) anterior transverse scan over the trochlea to evaluate these structures in an additional dimension, 4) posterior longitudinal scan and 5) posterior transverse scan of the olecranon fossa with flexed/extended elbow to evaluate the same objectives as the above mentioned scans and additionally to detect olecranon bursitis, and optional 6) distal dorsal longitudinal scan to differentiate soft tissue lesions such as rheumatoid nodules or gout tophi, 7) anterior transverse scan over the radius head to evaluate lesions of the radius head, tendopathy, calcinosis, 8) lateral humeroradial longitudinal scan to evaluate epicondylitis, 9) medial humeroulnar longitudinal scan to evaluate calcinosis, epicondylitis, signs of compression of the ulnar nerve. A linear transducer with a frequency of about 5-7.5 MHz is recommendable. The anterior distance between trochlea and the capitulum of the humerus between the bone and the joint-capsule of the elbow is > or = 2 mm in probable and > or = 3 mm in definite synovitis or effusions. Synovitis or effusions are probable if the difference between the right and left elbow is 1 mm, and they are definite if the difference is > or = 2 mm.

Arthritis, Rheumatoid↗

[Dynamics of morphologic changes in joint innervation during hypokinesia--a space flight model factor].

Using statistical treatment, a neuromorphological examination of the joint capsule of rats exposed to hypokinesia for 7, 15, 20, 30, 40, and 60 days was carried out. The exposure to 7 days caused an increase in the number of reactively changed nerve fibers and receptors. The exposure to 15 days resulted in a significant increase of the number of nerve fibers with destructive changes that involved mostly large-caliber fibers. However, 20- and, especially, 30-day hypokinesia was followed by a significant reduction of destructive changes. After 40- and 60-day exposure they again became very distinct. This suggested a wave-like pattern of structural changes. At every stage of experimental hypokinesia all the compartments of the joint nervous apparatus showed adaptive-compensatory reactions.

Adaptation, Physiological↗

M. articularis genus. Observations on arrangement and consideration of function.

On the basis of 44 adult Japanese cadavers, the mode of origin, insertion and innervation of the articularis genus muscle (m. articularis genus: AG) is described. All the muscle bundles that are inserted into the posterior aspect of the synovial membrane of the joint capsule as well as the suprapatellar bursa are defined as AG. The inserting fibers spread medially and laterally over the subsynovial connective tissue which is the outer layer of synovial membrane facing the femur. The fatty tissue between each muscle bundle gradually increases with depth. A few deeper muscle bundles of AG seem to be separated by a layer of fat from those of the superficial layer. The deepest muscle bundles arise from the anterior surface of the femur at a slightly lower level than the proximal apex of the suprapatellar bursa. It is inserted into the synovial membrane at the level of the junction of the suprapatellar bursa and proper joint cavity when the knee is extended. It is difficult to distinguish AG from m. vastus intermedius (Vi) only on the basis of the manner of origin and the surrounding fatty tissue. The innervation is in common with that of Vi, namely, a few nerves which run down obliquely to the lower medial part of Vi.

Adult↗

Boxer's knuckle--dorsal capsular rupture of the metacarpophalangeal joint of a finger.

An injury to the dorsal aspect of the metacarpophalangeal joint of a finger usually damages the sagittal fibers of the extensor tendon mechanism. Rupture of the underlying joint capsule, a far more serious injury, has received scant attention in the medical literature. The problem is often unrecognized because the extensor tendon may remain in its normal midline position. Eight dorsal capsular ruptures are described in six patients who had closed direct trauma to either the knuckle of their index or long fingers. Most of the injuries occurred in professional boxers.

Adult↗

Histology of the bone-implant interface 45 years after bilateral implantation of a Judet acrylic hip prosthesis: a case report.

The Judet acrylic femoral head hemiprosthesis was first implanted in 1946. We performed bilateral revision in one patient 45 years after implantation of a Judet prosthesis. Histological analysis of femoral neck remnants and joint capsule did not show aggressive osteoclastic bone resorption or signs of dynamic bone apposition as is frequently observed nowadays with failed total hip prostheses. Only limited tissue reaction was seen with some macrophages with a foamy cytoplasm. This case report confirms the extremely good tissue tolerance of PMMA, as reported by Judet in 1950, even after 45 years follow-up.

Follow-Up Studies↗

Responses of bone and joint blood vessels in cats and rabbits to electrical stimulation of nerves supplying the knee.

1. Experiments were performed to assess the extent to which knee joint blood flow in cats and rabbits is affected by electrical stimulation of the nerve supply to the knee. 2. Absolute changes in blood flow were measured using the radiolabelled microsphere (approximately 15 microns) technique whilst relative changes in blood flow were assessed using laser Doppler flowmetry. 3. Despite deep general anaesthesia, sympathetic nerve fibres innervating cat knee joint blood vessels showed marked 'tone'. 4. Blood flow to the joint capsule (synovium and overlying fibrous and areolar tissues) was substantially reduced (by approximately 90% in the cat and approximately 45% in the rabbit) during electrical stimulation of the articular nerve supply. 5. The percentage change in the laser Doppler flowmeter signal did not differ significantly from the percentage change in blood flow measured by microsphere technique. 6. Blood vessels in the cancellous bone of the distal femur (condyles) and proximal tibia (plateau) appear to be innervated by vasoconstrictor fibres which reach their effectors via the articular nerves. However, the cortical bone and red marrow of the diaphysis of the femur do not receive such innervation. 7. The potency of the vasoconstrictor influences acting on joint blood vessels could be of relevance in the pathogenesis of inflammatory joint diseases.

Anesthesia, General↗

Hip dysplasia in rabbits: association with nest box flooring.

PURPOSE: To study etiologic aspects of hip dysplasia in a colony of Dutch-belted rabbits. METHODS: Rabbits used in the study were part of a reproductive toxicologic study. Incidence of hip dysplasia among 296 Dutch-Belted rabbit kits raised on waxed cardboard, smooth Plexiglas, or Plexiglas covered with textured adhesive strips was recorded. All animals were examined at 2 to 4 weeks of age for inability to adduct one or more limbs, then were classified as normal or dysplastic. A subset of 16 juvenile male rabbits (4 normal, 12 affected) raised on Plexiglas flooring were given a physical examination at 12 weeks of age followed by complete necropsy. In four animals (one normal, three affected), pelvic radiography and neurologic examination were performed. RESULTS: Seven percent of the rabbits kits reared on waxed cardboard flooring and 22% of those reared on smooth Plexiglas flooring developed hip dysplasia. Animals reared on Plexiglas floor with traction strips did not have evidence of hip dysplasia. Among the animals selected for detailed analysis, body weight was similar between rabbits with or without splay leg. Affected animals had splaying of one or both hind limbs, various degrees of flattening and reduction of the size of the femoral head, subluxation of the hip, valgus deformity, and patellar luxation. Histologically, there was marked thickening of the hip joint capsule with fibrocartilage formation, mild trabecular bone loss, and bony sclerosis of the proximal portion of the femur and adductor muscle hypoplasia. CONCLUSIONS: Provision of non-slippery flooring during the postnatal period is critical in preventing development of hip dysplasia in rabbits. Hip dysplasia resulted in significant musculoskeletal changes, but not abnormal neurologic development.

Animal Husbandry↗

[Disarticulation of the knee. Surgical technic--prosthesis fitting].

The authors describe a modified technique for knee joint disarticulation surgery. Their approach provides two flaps, one medial and one lateral, which result in a posterior, longitudinal scar that remains outside the contact areas of the prosthesis. They abrade the lateral and posterior aspect of each condyle, peeling out the articular cartilage and re-covering the condyles with the joint capsule. This technique allows a satisfactory stability in prosthetic rotation, and improves the appearance of the artificial limb. For post-operative rehabilitation the authors use a tridimensional alignment jig and a prosthetic ankle with three degrees of freedom: flexion-extension, lateral-medial motion and rotation, making easier the swing phase while maintaining the obvious advantages of a pilon-type prosthesis.

Amputation, Surgical↗

Differential diagnosis in variants or abnormalities of the hip on MRI.

In the differential diagnosis of unspecific hip pain MRI becomes increasingly important. In particular it is useful in the diagnosis of avascular necrosis, primary and secondary bone tumors, osteomyelitis and synovial processes. According to the higher frequence of MR examinations of the hip the number of nonpathological incidental findings is rising. 39 'pitfalls' and abnormalities were found on MRI of 152 patients with unspecific hip pain. Soft tissue penetrating cortical lesions of the femoral neck (herniation pit, n = 4), physiological changes of bone marrow, synovial proliferation (n = 6) of the hip joint capsule, epiphyseal scars of the femoral head (n = 12) and the transient osteoporosis (n = 12) are some of the morphological changes of the hip, which may cause difficulties and misinterpretations on MRI of the hip. Knowledge of their radiological characteristics on MRI is important, especially in cases of unspecific hip pain.

Adult↗