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PubMedDate not supplied

[Use of a water jet for synovectomy: in vitro study of feasibility].

AIM: The selectivity of a water jet (WJ) is already used with clinical advantage in the surgery of liver, brain, kidney and herniated lumbar discs. The aim of the present study was to determine whether a WJ can be used for synovectomy without damaging the joint capsule and the cartilage. METHOD: 60 human cadaver knee specimens (67 +/- 14 years) were dissected into synovial and cartilage samples. They were randomly assessed to four pressure groups (pW = 3; 6; 9; 12 MPa) and three jet surface angles (beta = 30; 60; 90 degrees) The nozzle diameter was dD = 0.12 mm, the stand off distance of the jet was s = 10 mm with a feed rate of vV = 2 mm/s. The acquired parameters were depth of the cuts, histological layer, and change of the samples thickness. RESULT: There was a correlation of the cutting depth and the pressure (pW), whereas the jet-surface angle (beta) showed no correlation. The synovial layer of the cut likewise correlated with the pressure. At pW = 6 MPa the stratum subsynoviale could be cut selectively without damaging the fibrous capsule or the cartilage. The increase of the samples thickness was caused by an interstitial oedema. CONCLUSION: The different mechanical properties of the joint capsule and the stratum subsynoviale lead to the selective cutting of the water jet. Since the joint capsule was not damaged, the feasibility of WJ synovectomy has been proven. The device can be used for synovectomy in parts of the joint that are not visible as well as in very small joints.

Aged↗
PubMed1984

Role of joint afferents in relation to the initiation of forelimb stepping in thalamic cats.

To analyze the roles of joint afferents in relation to initiation of forelimb stepping in thalamic cats, we recorded the unit spikes of the cervical dorsal roots, stimulated the joint afferents, and applied local anesthesia to the joint capsule. Almost all of the joint afferents of the shoulder, elbow, wrist and finger adapted slowly and exhibited alternating firing during forelimb stepping. About 45% of the afferents of each joint showed firings as the limb moved from forward to backward. About 44% of the afferents exhibited discharges as the limb moved from backward to forward. The remaining afferents showed firings as the limb moved in both directions. The application of local anesthesia to joints of the shoulder, elbow or wrist resulted in a marked reduction of forelimb stepping. Forelimb stepping was evoked by electric stimulation of the joint capsule, when excitabilities of flexor motoneurons were increased due to muscle stretching. Impulses originating in the joint afferents of the forelimb entered the spinal cord and ascended to the dorsolateral funiculus of the cervical cord, since forelimb stepping was abolished after bilateral transection of this part. Our results indicate that joint afferents may play an important role in the initiation of forelimb stepping in thalamic cats walking on a motor-driven treadmill.

Afferent Pathways↗
PubMed2005

Transcriptional induction of matrix metalloproteinase-9 in the chondrocyte and synoviocyte cells is regulated via a novel mechanism: evidence for functional cooperation between serum amyloid A-activating factor-1 and AP-1.

Increased expression of matrix metalloproteinase-9 (MMP-9) by IL-1beta and TNF-alpha is regarded as a key factor in the degradation of cartilage during arthritis. However, the underlying molecular mechanism of this induction process especially in the cells of the joint capsule remains elusive. Chondrocytes and synoviocytes, the resident cells of joint capsule, markedly increase transcription of MMP-9 in response to IL-1beta- and TNF-alpha-mediated stimulation. Using progressively deleted and mutant promoter constructs of MMP-9, we show that serum amyloid A-activating factor (SAF)-1, a novel transcription factor, and the AP-1 family of proteins cooperatively regulate cytokine-mediated induction of MMP-9 in the resident cells of the joint capsule. In the MMP-9 promoter, SAF-1 and AP-1 DNA-binding elements are present in close proximity with only 14 nucleotides apart. SAF-1 DNA-binding activity is increased in both cytokine-stimulated cells as well as in osteoarthritic cartilage tissues. Although overexpression of SAF-1 could increase expression of the MMP-9 promoter and endogenous MMP-9 gelatinolytic activity, for maximal induction of MMP-9 gene concurrent participation of SAF-1 and AP-1 is required. Mutation of either one of these two elements resulted in a severe reduction in cytokine responsiveness of MMP-9 promoter and compromised the transactivation potential of both SAF-1 and AP-1. Simultaneous requirement for two distinct DNA-binding elements suggests that SAF-1 and AP-1 function in a mutually beneficial manner acting as essential coactivators to drive cytokine-mediated transcriptional activation of MMP-9.

Animals↗
PubMed2001

Effect of capsular injury on acromioclavicular joint mechanics.

BACKGROUND: Traumatic disruption of the acromioclavicular joint capsule is associated with pain and instability after the injury and may lead to degenerative joint disease. The objective of this study was to quantify the effect of transection of the acromioclavicular joint capsule on the kinematics and the in situ forces in the coracoclavicular ligaments in response to external loading conditions. METHODS: Eleven fresh-frozen human cadaveric shoulders were tested with use of a robotic/universal force-moment sensor testing system. The shoulders were subjected to three loading conditions (an anterior, posterior, and superior load of 70 N) in their intact state and after transection of the acromioclavicular joint capsule. RESULTS: Transection of the capsule resulted in a significant (p < 0.05) increase in anterior translation (6.4 mm) and posterior translation (3.6 mm) but not in superior translation (1.6 mm). The effect of capsule transection on the forces in the coracoclavicular ligaments was also significant (p < 0.05) in response to anterior and posterior loading but not in response to superior loading. However, differences were found between the forces in the trapezoid and conoid ligaments. Under an anterior load, the mean in situ force (and standard deviation) in the trapezoid increased from 14 +/- 14 N to 25 +/- 19 N, while the mean force in the conoid increased from 15 +/- 14 N to 49 +/- 23 N, or 227%. In contrast, in response to a posterior load, the mean in situ force in the trapezoid increased from 23 +/- 15 N to 38 +/- 23 N, or 66% (p < 0.05), while the mean force in the conoid increased only 9%. CONCLUSIONS AND CLINICAL RELEVANCE: The large differences in the change of force in the conoid and trapezoid ligaments suggest that these ligaments should not be considered as one structure when surgical treatment is considered. Furthermore, transection of the capsule resulted in a shift of load to the coracoclavicular ligaments, which may render the intact coracoclavicular ligaments more likely to fail with anterior or posterior loading. The results of the present study also suggest that the intact coracoclavicular ligaments cannot compensate for the loss of capsular function during anterior-posterior loading as occurs in type-II acromioclavicular joint injuries.

Acromioclavicular Joint↗
PubMed1997

Sodium urate arthritis: effects on the sensory properties of articular afferents in the chicken.

The physiological properties of joint capsule mechanoreceptors in the ankle joint of the chicken were studied in the 3-h period immediately after intra-articular injection of microcrystal sodium urate. The electrical activity was recorded from single C- and A-delta sensory fibres dissected from the parafibular nerve. C-fibres showed high levels of spontaneous activity and receptive fields that varied from single spots 1 mm in diameter up to 4 x 4 mm. Thresholds to mechanical stimulation ranged from 0.1 to 8 g and 80% of the units responded to movement of the joint. A-delta fibres showed little spontaneous activity and receptive fields that varied from 1 mm to 9 x 1 mm. Thresholds to mechanical stimulation ranged from 0.1 to 16 g and 17% responded to joint movement. A comparison of the physiological properties of the C- and A-delta fibres in sodium urate arthritis with similar fibres in normal and monoarthritic animals indicated an increased sensitivity in the C-fibres but not in the A-delta fibres. Sensitisation was observed in the significantly increased receptive field size, decreased response thresholds, increased response to joint movement and the high level of spontaneous activity. These changes in the sensitivity of the joint capsule C-fibre receptors provides peripheral neural evidence for the pain experienced in acute gouty arthritis.

Animals↗
PubMedDate not supplied

The labrum of the calcaneocuboid joint.

The authors describe a previously unreported anatomical structure in the calcaneocuboid joint of the foot and discuss the clinical significance. Fibroadipose synovial folds or labra are present in different locations throughout the calcaneocuboid joint of the foot. They appear to be wedge-shaped infections attached to the joint capsule in areas of incongruent joint spaces. Their surface is covered with synovial cells with a highly vascular loose connective tissue sublayer. Nerve fibers were seen in association with the joint capsule, but not within the V-shaped labrum. The clinical significance of the presence of the labrum is discussed, but their function is uncertain. These structures can project up to half the joint distance and have the possibility of producing impingement syndromes, or even tears. Since they are covered with two to three layers of synoviocytes, they also have the ability to produce a synovitis. The labrum can be identified using MRI, and once their presence is known arthroscopic repair of these structures is theoretically possible.

Aged↗
PubMed2005

Acetabular augmentation at six- to 30-year follow-up. A biochemical and histological analysis.

In developmental dysplasia of the hip, a deficient acetabulum may be augmented by placing local autogenous iliac osseous graft, or the ilium itself, over the head of the femur with the expectation that the added bone will function as a bearing surface. We analysed this bone obtained en bloc during subsequent surgery which was performed for degenerative osteoarthritis in three patients at 6, 25 and 30 years after the initial augmentation procedure. In each patient, the augmentation comprised of red cancellous bone covered on its articulating surface by a distinct layer of white tissue. Microscopy of this tissue showed parallel rows of spindle-shaped cells lying between linearly arranged collagen bundles typical of joint capsule. Biochemical analysis showed type I collagen, the principal collagen of joint capsule and bone, with no significant quantity of type II collagen, the principal collagen of cartilage. While the added bone produced by acetabular augmentation was durable, histological and biochemical analyses suggested that it had not undergone cartilage metaplasia. The augmented acetabulum articulates with the head of the femur by means of an interposed hip joint capsule.

Acetabulum↗
PubMed1996

Role of sympathetic postganglionic neurons in synovial plasma extravasation induced by bradykinin.

1. Plasma extravasation through the endothelium of blood vessels is an integral component of the inflammatory response and is dependent to a large extent on the inflammatory mediator bradykinin (BK). We studied plasma extravasation induced by BK perfusion (BK-induced PE) of the rat knee joint before and after various interventions that affect the sympathetic supply to the knee joint. We tested the hypothesis that plasma extravasation is dependent on the local sympathetic terminal supply to the synovia but not directly dependent on more proximal activity in the sympathetic neurons. As a control we used plasma extravasation induced by platelet activating factor (PAF), which acts directly on the endothelium of the blood vessels, that is, its action is independent of any innervation. Plasma extravasation into the knee joint cavity was determined spectrophotometrically by measuring, over time, the concentration of Evans blue dye extravasation into the joint perfusate following intravenous injection of the dye. 2. Surgical sympathectomy at the lumbar level (L2-L4), performed 4 and 14 days previously, reduced BK-induced PE by approximately 55-70%. 3. Decentralization of the lumbar sympathetic chain (cutting the preganglionic axons that innervate the postganglionic neurons to the hindlimb), interruption of the lumbar sympathetic chain during infusion of BK, or coperfusion of tetrodotoxin into the knee joint cavity did not reduce BK-induced PE. All three interventions abolish the activity in the sympathetic neurons but leave the peripheral postganglionic terminals in the joint capsule intact. 4. Surgical sympathectomy and decentralization did not affect plasma extravasation induced by the intra-articular perfusion with PAF. 5. Electrical stimulation of the lumbar sympathetic chain at frequencies of 0.25-5 Hz, which probably also significantly decreases blood flow through the joint capsule, reduced basal plasma extravasation, BK-induced PE and PAF-induced PE. This reduction was frequency dependent and was almost maximal at a stimulation frequency of 1 Hz. 6. In conclusion, BK-induced PE into the rat knee joint is dependent on the presence of intact sympathetic postganglionic nerve terminals innervating the joint capsule and not directly dependent on excitation of these neurons. However, electrical stimulation of the sympathetic neurons reduces the level of plasma extravasation, presumably because of vasoconstriction and decrease of blood flow through the joint capsule. These results indicate that peripheral action of inflammatory mediators on terminals of sympathetic neurons produces a facilitative effect on vascular permeability, whereas centrally generated excitation of these neurons, which depresses blood flow (vasoconstrictor function), decreases plasma extravasation. The effect on blood flow is presumed to occur at the precapillary resistance vessels by vesicular release of transmitter(s). The facilitative effect on permeability occurs at the venules and includes inflammatory-mediator-stimulated, non-vesicular-dependent production and release of a chemical substance (probably prostaglandin E2). Whether both functions are represented in the same class of sympathetic postganglionic neuron or in distinct ones remains to be elucidated.

Animals↗
PubMed1986

Pathology of the vertebral column of horses with cervical static stenosis.

Specimens of ligamentum flavum, joint capsule, and dorsal lamina were collected at surgery or necropsy from 25 horses with cervical static stenosis. All horses had myelographic evidence of dorsal compression of the spinal cord caused by soft tissue and/or bone in the caudal cervical area, primarily at C6-7. Most horses also had radiographic evidence of degenerative joint disease of articular facets. Histologically 19 horses had osteosclerosis and cartilage retention in the dorsal lamina, and 24 horses had increased fibrocartilage at the ligamentum flavum attachment to dorsal lamina. The ligamentum flavum and joint capsule had fibrovascular tissue in 20 horses. Fibrocartilaginous tissue, old hemorrhage, and fat necrosis were not unusual. One horse each had a synovial cyst, eosinophilic granulomas in the joint capsule, and osteochondrosis of articular facets. These findings indicate that abnormal biomechanical forces or instability of articulations result in stretching and tearing of the ligamentum flavum and joint capsule with subsequent fibrovascular and fibrocartilaginous proliferation, osteosclerosis of the dorsal lamina, and osteophyte formation on the articular facets.

Animals↗
PubMed1989

Sensory innervation of soft tissues of the lumbar spine in the rat.

The purpose of this study was to investigate neurophysiologically and anatomically the soft tissues of the dorsal compartment of the lumbar spine in order to understand better their possible role in low back pain. The focus was primarily on the lumbar facet joint and supraspinous ligament of the Sprague-Dawley rat. Microdissection of the dorsal ramus and electrophysiological and neuroanatomical studies of the dorsal ramus and its terminations in paravertebral tissue revealed that (a) there are mechanosensitive, slowly adapting fibers in the rat lumbar facet joint capsule; (b) there are slowly adapting, mechanosensitive units in the rat supraspinous ligaments that respond to tensile loading; both types of mechanosensitive units have high threshold; (c) mechanical stimulation of these tissues sometimes elicits afterdischarges lasting several minutes; (d) many extracellular recordings from the medial branch of the dorsal ramus appear to be reflex activity to mechanical stimulation; (e) silver impregnation of the rat joint capsule reveals individual axons, very few of which were encapsulated, suggesting that they terminate in free nerve endings; and (f) the nerves of the rat facet joint capsule contain 68, 160, and 200 kdalton polypeptide subunits of neurofilament protein (NFP). These results indicate that neurons of lumbar facet joint capsules and ligaments in the back are sensitive to mechanical strain and that the higher threshold neurons may serve a nociceptive (pain) function.

Animals↗
PubMed2002

Nerve fibers in lumbar spine structures and injured spinal roots express the sensory neuron-specific sodium channels SNS/PN3 and NaN/SNS2.

STUDY DESIGN: This prospective study examined the innervation of lumbar spine in tissues from patients with lower back pain and spine nerve roots from patients with traumatic brachial plexus injuries. OBJECTIVES: To demonstrate the presence of nerve fibers in lumbar spine structures and spine nerve roots, and to determine whether they express the sensory neuron-specific sodium channels SNS/PN3 and NaN/SNS2. SUMMARY OF BACKGROUND DATA: The anatomic and molecular basis of low back pain and sciatica is poorly understood. Previous studies have demonstrated sensory nerves in the facet joint capsule and prolapsed intervertebral disc, but not in the ligamentum flavum. The voltage-gated sodium channels SNS/PN3 and NaN/SNS2 are expressed by sensory neurone that mediate pain, but their presence in the lumbar spine is unknown. METHODS: Tissue samples of ligamentum flavum (n = 32), facet joint capsule (n = 20), intervertebral disc (n = 15), and spine roots (n = 8) were immunostained with specific antibodies to protein gene product 9.5 (a panneuronal marker), SNS/PN3, and NaN/SNS2. RESULTS: Protein gene product 9.5 immunoreactive nerve fibers were detected in 72% of the ligamentum flavum specimens and 70% of the facet joint capsule specimens, but in only 20% of the intervertebral disc specimens. The study detected SNS/PN3- and NaN/SNS2-positive fibers, respectively, in 28% and 3% of the ligamentum flavum specimens and 25% and 15% of the facet joint capsule specimens. Numerous SNS/PN3- and NaN/SNS2-positive fibers were found in the acutely injured spine roots, and some were still present in the dorsal roots in the chronic state. CONCLUSIONS: As the findings showed, SNS/PN3- and NaN/SNS2-immunoreactivity is present in a subset of nerve fibers in lumbar spine structures, including ligamentum flavum, and in injured spine roots. Selective SNS/PN3- and NaN/SNS2-blocking agents may provide new therapy for back pain and sciatica.

Adolescent↗
PubMed2005

Detailed pathological changes of human lumbar facet joints L1-L5 in elderly individuals.

Facet joints play an important role in intervertebral load transmission and are crucial for rotational kinematics. Clinically, the role of facet joints as a possible source of low back pain is seen as controversial and at present is not sufficiently investigated. In this study, human lumbar facet (zygapopyhysial) joints from donors with advanced age were analyzed macroscopically, for degenerative changes. The aim was to determine the extent and morphology of degenerative changes in these joints. Lumbar facet joints (L1-L5) of 32 donors were studied (mean age 80.1+/-11.2 years). Joint capsules were carefully removed and joint surfaces (5 zones) examined using magnifying glasses and probes. In the result, the majority of facet joints showed cartilage defects of varying extent. Defects were located mostly at the margins of the articular surface, the central zone being relatively well preserved. Defect localization was different between superior (most cartilage defects in superior zone) and inferior (most defects inferiorly) facets. Further, defects were more severe caudal (level of L5) and in older persons. Osteophytes were present in up to 30%, located mostly at the latero-dorsal enthesis of the joint capsule on the superior facet. In conclusion, most margins of the articular facets are subject to degenerative changes in the lumbar spine of elderly persons, the topographical pattern being different in superior and inferior facets. This observation can be explained by the segmental motion patterns during extension/flexion movements of the facets. Sometimes, due to the marginal extension, it is obvious that not all changes can be assessed by CT or MRI.

Age Factors↗
PubMed2003

Transmission security for single kinesthetic afferent fibers of joint origin and their target cuneate neurons in the cat.

Transmission between single identified, kinesthetic afferent fibers of joint origin and their central target neurons of the cuneate nucleus was examined in anesthetized cats by means of paired electrophysiological recording. Fifty-three wrist joint afferent-cuneate neuron pairs were isolated in which the single joint afferent fiber exerted suprathreshold excitatory actions on the target cuneate neuron. For each pair, the minimum kinesthetic input, a single spike, was sufficient to generate cuneate spike output, often amplified as a pair or burst of spikes, particularly at input rates up to 50-100 impulses per second. The high security was confirmed quantitatively by construction of stimulus-response relationships and calculation of transmission security measures in response to both static and dynamic vibrokinesthetic disturbances applied to the joint capsule. Graded stimulus-response relationships demonstrated that the output for this synaptic connection between single joint afferents and cuneate neurons could provide a sensitive indicator of the strength of joint capsule stimuli. The transmission security measures, calculated as the proportion of joint afferent spikes that generated cuneate spike output, were high (>85-90%) even at afferent fiber discharge rates up to 100-200 impulses per second. Furthermore, tight phase locking in the cuneate responses to vibratory stimulation of the joint capsule demonstrated that the synaptic linkage preserved, with a high level of fidelity, the temporal information about dynamic kinesthetic perturbations that affected the joint. The present study establishes that single kinesthetic afferents of joint origin display a capacity similar to that of tactile afferent fibers for exerting potent synaptic actions on central target neurons of the major ascending kinesthetic sensory pathway.

Afferent Pathways↗
PubMed1999

The normal ultrasonographic appearance of ovine joints, and the uses of arthrosonography in the evaluation of chronic ovine joint disease.

The ultrasonographic anatomy of the elbow, carpal, fetlock and stifle joints of six clinically normal sheep was determined using a 7.5 MHz linear transducer with stand-off pad. Examination of the joints was performed both prior to and after experimental distension of the joint capsule in four cadavers with up to 10 mL isotonic saline. This distension enabled the joint capsule to be imaged ultrasonographically as a 2 mm thick echogenic line. Isolation of the joint at necropsy enabled definitive identification of the structures seen ultrasonographically. Arthrosonography of five sheep with chronic arthritis/synovitis affecting one or more joints was performed, and the gross pathological changes examined at necropsy. The gross thickening of the joint capsule was visible ultrasonographically as a hyperechoic band up to 20 mm thick. Ultrasonography was a valuable diagnostic aid in the evaluation of chronic ovine joint disease, and has potential value in the prognosis for chronic ovine arthritis/synovitis.

Animals↗
PubMed1992

Anatomy and function of the bursa subacromialis.

The ligamentum coracohumerale, as the anterior limit of the bursa subacromialis, runs into the shoulder joint capsule, connecting--broadly based--above the sulcus intertubercularis. It does not, however, originate--as described previously--from the base of the processus coracoideus (viewed frontally), but rather medially from the base, i.e. on the side of the fossa supraspinatus. The sliding mechanism starting at 50 degrees affects the parietal sheet of the bursa subacromialis, whereby the laterally situated section slides under the medially situated section. With an abduction of up to 50 degrees, the lateral section congests in front of the corner of the acromion, sliding from there under the acromion, so that the--hitherto--medial section is located above the section now sliding away beneath it. This sliding mechanism continues on up to 100 degrees. At this point the parietal sheet of the bursa subacromialis lies as follows: The section that had been situated laterally at the beginning of the sliding mechanism now lies caudally to the section that had lain medially at the outset. The bursa subacromialis does not slide fully into the fossa supraspinatus, as in all of the cases observed, it is firmly connected, together with the fascia subdeltoidea, to the corner of the acromion. The visceral sheet does not change in the course of the sliding mechanism as described, as it is connected to the fascia of the supraspinatus muscle--with the exception of a medial stretch of 16 mm. A further finding deals with the course of the muscles of the caput breve of the biceps brachii. Individual muscle fibre components do not connect to the processus coracoideus, but rather run before the tip of the processus coracoideus into the ligamentum coracoacromiale, radiating not only into the ligamentum coracoacromiale, but also--certain components--into the shoulder joint capsule. Through this, the 'aponeurosis tendinis brachii' forms a tendon roof in front of the processus coracoideus that extends to the structures running along the head of the humerus. The muscle fibre components of the caput breve of the m. biceps brachii radiating into the shoulder joint capsule, together with the muscles of the rotator cuff and the ligamentum coracohumerale, keep the shoulder joint capsule tense, thus preventing constriction symptoms.

Bursa, Synovial↗
PubMed2002

Distribution of beta-endorphin and substance P in the shoulder joint of the dog before and after a low impact exercise programme.

Beta-endorphin and substance P were immunolocalized in the articular cartilage, synovial membrane and fibrous joint capsule of dogs. Twelve adult greyhounds were randomly assigned to one of three groups: control, limited exercise, or regimented exercise. On day 0, biopsies of articular cartilage and joint capsule were obtained from the left shoulder joints of dogs receiving limited and regimented exercise. On day 72, biopsies of joint capsule from right and left shoulders and articular cartilage from the right shoulder joint were analysed for the presence of glycosaminoglycans (GAG) and for immunolocalization of substance P and beta-endorphin. Regimented exercise increased the presence of GAGs and immunolocalization of substance P and beta-endorphin in articular cartilage and synovial membrane compared to day 0 biopsies and untreated controls. Localization of beta-endorphin became prominent in and around the chondrocytes. Substance P was increased in chondrocytes and extracellular matrix. Concomitant changes in localization of beta-endorphin and substance P may have a role in the modulation of the microphysiological environment, metabolism, or function of joint tissues in response to low-impact exercise.

Animals↗
PubMed1996

MRI in late sequelae of Perthes' disease: imaging findings and symptomatology in ten hips.

Five painful (group A) and five symptomless (group B) hips in nine patients with late sequelae of Perthes' disease were studied with plain radiography and magnetic resonance imaging (MRI) in order to correlate MRI findings with symptomatology. The unaffected hips were also studied. In group A hips, poor congruence of the articular cartilage surfaces was present in three of five cases, whereas good congruence was found in all group B hips. In one spherical but painful hip (group A), MRI revealed a protuberance in the anterolateral cartilage of the femoral head. The joint cartilage in group A and B hips was, on average, 0.5 and 1.5 mm thicker, respectively, than the cartilage in the unaffected hips. The lateral joint capsule was, on average, 3.0 mm thicker in group A hips than in the unaffected hips (P < 0.05), which possibly reflects reactive changes due to chronic irritation in the painful hips. The mean joint capsule thickness differed by only 0.5 mm between the unaffected and group B hips. Mean anterior acetabular coverage by MRI was 97 % in group A and 98 % in group B, while in the unaffected hips mean anterior coverage was 102 %. In an aspherical painful hip, MRI revealed a juxta-articular cyst not visible by radiography. A symptomless intra-articular fragment, due to osteochondritis dissecans, was well visualized with MRI. MRI is recommended for evaluation of pain in hips with late sequelae of Perthes' disease. It may show abnormalities in bony structures, as well as in joint capsule and cartilage.

Adult↗
PubMed2005

Intraarticular lesions in traumatic anterior shoulder instability: a study based on the results of diagnostic imaging.

BACKGROUND: Diagnostics of intraarticular lesions is important in the treatment of traumatic anterior shoulder instability. PATIENTS AND METHODS: We studied 30 patients: 26 men and 4 women. For all patients preoperative examinations involved arthrography, CT arthrography, MR arthrography, and 3D-CT. RESULTS: The articular capsule adhered to the margin of the glenoid in only 3 cases. In the remaining 27 patients, the joint capsule was detached, showing medial translation. Hill-Sachs lesions were present in 24 cases. Bankart lesions were detected in all cases, and they extended over 2-5 h. Osseous Bankart lesions were detected in 13 cases. MR arthrography revealed the articular labrum in all cases, but AIGHL in only 16 cases. Bankart lesions were found in all cases. When the patients were divided according to the frequency of dislocation, there was a correlation between both distance of the detached joint capsule and visualization of AIGHL and the frequency of dislocation. INTERPRETATION: From this study, the frequency of dislocation was higher in the patients with severe detachment of the joint capsule, in whom AIGHL could not be visualized by MR arthrography.

Adolescent↗