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General joint laxity is measured with the hyperextensometer, and by analyzing the values obtained in a group of European subjects norm curves are drawn up related to age and sex. The values found in various orthopedic diseases are put into these curves, and the importance of general joint laxity is discussed.
A simple pressure dolorimeter for the detection and quantification of joint tenderness is described and evaluated. The pressure dolorimeter was more sensitive than a modified Ritchie Index in measuring degree of joint tenderness and as sensitive in detecting tender joints. The interobserver error of the pressure dolorimeter was low, and in a drug withdrawal study, the pressure dolorimeter was able to detect change in joint tenderness whereas the conventional Ritchie Index was not. These results suggest that the pressure dolorimeter is a simple, reliable and sensitive instrument for measuring joint tenderness in patients with inflammatory joint disease. It is also inexpensive and readily available.
We have compared the finger hyperextensometer (Jobbins et al., 1978) and the scoring system of Carter and Wilkinson (1964), modified by Beighton et al. (1973), in the quantification of joint laxity in a population selected to demonstrate a wide range of joint movement. Both systems correlated well (P less than 0.001) with a 'global index' of joint laxity derived by adding the arcs of movement recorded at most joints in the body by the method of the American Academy of Orthopaedic Surgeons (1965). The Carter and Wilkinson system produced better correlations and is the method of choice for assessing generalized joint laxity.
Osteoarthritis as well as rheumatoid arthritis lead to chronical progressive destruction of diseased joints. As aggressive new treatments need to be evaluated, plenty of (semi-) quantitative methods for the radiological joint evaluation had been developed. They lack sufficient reproducibility due to their low objectivity. Modern approaches of computer-assisted radiological quantification should increase the reproducibility and efficiency of radiological scoring. Automatically calculated, computer-assisted measurements of joint space, cartilage- and synovial volume, periarticular assessment of bone mineral density and quantitative analysis of the subchondral plate will have major impact on the radiological routine of the future.
A QSAR model is successfully proposed to predict the toxicity effect on Photobacterium phosphoreum by nonpolar-narcotic-chemical mixtures and/or polar-narcotic-chemical mixtures. For nonpolar-narcotic-chemical mixtures and polar-narcotic-chemical mixtures, their corresponding hydrophobicity-based QSAR models are derived from regression analysis. Comparison of these two QSAR models make us believe that it is the joint effect of hydrogen bond in polar-narcotic-chemical mixture that leads to the difference between these two models. Such joint effect of hydrogen bond can be quantified as AMH and BMH by using the different partition coefficients of mixtures in various organic phase/water systems. And the regression analysis results convinced us that the introduction of AMH does improve the quality of the QSAR model with r2=0.948, S.E.=0.166 and F=745.201 at P=0.000 for total 84 mixtures.
The aim of this study was to determine the range of movement in gymnastic and dance populations. Sixty-five participants (41 females, 24 males; mean age 21.4 years) were assessed. The sample included dancers and gymnasts ranging from novice and club standard to international and professional status. Non-specialized physical education students acted as controls. Range of movement was measured at the shoulders, hips, lumbar spine and ankles using a Loebl hydrogoniometer, and inherent joint laxity was assessed using Beighton and coworkers' adaptation of the Carter and Wilkinson 9-point scale. The right and left sides of the body were assessed and measures of active and passive motion were recorded. A graded increase in laxity was observed from controls, through novice gymnasts, to dancers and finally international gymnasts. The greater laxity of females than males was also confirmed. Dancers and gymnasts had a greater passive range of movement in all joints, which was partly inherited and partly acquired. There was a large difference between their active and passive ranges, which appeared to render the joints unstable.
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OBJECTIVE: To determine the contact patterns at the tarsal joints under two levels of loading (150 and 600 N) with the foot in the neutral position, plantarflexion, dorsiflexion, inversion and eversion. DESIGN: In vitro measurements quantifying the size, location and patterns of contact. BACKGROUND: Several methods have been employed to study contact areas and patterns in joints such as the hip and knee; in contrast there is limited data on the joints of the foot. METHODS: Contact areas and patterns were determined by injecting coloured dyes, one for each level of loading, into the joint spaces in 23 pairs of feet: three pairs in the neutral position, five pairs in each of plantarflexion and dorsiflexion, and ten pairs in inversion (right foot) and eversion (left foot). RESULTS: Contact area maps were constructed for the ankle, subtalar, talonavicular, calcaneocuboid, cuneonavicular and the intercuneiform joints. Quantification of the surface areas was performed using a digitizer. The extent of the changes in contact area appeared to be related to the mobility of the joints under consideration, with the greatest changes in contact pattern and area being associated with the most mobile joints. CONCLUSION: The small change in absolute contact area with increased loading reflects the role of the foot, in providing a stable support for the body during gait.
A noninvasive, quantitative technique to estimate joint fluid volume using three-dimensional (3D) processing of magnetic resonance (MR) imaging and CT data was evaluated. The mean accuracy error of this 3D approach with MR imaging, performed on five fresh cadaver knees, was -2.4 +/- 5.1% SD when volume estimates were based on heavily T2-weighted transverse images. A considerably higher mean accuracy error of -12.5 +/- 16.9% SD was found when the 3D approach with CT was used (four fresh cadaver knees), probably because of the small attenuation differences between articular soft-tissue structures and joint fluid. A mean precision error of 4.9 +/- 2.3% SD was found when two radiologists independently evaluated in vivo MR imaging studies of 12 knees with joint effusion. Because of the low CT accuracy, no in vivo studies were performed using CT. Thus, this preliminary study shows that quantification of joint fluid volume with 3D data processing offers more accuracy with MR imaging than with CT. The 3D approach with MR imaging provides a potential tool for clinical studies.
We adapted the method of 99mTc-pertechnetate (99mTc) uptake measurements to the mouse knee for detection and quantification of arthritis because clinical assessment of mouse knee-joint arthritis is not reliable. The main points to ensure reproducibility of measurements were proper fixation and positioning of the knee and careful shielding of the rest of the body from the gamma-radiation detector. 99mTc uptake was calculated as the mean of three countings. The variation coefficient of these countings ranged from 0.007 to 0.082 in non-arthritic joints and from 0.025 to 0.081 in arthritic joints. Arthritis was scored as the ratio of the 99mTc uptake in the right knee versus that in the left knee. This ratio averaged 1.06 (S.D. 0.05) in non-arthritic mice 20 minutes after 99mTc administration i.p. On the second day after induction of arthritis in the right knee, this ratio ranged from 1.44 to 1.96; this was significantly higher (P less than 0.005) than in non-arthritic mice, and the increase remained significant during at least 20 days. 99mTc uptake measurements seem to be a useful method to detect and quantify arthritis of the knee joint in mice.
Evidence implicating synovial mast cells in the initiation and perpetuation of arthritis has increased. We have developed a method of joint lavage to monitor dynamic intraarticular events in the intact animal. Lavage was done before and after immunologic (passive sensitization followed by intravenous specific antigen or intraarticular anti-rat immunoglobulin E [IgE] heteroantiserum) and nonimmunologic (intraarticular calcium ionophore A-23187; phorbol 12-myristate, 13-acetate; and compound 48/80) synovial mast cell activation. To quantify and analyze synovial mast cell mediator release kinetics in situ, we measured lavage fluid histamine. With all activation protocols except A-23187, histamine release was evident within 5 minutes after introduction of the stimulus. The quantitative and chronological similarities between immunologically induced and compound 48/80-induced synovial mast cell histamine release kinetics suggested that connective tissue type mast cells are an important source of inflammatory mediators in rat joints. We also measured joint lavage fluid histamine levels in rats immunized with an active sensitization protocol. Histamine levels were determined by the autoanalyzer method and were confirmed by using a commercially available radioimmunoassay that uses a monoclonal antibody against acetylated histamine. We found that in many of these animals, at the peak of the serum IgE response, joint lavage fluid histamine levels were very high even before challenge with specific antigen, and that this increase was not due to diffusion into the joint of abnormally elevated plasma histamine. These data suggested that synovial mast cells are preferentially activated in states of high serum IgE immune responses. We have used a simple, inexpensive, rapid lavage technique to generate the first data on histamine release kinetics after selective synovial mast cell activation in the intact animal. The technique can be adapted for investigation of release kinetics of a variety of other substances from activated synovial cells and can be used in other arthritis models.
A method is detailed allowing the computation of three-dimensional (3D) joint angles. Each joint of the equine digit is modelled as a sequence of three single axis rotary joints. The Joint Coordinate System was used; it involves a specific sequence of cardanic angles. The decomposition of the angles was chosen so that the three elementary angles coincide with the flexion/extension, passive abduction/adduction and lateral/medial rotations. The algorithms and kinematic procedures were described for the equine front digital joints. This method was tested in vitro on four forelimbs. For each limb, angle values were measured while the member was loaded by a press (from 500 to 6000 N). These tests were repeated while a wedge raised one part of the hoof (toe, heel, lateral and medial sides) in order to induce modifications of the angular patterns of the joints. This method allowed a precise quantitative determination of 3D joint movements. The modifications occurring with the wedges are clearly identified and confirm some previously published semi-quantitative observations. Moreover, this method provides a way to collect objective data on the functional anatomy of joints and could be used to study connective shoeing thoroughly. It may be directly applied to other species and may be used by researchers interested in discreet articular movements, especially occurring in other planes than the sagittal one.
OBJECTIVE: This study addressed the following questions: How does 99mTc-IgG scintigraphy compare to physical examination in the detection of synovitis as determined histologically, and is 99mTc-IgG scintigraphy a sensitive detector of histologically documented synovitis activity in the absence of clinically detectable knee joint swelling? METHODS: The results of measuring synovitis activity by physical examination and by scintigraphy with technetium-99m labelled polyclonal human immunoglobulin G (99mTc-IgG) were compared with the results of histological examination of synovial biopsies taken from the knee joints of patients with rheumatoid arthritis (n = 21), osteoarthritis (n = 9) and various other rheumatic diseases (n = 10). RESULTS: The sensitivity of 99mTc-IgG scintigraphy in detecting synovitis activity, as determined histologically (85%), was higher than the sensitivity of joint swelling (65%). In the absence of clinically detectable knee joint swelling the sensitivity of 99mTc-IgG scintigraphy was 83%. CONCLUSION: This study shows that 99mTc-IgG scintigraphy is a more sensitive method than physical examination in detecting histologically documented synovitis activity.
The ability of scintigraphy with technetium 99m-labelled polyclonal human immunoglobulin G (99mTc-IgG) to detect and quantify arthritis activity was studied in 24 patients with RA and in 10 patients with OA. The results of 99mTc-IgG scintigraphy were compared with those of scintigraphy with 99mTc-labelled hydroxymethylene-diphosphonate (HDP). The mean joint scores of 99mTc-IgG scintigraphy in RA patients with active disease were significantly higher (P < 0.001) than the mean scores in patients with inactive disease. The mean joint scores were also higher in patients with erosions compared to those in patients without erosions (P < 0.05). For 99mTc-HDP scintigraphy no significant differences were found between the mean joint scores of these patient groups. Comparison of scintigraphic results between patients with RA and OA revealed that the mean joint score of 99mTc-IgG scintigraphy was significantly (P < 0.001) higher in the patients with RA than in patients with OA, whereas for 99mTc-HDP scintigraphy this difference was not significant. These results show that 99mTc-IgG scintigraphy, when compared to 99mTc-HDP scintigraphy, is a more specific method of detecting synovitis and, also, shows differentiation between different degrees of arthritis activity in RA.
OBJECTIVE: The rate of progressive joint space narrowing in the contralateral hip after total hip arthroplasty (THA) for osteoarthritis (OA) and the factors which may predispose patients to more aggressive joint space narrowing remain undefined. The current study sought to evaluate the rate and pattern of, and risk factors for, progressive joint space narrowing in the contralateral hip after THA for OA. METHODS: Each patient who underwent THA for OA in 1984-1985 was followed up longitudinally, and annual anteroposterior (AP) pelvis radiographs were obtained. The radiographic joint space width (JSW) of each contralateral hip joint was quantified, and the rates of JSW narrowing were determined. Evaluation of potential risk factors for accelerated progression of joint space narrowing included age, sex, side of surgery, weight, height, body mass index (BMI), hip pain, etiology of OA, and Kellgren/Lawrence radiographic grade. RESULTS: Ninety-nine patients and 619 AP pelvis radiographs were evaluated. The median initial JSW was 3.48 mm (interquartile range 1.55). JSW declined in a linear manner at a median rate of 0.10 mm/year. The rate of decline between baseline and followup in 20 months was predictive of the overall slope. Two subpopulations were identified. Eighty-five percent of patients maintained a slow decline in JSW (< or =0.2 mm/year), and 15% exhibited an accelerated decline in JSW (>0.2 mm/year). Kellgren/ Lawrence radiographic grade > or =2 and a diagnosis of primary OA were each associated with a more rapid decline in JSW (P = 0.006 and P = 0.02, respectively). Initial JSW, age, sex, weight, height, BMI, and hip pain were not risk factors for rapid decline in JSW. CONCLUSION: Radiographic hip JSW may be reliably quantified and followed up longitudinally using standard AP radiographs. Progression of JSW narrowing in the contralateral hip after THA for OA proceeds in a linear manner over several years. A subpopulation of patients with accelerated narrowing of contralateral JSW may be identified within 20 months, and may represent a suitable population with which to assess the potential efficacy of new disease-modifying agents.
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