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PubMed1992

Role of the capsulo-ligamentous structures in rotation and combined flexion-rotation of the lumbar spine.

We carried out experiments on whole cadaveric lumbar spines in order to determine the role that each of the capsulo-ligamentous structures play in axial rotation in the neutral position and in the flexed position. Eight specimens were first tested intact, then after division of all the apophyseal joint capsules between L1 and the sacrum. Another five specimens were also first tested intact, then after division of the supra- and interspinous ligaments and yellow ligament, and finally after cutting the posterior longitudinal ligament and posterior annulus at each level as well. The results show that there is considerable variation in the axial rotation of the lumbar vertebrae within the same spine and across different spines. The apophyseal joint capsules limit rotation both in neutral and flexed positions. In flexion, the amplitude of rotation in the lumbar spine is reduced. Of the capsulo-ligamentous structures, it is the posterior annulus and the posterior longitudinal ligament that seem to play the more important role in limiting axial rotation while the spine is flexed.

Adult↗
PubMed1977

The pig synovium, II. Some properties of isolated intimal cells.

I. The effect of trypsinization. Certain physiological and immunological properties of isolated intimal synoviocytes were studied in various in vitro systems. Suspensions of the synoviocytes were obtained by incubating sheets of joint capsule in a solution of trypsin and then scraping off the intimal cells with a small knife. Synovium was examined immediately after trypsinization, but before scraping, by light and electron microscopy. The intimal cells had withdrawn many of their long processes, acquired lamelliform pseudopodia, and somewhat resembled cells of the A-type (Barland et al. 1962). To test the viability of the trypsinized synovium, fragments of trypsinized joint capsule were explanted in organ culture with the intima in contact with a Millipore substrate (Fell et al. 1976). After two days the intimal synoviocytes had become branched and, as in untreated control explants, now resembled B-cells. II. Phagocytosis and opsonic adherence. In a freshly prepared suspension of synoviocytes scraped from trypsinized synovial tissue many cells were still branched, but during 1 1/4 hours' incubation in serum-containing medium the majority had withdrawn their processes and become rounded. Cells in the branched form had little capacity for phagocytosis, but most of those in the rounded form were actively phagocytic. After suspensions of intimal cells had been incubated with opsonized sheep erythrocytes, most of the rounded, but none of the few remaining branched cells, had formed rosettes. Intimal cells from scraped synovial tissue were maintained in Sykes-Moore chambers for periods of up to 48 hours. Although the young pig synovium contains only a small proportion of macrophage-like (A-type) cells, in the cultures the cell population consisted of cells indistinguishable from macrophages, with a few small colonies of typical fibroblasts. In marked contrast to the fibroblasts, the macrophage-like cells in the Sykes-Moore cultures were highly phagocytic and formed conspicuous opsonic rosettes. Excessive phagocytosis inhibited subsequent rosetting by the macrophage-like cells. III. The effect of antiserum, with and without complement, on synovial cells. In view of earlier work by Fell & Barratt (1973) the effect of rabbit antiserum to pig erythrocytes (AS) with and without serum complement (C') on intimal synoviocytes in a Sykes-Moore chamber was investigated. AS+C' either lysed the macrophage-like cells or caused them to fuse into multinucleate giant cells. In the presence of AS without C', the macrophage-like cells formed large lakes of multinucleated cytoplasm. Fibroblasts in the same cultures were much more resistant to lysis by AS+C' and did not form multinucleate giant cells when exposed to AS either with or without C'.

Animals↗
PubMedDate not supplied

Pharmacokinetic disposition of cefazolin in serum and tissue during canine total hip replacement.

Intraoperative cefazolin concentrations were measured in serum, joint capsule, cancellous bone of the acetabulum, and proximal cancellous bone of the femur in 15 dogs undergoing total hip replacement. Cefazolin (22 mg/kg intravenously [IV]) was administered every hour for three doses. The mean peak serum concentrations (+/- SEM) were 387.79 +/- 27.56 micrograms/mL, 521.71 +/- 28.00 micrograms/mL, and 542.20 +/- 30.91 micrograms/mL, respectively. Mean serum concentrations just before administration of doses 2 and 3 were 51.77 +/- 2.39 micrograms/mL, and 64.84 +/- 3.46 micrograms/mL, respectively. The mean cefazolin concentrations in the joint capsule, cancellous bone of the acetabulum, and cancellous bone of the femur were 34.71 +/- 2.50 micrograms/g, 28.70 +/- 7.40 micrograms/g, and 36.20 +/- 3.80 micrograms/g, respectively. The minimum inhibitory concentration of cefazolin for 90% of the common contaminants (MIC90) in this clinic is less than or equal to 2 micrograms/mL or per gram of tissue. Serum concentrations never fell below 15 times the MIC90 (lowest trough, 35.93 micrograms/mL), and the lowest tissue concentration (6.57 micrograms/mL in cancellous bone from the acetabulum) was still more than 3 times the MIC90. The mean tissue concentration was 15 times the MIC90.

Acetabulum↗
PubMed2006

Localization of SP- and CGRP-immunopositive nerve fibers in the hip joint of patients with painful osteoarthritis and of patients with painless failed total hip arthroplasties.

Using immunohistochemical methods we determined the presence of SP- and CGRP-immunopositive nerve fibers in the hip joint of patients with femoral neck fracture (controls, group 1), painful osteoarthritis (group 2), and painless failed total hip arthroplasties (group 3). Immunoreactive nerve fibers were found in the soft tissue of the fossa acetabuli as well as in the subintimal part of the synovial layer in the hip joint capsule of groups 1 and 2. In the capsule of controls the innervation density had a median of 5.7fibers/cm(2) for CGRP-ir and 3.2fibers/cm(2) for SP-ir afferents. In the osteoarthritic group, the density significantly increased to a median of 15.6fibers/cm(2) for CGRP-ir and 8.2fibers/cm(2) for SP-ir neurons (p=0.05). Patients with failed hip arthroplasties completely lacked these neuropeptide containing afferents. Innervation density in the fossa acetabuli of osteoarthritc patients showed a median of 14.1fibers/cm(2) for CGRP-ir and 5.9fibers/cm(2) for SP-ir afferents. From these data we assume that the hip joint capsule and the soft tissue of the fossa acetabuli are important triggers of nociception. This is supported by the fact, that patients with loosened total hip arthroplasties, where we failed to detect SP- and CGRP-immunoreactive fibers, did not feel pain. The upregulation of SP- and CGRP-positive neurons in response to arthritic stages suggests a mechanism involving neuropeptides in the maintenance of a painful degenerative joint disease and in mediating noxious stimuli from the periphery. Furthermore, these findings help to explain clinical observations, such as effectiveness of local therapy to control hip pain with intraarticular injection, synovectomy and denervation procedures.

Aged↗
PubMed1999

Expression of cartilage specific genes by human capsular cartilaginous cells.

The amount of proteoglycan production in tissue that was considered to have cartilaginously differentiated due to mechanical stress and cartilage specific gene expression were investigated. The inner layer of the joint capsule which forms a sliding surface with the femoral head in the case of dislocated hip arthoropathy showed higher proteoglycan production compared to that in the surrounding non-cartilaginous tissue. On examining gene expression, although large cartilaginous proteoglycan is originally absent in this region, gene expression of aggrecan and versican which are able to bind to hyaluronan was observed. Further, gene expression of decorin and link protein was also examined. These findings in the inner layer of joint capsule forming sliding surface with the femoral head suggested the importance of mechanical stress in cartilaginous differentiatiog of mesenchymal tissue.

Cartilage↗
PubMed2002

Shoulder proprioception and function following thermal capsulorraphy.

PURPOSE: Because monopolar radiofrequency energy has a denaturing effect on the glenohumeral joint capsule during thermal capsulorraphy, we hypothesized that thermal treatment would have a deleterious effect on the mechanoreceptors present within the capsule, thereby affecting proprioception and function. The purpose of this study was to evaluate proprioception and function following thermal capsulorraphy. TYPE OF STUDY: Case series. METHODS: Twenty subjects (13 male, 7 female) diagnosed with unilateral anterior, anteroinferior, or multidirectional glenohumeral instability with no significant concomitant pathologies, were treated with monopolar radiofrequency thermal capsulorraphy by one surgeon. Capsular redundancy was the primary diagnosis in all subjects. Subjects were bilaterally tested retrospectively 6 to 24 months (11.90 +/- 5.65 months) following surgery. Each subject's ability to actively reproduce joint positions (ARJP) and reproduce paths of motion (PMR) was measured with an electromagnetic motion analysis system. Both passive reproduction of joint positions (PRJP) and threshold to detect passive motion (TTDPM) were measured using a proprioception testing device. Function was quantified with the Shoulder Rating Questionnaire (SRQ). Proprioception data were analyzed with separate repeated measures ANOVA (P <.05). RESULTS: Statistical analysis revealed a significant ARJP difference between the involved and uninvolved limb (P =.005) indicating that reproduction error was less with the involved limb compared to the uninvolved limb. No significant interactions were present for TTDPM, PRJP, or PMR. The SRQ indicates that the subjects returned to near normal function (91.86/100 +/- 5.38 points) at the time of testing. CONCLUSIONS: The results from this study do not support our hypothesis of proprioception and functional deficits following thermal treatment. Normalized proprioception following thermal capsulorraphy may have resulted from the healing effects of thermal treated ligament, as reported in the literature, as well as facilitation of other mechanoreceptors present in adjacent tissue about the shoulder joint during rehabilitation. The results of this study indicate that no appreciative deleterious effects exist with proprioception and function following treatment of shoulder instability with thermal capsulorraphy.

Adult↗
PubMed1999

Distribution of sensory receptors in joints of the upper cervical column in the laboratory marsupial monodelphis domestica.

In order to investigate the sensory innervation, the upper cervical spine of a small laboratory marsupial (monodelphis domestica) was examined with serial section light microscopy and re-embedding of selected sections for electron microscopy. Large numbers of free nerve endings supplied by A delta- and C-fibres were found in the longitudinal ligaments and facet joint capsules. Electron microscopically, areas of direct contact between axon and collagen fibres of the surrounding connective tissue separated only by the basal lamina were observed. Such structural adaptations suggest mechanoreceptive or polymodal nociceptive functions. In addition, about 100 small lamellated corpuscles were found in the longitudinal ligaments mainly concentrated around the first intervertebral disk. Electron microscopy shows finger-like processes extending from the axon terminal into the inner core lamellae. These are the likely sites of the mechanoelectric transduction process. Smaller numbers of lamellated corpuscles were seen in the lower intervertebral disks and facet joint capsules. Lamellated corpuscles are known to function as rapidly adapting mechanoreceptors supplementing information supplied by muscle spindles to the CNS about position and movement of the cervical spine.

Animals↗
PubMedDate not supplied

[Function of the glenohumeral ligaments in active protection of shoulder stability].

UNLABELLED: We harvested the joint capsule, the glenohumeral ligaments, and the coracohumeral ligaments of 8 fresh formalin-preserved shoulder specimen. We made use of the van Gieson technique and a special silver impregnation for staining peripheral axons according to Nowotny. The ligaments were cut into slices with a thickness of 15 microns. In total we performed 10,000 cuts. We discovered axons in all ligaments. These axons had no relation to vessels or vessel walls. Besides these axonal structures we detected type II mechanoreceptors (Pacini receptor). CLINICAL SIGNIFICANCE: The neural structures discovered in the glenohumeral capsule are of clinical importance especially in consideration of the high account of recurrent shoulder dislocation and concomitant Bankart lesions. Receptors located in the glenohumeral ligaments might control the stabilizing shoulder musculature. On this premises, rupture or detachment of these ligaments will lead to a loss of the feedback mechanism.

Adult↗
PubMed2006

The value of ultrasonography in the preoperative diagnostic evaluation of patients with recurrent anterior shoulder dislocation: a prospective study of 44 patients.

The purpose of this study was to investigate the value of ultrasonography in the pre-operative assessment of patients with recurrent post-traumatic, anterior shoulder instability. Forty-four consecutive patients, 44 men and 12 women, with unilateral, post-traumatic, recurrent instability of the shoulder were included in the study. One experienced radiologist examined all patients, using a 5.0 or 7.5 MHz linear-array transducer, with the arm in different positions, one of which was used to provoke apprehension of the shoulder. Special attention was paid to the evaluation of the joint capsule, the anterior labrum, especially in terms of the presence of a Bankart lesion. All patients were subsequently treated surgically. After a diagnostic arthroscopy either an open or arthroscopic stabilisation of the shoulder was performed. Ultrasonography disclosed an unstable anterior labrum (equivalent to a Bankart lesion) in 36 shoulders; the lesion was verified in all 36 shoulders during arthroscopy. In three shoulders, arthroscopy disclosed an injured labrum, which had healed in an anterio-medial position on the scapular neck. In these three shoulders, ultrasonography failed to show any lesion. In five shoulders no Bankart lesion was found at arthroscopy. All these patients had increased shoulder laxity, and ultrasonography did not show any Bankart lesion. Furthermore a judgement of the joint capsule was not possible either. A bony Bankart lesion was found in four shoulders, using both arthroscopy and ultrasonography. The sensitivity of the ultrasonographic evaluation was 92%, and the specificity 100%. The positive predictive value was 100%, and the negative predictive value 63%. Ultrasonography showed a high correlation with the arthroscopic findings, with a high sensitivity and specificity. Therefore, we conclude that US can give important pre-operative information in patients with recurrent, unilateral, post-traumatic, anterior shoulder instability.

Adult↗
PubMed1992

[Pericoxal fat stripes and the capsule of the hip joint. The anatomical-radiological correlations].

The capsule of the hip joint can always be demonstrated on antero-posterior radiographs provided two conditions are met: 1. the so-called gluteus minimus fat stripe is shown and 2. the exposure is made in maximal external rotation which can be either active or, better still, passive. Under these conditions the joint capsule appears as a soft tissue band stretched between the margin ot the acetabulum and the upper end of the greater trochanter. Effusions or oedemas of the hip joint cause lateral displacement of the gluteus minimus fat stripe. Anatomical and radiological comparisons, including computed tomography, confirm that the joint capsule of the hip can be demonstrated in this way.

Adipose Tissue↗
PubMed2006

Three-dimensional Doppler sonographic vascular imaging in regions with increased MR enhancement in inflamed wrists of patients with rheumatoid arthritis.

OBJECTIVE: To compare three-dimensional (3D) power Doppler ultrasonography (PDUS) with contrast enhanced magnetic resonance imaging (MRI) in their capability to visualize synovial vascularity in inflamed wrists of patients with rheumatoid arthritis (RA). METHODS: Nine patients with RA showing clinically active arthritis of the wrist as determined by tenderness and swelling were examined by contrast enhanced MRI and 3D PDUS. Vascularity close to and inside the joint capsule was visualized by conventional power Doppler mode. In a region with high Doppler signal intensity (=region of interest/ROI) a 3D blood vessel tree was obtained by a free-hand sweep. 3D images were evaluated with regard to the number of blood vessels in the intra- and peri-articular region. MRI examinations were performed using a 1.5 T Scanner. In MRI, time resolved coronal contrast enhanced T1-weighted sequences with fat suppression were acquired during an 8 min period to assess tissue enhancement. Relative enhancement was calculated and compared to 3D PDUS findings. RESULTS: A 3D vascular tree consisting of peri- and intra-articular blood vessels could be demonstrated in the same anatomical ROI in which an increased gadolinium enhancement was measured by MRI in all examined RA patients. The number of penetrating vessels into the joint capsule, the number of intra-articular vessels and a semiquantitative estimation of the strength of blood flow were used to generate a 3D score for the intensity of synovial vascularity. CONCLUSION: When compared with clinical symptoms and the gold standard dynamic MRI, 3D PDUS is a reliable imaging technique for assessing synovial vascularity in inflamed wrists of RA patients.

Adult↗
PubMedDate not supplied

Postnatal development of substance P-, calcitonin gene-related peptide- and neuropeptide Y-like immunoreactive nerve fibres in the synovial membrane of the rat temporomandibular joint.

The postnatal (0-24 days) development of substance P (SP)-, calcitonin gene-related peptide (CGRP)- and neuropeptide Y(NPY)-like immunoreactive (LI) nerves in the rat temporomandibular joint (TMJ) was investigated immunohistochemically. Immediately after birth, SP- or CGRP-LI nerves were observed in most disc attachments. A few NPY-LI nerves were observed around the large blood vessels in the joint capsule. From days 3 to 6, the SP- or CGRP-LI nerves were first found close to the anterior, lateral, medial (third day) or posterior (sixth day) peripheral portion of the disc. The synovial cells (type A and B) first appeared at the anterior peripheral portion of the disc (sixth day), and then at the posterior, lateral and medial portions (seventh day). NPY-LI nerves were found around the blood vessels at the disc attachment on the sixth day, and then entered into the peripheral portion of the disc from days 10 to 14. At 14 days a few NPY-LI nerves were first found close to the blood vessels in the sublining layer of the synovial membrane. From days 18 to 24, a few NPY-LI nerves were located in the superficial layer of the synovial membrane. The central portion of the disc did not contain any nerves from days 0 to 24. Thus SP- or CGRP-LI sensory nerves are shown to innervate the rat TMJ at an earlier age than NPY-LI sympathetic nerves, which may modulate the regulation of blood flow in the joint capsule, disc and synovial membrane. However, it is considered that the disc itself does not contribute to the transportation of the afferent sensory information. Furthermore, from the fact that SP- or CGRP-LI nerves were found earlier than the appearance of the synovial cells, it is suggested that these nerves may be associated with the growth and proliferation of synovial cells.

Age Factors↗
PubMed1999

A study of mechanoreceptors in fibrocartilage masses in the defect of pars interarticularis.

We investigated the origin of low back pain associated with lumbar spondylolysis and spondylolytic spondylolisthesis by removing fibrocartilage masses from the lytic sites in symptomatic patients and staining the masses by the Gairns gold chloride method to examine mechanoreceptors. The fibrocartilage masses were found to contain four types of mechanoreceptors: Pacinian corpuscles, Ruffini receptors, Golgi tendon organ-like receptors, and free nerve endings. All of these mechanoreceptors were present at the periphery of the specimens, and Ruffini receptors and free nerve endings were abundant. Some mechanoreceptors had a slightly atypical structure, in addition to those with typical morphology. Comparison with mechanoreceptors in normal lumbar facet joint capsules showed that there were more mechanoreceptors in the fibrocartilage masses and a greater proportion of atypical structures at lytic sites. The presence of mechanoreceptors at lytic sites suggests that the fibrocartilage masses are not simply scar tissue filling the defect. Rather, these masses also appear to play a protective role by sensing instability via mechanoreceptors and transmitting this information as pain, while at the same time acting as ligament-like tissue that connects and stabilizes the separated vertebral arches.

Adolescent↗
PubMedDate not supplied

Low-field magnetic resonance imaging of the canine stifle joint: normal anatomy.

Low-field magnetic resonance imaging (MRI) was performed on the stifle joints of four normal adult mongrel dogs using a 0.064 Tesla scanner. Markers were placed on each stifle joint to serve as reference points for comparing gross sections with the images. A T1-weighted sequence was used to image one stifle joint on each dog in the sagittal plane and the other stifle joint in the dorsal plane. The dogs were euthanized immediately following MRI and the stifle joints frozen intact. Each stifle joint was then embedded in paraffin, again frozen, and sectioned using the markers as reference points. On T1-weighted images, synovial fluid had low signal intensity (dark) compared to the infrapatellar fat pad which had a high signal intensity (bright). Articular cartilage was visualized as an intermediate bright signal and was separated from trabecular bone by a dark line representing subchondral bone. Menisci, fibrous joint capsule, and ligamentous structures appeared dark. In the true sagittal plane, the entire caudal cruciate ligament was often seen within one image slice. The patella was visualized as an intermediate bright signal (trabecular bone) surrounded by a low intensity signal (cortical bone). The trochlea and the intercondylar notch were difficult areas to analyze due to signal volume averaging of the curved surface of these areas and the presence of several types of tissues.

Adipose Tissue↗
PubMedDate not supplied

Laser Doppler perfusion imaging of synovial tissues using red and near infra-red lasers.

A new laser Doppler perfusion imaging (LDI) system was evaluated by comparing it with the well-established radiolabelled microsphere technique for measuring blood flow in the rabbit knee joint capsule. In this study two laser sources (635 and 835 nm) were compared at three scan speeds (50, 10 and 4 ms/pixel). With blood flow to the rabbit hindlimb controlled via a peristaltic pump, the comparison of LDI and microsphere measurement techniques yielded highly significant correlations for both laser sources (r = 0.9; p = 0.0001; 14 measurements in 7 animals). Comparison of the three scan speeds demonstrated acceptable agreement without significant bias between measurements, suggesting that the inevitable narrowing of the bandwidth at the fastest scan speed does not cause significant deterioration of the signal. The flux values obtained with 635 and 835 nm laser sources were linearly related (r = 0.93, p = 0.0001; 66 measurements in 12 animals), although there was a small but significant bias for higher values with the 635-nm laser (mean ratio of flux values 1.06, 95% confidence interval 1.01-1.12). These results validate the use of LDI with either wavelength laser for the assessment of joint capsule perfusion.

Animals↗
PubMed2003

[Basic principles of radiosurgical systems and their applications in arthroscopy].

Electrosurgical devices are being used in each medical subdiscipline,and, only recently, they have found widespread distribution in the field of arthroscopic surgery, as well. This development is mainly due to the construction of small and relatively cheap devices that work in a bipolar mode at high frequency. A local plasma field is being built up between the electrodes at the tip of the probe which has enough energy to allow the disintegration of molecules within the treated tissue. The local current flow helps to minimize the numerous disadvantages of monopolar or Laser-based systems. Nevertheless, there is considerable discrepancy between the wide spectrum of clinical use on the one hand and the knowledge of mid- or even long-term biological effects on the treated tissue on the other. So far, clinical and experimental studies exist for the frequent indications of chondroplasty and capsular or ligamental shrinkage. But, still, there is no agreement upon these indications. Studies have shown a considerable number of dead chondrocytes or fibroblasts within a depth of several millimeters within the tissue of the joint capsule or the articular cartilage after electrosurgical treatment. But especially these cells are thought to be essential for the maintenance of the tissue. While the results of other studies seem to be less critical, some authors propose not to use electrosurgery in arthroscopy at all, until further studies prove the safety of these devises. Unfortunately, there is no reliable feedback system for the temperature increase within the treated tissue or other important parameters. The use of these instruments affords a high degree of experience from a skilled arthroscopic surgeon.

Animals↗
PubMedDate not supplied

Arthroscopic capsular release for contracture of the wrist: a new technique.

SUMMARY: Stiffness of the wrist can occur following trauma or surgery. In some patients, loss of motion may be refractory to conservative treatment and operative treatment may thus be indicated. The authors report the results and technique of arthroscopic capsular release of the wrist. A cadaveric study was performed to assess the safety of arthroscopic capsular release. Arthroscopic capsular release was performed on 2 patients with limited wrist mobility. The average distance from the radiocarpal joint capsule to the neurovascular structures were 6.9 mm to the median nerve, 6.7 mm to the ulnar nerve and 5.2 mm to the radial artery. At 6 months follow-up, the average range of motion had improved from 17 degrees flexion and 10 degrees extension to 47 degrees flexion and 50 degrees extension. The average grip strength had improved from 13 to 31 kg. Pain measured on a visual analogue score (0-10) had improved from 1.5 to 1.0. There were no complications. Arthroscopic capsular release of the wrist is a safe and minimally invasive technique that provides good improvement to range of motion.

Adult↗
PubMed1993

[Mechanoreceptors in the distal aspects of the m. vastus medialis?].

Five cadavers were fixed in Jores' solution and alcohol. The distal parts of the medial vastus muscle and the medial parts of the patella ligament and of the capsule of the knee joint were prepared and histologically examined. Previous examinations had shown mechanoreceptors in the knee joint ligaments; the present study was designed to find whether mechanoreceptors could be identified in the anatomical structures mentioned, in which case an arthrotomy by the Payr access would interrupt the muscle reflexes. Only some mechanoreceptors in the medioventral parts of the knee joint capsule close to the tendon of the great muscle could be identified. Thus, when the Payr access is used there is no interruption of the sensibility transmitted by proprioceptors.

Adult↗