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At least 127 records · Page 7Linked to original sources
PubMed1993

[Sonographic diagnosis in shoulder joint instability. Possibilities and limitations].

Ultrasound evaluation expands the possibilities of diagnostic imaging techniques for patients with shoulder instabilities. Static ultrasound investigation documents the acute or chronic dislocated shoulder. Dynamic evaluation demonstrates the direction of instability. Concomitant Hill-Sachs lesions or rotator cuff tears can be diagnosed with high diagnostic accuracy. Clinically relevant documentation of labrum defects (Bankart lesions) by ultrasound is not possible with the technique currently available.

Humans↗
PubMed2003

Evaluation of shoulder internal rotator muscle strength in baseball players with physical signs of glenohumeral joint instability.

OBJECTIVES: To identify whether subjects with glenohumeral translational instability present with a strength deficit in their internal rotator musculature, and therefore to determine if general strengthening exercises are warranted for the management of this condition. METHODS: Eighteen male baseball players were allocated to two groups on the basis of expert clinical evaluation of the presence (n=8) or absence (n=10) of shoulder translational instability. A strain gauge was used to calculate the force generated during maximal isometric internal rotation contractions in neutral shoulder rotation and 30 degrees of internal rotation. RESULTS: The Mann-Whitney test identified no significant difference in force production during the maximum contractions in neutral rotation between the two subject groups. In the position of 30 degrees shoulder internal rotation, subjects with glenohumeral translational instability produced significantly greater force than the control group (p<0.05). CONCLUSIONS: High load strength testing cannot be used as a diagnostic tool to identify people with glenohumeral instability. Similarly, heavy resistance strengthening exercises for the internal rotator musculature are not warranted during rehabilitation.

Adolescent↗
PubMed1990

Hip joint instability in an infant with paraplegia following aortic surgery.

A report on an infant with paraplegia following aortic surgery who suffered from coarctation of the aorta and a ventricular septum defect (VSD). The spinal paralysis was complete and flaccid. He was found to have paralytic bilateral dislocatable hip joints. Magnetic resonance image (MRI) of spinal cord showed no pathological findings. The hip joints were treated by a hip abduction brace.

Aortic Coarctation↗
PubMed2000

Tibial tubercle malposition in patellar joint instability: a computed tomograpy study in full extension and at 30 degree flexion.

We evaluated the tibial tubercle position in knees with patellar instability. CT in full extension and at 30 degree flexion was used in 18 knees with instability and 18 control knees. Scans were taken at the level of the femoral epicondyles, tibial tubercle and distal tibia. We found that in full extension, the tibial tubercle was in a more lateral position in the unstable than in the control knees. At 30 degree flexion, the tibial tubercle in the unstable knees rotated internally, but it was never within the normal range. CT scans taken in full extension and at 30 degree flexion seem to be of value for ascertaining the degree of tibial tubercle malposition during knee flexion in patellar instability.

Adolescent↗
PubMed1999

Talocrural and subtalar joint instability after lateral ankle sprain.

PURPOSE: Recurrence of lateral ankle sprain (LAS) is common among recreational and competitive athletes. Talocrural (TC) joint laxity has traditionally been seen as the cause of mechanical instability after LAS. The purpose of this study was to examine the use of stress fluoroscopy and physical examination in the assessment of TC and subtalar (ST) instability in subjects with and without a history of LAS. METHODS: Twelve subjects with a history of unilateral LAS and eight healthy controls were examined by two blinded examiners. The first examiner performed physical examination on each ankle by using the anterior drawer (AD), talar tilt (TTPE), and medial subtalar glide (MSTG) tests. Laxity in each ankle was assessed on a 4-point scale. The second examiner performed stress fluoroscopy taking AP views with and without a manually applied supination stress to assess TC laxity and a sidelying modified Broden view with and without stress to assess ST laxity. Subjective examination of the images was used to determine excessive TC and ST laxity. RESULTS: Seventy-five percent of previously injured subjects demonstrated unilateral laxity differences of the TC joint using stress fluoroscopy. Of the nine with excessive talar tilt on fluoroscopy, 78% demonstrated excessive laxity with the AD and MSTG tests, and 67% demonstrated laxity with the TTPE test. Sixty-seven percent of those with TC laxity also demonstrated either excessive unilateral or bilateral laxity of the ST joint under stress fluoroscopy. CONCLUSIONS: These data suggest the existence of a subpopulation of patients with a history of LAS who demonstrate a pattern of combined TC and ST laxity.

Adult↗
PubMed1996

[Arthroscopic image of wrist joint instability].

In a consecutive series of 107 arthroscopies, 88 wrists showed a ligamentous lesion on the ulnar side. The TFCC was affected in 90% (79 patients), the triquetrum in 53% (47 patients), the ulnocarpal ligaments in 22% (19 patients) and the hamate in 17% (15 patients). The number of ligament injuries averaged three per wrist. Surprisingly, there were multiple lacerations noted in 22% of the TFCC and these occurred in characteristic combinations.

Adolescent↗
PubMed1993

Watson-Jones tenodesis for chronic ankle joint instability.

Twenty-three patients (22 soldiers and 1 civilian) were admitted to the Cambridge Military Hospital between May 1990 and May 1992 with chronic inversion instability of an ankle and underwent Watson-Jones Tenodesis. A retrospective study was carried out to evaluate their results.

Ankle Injuries↗
PubMed1989

[Arthroscopic semitendinosus-plasty with lateral extra-articular stabilization in anterior knee joint instability].

Within the framework of a prospective study, 40 patients were examined postoperatively 12 months after their anterior cruciate ligament had been replaced by a doubled semitendinosus tendon arthroscopically combined with a lateral extra-articular procedure. "Second look" arthroscopy was possible in four cases. Evaluation was conducted according to the system of Müller and the Lysholm scoring system. According to the Müller system very good or good results were achieved in 97.5%; 95% of the patients achieved 91-100 points in the Lysholm scoring system. No substantial restrictions in the knee joint's range of movement were reported; there were also no other complications. The operative technique and the rehabilitation regimen are documented.

Adolescent↗
PubMed1992

Lunate-triquetral and midcarpal joint instability.

Instability of the ulnar side of carpus centers around the triquetrum, which is suspended by the ulnar triquetral ligaments and supported proximally by the TFCC. The triquetrum guides the lunate by an interosseous membrane and stout palmar ligaments that provide a relatively rigid connection between the two bones. Disruption of the LT ligament is frequently associated with pathology in the ulnar carpal area and may progress to triquetral instability, VISI, and finally, degenerative arthritic changes on the ulnar side of the carpus. The diagnosis of LT injuries is made by stress radiographs, arthrography, video-fluoroscopy, and arthroscopy. Treatment is initially nonoperative, but if symptoms persist, surgery is warranted. Arthroscopic debridement and pinning the LT joint, ligament repair or reconstruction, and intercarpal arthrodesis have all been reported as successful treatments. For the chronic problem confined to the LT joint, a limited intercarpal arthrodesis of the joint is the most predictable procedure for relieving pain without causing any significant restrictions in wrist motions. When there is a dissociation pattern in addition to LT instability, a more extensive intercarpal arthrodesis is required. Midcarpal instability occurs at the triquetral-hamate joint and is characterized by a dynamic subluxation of the joint. During ulnar deviation, the joint undergoes an exaggerated shift from volar flexion to dorsiflexion. Supportive care is generally successful; although in chronic cases, a midcarpal joint arthrodesis is often required.

Arthrodesis↗
PubMed1999

[Anatomic reconstruction of the lateral ligaments of the ankle using a plantaris tendon graft in the treatment of chronic ankle joint instability].

The purpose of this work was to present our technique of anatomic reconstruction of the lateral ankle ligaments using a free plantaris tendon graft. Between 1988 and 1997, 52 ankles (48 patients) were treated for chronic ankle instability resisting to a training program of minimally 3 months. The average age was 28.6 years (16 to 46 years) at the time of surgery. There were 30 ankles in men and 22 ankles in females. 4 patients were treated on both ankles. 50 ankles were available for a follow-up investigation after a mean of 3.5 years (1 to 10 years). Based on the AOFAS-Hindfoot-Scale an average score of 97.9 points (90 to 100 points) was found. The functional result was found to be excellent in 39 ankles (78 %), good in 9 ankles (18 %), fair in 2 ankles (4 %), and poor in 0 ankle (0 %). Dorsi-/plantarflexion was not restricted in any ankle. Supination was slightly restricted in 2 ankles, but not increased in any ankle. High patient's satisfaction with respect to the achieved stability was found in all but one ankle. No deterioration with time was observed in any case. The overall good and excellent results with this method may be explained by the strictly anatomic reconstruction that did not alter the kinematics nor the mechanics of the ankle joint complex. In addition the peroneal tendons were not weakened. We feel that this procedure is a better alternative to other more complex ligament reconstructions, especially tenodesis operations by using the peroneal tendon.

Adolescent↗
PubMed2001

Kinematic evaluation of atlantoaxial joint instability: an in vivo cineradiographic investigation.

Although range of motion has been considered the best parameter to quantify atlantoaxial instability, no other kinematic parameters have been determined for dynamic quantification. The objectives of this study were to investigate the kinematics of the normal and pathologic atlantoaxial joints by cineradiography and to determine the in-vivo kinematic parameters, if any, for the quantification of atlantoaxial instability. Sagittal plane motion of the atlantoaxial joints was analyzed by cineradiography in 12 healthy volunteers and 15 patients with atlantoaxial subluxation. In both flexion and extension, C1-C2 sagittal rotation and C1 translation in the sagittal plane were measured continuously to determine the time-displacement curves for both parameters. All patients with atlantoaxial subluxation and seven of the volunteers had the sigmoid pattern in their time-displacement curves in sagittal rotation. In these cases, atlantoaxial motion showed different points of the onset of rapid increase in motion in their sigmoid curves between flexion and extension. The discrepancy between these points was more significant in the patients than in the volunteers. In most of the patients who had atlantoaxial instability, subluxation occurred when the atlantoaxial joints were still in a more extended position and they were reduced when they were still in more flexed position. The discrepancy showed characteristics similar to those of the neutral zone observed during in vitro investigations, suggesting that it becomes a good indicator of in vivo atlantoaxial instability.

Adult↗
PubMed1997

[Surgical treatment of chronic ankle joint instability--many variations in German clinics. Analysis of a 1994 German survey].

A questionnaire was mailed to 400 orthopaedic department chairpersons in Germany listed by the "Deutsche Gesellschaft für Unfallchirurgie" to evaluate the current surgical approach to chronic ankle instability. The aim of the survey was to analyze and to classify the reconstruction method of the individual institution. Questionnaires were returned from 267 hospitals (66.7%). The number of ligament reconstructions performed at individual institutions ranged from 1 to over 100 (mean 17.5). The most frequently used procedures of primary choice for reconstruction of the ligaments are: periosteal flaps (45.3%), anatomical repair (23.6%), different tenodeses (20.6%), and free anatomical implants of autologous or exogenous material (10.5%). 50% of the participants use reconstructions in which the injured ligament is repaired secondarily without augmentation or with periosteal flaps. The remaining part of the German surgeons prefers tenodeses or various other procedures. It is interesting to note that there is a high number of different procedures not namely known in the literature which are considered as individual modifications. With better knowledge of the function of the single ligament and general exposure of the ligaments for simple overlap and direct suture, the rate of primary non-anatomical reconstructions may be decreased in the future.

Ankle Injuries↗
PubMedDate not supplied

[Experimental analysis of neutral, asymmetric and constraint liners for total hip replacement: investigation of range of motion and protection against joint instability].

AIM: Recurrent dislocation after total hip replacement is a severe complication, which requires specific treatment and implants. The purpose of the present study was to compare a constraint liner with an elevated rim and standard liner regarding their range of motion and dislocation stability. METHOD: With a test device, range of motion until impingement (ROM (Imp)) and dislocation (ROM (Lux)) were experimentally analyzed using the above-mentioned insert types of a commercial total hip system. On the basis of movement combinations associated with dislocation, the ROM was determined. Further measuring parameter was the resisting moment against subluxation of the femoral head. RESULTS: The constraint liners showed clear restriction of the movements "internal rotation combined with 90 degrees flexion and 0 degrees adduction" and "external rotation with 10 degrees extension and 15 degrees adduction" of up to 20 degrees compared to the neutral liner. ROM (Imp) was only decreased by about 8 degrees with the elevated-rim liner. The constraint liners revealed the highest resisting moments in subluxation, however, at adequate orientation in the acetabular cup the elevated-rim liners provided a higher ROM (Lux) of up to 12 degrees. Both designs were superior to the neutral liner at retroversion and steep cup position regarding resisting moment and ROM (Lux). CONCLUSION: In case of insufficient soft tissue tension the use of constraint liners may increase the dislocation stability, however, in contrast to elevated-rim liners the impingement-free movement interval is clearly reduced. Thus, material damage and high shear stress in the bone interface can result. Therefore, constraint liners should only be used in exceptional cases.

Equipment Failure Analysis↗
PubMed2005

Distal radioulnar joint instability in distal radius fractures: the role of sigmoid notch and triangular fibrocartilage complex revisited.

The stabilising effects of various structures of the distal radioulnar joint (DRUJ) have been heavily debated. This biomechanical cadaveric study examined the effects of the volar and dorsal lips of the sigmoid notch and the volar and dorsal aspects of the triangular fibrocartilage complex (TFCC) on DRUJ stability. Sequential fractures of the distal radius and sectioning of the TFCC were performed followed by measurements of ulnar translation with the forearm in pronation, neutral and supination. A dorsal lunate facet fracture created instability in pronation. Lunate facet fractures alone did not create instability in other forearm positions. Sectioning of the volar TFCC after loss of the dorsal TFCC by a dorsal lunate facet fracture caused DRUJ instability with the forearm in neutral position. Sectioning of the dorsal TFCC after loss of the volar TFCC due to a volar lunate facet fracture created instability in neutral and pronated positions.

Biomechanical Phenomena↗