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PubMedDate not supplied

MR imaging of temporomandibular joint abnormalities associated with cervical hyperextension/hyperflexion (whiplash) injuries.

Patients often have temporomandibular joint (TMJ) dysfunction-related symptoms after cervical hyperextension/hyperflexion injuries ("whiplash") caused by rear-end motor-vehicle collisions. To determine abnormalities of the TMJ associated with these injuries, 33 consecutive symptomatic patients (66 joints) with no direct trauma to the jaw, mouth, head, or face due to the accident and no prior history of TMJ dysfunction underwent magnetic resonance (MR) imaging, and the images were retrospectively analyzed. Overall, 29 (88%) patients had some type of TMJ abnormality related to whiplash injury. Displacement of the disk was seen in 37 (56%) of the TMJs as follows: 21 (32%) had anterior displacement with reduction, nine (14%) had anterior displacement without reduction, six (9%) had lateral or medial displacement, and one (2%) had posterior displacement. On T2-weighted images, 43 (65%) TMJs had abnormal joint fluid or edema, predominantly affecting the joint capsule and/or lateral pterygoid muscles. The finding that many of the patients had joint fluid and/or soft-tissue edema indicates that T2-weighted images are especially useful for assessment of patients with a history of whiplash injury.

Adult↗
PubMed1998

Gene expression of noncollagenous bone matrix proteins in the limb joints and intervertebral disks of the twy mouse.

The twy (tiptoe walking Yoshimura) mouse is an autosomal recessive mutant manifesting multiple osteochondral lesions characterized by pathologic calcium deposition. To elucidate the pathophysiology of the limb joint lesions and the intervertebral disk lesions of the twy mouse, we assessed the mRNA expression of noncollagenous bone matrix proteins such as osteocalcin, osteonectin, osteopontin, and matrix Gla protein (MGP) by in situ hybridization, but only expression of MGP was observed in association with the pathologic calcium deposits in twy mice. Mild degeneration and abnormal growth of the cartilage in contact with the joint capsule was observed at 5 weeks in the articular cartilage of the ankle joint of the twy mouse, and MGP gene expression was observed at the same time. Simultaneous growth of synovial membrane cells and relatively undifferentiated articular cartilage cells in the knee joint, and of cartilage-like cells near the insertion of the cruciate ligament was observed in the twy mouse, and MGP gene expression was found to be present at the same time. Hypertrophy of abnormally proliferated chondrocyte-like cells, which are different from fibrocartilaginous cells of the annulus fibrosus, was observed in the intervertebral disks of the twy mouse at 3 weeks of age, and MGP gene expression was noted at the same time. These findings suggest that abnormal expression of MGP plays a major role in the pathologic calcification of the twy mouse.

Animals↗
PubMed1997

Ischemic necrosis of the entire femoral head and rapidly destructive hip disease: potential causative relationship.

OBJECTIVE: Rapidly destructive hip disease (RDHD) is an uncommon disorder of the hip that has been considered a disease of unknown cause and distinct from ischemic necrosis of the femoral head. The objective of this study was to investigate ischemic necrosis of the femoral head as one potential cause of RDHD. DESIGN AND PATIENTS: In 600 patients who underwent MR imaging of the hip, 20 cases of ischemic necrosis involving the entire femoral head in 18 patients (3%) were retrospectively studied with routine radiography and MR imaging. All patients had surgically confirmed ischemic necrosis of the femoral head. RESULTS AND CONCLUSIONS: All patients showed rapid destruction of the femoral head on routine radiography and MR imaging as compared with the gradual onset of clinical symptoms. Plain radiographs showed several bone fragments at the inferomedial aspect of the femoral head (75%), acetabular erosions (55%), eccentric depression at the lateral articular surface of the femoral head conforming to the adjacent acetabulum (35%), and mild osteoarthritis (15%). Bone sclerosis was often present at sites of impaction between the femoral head and the acetabulum. MR imaging showed marked distention of the joint capsule in all cases. In 14 of 20 cases, the contents of the joint space showed predominantly low or intermediate signal intensity on T1- and T2-weighted images. Ischemic necrosis involving the entire femoral head may represent one of the causes of RDHD.

Adult↗
PubMed2001

[Experiences with Eaton-Littler reconstruction for therapy of ligament instability of the thumb saddle joint].

UNLABELLED: Painful instability of the thumb carpometacarpal joint is a rare diagnosis. Between October 1995 and August 1999, eight operations of ligament reconstruction for unstable thumb carpometacarpal joints were performed. We report on the follow-up of these patients which took place at an average time of 12.27 months (range 5 through 36 months) after the operation. Painful hypermobility of the non-arthrotic thumb carpometacarpal joint was the indication for performing the operation in all cases. By this operation, the joint capsule is reinforced in two planes: the existing palmar ligament of the carpometacarpal joint is reinforced while it provides ligament support for the radial aspect of the joint that is otherwise membranous. In our study, we compared the pinch strength, the overall strength of the hand, the motion of the thumb, and radiographic findings for the amount of subluxation before and after performing the operation. In addition, each result was investigated with the DASH-questionnaire (DASH = Disability of Arm--Shoulder--Hand). The results were good or excellent in six cases, satisfactory in one case, and poor in one case. Pinch strength increased from a preoperative average of 19.6 N to 34.3 N and the vigor increased from 84.8 N to 113.1 N. Subluxation on the radiographs could be reduced from an average of 6.0 mm to 3.5 mm. All operated patients were investigated using the DASH-questionnaire. Herein the average score was 22.92 on a scale whereby 0 reflects minimum and 100 maximum disability. CONCLUSIONS: Our experience with the Eaton-Littler procedure for stabilisation of the hypermobile painful thumb carpometacarpal joint were mostly positive. The objective results as well as the results of the evaluation of the DASH-questionnaire could confirm this impression.

Adolescent↗
PubMed1992

Meniscus-like synovial fold in the atlantoaxial (C1-C2) joint.

Some of the synovial joints in the human body have a fibrocartilaginous disc interposed between the joint surfaces to absorb or evenly distribute loads. Examples of fibrocartilagenous discs include the intervertebral disc, knee joint meniscus, and triangular fibrocartilages in the distal radioulnar joint and the acromioclavicular joints. The joint capsule and the surrounding tissue from nine cervical spines (18 C1-C2 joints) were dissected and prepared for gross examination and histology. We found meniscus-like synovial folds in 13 of the 18 atlantoaxial joints. These folds were located at the anteromedial and posteromedial aspect of the joint. Each synovial fold was of semilunar shape, with a thickened outer edge and thin inner edge giving a wedge-shape cross section. In one case, the synovial fold was grossly similar in appearance to a knee joint meniscus, and on histological examination there was evidence of cartilagenous metaplasia in part of the fold. The findings are compared with the limited data reported in the literature.

Aged↗
PubMedDate not supplied

Anatomic study of arthroscopic portal sites of the ankle.

Numerous anatomic structures are at risk when performing ankle arthroscopy through the more commonly utilized portals. The purpose of this paper was to demonstrate the relative safety of each of the arthroscopic portal and Acufex external ankle distractor pin sites by measuring their proximity to the neurovascular structures surrounding the ankle joint. Six fresh cadaver specimens and 12 fresh-frozen, below-knee amputations were utilized for this study. An Acufex ankle distractor was applied using the standard technique. Anteromedial, anterolateral, anterocentral, posterolateral, and posteromedial portals were placed using an 11-blade scalpel to make 5-mm longitudinal incisions. The joint capsule was penetrated and a 3-mm arthroscope was placed into the ankle joint. The skin surrounding each of the portals was carefully removed and the proximity of any nerves or vessels was measured with respect to the arthroscope. At least one incidence of contact or penetration of a nerve or vessel was noted for each site. The anterocentral portal was at greatest risk for nerve or vessel damage. The anterolateral, anteromedial, and posterolateral portals were the safest areas for portal placement, with no penetration of neurovascular structures in any case.

Ankle↗
PubMed1995

The deep peroneal nerve in the foot and ankle: an anatomic study.

Injury to the deep peroneal nerve in the foot and ankle may result from trauma, repetitive mechanical irritation, or iatrogenic harm. The nerve is most susceptible to injury along its more distal anatomic course. Dissection of 17 cadaver specimens was undertaken to describe the course of the deep peroneal nerve and quantify its branch patterns. In the distal one third of the leg, the nerve was located superficial to the anterior tibial artery between the tibialis anterior and extensor hallucis longus muscles. Typically, the nerve crossed deep to the extensor hallucis longus tendon to enter the interval between the extensor hallucis longus and extensor digitorum longus at an average distance of 12.5 mm proximal to the ankle. A proximal bifurcation was usually present at an average distance of 12.4 mm distal to the mortise. The lateral terminal branch penetrated the deep surface of the extensor digitorum brevis to provide motor innervation. The medial terminal branch passed over the talonavicular joint capsule, and coursed an average of 2.9 mm lateral to the first tarsometatarsal joint. Within the forefoot, it passed deep to the extensor hallucis brevis tendon, bifurcated in the midmetatarsal region, and then arborized, supplying sensibility to the first toe interspace and the adjacent sides of the first and second toes.

Ankle↗
PubMed1984

Lumbar apophyseal joint arthrography.

Lumbar apophyseal (facet) joint arthropathy is an important cause of low back pain and sciatica. Apophyseal joint arthrography sometimes shows "leakage" of contrast medium from the joint capsule. A histological explanation for this "leakage" at the lumbo-sacral apophyseal joint is suggested.

Adult↗
PubMed1981

Anatomy and function of the ligaments of the lower cervical spine in the dog.

Ligaments of the lower cervical spine (C3 to C7) were studied in 27 canine cadavers. The gross anatomy and attachment sites were determined by dissection, and representative samples of the flaval ligament, facet capsules, and dorsal longitudinal ligament were examined by light microscopy and were stained for elastin content. Selected functional spinal units were placed in a specially constructed humidification chamber and were fixed in position, using methyl methacrylate bone cement. The specimens were stressed in flexion and extension, and vertebral displacement was measured before and after severance of the spinal ligaments. The flaval ligament had a marked elastin content and contained randomly oriented collagen bundles. The dorsal longitudinal ligament possessed a negligible elastic fiber content and demonstrated longitudinally oriented collagen bundles. The facet capsules possessed an inner synovial lining and outer fibrous layer typical of synovial joint capsules. In general, the severance of spinal ligaments resulted in small increments of displacement until failure occurred, which was often sudden and complete. The flaval ligament, facet capsules, dorsal longitudinal ligament, and intervertebral disk were the major ligamentous stabilizers of the lower cervical spine.

Animals↗
PubMed1987

[Current status of the therapy of anterior cruciate ligament injuries].

This review presents the current concepts in the treatment of anterior cruciate ligament (ACL) injuries. Conservative treatment emphasising strengthening of the muscles to stabilise an unstable knee is discussed. The agonistic and antagonistic functions of the hamstrings and the quadriceps muscle in relation to the ACL are described. The possible mechanisms of muscular stabilisation of the knee are discussed on a neurophysiological basis. The existence of joint specific receptors is pointed out and their reflex and perceptive functions are demonstrated. Taking this into account one can deduce a two-step mechanism of joint protection: 1) via the mechanical strength of the joint capsule and ligaments and 2) via reflex muscle contractions. It follows therefrom that in an unstable knee with a lax capsule and disturbed reflex mechanisms, strengthening of muscles alone is insufficient and cannot protect the joint from progressive deterioration. Therefore, surgical treatment is necessary for an ACL deficient knee. Our indications for ACL reconstruction are described. In addition, the existing methods of surgical replacement of the ACL are critically elucidated. In our opinion, an extraarticular repair tendon transfer as the only surgical procedure to regain stability is of only historical interest. However, extraarticular repair of the medial or lateral capsule is often a necessary additional step to restore stability of the knee. The replacement of the ACL is the crucial step. Using autogenous grafts one must consider the doubtful outcome of biological response leading to necrosis and revascularization in the transplant.(ABSTRACT TRUNCATED AT 250 WORDS)

Humans↗
PubMed1978

Development of the diarthrodial joints in the rat embryo.

The development of appendicular synovial joints of both legs was studied with histological and histochemical techniques in 43 rat embryos aged 12 to 21 days. From this and previous studies, it appears that joints develop by a sequence of cellular events leading to a full expression of the phenotypic characteristics. The classically described stages: cell condensation, three layered mesenchyme, vascular invasion and joint clefting, were chronologically recorded in all joints. The observations relevant to the intra-articular structures, such as joint capsule, menisci and ligaments, were also presented. Previously unreported, cellular aspects were described during joint morphogenesis and their biological significance was discussed. Among these cellular aspects, of particular interest are: a. an early wave of cell necrosis occurring immediately after differentiation of the interzone. Disappearance of necrotic cells is thought to prevent chondrification of this tissue by clearing up the cells with chondroblastic potentialities; and b. a morphologically peculiar type of cells that differentiate alongside, and by the time of, clefting and seem to be related to this process. Thus, the joint clefting appears also to result from a cell-tissue related phenomenon, acting in conjunction with the joint motion, the importance of which has been previously demonstrated.

Animals↗
PubMed1985

Descriptive anatomy of fibrocartilaginous menisci in the finger joints of the hand.

Observations were made from the dissection of 156 digital joints (thumbs excluded). In all joints fibrocollagenous menisci projected into the articular cavity from a ring-like structure based on the joint capsule. These meniscal structures separated the articulating cartilage surfaces at the margins of the joint. Histological examination confirmed a fibrocartilaginous nature of the tissue which demonstrated positive staining for proteoglycans and collagen fibers. Although generally similar in form, these meniscal structures varied in extent when compared between joint groups. The greatest amount and articular contribution was noted in metacarpophalangeal joints with least being found distally.

Aged↗
PubMed2006

[Arthroscopic meniscal repair with an all-inside suture system].

OBJECTIVE: Application of an arthroscopic suture system to restore the form and function of the meniscus by adaptation of a longitudinal tear close to the base. INDICATIONS: Unstable longitudinal tears near the base of the meniscus, mainly in the posterior horn of the medial or lateral of the meniscus. Dislocated bucket-handle tears of the medial and lateral meniscus close to the base. CONTRAINDICATIONS: Poor tissue quality with fibrillated meniscal tissue. Meniscal tears in the avascular zone (zone I). Insufficient blood supply from the joint capsule and the base of the meniscus. Degenerative meniscal lesions. Anterior or posterior knee joint instability. Allergic reactions to nonresorbable suture material. SURGICAL TECHNIQUE: Standard anterior arthroscopic portals. Arthroscopic assessment of the meniscal tear using the probe. Revitalization of the tear margins and perforation of the meniscal base to induce bleeding. Adaptation of the tear margins and fixation with a suture-anchor system using an ipsilateral standard portal for tears in the posterior horn or by way of a contralateral standard portal for tears in the lateral horn. POSTOPERATIVE MANAGEMENT: Full weight bearing with the knee in extension in a knee immobilizer, relative to the pain threshold in the 1st postoperative week. Range of motion exercises without weight bearing from full extension to 90 degrees knee flexion (0/0/90). If simultaneous reconstruction of the anterior cruciate ligament (ACL) is being performed, rehabilitation protocols follow the principles for ACL reconstruction. RESULTS: Since the year 2000, meniscal tears in more than 300 patients have been repaired with the all-inside suture system. In the context of a multicenter study by ESSKA (European Society for Sports Medicine, Surgery and Arthroscopy) involving 20 patients, the result was evaluated by direct MRI arthrography (gadolinium). The suture bar anchors were generally not detectable, the incision channels produced a hypodense signal in the meniscus tissue. If re-rupture occurred, it was because the meniscus had pulled out of the suture loop. Cartilaginous lesions were not found. There were no complications related to the nonresorbable suture bar anchors.

Arthrography↗
PubMed1999

The effect of thumb metacarpophalangeal ulnar collateral ligament attachment site on joint range of motion: an in vitro study.

Although reconstruction of the torn thumb metacarpophalangeal (MCP) joint ulnar collateral ligament (UCL) has been shown to reduce symptoms, final joint motion may be different from that of the uninjured state. It was hypothesized that nonanatomic repositioning of the UCL might affect joint motion; therefore, the effect of UCL attachment site on MCP range of motion was investigated. The UCL and MCP joint capsule were visualized in each of 8 fresh cadaveric hands without otherwise disrupting the joint. The centers of the ligament attachments were marked with pins and each specimen was mounted on a testing frame capable of applying loads through the flexor and extensor tendons. After measuring the flexion, extension, and radial and ulnar deviation ranges of motion of the intact specimen, the origin of the ligament (on the metacarpal) and an attached bone block were elevated and repositioned 2 mm proximal and 2 mm palmar and range of motion was tested. The origin was reattached in its anatomic location and the insertion of the ligament was similarly elevated and displaced 2 mm in distal, dorsal, and palmar directions. Compared with the intact joint, palmar placement of the UCL origin on the metacarpal increased radial deviation (from a mean of 18 degrees to a mean of 27 degrees); proximal placement of the origin decreased it (from 18 degrees to 10 degrees). Similarly, dorsal placement of the UCL insertion on the phalanx increased radial deviation (from 18 degrees to 25 degrees) and distal positioning of the insertion decreased it (from 18 degrees to 11 degrees). Relative to intact joint flexion range of motion (mean, 57 degrees), distal placement of the UCL phalangeal insertion restricted motion (mean, 47 degrees), as did palmar placement (mean, 48 degrees). Extension and ulnar deviation motions were unaffected by ligament attachment position. This study demonstrates that nonanatomic reconstruction of the UCL alters normal MCP joint range of motion.

Biomechanical Phenomena↗
PubMed1987

A posterior arthroscopic approach to bullet extraction from the hip.

A 22-year-old male sustained a gunshot injury to the left hip region. The bullet lodged in the articular surface of the femoral head posterosuperomedially. The location of the bullet within the hip joint stimulated the performance of an arthroscopy of the hip through a posterior approach. The authors are unaware of any other report in the literature describing such an approach. To minimize the dangers, a limited posterior incision was made and deepened through the short rotators. The arthroscope was introduced through the incision to perforate the posteroinferior portion of the hip joint capsule. The bullet was easily visualized with a 70 degree arthroscope. Positioning at the joint and traction are vital components to visualization. The use of three-dimensional CT scanning is an aid to the graphic understanding of the bullet's pathway and relations to the surfaces of the hip joint.

Adult↗
PubMed1999

Monosynaptic Ia pathways at the cat shoulder.

1. The study aimed to describe in cat forelimb and shoulder motoneurones the convergence and projection patterns from large muscle spindle afferents (Ia). In 11 chloralose-anaesthetized cats maximum Ia EPSPs evoked by electrical stimulation of ipsilateral forelimb nerves were obtained in 309 intracellularly recorded alpha-motoneurones. 2. Groups of motor nuclei displayed similar Ia patterns. As in the distal forelimb they were often interconnected by bidirectional pathways, which were used to combine Ia synergistic groups. Three such groups are described at the shoulder. 3. The first group was composed of the main flexors of the scapulo-humeral joint. Regular disto-proximal Ia excitation from elbow extensors (and median afferents) indicates a coupling of flexion in the scapulo-humeral joint to the angular position of the elbow. 4. The second group comprised the outward rotators of the humerus with differentiated Ia convergence onto the different group members. The patterns of Ia excitation received and sent by the group members demonstrate that the outward rotators are incorporated in versatile synergisms and may occupy a central position in steering forelimb movements. 5. The third group was formed by the spinatus muscle and the subscapularis. This arrangement is suggested by the common convergence onto them from the elbow extensors and flexors. The pattern may serve to guide and keep the humeral head in the joint capsule. 6. The Ia synergistic groups receive Ia convergence from muscles acting at distant joints and also project to distant muscles. This is discussed as part of an extended pattern of Ia connections along the forelimb. In this way the shoulder muscles would be incorporated in flexor and extensor oriented synergisms which are needed to co-ordinate the muscular activation along the multijoint forelimb during locomotion. When the shoulder Ia pathways are compared with those in the distal forelimb, organization of the Ia system apparently follows a few basic principles which have adapted to the mechanical situation at the particular joints and their mechanical interaction.

Animals↗
PubMed1977

Capsular visualization in lipohemarthrosis of the knee.

A new sign for the diagnosis of lipohemarthrosis on vertical beam lateral knee radiographs depends upon visualization of the joint capsule due to the presence of fat lying both within and outside of the joint. Recognition of lipohemarthrosis on routine knee radiographs may aid in the diagnosis of subtle tibial plateau fractures.

Hemarthrosis↗