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PubMed1995

In vivo quantification of the cat patellofemoral joint contact stresses and areas.

A new method for in vivo measurement of patellofemoral joint contact areas, stresses, and patellar displacements, with joint loading approximating physiologic conditions was developed. Joint contact measurements were obtained using pressure sensitive film inserted directly between articular joint surfaces. Two-dimensional joint kinematics were measured using a high-speed video based motion analysis system. Joint loading, provided by quadriceps muscle stimulation, was measured with an implantable force transducer (IFT). Variations in joint mechanics as a function of joint flexion angle, joint loading and joint stability (anterior cruciate ligament intact or transected) were determined for four adult male cats. The contact measurements obtained with the pressure sensitive film displayed high repeatability with a standard error of +/- 6.8% of the mean value of the median pressure and +/- 4.4% of the mean contact area value. Substantial differences in joint mechanics were reliably detected with the new technique. The influence of experimental procedures, such as incisions in the joint capsule and insertion of pressure sensitive film between the articular surfaces, produced minimal changes in the joint kinematics during muscular contraction.

Animals↗
PubMed2003

Somatosensory properties of cuneocerebellar neurones in the main cuneate nucleus of the rat.

Cells in the main cuneate nucleus (MCN) are known to provide a direct projection to the cerebellum, but the precise nature of the information these cells transmit to the cerebellum is unknown. The present study employed anatomical and electrophysiological procedures to determine the location of cuneocerebellar cells in the MCN, and their somatosensory properties in the rat. The location of neurones projecting to the cerebellum was determined with injections of the retrograde tracers, horseradish peroxidase or Fluoro-Gold in vermal and paravermal regions of the cerebellum. Topographically, the majority of retrogradely labelled cells in the MCN were found to lie primarily ventrolateral in the nucleus and rostral to the level of the obex. Single unit recordings from 69 well characterized MCN cells, identified as projection cells by antidromic activation from stimulation of the inferior cerebellar peduncle, were classified according to their responses to cutaneous stimulation and manipulation of joints and muscles. A slight majority of cells (37.7%) responded only to manipulation/stimulation of joints, and 30.4% of cells responded only to cutaneous stimulation. The remaining cells received convergent input from joint and cutaneous receptors. Cutaneous responsive cells all rapidly adapted to maintained stimuli, and had large receptive fields (RFs) that were generally located over the joints. These cells could be activated by passive movements of the forelimb that deformed the RF. They only discharged during movements and were silent during maintained limb positions. Cells responsive to punctate mechanical stimuli applied to the joint capsules, responded to passive movements of the forelimb, but typically only discharged towards the limits of joint movement, and adapted within a few seconds. Once adapted, small perturbations of joint position resulted in vigorous dynamic responses. The results indicate that the neurones in the MCN of the rat which project directly to the cerebellum are localized in the rostral half of the nucleus. They transmit predominantly dynamic information from joint and cutaneous receptors that are likely to be normally activated as a result of limb movements. These cells could signal information about evolving movements or disturbances of forelimb posture or stance.

Animals↗
PubMed2002

Determining the resting position of the glenohumeral joint: a cadaver study.

STUDY DESIGN: Single-session repeated-measures design. OBJECTIVE: To define the resting position of the glenohumeral joint by investigating the magnitude of the anterior and posterior displacements of the humeral head and medial and lateral rotation ranges of motion (ROMs) of the glenohumeral joint at different abduction angles in cadaver specimens. BACKGROUND AND PURPOSE: The resting position of a joint is the position in the joint's ROM at which the joint capsule has its greatest laxity. It is frequently chosen as the position for assessing and treating joints with dysfunction. However, no study has been conducted to determine the resting position of the glenohumeral joint. METHODS: Seven freshly frozen cadaver shoulder specimens (age at time of death [mean +/- SD] was 66.9 +/- 2.5 years) were studied. Specimens were mounted on a system that uses computer-controlled hydraulics and motors to induce and monitor translation and rotation movements of the glenohumeral joint. The magnitudes of total displacement (DTotal) of the head of the humerus and total ROM (RTotal) of the glenohumeral joint were measured in the plane of the scapula at 0 degrees (neutral), 30 degrees, 40 degrees, 50 degrees, 60 degrees, and the end range of glenohumeral joint abduction. The resting position was determined as the midpoint of the shared range of the 95% to 99.9% confidence intervals of the predicted abduction position where the peaks of displacement and rotation occurred. RESULTS: The DTotal measurements (mean +/- SD) at 0 degrees, 30 degrees, 40 degrees, 50 degrees, 60 degrees, and the end range of glenohumeral joint abduction were 30.53 +/- 9.35, 44.87 +/- 7.34, 45.35 +/- 8.53, 43.99 +/- 10.02, 39.63 +/- 9.85, and 23.80 +/- 10.42 mm, respectively. The RTotal measurements (mean +/- SD) for the same positions were 67.15 degrees +/- 15.87 degrees, 95.64 degrees +/- 24.26 degrees, 98.88 degrees +/- 29.56 degrees, 97.08 degrees +/- 30.17 degrees, 90.91 degrees +/- 28.73 degrees, and 63.48 degrees +/- 25.93 degrees, respectively. The resting position was located at 39.33 degrees +/- 4.37 degrees of glenohumeral abduction (45.13% +/- 7.58% of the available abduction ROM). The resting position (Y) varied linearly with the maximum available abduction ROM (X) (Y = 0.607X - 13.120, R2 = 0.679, F = 10.61, P = 0.023). There was a main effect of joint position on both displacement (P<0.001) and rotation ROM (P<0.001). CONCLUSION: In the plane of the scapula, the resting position of the glenohumeral joint (angle measured between the scapula and humerus) occurred at 39 degrees of abduction (45% of the maximum available abduction ROM) and varied linearly with the amount of available abduction ROM. This finding suggests that in patients with glenohumeral joint hypomobility the resting position is located closer to neutral and that evaluation and treatment should be initiated accordingly at a smaller angle of abduction than the traditional resting position. Our data were derived from cadaver specimens, therefore, caution should be taken when generalizing the results of the present study to a patient population.

Aged↗
PubMed1986

Overuse syndrome of the upper limb in musicians.

A series of 379 musicians with painful overuse syndrome ("RSI") were examined and studied. The commonly used diagnosis for the condition of "tenosynovitis" or "tendinitis" could not be substantiated as it appeared to be a distinct clinical entity rather than a collection of unrelated disorders. The patients in this series showed muscular and joint capsule overuse. Those with painful hands and wrists showed persisting tenderness in the intrinsic muscles and joint ligaments, notable in the carpometacarpal joints of the thumb and the radial side of the wrist. Tenderness of more proximal muscle groups was also usually present. Pain generally started in a particular area, then spread both proximally and distally. The patients felt depressed. The treatment that evolved from the study was radical rest of the tender structures by the total avoidance of pain-inducing activities. The condition did not appear to be inflammatory in nature. The prevention of overuse lies in the control of use.

Adolescent↗
PubMed2004

[Calcium pyrophosphate dihydrate-crystal induced arthropathy].

Calcium pyrophosphate dihydrate (CPPD) crystal induced arthropathy (CPPD-CA; systemic articular chondrocalcinosis) characterized by deposition of CPPD-crystals in fibro- and hyaline cartilage, joint capsule and periarticular tissues is associated with a variable clinical spectrum of inflammatory degenerative and occasionally destructive joint and vertebral manifestations including neurologic complications and rarely tophaceous-tumoral tissue calcifications. Microcrystal formation in the extracellular matrix of cartilage and tendons is based on genetic and acquired dysregulation of chondrocyte pyrophosphate metabolism and presumably linked to gene mutants on the short arm of chromosome-5 (gene locus 5p15.1 and ANKH gene). Idiopathic disease occurs rarely in hereditary-familial and frequently in sporadic manifestation with increasing prevalence due to aging; a secondary form is significantly related to endocrine and metabolic disorders (as to hyperparathyroidism, hemochromatosis etc.). The impact of the clinical syndrome in practice is important in differential diagnosis of age related conditions like acute mono- or oligoarthritis, systemic osteoarthritis and polymyalgia rheumatica. Actual treatment ignores established prevention of systemic cartilage calcification and is oriented to symptomatic relief.

Arthrography↗
PubMedDate not supplied

Hip arthroscopy using a limited anterior exposure: an alternative approach for arthroscopic access.

SUMMARY: Hip arthroscopy is a technically difficult procedure to perform. A limited anterior approach to the joint has made hip arthroscopy technically less difficult in our hands and has enabled us to treat a wide range of hip pathology. Five hip arthroscopies were performed using a modified 4-cm Smith-Petersen anterior approach to the hip exposing the joint capsule as manual traction is applied. The arthroscope is then easily introduced making visualization of the hip joint possible. The 5 hip arthroscopies resulted in either removal of loose bodies or debridement of an osteochondral fragment, synovitis, or cartilaginous debris. There were no complications postoperatively. We believe that hip arthroscopy through a limited anterior approach provides an easy and safe alternative method for arthroscopic access to the hip joint. Importantly, there is a decreased risk of neurovascular trauma and iatrogenic damage to the articular cartilage and acetabular labrum when introducing instruments into the hip joint.

Adolescent↗
PubMed2000

Myxoma is not a single entity: a review of the concept of myxoma.

Myxoid lesions can be subdivided into (1) mainstream myxomas of soft tissues, (2) mainstream myxomas located outside the soft tissue, (3) inadequately substantiated myxomas, (4) myxoid soft tissue tumors or lesions not regarded as myxomas, (5) myxoid fatty conditions, (6) other soft tissue lesions and tumors that are sometimes markedly myxoid, (7) other soft tissue tumors in which myxoid foci may be seen, and (8) nonneoplastic myxoid conditions of soft tissue. More than 60 such conditions are listed and the five entities regarded as mainstream soft tissue myxomas (namely, intramuscular myxoma, juxta-articular myxoma, superficial angiomyxoma, aggressive angiomyxoma, and myxoid neurothekeoma [myxoma of nerve sheath]) are reviewed in detail. Intramuscular myxoma is exclusively intramuscular, usually affects middle-aged women, is most commonly located in the thigh, and does not recur after simple excision. Multiple intramuscular myxomas are rare and are usually associated with monostotic or polyostotic fibrous dysplasia and Albright's syndrome. Juxta-articular myxoma histologically resembles an intramuscular myxoma, but involves periarticular tendons, ligaments, joint capsules, muscles, and even the subcutis of adults. It may be associated with osteoarthritis of the adjacent joint. Some 30% recur locally. Superficial angiomyxoma also has been called cutaneous myxoma. It affects all ages, with a peak incidence in the third and fourth decades; arises in the trunk, lower limb, head, and neck regions; and usually measures less than 5 cm in diameter. Epithelial components are present in approximately 25% of tumors. Approximately one third recur locally, but there have been no metastases. Patients with multiple lesions may have the Carney complex. Aggressive angiomyxoma usually arises in the pelvic and perineal regions and affects females seven times as often as males. Tumors usually measure 10 cm or more in diameter, invade surrounding tissues, and recur in approximately 50% of cases. None have metastasized. Myxoma of nerve sheath (the myxoid variant of neurothekeoma) preferentially affects the dermis and subcutis of the cervicofacial areas and shoulders of young women. Most patients are younger than 40 years; one third of them are in the second decade of life. The majority of tumors measure between 0.5 and 1.5 cm. Only three of 102 cases compiled from the two largest published series recurred; none metastasized. The different clinicopathologic features and behavior of these five mainstream myxomas indicate that myxoma is not a single entity.

Adult↗
PubMed1983

Detections of movements imposed on finger, elbow and shoulder joints.

The angular displacements necessary for 70% correct detection were determined in normal subjects at the shoulder and elbow joints and at the terminal joint of the middle finger. Angular velocities of displacement between 0.125 degrees and 160 degrees/s were tested. Each joint was tested in the mid-range of its normal excursion. The joints were carefully supported for testing and the muscles acting at the joints were relaxed. When assessed in terms of angular displacements and angular velocities, proprioceptive performance at the shoulder and elbow joints was superior to that at the finger joint. Optimal performance at the finger joint was attained over the range of angular velocities from 10 degrees to 80 degrees/s. Optimal performance at both more proximal joints was optimal over a wider range (2 degrees-80 degrees/s). Active pointing movements made without vision of the moving part were performed at each joint at velocities within the range of optimal proprioceptive performance. However, when detection levels and displacement velocities were expressed in terms of linear displacements and velocities at the finger tip for all three joints, the finger joint gave the best performance and the shoulder the worst. In practical terms, therefore, displacements of a given linear extent are best detected if they move distal joints and worst if they move proximal joints. For the elbow and finger joints the detection level and velocity data were expressed also in terms of proportional changes in the lengths of muscles operating at these joints, and as proportional changes in the distance between the points of attachment of the joint capsules. Analysis in terms of proportional changes of muscle length showed remarkably similar performance levels at both joints. This suggests that intramuscular receptors are important determinants of proprioceptive performance. Analysis in terms of joint capsular displacement did not unify the data: on this form of analysis proprioceptive performance at the elbow joint was superior.

Adult↗
PubMed2003

MRI features of the acromioclavicular joint that predict pain relief from intraarticular injection.

OBJECTIVE: Our objective was to evaluate the predictive value of various MRI findings in the acromioclavicular joint for pain relief after intraarticular injection. MATERIALS AND METHODS: The acromioclavicular joint of 50 patients (20 women, 30 men; mean age, 51 years; range, 25-75 years) was evaluated on MRIs of the shoulder. Osteophytes, subchondral cysts and irregularities, bone marrow edema, joint effusion, and joint capsule hypertrophy were assessed by two musculoskeletal radiologists in consensus. Local anesthetics were injected into the acromioclavicular joint with fluoroscopic guidance. Patients graded pain relief on a visual analogue scale (0-100%) after 15 min. The relationship between pain relief and MRI findings was assessed with the Mann-Whitney U test. Pain relief equal to or greater than 70% was rated as a positive response to the injection. This cutoff value was used to calculate sensitivity, specificity, accuracy, and predictive values of the various MRI findings in determining which acromioclavicular joints were responsive to joint injections. RESULTS: Mean pain relief after injection was 38%. Pain relief was significantly related to capsular hypertrophy (p = 0.007) and was equal to or greater than 70% in 11 patients. The sensitivity in diagnosing a successful injection (range, 9-82%) was highest for caudal osteophytes (82%) and capsular hypertrophy (73%). The specificity (range, 51-97%) was highest for subchondral cysts (97%), subchondral bone marrow edema (95%), and joint effusion (92%). CONCLUSION: Pain relief after intraarticular injection is significantly related to capsular hypertrophy diagnosed on MRI. MRI findings have a reasonable sensitivity and a high specificity in predicting relevant short-term pain relief after intraarticular injection.

Acromioclavicular Joint↗
PubMed1993

[An analysis of overstrain injuries in rock climbing].

Between spring and autumn 1990 a study was performed with the goal of recording and classifying overstrain injuries due to rock-climbing and to define their causes. Of the 332 climbers participating in the study, 114 (34.4%) had suffered from at least one overstrain injury. The degree of climbing skill proved to be the main risk factor; with increasing climbing skills of the observed persons the percentage of injuries increased very substantially. The degree of climbing skill also was the only significant difference between injured and non-injured persons--injured persons had a climbing skill which was 1.3 degrees (UIAA) higher. Warming up was unable to prevent most overstrain injuries. A total of 237 injuries were described. 34.6% of these were long-term defects such as foot deformations and nail dystrophies of the toes. 65.4% were overstrain injuries; 90.3% of these cases concerned the upper part of the body and the upper extremities including the thoracic girdle, areas which are particularly strained in climbs of high degrees of difficulty. The areas affected were almost exclusively tendons, joint capsules and ligaments. By far the most frequent injury of the upper extremity was the proximal interphalangeal joint injury, followed by injuries to the proximal phalanx, the flexor tendons of the forearm and the distal interphalangeal joint. With regard to training injuries, finger injuries occurred most frequently in addition to elbow injuries. 51% of the overstrain injuries were severe, with healing times of months to years. Only 30% of the injured persons consulted a physician.

Athletic Injuries↗
PubMedDate not supplied

Proximal tibiofibular bifurcation synostosis for the management of longitudinal deficiency of the tibia.

Three adults with severe longitudinal deficiency of the tibia (LDT), in which an unossified proximal tibial anlage was present, who had been treated with proximal tibiofibular bifurcation synostosis (PTFBS) in early childhood, were evaluated between 20 and 31 years after the index procedure. All three were found to be functioning well as below-the-knee (BK) amputees. Mediolateral stability and anteroposterior instability of the knee were present in all cases. Instrumented motion analysis revealed diminished loading characteristics of the prosthetic limb, similar to that described for BK amputees in general. The most significant gait deviations at the knee unique to this study group were a quadriceps-avoidance gait pattern and an increased dynamic varus alignment. Instrumented muscle testing suggested that these deviations were a consequence of ligamentous instability. This study supports the concept that the presence of a proximal tibial anlage in severe LDT is indication for a surgical strategy that preserves the biological knee joint. The PTFBS maintains the integrity of the knee-extensor mechanism, the fibular collateral ligament, the tibiofemoral joint capsule, and the medial collateral ligament, enhancing the long-term stability and function of the knee joint.

Adult↗
PubMed1999

Sacroiliac joint involvement in activation of the porcine spinal and gluteal musculature.

In the search for causes of low back pain, the sacroiliac joint has gained renewed interest as a possible pain generator. There is reason to believe that the sacroiliac joint plays a regulatory role involving reflex muscle activation, which controls trunk mobility and stability, as well as locomotion. The aim of this experimental study was to determine whether stimulation of nerves in the sacroiliac joint and joint capsule could elicit contractions in porcine gluteal or lumbar spinal muscles. Via a lateral retroperitoneal approach and using hypodermic needles, bipolar stimulating wire electrodes were inserted into the ventral area of the sacroiliac joint and directly under the surface of the capsular membrane, in 10 adolescent pigs (45 kg). This procedure was performed bilaterally, thus establishing two bilateral stimulation sites in the joints. Six electromyographic electrodes were unilaterally inserted into the following muscles: multifidus, gluteus medius, gluteus maximus, and quadratus lumborum. On stimulation within the ventral area of the joint, predominant responses occurred in both the gluteus maximus and quadratus lumborum muscles. However, when stimulating the capsule, the greatest muscular responses were detected in the multifidus muscles. This study addressed the possible regulatory function of the sacroiliac joint, namely, its involvement in activation of the spinal and gluteal muscles, which help control locomotion and body posture, as well as provide stability on the segmental level in the lumbar spine.

Animals↗
PubMed1979

Hypermobility of the incudostapedial joint: a clinical entity.

During exploratory tympanotomy for conductive deafness, the surgeon is occasionally perplexed to find no apparent cause for the air-bone gap. This unexplained deafness has been called "inner ear conductive hearing less" because of the apparent absence of pathology in the middle ear. The incudostapedial joint was studied in 68 vertically sectioned temporal bones and the anatomy is presented. Varying amounts of laxity is observed in the normal joint capsule at the time of surgery. A theory is suggested in which an elongated capsule allows incus motion without energy transmission to the stapes. It is proposed that hypermobility of the incudostapedial joint may exist and explain conductive hearing loss of undetermined etiology.

Audiometry↗
PubMed1992

[Arthroscopic technique for replacing the anterior cruciate ligament using a free patellar tendon transplant].

The replacement of the anterior cruciate ligament (ACL) by a free patellar tendon graft is a well-known procedure. The disadvantage is that the necessary arthrotomy destroys the nerve supply of the joint capsule. Therefore, we developed a procedure of ACL replacement that can be done by arthroscopy without opening the joint except for a small incision needed for the arthroscopy and working canal. The surgical technique is described.

Anterior Cruciate Ligament↗
PubMed1977

Clinical significance of arthrography of the humeroscapular joint.

This paper discusses the possibility of using arthrography of the humeroscapular joint for further differentiation of the syndrome of humeroscapular periarthritis. A description of the normal arthrogram is followed by a discussion of the arthrographic features of rupture of the rotator cuff, rupture of the long biceps tendon, and anomalies of the joint capsule.

Humans↗
PubMed1993

Full-thickness supraspinatus tendon tears with intact superior glenohumeral capsule.

Fourteen of 318 consecutive shoulder arthroscopies performed over 5 years were found to have a complete tear of the supraspinatus tendon with an intact superior glenohumeral joint capsule. All tears were surgically repaired into a bony trough in the greater tuberosity. All of these tears were found in the past 2 years, representing the last 155 arthroscopies performed. This would indicate that there were probably similar lesions that were missed in earlier cases. This represents a significant pitfall injury that may yield a negative arthrogram and may be overlooked in arthroscopic shoulder surgery unless close inspection of the bursal side of the rotator cuff is accomplished.

Arthroscopy↗
PubMed2004

Extensor mechanism slide for the treatment of proximal interphalangeal joint extension lag: an anatomic study.

PURPOSE: We describe a technique for correction of proximal interphalangeal joint (PIP) extensor lag secondary to angulation and/or shortening of proximal phalanx fractures. METHODS: Proximal phalanx fracture malunions with 2.5 mm of shortening, 5.0 mm of shortening, and apex volar angulation of 40 degrees were simulated in 15 cadaver fingers, creating PIP extensor lags. The metacarpophalangeal (MCP) joint was pinned in neutral. Transection of the ulnar and radial sagittal bands, the extensor digitorum communis (EDC) insertion on the MCP joint capsule, and the juncturae tendinae then was performed. The PIP extensor lag before and after each of the earlier-noted releases was recorded. The MCP joint then was freed and MCP hyperextension was recorded. With the MCP joint in neutral position the sagittal bands then were reapproximated with sutures and MCP extension was measured. RESULTS: The 2.5 mm of axial shortening, 5.0 mm of axial shortening, and 40 degrees of apex volar angulation fracture models produced an average extensor lag of 6.2 degrees , 25.8 degrees , and 42.5 degrees , respectively. Maximal correction of PIP extensor lag required transection of both sagittal bands, EDC insertion on the MCP capsule, and the juncturae tendinae with an average residual extensor lag of -0.8 degrees for the 2.5-mm shortening model, 0.7 degrees for the 5.0-mm shortening model, and 3.2 degrees for the 40 degrees -angulation model. The MCP joint hyperextension increased by 20 degrees to 30 degrees after the releases but decreased to only 1.8 degrees if the sagittal bands were reapproximated to the EDC tendon at their new resting position with the MCP joint in neutral position. CONCLUSIONS: In the cadaver model the PIP extensor lag can be improved substantially by transection of the sagittal bands, release of the EDC insertion on the MCP capsule, transection of the juncturae tendinae, and reapproximation of the sagittal bands to the EDC tendon.

Aged↗
PubMed1990

Dacron fabric-enveloped hydroxyapatite prosthesis for sternal tumor defect: an autopsy report.

A 38-year-old housewife with solitary plasmacytoma of the manubrium who underwent a subtotal sternectomy treated by resection of the lesion is reported. This was followed by replacement with a Dacron fabric-enveloped hydroxyapatite prosthesis. The Dacron fabric was sutured to the surrounding tissues, and then the clavicle was passed through the cylindrical-shaped Dacron fabric to form a sternoclavicular joint capsule. The patient returned to her daily life 3 months after the operation. She had no trouble in her daily living, without any dislocation of the sternoclavicular joints or any displacement of the artificial sternum. The autopsy examination about 1 year after the operation showed that the Dacron fabric enveloping the artificial sternum became stronger with time. The sternoclavicular joint also was stably fixed, and the Dacron fabric fulfilled its function as an artificial articular capsule and biologic fixation of the surrounding supporting tissues.

Adult↗