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PubMed1981

Pyrophosphate arthritis with local amyloid deposition.

Pyrophosphate and capsular chondromatosis were demonstrated histologically in 15 cases, 14 of which also exhibited local deposition of amyloid. A systematic examination of the joint capsule in 57 consecutive hip replacement operations for osteoarthritis revealed these changes in 6 of the cases (10.5 per cent). Microscopic examination which was done if intraarticular calcifications were grossly visible at operation, showed the same changes in 8 knees, 4 with osteoarthritis and 4 with meniscal disease. The changes were also seen in the menisci. Only one patient was suffering from chronic, polyarticular pyrophosphate arthritis. In the other cases neither change had been expected a priori, and the patients had no signs of systemic articular disease or amyloidosis. Most of them were elderly, but in good health.

Adult↗

PubMed1997

Tachykinin regulation of basal synovial blood flow.

1. Experiments were performed to investigate the role of endogenously released tachykinins in the regulation of blood flow to the rat knee joint. Synovial perfusion was assessed by laser Doppler perfusion imaging, which permitted spatial measurement of relative changes in perfusion from control (pre drug administration), expressed as the percentage change. Most experiments were performed on the exposed medial aspect of the knee joint capsule. 2. Neither the selective tachykinin NK1 receptor antagonist, FK888, nor the selective tachykinin NK2 receptor antagonist, SR48968, significantly influenced synovial blood flow at doses of 10(-12), 10(-10) and 10(-8) mol. However, topical co-administration of these agents produced significant dose-dependent reductions in basal synovial perfusion of 6.3 +/- 4.6 and 12.0 +/- 3.4 and 19.9 +/- 2.6%, respectively; n = 29. The non-selective tachykinin NK1/NK2 receptor antagonist, FK224, also produced significant (at 10(-10) and 10(-8) mol), but less potent, reductions in perfusion of 5.3 +/- 4.0, 8.4 +/- 2.2 and 5.9 +/- 2.8%, respectively; n = 25. 3. Topical administration of the alpha 1-, alpha 2-adrenoceptor antagonist phenoxybenzamine elicited a 31.3 +/- 6.2% increase in blood flow which was substantially reduced to 10.4 +/- 3.8% by co-administration of the FK888 and SR48968 (both at 10(-8) mol; n = 8-13), suggesting that normally there is sympathetic vasoconstrictor "tone' which is opposed by the vasodilator action of endogenous tachykinins. 4. One week after surgical interruption of the nerve supply to the knee joint, co-administration of FK888 and SR48968 (both at 10(-8) mol) now produced slight vasodilatation (6.7 +/- 4.6%; n = 9) which did not differ significantly from vehicle treatment. Depletion of tachykinins from sensory nerve fibres by systemic capsaicin administration also resulted in abolition of the vasoconstrictor effect of FK888 and SR48968 (both at 10(-8) mol), with these agents only producing a slight vasodilatation (2.5 +/- 5.3%; n = 6). 5. By use of a near infra-red laser source it was possible to image knee joint perfusion transcutaneously, the overlying skin being left intact. In this more physiological situation, close intra-arterial injection of the combination of FK888 and SR48968 (both at 10(-8) mol) again elicited vasoconstriction (48.8 +/- 16.2% reduction in blood flow; n = 4). 6. These results indicate that endogenous tachykinins may be continuously released from sensory fibers innervating the joint. Basal release of tachykinins could therefore be an important physiological influence opposing sympathetic vasoconstrictor tone.

Administration, Topical↗

PubMedDate not supplied

[Tissue burden with exogenous trace elements caused by roentgen contrast media in bone cements].

In 44 patients undergoing a change of total hip prosthesis, made of Co-Cr alloy and at one point with a Refobacin-Palacos chain we analyzed samples of the hip joint capsule and fascia lata. Using Instrumental Neutron Activation Analysis (INAA) up to 18 elements were analyzed. The findings demonstrate that the tissues in the surroundings as well as in direct contact with the total hip prosthesis are burdened by corrosion products of the alloy and by decomposition of the bone cement. The decomposition of bone cement can be shown in the extraordinary high concentration of Barium, Zirconium and Hafnium which are added to Bone Cements as X-ray contrast. Microscopic findings at the same time complete and confirm the trace element analyses.

Adult↗

PubMed1991

The 'cold hip' sign on bone scan. A retrospective review.

The "cold hip" sign on bone scan is often seen in patients referred with irritable hip. This sign is due to fluid in the hip joint under pressure causing impaired perfusion of the structures within the joint capsule. In a retrospective review, 22% of patients with this sign on bone scan were found to have septic arthritis at surgery. This fact would appear to justify surgical drainage or aspiration of any hip showing this sign on scan. An attempted follow-up study through the medical records was incomplete because of the short follow-up on most patients. The possibility that temporary impairment of blood supply to the head of the femur causes long-term damage to the hip is unanswered on this study, and a long-term recall follow-up study is underway.

Arthritis, Infectious↗

PubMed1994

Tendon arthroplasty for treatment of trapeziometacarpal arthrosis.

Trapeziometacarpal arthrosis is common among middle-aged women, and the surgical treatment options include arthrodesis, excision of the trapezium, prosthetic replacement of the trapezium, reconstruction of the ligaments, and various tendoplasties. We have prospectively studied a simple tendoplasty in which a strip of abductor pollicis longus tendon was anchored to the flexor carpi radialis tendon, the intact part of the abductor pollicis tendon, and the joint capsule, after excision of the trapezium, and carried out 27 operations in 25 patients. The thumb was immobilised for only eight days. Systematic exercises were started on the day of operation. Complete pain relief was obtained in 17 patients and partial relief in eight. Grip strength improved. The mobility was unaltered and functionally satisfactory. Three patients were reoperated on for cutaneous nerve entrapment and one for carpal tunnel syndrome. The procedure is simple, and the patients' symptoms improved without failures. The intensive supervised postoperative physiotherapy was essential to achieve the final results.

Adult↗

PubMed1991

Juxta-articular osteoid osteoma.

Osteoid osteomas that arise at the end of a long bone, within the insertion of the joint capsule (juxta-articular, intra-articular), may cause misleading clinical, radiographic, and histologic findings, resulting in unnecessary diagnostic tests and a delay in definitive treatment. To clarify optimum diagnostic procedures, we reviewed 20 cases of juxta-articular osteoid osteomas and found a mean delay from presentation to correct diagnosis of 24 months. Plain radiographs were either negative or showed only secondary changes. A periosteal reaction and proliferative synovitis with chronic inflammation was common, which could be misinterpreted as rheumatoid arthritis. Optimum diagnostic procedures were a bone scan followed by plain tomograms and an excisional biopsy of the nidus.

Adolescent↗

PubMedDate not supplied

Ultrasonography of the hand in rheumatoid arthritis.

High resolution ultrasonography of the hand and wrist was performed on 20 patients with definite or probable rheumatoid arthritis (ARA standard criteria) in its early stage. In all the patients, swelling of the soft tissues of the fingers corresponded to an enlargement of the joint capsule containing a hypoechoic exudate. The rheumatoid nodules appeared as fluid-filled rounded cavities with sharp borders. Rheumatoid tenosynovitis was observed in 18/20 patients. This corresponded to oval or spindle-shaped cavities with a hypoechoic (10/18 cases) or anechoic content (8/18 cases) and with the tendon ribbon inside. Rupture of a tendon was diagnosed in 8/20 cases and it was always confirmed at surgery. Tenosynovitis of the flexor carpi ulnaris at the wrist level was observed in 10/20 patients. Ultrasonography is proposed as an effective first-line approach and as a periodical follow-up survey in early stage rheumatoid arthritis, in combination with standard radiography.

Arthritis, Rheumatoid↗

PubMed1995

Microendoscopy of the synovial vasculature in the rabbit knee joint.

The functional morphology of the synovial vasculature in the rabbit knee joint was investigated using our technique of microendoscopy, which involves an in vivo microscopy via a 1.9-mm endoscope. In the vessels of the fibrous tissue of the joint capsule it was found that after intraarticular administration of epinephrine the blood flow and the vascular diameters decrease for 3-5 min. In the areolar part of the synovial tissue, an external elevation of the intraarticular pressure causes collapse of the capillaries at 10-15 mm Hg, whereas the collapse pressure of the arterioles is 30-40 mm Hg. Intraarticular application of Neuropeptide Y (NPY) leads to a marked vasoconstriction including the arteriovenous anastomoses, whereas after epinephrine the arteriovenous anastomoses remain patent or dilate during the arteriolar constriction phase. It is concluded that the technique of microendoscopy allows a valuable in vivo investigation of the synovial microvasculature.

Animals↗

PubMed1984

[3H]proline incorporation in vivo in capsular tissues and menisci during the development of osteoarthritis. An experimental study with rabbits.

In an effort to clarify factors related to the pathogenesis of experimental osteoarthritis, biochemical alterations were studied in articular soft tissues of adult rabbits through the immobilization of the knee of the hind leg in extension for 3, 7, 11, 18, 35 or 56 days. The medial collateral ligament and medial meniscus of the knee, as well as the joint capsule of the hip, were analysed. Total protein synthesis (measured by [3H]proline incorporation) increased in the immobilized legs in all of the tissues examined. The collagen synthesis rate (estimated by specific radioactivity of hydroxyproline) in the medial collateral ligament was enhanced, whereas the collagen content (measured as hydroxyproline concentration) of the tissue declined temporarily. This observation suggests that the collagen degradation rate transiently exceeds that of collagen synthesis. The results indicate that distinct biochemical alterations occur in the periarticular tissues during the early phases of immobilization-induced osteoarthritis. It is of interest that biochemical changes similar to those of the immobilized leg were seen, to a lesser extent, in the structures of the contralateral nonimmobilized leg.

Animals↗

PubMed2006

Effects of knee injection on skeletal muscle metabolism and contractile force in rats.

OBJECTIVE: We tested the hypothesis that intrusion of the knee joint capsule alters quadriceps muscle metabolism and function independently from the damage induced to knee cartilage. METHODS: Adult rats were separated into four groups: intraarticular injections of saline (SAL; n=9); intraarticular injections of papain, a model for osteoarthritis (PIA; n=7); sham injections (SHAM; n=8); and controls (CTL; n=5). 31P magnetic resonance spectroscopy (31P-MRS) was performed after 2 weeks. Spectra were obtained from the left quadriceps: two at baseline, eight during electrical stimulation with simultaneous measurement of contractile force, and 15 during recovery. 31P-MRS data were presented as the ratio of inorganic phosphate (Pi) to phosphocreatine (PCr), concentrations of PCr [PCr], intramuscular pH, and the rates and time constants of PCr breakdown during stimulation and PCr recovery. Intramuscular cytokine concentrations were measured within the quadriceps. Histologic slides of the knees were scored for severity of cartilage damage. RESULTS: The interventional groups produced values of Pi/PCr ratio, [PCr], contractile force and pH that were significantly different from CTL. These changes in muscle function were accompanied by higher concentrations of interleukin-1 observed with PIA and SAL. We did not observe any effect of cartilage damage on muscle function or metabolism. CONCLUSIONS: Knee joint intrusion alters quadriceps muscle metabolism with accelerated depletion of energy stores and fatigue during stimulation. This study demonstrates that needle intrusion into the knee joint results in muscle dysfunction, independently from the extent of cartilage damage.

Animals↗

PubMed2001

Histological demonstration of voltage dependent calcium channels on calcitonin gene-related peptide-immunoreactive nerve fibres in the mouse knee joint.

The afferent (excitability) and efferent functions (release of neuropeptides) of primary afferent nerve fibres are based on Ca(2+)-influx. The aim of the present study was to examine the presence of L- and N-type Ca(2+)-channels at sensory nerve fibres in the mouse knee joint capsule. Specific fluorescent labelled channel blockers and antisera against these channel subtypes were combined with an immunohistochemical staining for calcitonin gene-related peptide (CGRP), a neuropeptide that is widely distributed in primary afferents. There was a nearly complete colocalisation of CGRP immunoreactivity and the binding of omega-conotoxin GVIA (toxin VIA of Conus geographus or BODIPY-verapamil (BODIPY(R) FL verapamil, hydrochloride) demonstrating the presence of N-type and L-type Ca(2+)-channels, respectively. These data were further confirmed by identical results obtained after an immunohistochemical demonstration of the two channel subtypes at the peptidergic nerve fibres.

Animals↗

PubMed1979

Neonatal hip instability. Reason for failure of early abduction treatment.

A series of nine children with hip joint instability in 17 hips, diagnosed neonatally, is presented. Seven had bilateral idiopathic instability and two instability secondary to arthrogryposis, one of them bilateral. After reduction seven of the children (14 hips) were treated with abduction devices, which in all cases did not lead to stability in one or both hips. In these cases arthrography revealed that closed reduction was impossible due to narrowing of the joint capsule (hour-glass shape) and the interposition of a capsular fold including the acetabular labrum. The same types of changes were seen within 1 or 2 months after birth in three hips which had had no abduction treatment before arthrography. At open reduction of 11 hips it was found that the narrowing of the capsule was caused by the tendons of the iliopsoas and rectus femoris muscles. Excision of the capsular fold (labrum) was not necessary. The femoral head was deformed and anteverted. Failure of conservative treatment can be due either to incomplete reduction or to inadequate immobilization. Our analysis has shown that the most probable reason is incomplete reduction due to interposition. An obstacle to reduction should be suspected if abduction is restricted at birth, if primary reduction is difficult and the position difficult to maintain or if instability persists after 8 weeks of treatment. On the basis of our material the incidence of such an impediment to reduction was 0.08 per thousand births in the region studied during a 5-year period.

Acetabulum↗

PubMed1995

Histologic appearance of axial osteochondral fragments from the proximoplantar/proximopalmar aspect of the proximal phalanx in horses.

Osteochondral fragments from the axial proximoplantar/proximopalmar region of the proximal phalanx were removed from 38 joints in 30 horses. Ninety-three percent of the horses were Standardbreds, and 28 of the 30 had a low-grade lameness. All but 1 of the horses had hind limb involvement. A total of 43 fragments were removed. Most (71%) of the fragments involved the medial aspect of the joint and had to be dissected from a covering of synovial tissue. Histologically, the circumference of most fragments consisted of a transition zone at the attachment of the joint capsule, a region of nonarticular, non-weight-bearing cartilage, a region where organized, dense connective tissue, presumably remnants of the short sesamoidean ligament were attached, and a region consisting of irregular truncated bony surfaces covered by healing of chronic fracture. There were several areas of degenerate hyaline cartilage, but no areas of normal hyaline cartilage or areas containing related cartilage cores or other evidence of delayed endochondral ossification. Immunohistochemical staining of 4 segments from 1 horse revealed sensory substance P immunoreactive nerves in the fibrous tissue surrounding the bony fragments and within the central cancellous spaces. The histologic appearance suggests that these osteochondral fragments may be a result of fracture, rather than a manifestation of osteochondrosis.

Animals↗

PubMed1989

Serial sectioning, electron microscopy, and three-dimensional reconstruction of fine nerve fibres and other extended objects.

Two different techniques for three-dimensional reconstructions of nerve fibres or other extended fine tissue structures were developed to study the afferent innervation of the cat's knee-joint capsule. The re-embedding technique starts with series of semithin sections for light microscopic reconstructions. In a second step, selected semithin sections can be re-embedded for ultramicrotomy to examine ultrastructural details. This method offers the possibility to investigate fine structures over a distance of several hundred micrometres without any loss of ultrastructural information. The serial section-ESI technique is based on the electron spectroscopic imaging of semithin sections. Small tissue blocks are cut into series of either semithin or alternate semi- and ultrathin sections which can be directly used for a complete ultrastructural investigation. Finally, true-to-scale three-dimensional reconstructions are performed by graphical techniques or computer-aided methods.

Afferent Pathways↗

PubMed2004

In vitro low-speed side collisions cause injury to the lower cervical spine but do not damage alar ligaments.

Whether injuries to the alar ligaments could be responsible for complaints of patients having whiplash injury in the upper cervical spine is still controversially discussed. It is known that these ligaments protect the upper cervical spine against excessive lateral bending and axial rotation movements. The objective of the present in vitro study was therefore to examine whether the alar ligaments or any other structures of the cervical spine are damaged in side collisions. In a specially designed acceleration apparatus, six human osteoligamentous cervical spine specimens were subjected to incremental 90 degrees side collisions from the right (1 g, 2 g, 3 g, etc.) until structural failure occurred. A damped pivot table accounted for the passive movements of the trunk during collision, and a dummy head (4.5 kg) ensured almost physiological loading of the specimens. For quantification of functional injuries, the three-dimensional flexibility of the specimens was tested in a spine tester before and after each acceleration. In all six specimens, structural failure always occurred in the lower cervical spine and always affected the facet joint capsules and the intervertebral discs. In four specimens, this damage occurred during the 2 g collision, while in the other two it occurred during the 3 g and 4 g collision, respectively. The flexibility mainly increased in the lower cervical spine (especially in lateral bending to both sides) and, to a minor extent, in axial rotation. In vitro low-speed side collisions caused functional and structural injury to discoligamentous structures of the lower cervical spine, but did not damage the alar ligaments. Since the effects of muscle forces were not taken into account, the present in vitro study reflects a worst-case scenario. Injury thresholds should therefore not be transferred to reality.

Acceleration↗

PubMed1992

Neck injuries: I. Occipitoatlantal dislocation--a pathologic study of twelve traffic fatalities.

Twelve of 155 persons killed in traffic crashes had occipitoatlantal dislocations. Nine were vehicular occupants, 2 were cyclists, and one was a pedestrian. The dislocations involved various combinations of lacerations of the alar ligaments, the occipitoatlantal joint capsules, the dura mater, the tectorial membrane, the rectus capitis muscles, and the suboccipital muscles. In 2 instances, an occipital condyle failed instead of the corresponding alar ligament, producing condyle fractures. Atlas ring fractures occurred in 3 instances. Axial and subaxial cervical trauma were uncommon. Facial or mandibular fractures occurred in a majority of cases, vault skull fractures were uncommon, and basilar fractures were absent. Pontomedullary brainstem lacerations occurred in 9 of the 12, and 4 had midbrain lacerations. The majority of the victims succumbed to acute neurogenic shock as the sole or the major mechanism of death. The biomechanical basis for occipitoatlantal dislocation is discussed, and the author suggests that distraction, in concert with variable combinations of extension, rotation, and posterior translation is responsible for occipitoatlantal dislocations.

Accidents, Traffic↗

PubMed1979

[Comments on the lateral load capacity of the phalangeal joints (author's transl)].

The article compares the load capacity of the collateral ligaments of the metacarpo-phalangeal and interphalangeal joints exposed to a laterally applied force. The tests were performed in vivo with 50 each female and male volunteers. It was found that the average load capacity of the metacarpo-phalangeal and interphalangeal joints in women was 5.8 kp and in men 12.3 kp. Furthermore, the bones of the long fingers with the preserved joint capsules and collateral ligaments of ten corpses were also examined, and the collateral ligaments exposed to a load which was increased to the point of their destruction. The average values found in this manner were 26.5 kp for the metacarpo-phalangeal collateral ligaments and 15.4 kp for the interphalangeal collateral ligaments. This means that the pain threshold is usually below the destruction limit, so that generally there will be no spontaneous overloading. It is important for the construction of endoprostheses that their stability level should always be above that of the pain threshold and should attain at least the values of the tear tests, since otherwise these endoprotheses will not function properly. These basic prerequisites enable a comparative study of endoprostheses, the results of which will be presented at a later date.

Adult↗

PubMed2005

[Hyperextension trauma of the finger].

In 2 patients, a man aged 30 and a woman aged 31, a hyperextension trauma of the proximal interphalangeal joint of the right index finger and the left middle finger respectively was diagnosed. The man underwent surgery for volar plate rupture in the acute phase. The woman presented 7 weeks after the trauma with a chronic flexion contracture; she had an avulsion fracture of the second phalanx and was treated conservatively with splints and exercise therapy. The hyperextension trauma of the proximal interphalangeal joint of a finger is one of the most frequently occurring hand traumas. In the more severe cases, there can be substantial damage to the structures ofthe joint capsule, such as a volar plate rupture. In the acute phase, a ruptured volar plate results in pain and dorsal dislocation. In the long term however, two significant late complications can arise: the chronic post-traumatic hyperextension deformity and the flexion contracture. These complications are difficult to treat, but can be prevented by adequate initial treatment. The diagnosis of volar plate rupture is essential to this and can be formulated after a carefully conducted history taking and physical examination usually with simple radiological studies ofthe affected digit. Treatment of a volar plate rupture can be either conservative or surgical and is directed at regaining finger function and preventing complications. For the treatment to be successful, intensive physiotherapy during follow-up is essential.

Adult↗