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At least 397 records · Page 22Linked to original sources
PubMed1995

Reconstruction with tenodesis in an adult flatfoot model. A biomechanical evaluation of four methods.

Six fresh-frozen adult cadaveric specimens were mounted in an Instron materials testing machine with use of a cemented intramedullary rod. Angular relationships between the first metatarsal and the talus were recorded with a sonic digitizer. A flatfoot deformity was created by dividing the talonavicular joint capsule (superiorly, medially, and inferiorly), the spring ligament, the anteromedial aspect of the subtalar joint capsule, and the plantar fascia. Angular displacement in the sagittal and transverse planes was recorded at no load and at 100, 350, and 700-newton plantar loads. Each specimen was subjected to four different reconstructions with tenodesis, and the angular relationship between the first metatarsal and the talus was measured at the four levels of load. A reconstruction with use of the peroneus longus tendon was performed by preserving its insertion into the first metatarsal, rerouting the tendon and passing it from medial to lateral through a calcaneal bone tunnel, and anchoring it to the lateral aspect of the calcaneus. A reconstruction with the tibialis tendon was performed by passing the medial third of the tendon from dorsal to plantar through the navicular and from medial to lateral through the calcaneal bone tunnel and securing it to the lateral aspect of the calcaneus. The reconstruction with the tibialis anterior tendon was repeated with the tendon graft routed along the medial aspect of the navicular, directly through the calcaneal bone tunnel. The fourth reconstruction was done with use of an Achilles tendon allograft.(ABSTRACT TRUNCATED AT 250 WORDS)

Achilles Tendon↗
PubMed1990

Distal humeral migration as a component of multidirectional shoulder instability. An anatomical study in autopsy specimens.

The object of the present study of autopsy specimens was to evaluate distal humeral migration during abduction allowed by sequential severance of capsular and ligamentous structures stabilizing the shoulder joint. A kinesiologic testing device continuously registered distal humeral migration, abduction angle, rotation, and flexion-extension. No distally directed force was applied to the humerus except the weight of the apparatus. Significant distal migration was recorded in the entire range of abduction (0 degrees -60 degrees) after solitary severance of the coracohumeral ligament as well as the proximal part of the anterior joint capsule. Further sectioning of the proximal part of the posterior capsule did not significantly increase distal humeral migration. Maximum distal migration (25 mm) was measured at 20 degrees of abduction. Applying an internal torque to the humerus significantly prevented distal migration as long as the posterior capsule was kept intact. Clinical testing for distal humeral migration should be performed with the shoulder joint at 20 degrees of abduction and neutral rotation. Furthermore, distal humeral migration can be significantly reduced by internal rotation of the humerus when the posterior joint capsule is intact.

Aged↗
PubMed1989

Axillar ultrasound of the glenohumeral joint.

A new ultrasonographic method for detection of intraarticular effusion in the glenohumeral joint was developed. The distance between the humerus and the joint capsule is measured at the axilla with the humerus in 90 degrees abduction. Effusion was detected by ultrasonography in 10 of 11 joints in which effusion was confirmed by intraarticular puncture. Intraarticular injection of physiological NaC1 solution could be seen as a change in the scan. The mean ultrasonographic distance between the head of humerus and the joint capsule was 2.4 mm (SD 0.5 mm) in 80 shoulder joints of 40 healthy adults. Thus, intrasynovial effusion can be suspected if the distance is 3.5 mm (mean + 2 SD) or more, or the difference between both sides is 1 mm or more.

Adult↗
PubMed1995

Fine structure of vesiculated nerve profiles in the human lumbar facet joint.

The ultrastructural features of vesiculated nerve profiles were examined within a perivascular plexus of unmyelinated nerve fibres around small arteries and arterioles in the posterior facet joint capsule. Such profiles were exclusively observed in the dense fibrous layer and the adjacent part of the subintimal layer. The ligamentum flavum lacked any type of innervation. The vesiculated nerve profiles were tentatively classified on the basis of the fine structural appearances of their vesicular content. Two major types of nerve profiles could readily be distinguished in the capsular tissue. Both displayed a variable number of mitochondria, neurotubules and neurofilaments. The first type, containing predominantly small vesicles with an electron-dense granule or core, was frequently encountered and considered to be adrenergic in function. Profiles similar in morphology were also observed in the synovial plical tissue. A second type of profile, found in the joint capsule, contained varying proportions of small agranular (clear) vesicles and mitochondria. Some of these profiles exhibited an accumulation of mitochondria and were considered to be sensory in function. Nerve profiles filled with predominantly small flattened vesicles were occasionally encountered.

Adult↗
PubMedDate not supplied

Does total hip arthroplasty mean sensorial and proprioceptive lesion? A clinical study.

Total hip arthroplasty means sacrificing the joint capsule and the mechanoreceptors contained therein. Recent neurophysiological experiences seem to redefine the sensorial and proprioceptive role of the joint capsule in favor of the activity of the muscular mechanoreceptors, particularly in the area of the coxofemoral joint. The authors have examined the sensorial lesion caused by total hip arthroplasty in a group of 20 patients. Clinical testing was conducted prior to surgery, 7 and 40 days later. The tests were aimed at exploring the perceptive and proprioceptive activity of the hip, and showed marked decrease in all of the receptorial activity one week after surgery. After 40 days perceptive function was completely recovered, as the scores for tests conducted were the same as those obtained prior to surgery: proprioceptive activity was instead considerably improved, with significant changes in most parts of the tests. The authors conclude by observing that total hip arthroplasty does not cause permanent lesion of the perception of joint movement; furthermore, renewed coxofemoral mechanics allow for a better proprioceptive response with strengthening of static and dynamic antigravitational reactions.

Age Factors↗
PubMed1983

Hemodynamics of the juvenile knee in relation to increasing intra-articular pressure. An experimental study in dogs.

The relationships between intraosseous pressure and regional blood flow in the juxta-articular epiphyses were determined in the knees of immature dogs. Intraosseous pressures were continuously registered in one knee. Regional blood flow rates were simultaneously determined by the microsphere technique before and after venous tamponade of both knee joint capsules. During complete venous tamponade the intraosseous pressure of the distal femoral epiphyses rose 268%, while flow increased 122%. A concurrent 20-fold flow increase of the knee capsule and 3-4-fold flow increase of the proximal femoral bone was observed. Evacuation of the knee joints resulted in an immediate drop of the intraosseous pressure of the distal femoral epiphyses, whereas hyperaemia prevailed for at least half an hour and was most pronounced in the distal femoral epiphyses and knee joint capsule. Intraosseous pressure registration did not significantly influence regional blood flow. It is suggested that the changes of intraosseous pressures during knee joint tamponade reflect changes in the venous outlet resistance. The results demonstrate the significance of intra-articular pressure increase on the hemodynamics of the juxta-articular tissues of the knee and proximal femoral bone. These findings may be of importance in the pathogenesis of growth disturbances observed in juvenile degenerative arthritis.

Animals↗
PubMed1994

Isotope bone scanning for acute osteomyelitis and septic arthritis in children.

We prospectively studied 86 children to assess the value and accuracy of isotope bone scanning in the diagnosis of suspected acute haematogenous osteomyelitis and septic arthritis. The patients were scanned because of difficulty in localising the exact site of the pathology. Characteristic scan appearances were found. In osteomyelitis there was increased or decreased uptake extending beyond the confines of the joint capsule; in septic arthritis there was increased or decreased uptake on either side of the joint line, but largely limited to and uniform within the joint capsule. The bone-scan images were correlated with the final diagnosis in 34 sites of septic arthritis and in 62 sites of osteomyelitis. The overall accuracy of the bone scans was 81%. The predictive value for a positive scan to be correct was 100% for a cold scan and 82% for a hot scan. The main reason for a false-positive scan was contiguous soft-tissue infection. The predictive value for a negative scan to be correct was 63%. One reason for a false-negative scan was that the patient was in the transitional phase from cold to hot.

Adolescent↗
PubMed1990

Surgical repair of peripheral detachment of the medial meniscus in 34 cattle.

A detachment of the periphery of the medial meniscus from the joint capsule and medial collateral ligament in 34 cattle was repaired by securing the meniscus to the joint capsule with vertical mattress sutures during arthrotomy. Of 28 cattle with follow-up reports, 20 had recovered satisfactorily by their owners' evaluations; 17 were either not lame or slightly lame after the operation and three were moderately lame. Three of four cattle without follow-up reports were either not lame or slightly lame when discharged from the hospital.

Animals↗
PubMedDate not supplied

[Structure and vascularization of the knee joint menisci].

INTRODUCTION: The structural properties are important for the pathophysiology and healing of meniscus lesions. MATERIAL AND METHODS: We analyzed the collagenous fiber texture of 44 menisci by scanning electron microscopy after exposure of the collagen fibrils with NaOH. The distribution of fibrocartilage and dense connective tissue is investigated by light microscopy. The vasculature of the menisci is demonstrated by injection techniques as well as by the immunohistochemical proof of laminin as a component of the basement membrane in the wall of blood vessels. RESULTS: The meniscus surface is covered by a network of thin fibrils. Beneath the superficial network there is a layer of lamellar fiber bundles that intersect under various angles. The major part of the collagen fibrils is located in the central portion between the superficial layers and runs in a circular direction. In the external circumference the meniscus is composed of dense connective tissue that histologically resembles to tendon tissue. In the internal circumference and in the superficial layers the meniscus consists of fibrocartilage. Blood vessels enter the meniscus from the adjacent joint capsule. In the adult blood vessels are present only in a peripheral rim close to the joint capsule. The ligamentous anterior and posterior horns are completely vascularized regardless of age. CONCLUSIONS AND CLINICAL RELEVANCE: Our results allow the following conclusions. Reports from the literature, that describe an arcade-like collagenous fiber texture are incorrect. Our result show that there is a causal coherence between the circular orientation of the collagen fibers and the frequency of longitudinal meniscal tears. The occurrence of well vascularized dense connective tissue in the external circumference must be considered as cause for the well healing of peripheral meniscus lesions.

Adolescent↗
PubMed1991

Magnetic resonance imaging of temporomandibular joint after surgical treatment of internal derangement.

Sagittal and coronal surface coil magnetic resonance imaging was performed on 21 patients who about 2 years earlier had surgery for temporomandibular joint internal derangement. Surgical procedure included disk repositioning (23 joints) and diskectomy (seven joints). At the time of reimaging, 20 joints showed recurrence of pain and 10 joints were asymptomatic. Extensive fibrous tissue was seen in the joint space and in the joint capsule in 13 of the 20 painful joints, whereas minimal fibrous tissue in the lateral capsule wall was seen in 3 of the 10 nonpainful joints. Fibrous tissue was surgically confirmed in 10 of the painful joints. Disk displacement was seen in 11 of the 23 joints that had surgical disk repositioning. Disk displacement was seen in both painful (9/17) and nonpainful joints (2/6). It was concluded that magnetic resonance imaging is an excellent method for postoperative imaging of the temporomandibular joint and that attention should be directed to the presence or absence and extension of the fibrous tissue in the joint space and in the joint capsule.

Adolescent↗
PubMed1985

Calcification of entheses associated with X-linked hypophosphatemic osteomalacia.

We undertook a retrospective analysis of 26 patients with X-linked hypophosphatemic osteomalacia (or rickets), whose ages ranged from 1 to 62 years and who were from 11 different kindreds, to determine the prevalence and clinical characteristics of a unique disorder of the entheses (tendons, ligaments, and joint capsules). We found a generalized involvement of the entheses, with exuberant calcification of tendon and ligament insertions and of joint capsules, in 69 per cent of the subjects. The prevalence and extent of disease increased with age but were not correlated with sex. Commonly affected sites included the hand and sacroiliac joints. Histologic evaluation in a selected patient revealed intratendinous lamellar bone but no inflammatory cells. Our observations indicate that this disorder is an integral part of X-linked hypophosphatemic osteomalacia and exhibits clinical, radiographic, and histologic characteristics that differentiate it from degenerative disorders of these tissues and seronegative spondyloarthropathies.

Adolescent↗
PubMed1984

Anomalous contrahentes muscles in human feet.

Anomalous muscles were found in the third layer of plantar musculature in 2 human feet. Although they occupied the approximate position of m. adductor hallucis caput obliquum , they were larger than that muscle and showed more extensive insertions. In one specimen the muscle inserted into the areas of the metatarsophalangeal joint capsules of the first and second toes. In the second specimen the insertion was into the metatarsophalangeal joint capsules of the 4 medial toes. The m. adductor hallucis caput transversum was missing in both feet. Both muscles were supplied by ramus profundus n. plantaris lateralis. The location and innervation of these unusual muscles indicates that they are contrahentes .

Foot↗
PubMed1991

[Pneumarthro-computed tomography in the diagnosis of recurring luxations and instabilities of the shoulder].

32 patients in whom recurrent dislocations or instability of the shoulder had been diagnosed, were examined via CT. Air was used as contrast agent. The results of pneumarthro-CT were re-checked 28 times by surgery and 6 times by arthroscopy. In all cases, Hill-Sachs defects and bony Bankart lesions had been correctly diagnosed. There were no faulty findings. Rate of accuracy of CT in detecting ruptures of the joint capsule from the neck of the scapula was 94%, in detecting lesions of the labrum glenoidale 88%, and in imaging an extended joint capsule 84%.

Adult↗
PubMed2002

Ultrasonography of the hip in the evaluation of children with seronegative juvenile rheumatoid arthritis.

OBJECTIVE: To find an objective measure of hip joint effusion with ultrasound (US) in patients with juvenile rheumatoid arthritis (JRA). METHODS: The hip joints of 24 children with JRA were evaluated with US. All patients were negative for rheumatoid factor and antinuclear antibodies. Patients with unilateral or bilateral hip pain, swelling, or limitation of range of motion were included. In each hip, the distance from the femoral neck to joint capsule was measured. Values were compared to measurements in a control group of 24 children with no history of hip joint or rheumatic disease. Statistically significant differences between the 2 groups were analyzed by t test. Two standard deviations above the control group mean was used as the standard for an effusion. RESULTS: There was a statistically significant difference in US joint space between the children with JRA and the control subjects (p < 0.001). The mean in the control group was 0.43 cm and the mean in the JRA group was 0.60 cm. A distance of 0.59 cm from femoral neck to joint capsule was determined to be consistent with an effusion. Using this standard, 71% of the children with JRA had effusion in at least one hip, and 25% had effusion bilaterally. No control subjects had measurements above this level. CONCLUSION: Ultrasonography is effective in the evaluation of hip joint involvement in patients with JRA, and may be useful in facilitating the diagnosis, classification, and followup of this illness.

Adolescent↗
PubMedDate not supplied

Etiology of acquired hammertoe deformity.

The most important feature of acquired hammertoe deformity is hyperextension of the proximal phalanx. The position of the proximal phalanx at the normal metatarsophalangeal joint is subject to the antagonistic action of the extensors and intrinsic flexors. The plantar joint capsule and the attached extensions of the plantar aponeurosis make an important contribution to the dynamic balance of this joint. The balance is distrubed in acquired hammertoe deformity because of age-related inefficiency of the plantar structures (the intrinsic flexors, the plantar joint capsule, and the plantar aponeurosis). This concept evolved from clinical obervations and measurements from roentgenograms of the feet of patients from different age groups. Hyperextension of the toes can be corrected by increasing tension on plantar structures. Dorsiflexion of the lesser toes, as measured on lateral weightbearing roentgeograms, is significantly increased in older age groups as compared with younger ones (means of 33 degrees, 33 degrees, 39 degrees 37, degrees vs 23 degrees, 24 degrees, 25 degrees, 25 degrees). These observations suggest elongation of the plantar structures beyound physiological length. Higher-heeled shoes worn for many years may be responsible because they maintain dorsiflexion of the toes and stretching of the plantar structures even during the foot flat interval of the walking cycle. Hyperextension of the proximal phalanx may be the primary deformity. In this position, the long extensor loses its tendodesing effect and flexion deformity of the proximal interphalangeal joint results.

Adult↗
PubMedDate not supplied

Calculation of beta dosimetry in radiation synovectomy using Monte Carlo simulation (EGS4).

Using the EGS4 Monte Carlo code, absorbed dose rate factors were estimated for four radionuclides of interest in radiation synovectomy, an intra-articular radiation therapy to treat rheumatoid arthritis. The treatment consists of the injection of a beta-emitting radionuclide into the joint capsule in order to eliminate diseased synovium through irradiation. The radionuclides investigated are 32P, 90Y, 165Dy, and 198Au. Calculations reveal the absorbed dose factor (cGy cm2/MBq s) as a function of distance (mm) in an EGS4 model of the rheumatic joint. The model incorporates bone, articular cartilage, joint capsule, and tissue (synovium) components found in all synovial joints, with dimensions in the model corresponding to dimensions typically found in larger joints, e.g., the knee, shoulder, or hip. Results are compared with previous, analytical approaches to beta dosimetry in radiation synovectomy. In addition, radiation backscatter due to the presence of bone is investigated and determined to have a negligible enhancement effect on absorbed dose to synovium.

Arthritis, Rheumatoid↗
PubMed1990

Peripheral detachment of the medial meniscus with injury to the medial collateral ligament in 50 cattle.

In 50 cattle the periphery of the medial meniscus had separated from the joint capsule and medial collateral ligament. The meniscus was hypermobile when varus and valgus stress were applied to the stifle joint, and concurrent injury to the collateral ligament allowed the medial side of the stifle joint to gape. Separation of the medial collateral ligament from the joint capsule and medial meniscus was seen at arthrotomy in 34 animals. In addition to signs of stifle injury, the affected cattle tended to abduct the leg and bear weight on the medial claw.

Animals↗
PubMed1995

[Scanning electron microscopy of the synovial membrane of the distal phalangeal joint and the navicular bursa in horses].

20 extremities of horses were used to investigate the synovial membrane of the distal interphalangeal joint and the navicular bursa. From each extremity five specimens were taken from the distal interphalangeal joint capsule, two further from the navicular bursa. Synovial villi were found near the articular cartilage as well as everywhere where the joint capsule did not form a tight periostal cover or was not connected with ligaments or tendons. Some lay between the articular surfaces of the phalanx media and phalanx distalis. Besides synovial villi and synovial folds "trabecular-like" cords of synovial membrane were demonstrated in the dorsal recess of the distal interphalangeal joint. These extend from one side of synovial membrane to another but they do not have a free ending. The surface of the synovial membrane and the arrangement of several synovial structures are documented.

Aging↗