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PubMed1996

A morphological study of the fibrous capsule of the human lumbar facet joint.

STUDY DESIGN: Macroscopic and microscopic investigations of the human lumbar facet joint capsule were undertaken. OBJECTIVE: To describe the morphologic characteristics of the fibrous capsule of the lumbar facet joints. SUMMARY OF BACKGROUND DATA: Previous biomechanical and neurophysiologic studies by the authors have shown that the lumbar facet joint capsule may be a source of low back pain. METHODS: Macroscopic investigation was performed on the facet joint capsules dissected from five fresh adult cadavers. For microscopic studies, facet joint capsules obtained from cadaver dissection and spinal surgeries were stained by the hematoxylin and eosin method and the Elastica-Van Gieson method. RESULTS: The outer layer of the fibrous capsule is a dense regular connective tissue that is composed of parallel bundles of collagenous fibers. The inner layer of the fibrous capsule consists of bundles of elastic fibers, similar to the ligamentum flavum. In the superior and middle part of the joint, the fibers run in the medial to lateral direction, crossing over the joint gap. In the inferior part of the joint, the fibers are relatively long and run in a superior-medial to inferior-lateral direction, covering the inferior articular recess. They are thicker than the layer in the superior and middle parts of the joint. CONCLUSIONS: Anatomical and histologic features of the lumbar facet joint capsule are different between its outer layer and inner layer. This complex of morphologic factors can affect the biomechanics and neurophysiology of the lumbar facet joint.

Adult↗
PubMed2003

Immunohistochemical analysis of the extracellular matrix in the posterior capsule of the zygapophysial joints in patients with degenerative L4-5 motion segment instability.

OBJECT: Although the hypertrophied shape of the zygapophysial joints in degenerative instability of the lumbar spine is well known, its underlying pathophysiological mechanism is unclear. The authors sought to provide evidence that there is increased fibrocartilaginous metaplasia in the posterior joint capsule resulting from greater mechanical loading; the authors suggest that these capsular changes are central to understanding the altered joint shape. METHODS: The LA-5 posterior articular complex was removed in 14 patients undergoing fusion for degenerative instability. After methanol-assisted fixation, cryosections were immunolabeled for a wide range of extracellular matrix molecules. These were collagens (Types I, II, III, V, and VI), glycosaminoglycans (chondroitin 4 and 6 sulfates; dermatan- and keratan-sulfate), and proteoglycans (versican, tenascin, aggrecan, and its associated link protein). The grade of degeneration of the articular complexes was assessed radiologically and histologically. CONCLUSIONS: The results of this study provide molecular evidence for an altered loading history on the joint capsule. The pronounced loss of intervertebral disc height that occurred in all patients with severe degeneration of the lumbar motion segment promotes an increased range of axial rotation that places the posterior capsule under greater mechanical load. Compared with normal joints studied previously, the posterior capsules involved in these degenerative joint complexes were hypertrophied and fibrocartilaginous throughout. Cartilaginous metaplasia was especially pronounced at the attachment sites (entheses) where the fibrocartilage now extended beyond the original level of the joint space, and capped the osseous spurs arising from these attachment sites.

Adult↗
PubMed2000

Effects of mechanical stress on expression of differentiated phenotypes of chondrocytes.

In the patients with dislocated hip arthropathy, cartilage gene expression was confirmed in weight-bearing inner layer tissues of the joint capsule. Because these inner layer tissues of the joint capsule formed joint-like structures with the femoral head for a long period, cartilaginous genes may have been expressed in the weight-bearing inner surface of the joint capsule. There was a difference in expression of the genes between weight-bearing and non-weight-bearing parts. From a quantitative comparison between GAPDH and aggrecan gene expression, aggrecan gene expression was 30-fold higher in the weight-bearing part than in the non-weight-bearing part. Aggrecan gene expression was not detected in outer layer tissues of the joint capsule. Type II collagen and TGF-beta genes were also detected, and both genes showed differences in expression between the weight-bearing and non-weight-bearing parts like the aggrecan gene. This may have been because mechanical stress caused cartilaginous differentiation in undifferentiated mesenchymal tissues in the inner layer of the joint capsule. Cell differentiation and proliferation caused by mechanical stress are indicate key role to osteoarticular tissues, and it is considered important for orthopedic treatment to evaluate the process in detail.

Aged↗
PubMed1978

[Reactive-destructive changes in the nervous elements of the capsule of the hip joint in coxarthrosis].

Specimens of the hip joint capsule were obtained during surgical treatment in 56 patients suffering from different kinds and stages of coxarthrosis. Neuronal elements of the capsule were stated to undergo reactive-destructive changes. Demyelinization of the capsule nerve fibers seems to be one of the causes producing painful sensation in the affected joint at coxarthrosis. Displastic and idiopathic coxarthrosis produces the destruction of less degree with preservation of the capsule nerves for a longer period; traumatic coxarthrosis with an aseptic necrosis of the femoral head is followed by a more profound destruction and the development of the disease is of shorter duration.

Adult↗
PubMed1997

The sensory innervation of the hip joint--an anatomical study.

Typically obturator nerve blockade is used to relieve hip pain. It sometimes only has a minor effect in resolving symptoms. This clinical observation led us to examine comprehensively the sensory nerve innervation of formalin-fixed hip joint capsules. Following macroscopic preparation, the area of the hip joint capsule was inspected with the aid of an operating microscope. We discovered a separation between the anterior and posterior sensory innervation of the hip joint capsule. The anteromedial innervation was determined by the articular branches of the obturator n. Additionally, the anterior hip joint capsule was innervated by sensory articular branches from the femoral n. In the posterior part we found articular branches from the sciatic n., which in addition to the articular branches from the nerves to the quadratus femoris m., innervate the postero-medial section of the hip joint capsule. Moreover, articular branches of the superior gluteal n. were found, which innervate the posterolateral section of the hip joint capsule. This anatomical study demonstrates that the obturator n. block is insufficient for the treatment of hip pain. Further investigations will determine if these nn. can be reached percutaneously. Effective neural blockade of the hip joint must include the femoral n., the sciatic n. and the superior gluteal n.

Femoral Nerve↗
PubMed2006

Regional variation is present in elbow capsules after injury.

Myofibroblast numbers and alpha-smooth muscle actin expression are increased in anterior joint capsules of patients with posttraumatic elbow contractures. The purpose of our study was to determine whether these changes occur regionally or throughout the entire joint capsule. We hypothesized that the alpha-smooth muscle actin mRNA expression and the myofibroblast numbers in posterior joint capsules would be elevated in elbows obtained from patients with posttraumatic joint contractures compared with joint capsules obtained from organ donor elbows without contractures. Semiquantitative reverse transcription-polymerase chain reaction was used to evaluate relative mRNA levels of alpha-smooth muscle actin. Glyceraldehyde-3-phosphate dehydrogenase was used to normalize the levels. Immunohistochemical analysis was used to determine the myofibroblast cell numbers. Higher alpha-smooth muscle actin mRNA levels were observed in elbows of patients with contractures compared with organ donor elbows without contractures. Immunohistochemical studies determined that myofibroblast numbers and the percentage of total cells that were myofibroblasts were elevated (2-2.5-fold) in the joint capsules from patients with posttraumatic joint contractures compared with similar tissue obtained from organ donor elbows without contractures. These results suggest elevated myofibroblast numbers occur throughout the whole joint capsule in posttraumatic elbow contractures, although there is some regional variation.

Actins↗
PubMed2006

Pain generation in lumbar and cervical facet joints.

Facet joints are implicated as a major source of neck and low-back pain. Both cervical and lumbar facet syndromes have been described in the medical literature. Biomechanical studies have shown that lumbar and cervical facet-joint capsules can undergo high strains during spine-loading. Neuroanatomic studies have demonstrated free and encapsulated nerve endings in facet joints as well as nerves containing substance P and calcitonin gene-related peptide. Neurophysiologic studies have shown that facet-joint capsules contain low-threshold mechanoreceptors, mechanically sensitive nociceptors, and silent nociceptors. Inflammation leads to decreased thresholds of nerve endings in facet capsules as well as elevated baseline discharge rates. Recent biomechanical studies suggest that rear-end motor-vehicle impacts give rise to excessive deformation of the capsules of lower cervical facet joints. Still unresolved is whether this stretch is sufficient to activate nociceptors in the joint capsule. To answer this question, recent studies indicate that low stretch levels activate proprioceptors in the facet-joint capsule. Excessive capsule stretch activates nociceptors, leads to prolonged neural afterdischarges, and can cause damage to the capsule and to axons in the capsule. In instances in which a whiplash event is severe enough to injure the joint capsule, facet capsule overstretch is a possible cause of persistent neck pain.

Animals↗
PubMedDate not supplied

Autonomic and sensitive somatic innervation of the ostrich elbow and knee joints articular capsule.

The present research was carried out on the fibrous layer of the ostrich's elbow and knee joints articular capsule, employing opportunely modified gold chloride Ruffini's method, to study the autonomic and sensitive somatic nerve components. The distribution of both nerve components followed frequently the vascular networks. The autonomic innervation was represented by isolated or grouped ganglion cells, frequently placed along the course of nerve trunks, close to the epineurium or located within the perineural connective tissue. The sensitive somatic innervation was constituted by free and encapsulated corpuscles. The last one, morphologically classified as Pacini, Pacini-like and Golgi-Mazzoni's corpuscles, were found isolated or grouped to constitute simple and complex flower sprays, "opposito-polar corpuscles" and "poichilomorphous fibres". The very few Golgi-Mazzoni's corpuscles were found only in the knee joint articular capsule. The two nerve components, found in the considered districts, did not shown significant quanti-qualitative and topographic differences. This datum, at least in appearance, seems to conflict with the ostrich functional aptitudes. In fact, the ostrich is a bird unable to fly but very able to run.

Adrenergic Fibers↗
PubMed2003

A systematic review of low level laser therapy with location-specific doses for pain from chronic joint disorders.

We investigated if low level laser therapy (LLLT) of the joint capsule can reduce pain in chronic joint disorders. A literature search identified 88 randomised controlled trials, of which 20 trials included patients with chronic joint disorders. Six trials were excluded for not irradiating the joint capsule. Three trials used doses lower than a dose range nominated a priori for reducing inflammation in the joint capsule. These trials found no significant difference between active and placebo treatments. The remaining 11 trials including 565 patients were of acceptable methodological quality with an average PEDro score of 6.9 (range 5-9). In these trials, LLLT within the suggested dose range was administered to the knee, temporomandibular or zygapophyseal joints. The results showed a mean weighted difference in change of pain on VAS of 29.8 mm (95% CI, 18.9 to 40.7) in favour of the active LLLT groups. Global health status improved for more patients in the active LLLT groups ( relative risk of 0.52; 95% CI 0.36 to 0.76). Low level laser therapy with the suggested dose range significantly reduces pain and improves health status in chronic joint disorders, but the heterogeneity in patient samples, treatment procedures and trial design calls for cautious interpretation of the results.

Arthralgia↗
PubMed2006

The subanconeus muscle.

There is a paucity of information in the extant literature regarding the detailed anatomy of the subanconeus (articularis cubiti) muscle. Our current study seeks to elucidate further the presence, morphology, and potential function of this muscle. Eighteen cadaveric upper extremities underwent dissection of their posterior elbow joint capsule with special attention to any fibres attaching to it from the triceps brachii muscle. We found that all specimens had various amounts of muscular attachment of the medial head of the triceps into the posterior joint capsule. It was noted that the highest concentration of fibres was into the joint capsule near the groove for the ulnar nerve. No specimen was found to have a distinct muscle belly associated with these connections to the joint capsule. On all sides these fibres were simply deeper attachments of the medial head of the triceps brachii muscle. Following tension on these deeper fibres retraction of the joint capsule was not noted but rather compression of the capsule. We would speculate on the basis of our study that these fibres of the medial head of the triceps brachii muscle do not represent a separate muscle per se and do not retract the posterior elbow joint capsule with extension of the forearm as has been theorised. It is possible that compression of the posterior elbow joint capsule from these deeply placed fibres of the triceps brachii restricts the elbow fat pad from being displaced and allows it to cushion the contact made between the olecranon process and the olecranon fossa.

Aged↗
PubMed2006

[Ultrasound evaluation of the acromioclavicular joint--a correlation of anatomical and sonographical findings].

AIM: To compare ultrasound imaging to the anatomy of the acromioclavicular joint. METHODS: 13 cadaveric acromioclavicular joints were examined by ultrasound (11 MHz linear array transducer) to determine the limits of the joint capsule and the width of the joint space. The results were compared to macroscopic sections. RESULTS: Anatomical variations were observed. The joint space of one specimen was completely filled by fibrous tissue, leaving 12 specimens for a complete study. A hypoechoic meniscoid disc was attached to the superior joint capsule, resulting in a convex curvature of the cranial part. The mean sonographic width of the joint space was 3.9 mm +/- 1.7 mm standard deviation (SD). The mean distance of the joint capsule from the articular bone rim of the clavicle, the acromion, and from the middle of the joint space was 1.1 +/- 1.0 mm, 1.3 +/- 0.7 mm, and 2.1 +/- 0.9 mm, respectively. The distance from the joint space to the capsular insertion on the clavicle and on the acromion was 4.4 +/- 1.4 mm and 5.3 +/- 2 mm, respectively. The mean difference between ultrasound and anatomical measurements in the vertical (cranio-caudal) plane was 0.5 +/- 0.5 mm (SD), whereas the mean difference between measurements in the horinzontal (medio-lateral) plane was 1.3 +/- 1.1 mm (SD). CONCLUSION: Due to low cost, safety and wide availability, sonography is suited for the evaluation of the acromioclavicular joint. However, when interpreting the results, errors in measuring, limitations in resolution of the system used, and the anatomy of the acromioclavicular joint and its anatomical variants have to be taken into consideration.

Acromioclavicular Joint↗
PubMed1992

Ankle joint (artc. intertarsalis) receptors in the domestic fowl.

The physiological responses of joint capsule sensory receptors in the ankle joint of the chicken were studied by recording the electrical activity from single sensory afferent nerve fibres dissected from the parafibular nerve. All units included in this study were sensitive to mechanical stimulation of the joint capsule and were classified with respect to nerve conduction velocity, receptive field size and response threshold. Rapidly adapting mechanoreceptors formed 23% of the receptors present in the sample and responded to the mechanical probe by giving a single response or a short burst of activity at the onset of stimulation. The majority of units identified showed a slowly adapting response and on the basis of conduction velocity were divided into group IV (CV 2.5 m/s), group III (CV 2.5-20 m/s) and those units conducting over 20 m/s. Group IV units had single spot-like receptive fields and mechanical thresholds ranging from 0.6 to 60 g. Group III units could be divided into two groups based on receptive field size. One group had spot-like receptive fields 1-2 mm in diameter, whereas in the other group the receptive fields were larger (over 2 x 3 mm). The large receptive field units had significantly faster conduction velocities, lower mechanical thresholds and steeper stimulus-response curves than small receptive field units. In response to movement of the joint very few of the receptors, whether rapidly or slowly adapting, were found to be excited by moving the joint by hand in the middle of its physiological range. The physiological properties of these avian mechanoreceptive fine afferent units suggest that while some are activated by normal joint movement and non-noxious local mechanical stimulation of the joint capsule, others have nociceptive functions. The receptors present in the ankle joint were correlated with the anatomical structures found in the avian joints and their physiological properties compared and contrasted to the joint receptors found in mammals.

Action Potentials↗
PubMedDate not supplied

Structural and mechanical properties of the glenohumeral joint posterior capsule.

The purpose of this study was to quantify regional variations in material properties of the glenohumeral joint posterior capsule and to compare these data with the anterior band of the inferior glenohumeral ligament (AB-IGHL). Mechanical properties were determined for individual bands of the AB-IGHL, superior posterior capsule (SUP-PC), middle posterior capsule (MID-PC), and inferior posterior capsule (INF-PC). Significant differences in tissue thickness were found among the 3 posterior capsular regions and the AB-IGHL. The AB-IGHL was thicker than the MID-PC (P=.03) and INF-PC (P=.01), and the SUP-PC was thicker than the INF-PC (P=.02). Except for significant differences in failure strains, material properties were not significantly different among the 4 tissue regions. There were no significant differences between tissue bands in modulus (P=.2), maximum stress (P=.46), or strain energy density (P=.62). Specimens failed primarily near the glenoid insertion (75%), with 4 specimens failing at the humeral insertion and 2 others failing in the tissue's mid substance.

Aged↗
PubMed1995

Adhesive capsulitis of the shoulder: MR diagnosis.

OBJECTIVE: Adhesive capsulitis is a clinical syndrome of pain and severely decreased joint motion ("frozen shoulder") caused by thickening and contraction of the joint capsule and synovium. Although arthrographic criteria for the diagnosis have been described, to our knowledge, the MR characteristics have not been reported. Accordingly, we studied the MR findings in 10 patients with this syndrome. MATERIALS AND METHODS: MR images of 25 subjects were included in the study. Nine had adhesive capsulitis documented by arthrography, and one had adhesive capsulitis proved at surgery. The MR findings in these patients were compared with those of 15 asymptomatic volunteers. Images were assessed for thickness of the joint capsule and synovium, for thickness of the coracohumeral ligament, and for volume of articular fluid. Capsule and synovium thickness was measured adjacent to the axillary recess. The volume of intraarticular fluid was calculated from direct measurements of the axillary recess and biceps tendon sheath. The rotator cuff interval was qualitatively evaluated for the presence of abnormal tissue. RESULTS: Thickening of capsule and synovium on MR images was characteristic of adhesive capsulitis, with a significant difference between mean thickness in patients with adhesive capsulitis (5.2 mm) and in asymptomatic volunteers (2.9 mm) (p < .01). Capsule and synovium thickness greater than 4 mm was a specific (95%) and sensitive (70%) criterion for the diagnosis of adhesive capsulitis. There was no significant difference in volume of articular fluid or thickness of the coracohumeral ligament between patients with adhesive capsulitis and asymptomatic volunteers (p > .5). The rotator cuff interval was not useful for assessing changes of adhesive capsulitis. CONCLUSION: Joint capsule and synovium thickness greater than 4 mm is a useful MR criterion for the diagnosis of adhesive capsulitis. The volume of articular fluid seen on MR images is not significantly diminished in patients with adhesive capsulitis.

Adult↗
PubMed1998

Central projection of proprioceptive information from the wrist joint via a forearm 'muscle' nerve in the cat.

1. Peripheral nerves arising in joint capsules are known to contain a 'contaminating' contribution from muscle afferent fibres. In the present report we provide the first electrophysiological evidence that some joint afferent fibres may take an 'ectopic' path to the central nervous system via a nearby muscle nerve. 2. Experiments were conducted in anaesthetized cats in which a distal extension of the indicis proprius nerve was observed to project beyond its own muscle to the dorsal surface of the wrist joint capsule which is also supplied by the 'classic' wrist joint nerve, a branch of the dorsal interosseous nerve. Both the proximal and distal segments of the indicis proprius nerve were exposed for recording, by means of silver hook electrodes, while each segment remained in continuity. 3. Individual wrist joint afferent fibres with receptive fields on the dorsal surface of the joint capsule could be identified electrophysiologically within the distal segment of the indicis proprius nerve. In each of these cases the same fibre could also be identified at the proximal recording site. The identity of each of these simultaneously recorded units was established (1) by the short fixed interval between their times of spike occurrence, (2) from the exact correspondence of the capsular receptive field for the simultaneously recorded spikes, and (3) by the unfailing correlation in the presence, or absence, of the distally and proximally recorded spikes in association with either manual or controlled stimulation of the wrist joint capsule. Most joint afferent fibres identified with this projection path were in the group II range of conduction velocities and had conventional properties but group III fibres also appeared to be represented. 4. The present demonstration that some joint afferent fibres may be located within 'muscle' nerves emphasizes the importance of activating deep inputs, of joint or muscle origin, by adequate stimulation of the peripheral receptors in order to examine selectively the central actions of either source of input. Electrical stimulation of the peripheral nerves may lead to interpretative ambiguities.

Afferent Pathways↗
PubMed1980

[Connective tissue in non-union and pseudarthrosis of long bones. Part I: Capsule of false joints in dogs (author's transl)].

Animal experiments were carried out on 28 dogs which underwent osteotomy of the femur without postoperative fixation. For systematic light- and transmission electron microscopy tissue from this area of 7 dogs was prepared. Result was a functional morphology of connective tissue. Instability of bone fragments is regarded as the most important factor in pathogenesis of pseudarthrosis. Pathologic mobility in the osteotomy area caused specific altered differentiation of local connective tissue cells, leading to a joint capsule-like formation of connective tissue. "Lining cells" to the pseudarthrotic cavity are fibroblasts and histiocyts, comparable to the "lining cells" of normal stratum synoviale. These cells are surrounded by some collagenous fibres and large amounts of amorphous ground substances. They derive means of numerous transitional forms. The capsule-like tissue formation aside the pseudarthrotic cavity is comparable to stratum synoviale of normal joints. In some of these capsule-like areas there are degenerative alterations similar to those of joint capsules in osteoarthritis.

Animals↗
PubMed1978

Ultrastructure of the joint receptors in the frog (Rana temporaria).

The ultrastructure of sensory nerve endings was examined in joint capsules of large limb joints in three adult frogs (Rana temporaria). The joint receptors are represented by the only one kind of sensory nerve endings--by free nerve endings. The unmyelinized preterminal desintegrates into single terminals. This branching is bound on the most peripheral cell of the Schwann cell by means of mesaxons, they pass from the pericaryum of the Schwann cell peripherally. The branches of the nerve terminal are surrounded by a cover of 1...3 cytoplasmatic processes of the Schwann cell. The surface lamella is covered by a distinct basal membrane. Bundles of collagenous fibrils pass along the branches of the nerve terminal. Quite naked nerve endings were not observed. The axoplasma of the nerve terminal contains strikingly few cell organels. Besides axially passing neurofilaments and neurotubules only sporadic mitochondria and clear vesicles were observed. The accumulation of mitochondria, characteristic for the axoplasma of nerve terminals, was observed in no case. Free nerve endings which were found in the joint capsules of the frog belong among so called "free penicillate nerve endings".

Animals↗
PubMed1982

Stability of the canine shoulder joint: an in vitro analysis.

The stability of the canine shoulder joint was assessed with and without the restraining effects of selected supporting structures. Shoulder joints from medium-sized (15 to 30 kg) canine cadavers were dissected, and all soft tissues were removed except for the 4 cuff muscles (supraspinous, infraspinous, teres minor, subscapular), the biceps muscle (m biceps brachii) and the joint capsule with its associated glenohumeral ligaments. The humerus was fixed in position, and with the shoulder extended, the joint was stressed into abduction, adduction, internal rotation, and external rotation. The range of motion was measured from transverse pins placed above and below the joint. Measurements were made before and after severance of the cuff tendons and joint capsule. In selected joints, medial and lateral luxations were created. The biceps tendon was then transposed medially or laterally, respectively, to aid joint stability. Selected medial luxations were stabilized by transferring a portion of the insertion of the supraspinous tendon to a medial location. All joints were stressed as just described, and the range of motion was measured before and after tendon transfer. The joint capsule with its associated glenohumeral ligaments was an important restraint of joint motion. Lateral transfer of the biceps tendon partially corrected lateral joint instability by imposed marked rotational constraints on the joint. Medial transfer of the biceps tendon or the supraspinous tendon partially corrected medial joint instability, but did not resolve rotational abnormalities.

Animals↗