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PubMed1997

[The trochanteric flip osteotomy.].

GOAL OF SURGERY: Easy access to the posterior, superior and anterior joint capsule through an osteotomy which reduces the risk of complications and the incidence of non-union. INDICATIONS: Hip joint revision with or without intertrochanteric osteotomy, periarticular ossifications, difficult total hip procedures, exchange procedures. CONTRAINDICATIONS: Absolute: None Relative: Distal transfer of the trochanter. PREOPERATIVE WORK UP: Radiographs in 2 planes (anterior-posterior pelvis+"false profile" hip). POSITIONING AND ANAESTHESIA: Lateral decubitus. General anaesthesia. SURGICAL TECHNIQUE: In lateral decubitus the greater trochanter will be osteotomized from posterior leaving a 1 to 1.5 cm thick bony wafer uniting the insertion of the gluteus medius and minimus with the origin of the vastus lateralis. The trochanteric crest remains untouched. After refixation with nonresorbable sutures #3 the fragment is not subjected to a unidirectional tension by the abductors which could interfere with the consolidation. POSTOPERATIVE MANAGEMENT: Bed rest with lower limb in neutral position. Mobilization with 2 canes on the 2nd postoperative day. The timing of partial weight bearing depends on the type of surgery. Abductor exercises after 6 weeks. POSSIBLE COMPLICATIONS: Bony wafer too thin or too thick. Inadequate refixation. Delayed consolidation. Cranial migration of the greater trochanter. RESULTS: Between 1991 and 1994 41 patients were operated. Diagnoses, see Table 1. Method of refixation: see Table 2. After 21+/-9 months 39 patients could be reexamined clinically, and radiological after 17+/-11 months: 38 osteotomies consolidated. Cranial migration varied between 0 and 8 mm. 25 patients were free of symptoms, 12 had slight and 2 moderate pain over the trochanter. Avulsion of wire cerclage: 2, foreign body irritation: 2 necessitating implant removal.

English Abstract↗
PubMed1989

[Functional anatomy of the upper ankle joint].

The ankle joint is regarded as a hinged joint with a range of motion of about 60 degrees. The shape of the trochlea tali varies, so the axis of rotation and the compensative movements of the fibula do. The ligamentous stabilizers of the medial side are thicker than the lateral ones. At the other hand, the lateral malleolus is more voluminous than the medial one. The lig. fibulotalare ant. is a reinforcement of the joint capsule, the lig. fibulocalcaneare has no connection to the jointcapsule, the lig. fibulotalare post. is partially running through the joint. In neutral- and plantarflexed position, the lig. fibulocalcaneare forms a groove which takes up the tendon sheat of the peroneal tendson. In dorsalextended position the tendons are pushed laterally by the tense ligament. This mechanism supports the peroneal tendon luxation in dorsal extension.

Ankle Joint↗
PubMed1980

Computed tomography of the lumbar facet joints.

Lumbar facet joints are difficult to image with conventional radiographic techniques. A series of 100 consecutive cases of low back pain and sciatica was examined with CT. Abnormal facet joints were found in 65. Abnormalities demonstrated by CT included osteophyte formation, hypertrophy of articular processes, articular cartilage thinning, vacuum joint phenomenon, and calcification of the joint capsule. In patients with sciatic or low back pain, CT is indicated to demonstrate treatable abnormalities of the facet joints.

Humans↗
PubMed1985

Fluid compartmentation and articular mechanoreceptor discharge in the cat knee joint.

Experiments were performed to determine the effect of alteration of intra-articular pressure in different areas of the cat knee joint on the discharge of slowly adapting mechanoreceptors in the posterior region of the joint. At physiological (subatmospheric) pressures the anterior and posterior regions of the knee joint are not hydraulically continuous. However, at supra-atmospheric pressures between 2.5 and 9 cmH2O there is free communication between these areas. The discharge of receptors in the posterior region of the joint is influenced by intra-articular pressure changes in the posterior region when these are supra-atmospheric. However, pressure changes in the anterior region of the joint have little effect on the discharge of these receptors until free communication occurs between anterior and posterior regions. It is suggested that articular mechanoreceptors detect tension changes in collagen fibrils rather than volume changes of the joint capsule.

Action Potentials↗
PubMed1990

Joint receptors modulate short and long latency muscle responses in the awake cat.

Nerve cuff electrodes were chronically implanted around multiple peripheral nerves in adult cats, including the medial and posterior articular nerves (MAN and PAN) to the knee while EMG electrodes were implanted into seven hindlimb muscles. Randomized load perturbations producing mid-range knee flexions at varying angular velocities were subsequently applied to awake cats. Recordings were initially obtained with knee joint innervation intact and then after local anaesthetic or saline control solution was injected into the knee. Averaged neurogram and EMG responses to the imposed movements were utilized to assess the contribution of joint mechanoreceptor activity to the evoked muscle responses. Additionally, spike-triggered averaging techniques and peri-stimulus time histograms of single joint afferent units isolated from the articular nerve cuffs were utilized to characterize unitary joint receptor responses. The averaged whole nerve response to knee joint perturbations on each of the cuffed articular nerves revealed phasic increases in activity relative to constant background levels. The earliest phasic responses on the articular nerves were initiated at latencies that were too short to be voluntary, occurring in the short latency (reflex) period. Detectable joint receptors were not recruited until after the earliest excitatory responses of agonist/antagonist muscle pairs acting across the knee had occurred, presumably resulting in mechanical loading of the knee joint capsule and subsequent activation of articular mechanoreceptors. Introduction of local anaesthetic into the knee was accompanied by marked diminution in joint afferent activity. Perturbation-evoked muscle responses were characterized by increased activity above background levels in all seven muscles studied, including antagonist muscle pairs. Local anaesthetic-mediated loss of knee joint mechanoreceptor input altered the latency, amplitude and duration of EMG responses in each muscle. The effect of joint anaesthesia in the short latency period was a generalized decrease in all muscle responses relative to normal and saline controls. The loss of afferent input after joint anaesthesia was also associated with altered muscle responses during the long latency period, when both reflex and voluntary mechanisms could potentially contribute to the generation of EMG activity. Interestingly, long latency activity after joint anaesthesia was characterized by "unbalancing" in the EMG responses of some antagonist muscle pairs. This alteration of normal antagonist pair co-contraction patterns served to increase the magnitude of the imposed perturbations, rather than to bring the movements under control. Analysis of single joint afferents isolated from whole joint nerve recordings demonstrated that some joint afferent units were tonically active at quiescent, mid-range knee positions. Additionally, isolated afferents demonstrated different time courses of response to imposed perturbations.(ABSTRACT TRUNCATED AT 400 WORDS)

Animals↗
PubMed2002

Spontaneous sternoclavicular joint infections.

Spontaneous sternoclavicular (SC) joint infections are uncommon. Most cases of contained SC joint infections respond well to conservative treatment measures such as intravenous antibiotics and local drainage. However, some cases are more extensive, extending beyond the boundaries of the joint capsule, occasionally involving the anterior chest wall and mediastinum. We report our experience with 3 patients with spontaneous advanced SC joint infections. Radical surgical treatment seemed to provide the best control of this infection.

Actinomycetales Infections↗
PubMed1985

Torsional fatigue of the lumbar intervertebral joints.

The effect of cyclic torsional loads on the behavior of intact lumbar intervertebral joints was investigated. A total of 24 specimens, divided in two groups, were tested. In the first group, a specimen was subjected to a specified constant cyclic torque, and the resulting change in angular displacement with time was recorded. The specimens in the second group were subjected to a specified constant angular displacement and the resultant torque recorded. The results of the constant torque tests showed that fatigue failure was primarily a function of the averaged initial angular displacement and secondarily of the applied torque. The critical threshold values appear to be an initial angular displacement of +/- 1.5 degrees. All specimens, displaying an averaged initial angular displacement of less than +/- 1.5 degrees, did not fail in fatigue, while the others did. However, the specimens with angular displacements of less than +/- 1.5 degrees had lower applied torques (11.3 and 22.6 Nm), while specimens with higher applied torques (33.9 and 45.2 Nm) all exceeded the +/- 1.5 degrees threshold and failed in fatigue. Failure locations occurred in such diverse regions as end-plates, facets, laminae, capsular ligaments, etc. All specimens exhibited a synovial fluid discharge from the apophyseal joint capsule sometime during testing. Post-test examinations of all the cartilage surfaces showed fibrillation, whether or not the intervertebral joint failed.

Adult↗
PubMed1981

Septic arthritis in rheumatoid disease causing bilateral shoulder dislocation: diagnosis and treatment assisted by grey scale ultrasonography.

Signs of sepsis may be obscure in patients with rheumatoid arthritis, particularly in association with long-term steroid therapy. If mortality is to be avoided, a high index of suspicion must be maintained for the diagnosis, and doubtful joints should be aspirated for culture and prompt therapy with the correct antibiotic. In this report a patients with advanced rheumatoid arthritis presented with bilateral shoulder dislocation due to septic arthritis. Ultrasonography was particularly helpful in guiding a 20 G needle to fluid collections with the debris-filled joint capsules and in facilitating successful aspiration. Ultrasound also provided a painless, noninvasive, and safe method of serial assessment of the joints after therapy.

Arthritis, Infectious↗
PubMed1979

The medial adductor approach to arthrography of the hip in children.

In small infants and children, the medial or adductor approach for arthrography of the hip has several advantages over direct anterior insertion of the needle into the joint capsule, primarily the fact that extravasated contrast material runs along the adductor area and is not superimposed on the hip joint.

Child, Preschool↗
PubMedDate not supplied

[Preliminary experiences on triscaphoid arthrodesis].

The authors report their experience of 5 patients (4 males, 1 female) with a mean age of 36.4 years (min 25 years, max 45 years), undergoing triscaphoid arthrodesis between May 1989 and August 1993. The patients suffered from rotatory dislocation of the scaphoid (1 case) and stage 3A of Kienboeck's disease according to Lichtman's classification (4 cases). The paper describes the surgical technique used for partial arthrodesis of the wrist performed using plexual anesthesia. A dorsal access route is used through a curved longitudinal skin incision corresponding to the anatomical site of the scaphoid. The skin flaps are then peeled back revealing the surface veins and sensitive branches of the radial nerve which are isolated and conserved. Having cut through the retinaculum of the extensors, the extensor tendons are spread so as to reach the joint capsule which is sectioned crosswise. After the bone to be fused have been exposed, the cartilage is removed from the joint faces between the scaphoid, trapezium and trapezoid and, using a osteotribe, the subchondral bone is removed to reveal the spongy bone, leaving a space of approximately 6 mm between the spongy surface of the bones to be fused. Arthodesis is stabilised using Kirschner wires or metal minicambres enclosing scaphoid, trapezium and trapezoid. Spongy tissue is taken from the distal radial head and used as a graft to fill the spaces created between them which will consolidate over time. The wrist is immobilised in a plaster cast for 8 weeks before starting functional rehabilitation. Patients were checked both clinically and radiographically with a mean follow-up of 36.4 months (min 25, max 50 months). Using the assessment criteria proposed by Minami et al. excellent results were obtained in 4 patients (80%) with the disappearance of painful symptoms, joint excursion 50% greater than the normal wrist, and hand grip 70% greater than in the controlateral hand. There was good radiographical consolidation of the arthrodesis. Poor results were only recorded in one case (20%) with persisting pain and functional impotent. Radio-scaphoid arthrosis was observed radiographically consequent to hypercorrection of the scaphoid with a radio-scaphoid angle of less than 45 degrees. The authors underline the technical difficulty of this arthrodesis characterised by reduction of the scaphoid in a correct position in which the radio-scaphoid angle must be 45 degrees when measured from a lateral position. Lastly, the authors conclude that this from of arthrodesis may be used with good results to treat wrist pathologies such as rotatory scaphoid dislocation, triscaphoid arthrosis and Kien-boeck's disease at stage 3A according to Lichtman. They also affirm that arthrodesis limited to the wrist is preferable to total arthrodesis because it enables some joint movement to be conserved which is important for hand function.

Adult↗
PubMed1975

Biomechanically important articular surfaces in the talocrural joint.

The authors investigated the influence of relations between the utile areas of the articular faces in ankle joint in medial twisting of the foot. For their investigation they used the material from the Institute of Anatomy "Drago Perović", Institute of Pathology and Institute for Forensic medicine of the Medical Faculty of Zagreb. Investigations were performed in articular faces of the tibia, fibula and talus on the left and right legs of the adults. Mutual comparing of the joint faces, their areas and altitudes, angles between the medial malleolus and tibia, and the altitudes of the medial and lateral malleolus has shown great individual differences. According to these results the authors concluded that the disproportion of the articular bodies caused habitual medial twisting of the foot. The importance and the role of ligaments, muscles and joint capsule were not the object of this investigation. The obtained results are a contribution to the functional anatomy of the ankle joint, and to the clinical pathology of this region.

Adult↗
PubMedDate not supplied

Soft-tissue stabilizers of the elbow.

Elbow stability is afforded by both static and dynamic structures. Static structures include the complex bony architecture and soft-tissue stabilizers. Knowledge of the anatomy and biomechanics of the stabilizers is important to understand, diagnose, and treat elbow instability. Bony anatomy, detailed elsewhere, contributes to the inherent stability of the elbow. The static soft-tissue stabilizers consist of the anterior and posterior joint capsule and both medial and lateral collateral ligament complexes. Additional stability is conferred by dynamic structures--the muscles crossing the elbow joint.

Biomechanical Phenomena↗
PubMed2001

Osteoarthritis as a systemic disorder including stromal cell differentiation and lipid metabolism.

For many years articular cartilage has been the focus of research aimed at improving understanding of and treatment for osteoarthritis. Although much is known about the tissue, research has had little success in elucidating the pathogenesis of generalised osteoarthritis. A new hypothesis is required. Substantial changes in many tissues, including bone, muscle, ligaments, and joint capsule, as well as cartilage, are increasingly recognised in this disease, and not all these changes are localised to the affected joints. There is also a well established link with obesity. These observations, the common origins of the mesenchymal cells that maintain these tissues, and the possible role of neuroendocrine factors that can regulate bone mass, result in the hypothesis that systemic factors that include altered lipid metabolism could explain the diversity of physiological changes in generalised osteoarthritis. If proven, this hypothesis could have important implications for a new approach to pharmacological intervention in the early stages of the disease.

Adipocytes↗
PubMed1993

Arthroscopic observations before and after manipulation of frozen shoulder.

The purpose of this article is to report the arthroscopic findings before and immediately after manipulation for frozen shoulder. Twenty patients were selected for manipulation under general anesthesia after failing to improve with conservative measures in 6 months. The findings showed the joint capsule was difficult to penetrate with the arthroscope cannula and obturator because of the thickness of the capsular tissue. The glenohumeral joint accepted less than the normal amount of fluid. The humeral head was tight against the glenoid even in the suspended position. The main intraarticular finding was vascular synovitis. There were no intraarticular adhesions or degenerative changes. An immediate postmanipulation second-look arthroscopy showed there was synovial and capsular hemorrhage indicative of tearing from the manipulation. After glenohumeral manipulation, the joint accepted more fluid, and the humerus was easily distracted away from the glenoid with intraarticular distention.

Arthroscopy↗
PubMed1985

[Soft tissue changes in the wrist in chronic polyarthritis. Results of weak-radiation exposures in 3 planes].

The x-ray anatomy of the soft tissues of the wrist in three views is described and the normal width of the joint capsules, tendon sheaths and tendons at 25 suitable measurement point determined. Only the saccular recess of the inferior radio-ulnar joint depends on sex and age. The normal width of the soft tissues differs considerably within a group of individuals but not between both sides of a single person. As the width of some soft tissues depends on slight deviations from the standard position an identical and exact position is a prerequisite when both sides are to be compared. The shape of the soft tissue changes in rheumatoid arthritis has been shown. Furthermore the incidence of pathologic soft tissue changes has been determined in 86 cases of early and later stages of rheumatoid arthritis. These values show the sensitivity of the 25 measurements. The analysis of soft tissues is an integral part of the assessment of arthropathies.

Adult↗
PubMed1980

Arthroscopic examination of experimentally induced pathologic conditions of the rabbit temporomandibular joint.

Because of the difficulty in diagnosing and treating diseases of the temporomandibular joint, there seems to be a need for a simple, safe technique of examination. The purpose of this study was to examine the usefulness of the arthroscope in diagnosing pathologic conditions of the temporomandibular joint. Various pathologic conditions were produced in the mandibular joints of rabbits. These included steroid-induced arthropathy, chronic inflammatory changes in the synovium, acute inflammatory disease, and gross damage to the condyle and disk. The joints were then visualized with the arthroscope and photographed. Biopsy specimens of what appeared to be the involved areas of the condylar surface and joint capsule were taken for histologic study. The arthroscopic findings were correlated with the biopsy findings and histologic sections of the entire joint.

Animals↗
PubMed1997

Interleukin-6 reduces cartilage destruction during experimental arthritis. A study in interleukin-6-deficient mice.

Using interleukin (IL)-6-deficient (IL-6(0/0) mice or wild-type mice, we investigated the controversial role of IL-6 in joint inflammation and cartilage pathology during zymosan-induced arthritis (ZIA). Monoarticular arthritis was elicited by injection of zymosan into the right knee joint cavity. Production of IL-1, tumor necrosis factor (TNF), IL-6, and nitric oxide by the inflamed knee was assessed in washouts of joint capsule specimens. Plasma corticosterone was measured using a radioimmunoassay. Proteoglycan synthesis was assessed using [35S]sulfate incorporation into patellas ex vivo. Joint swelling was quantified by joint uptake of circulating 99mTechnetium pertechnetate. Histology was taken to evaluate cellular infiltration and cartilage damage. Zymosan caused a rapid increase in articular IL-1, IL-6, TNF, and NO levels. Except for IL-6, the released amounts and time course of these mediators were comparable in the IL-6-deficient mice and the wild-type mice. Elevated plasma corticosterone levels were measured during the first day of arthritis in both strains. At day 2 of ZIA, joint inflammation (joint swelling and cell exudate) in IL-6-deficient mice was comparable with that in the wild-type mice. The marked suppression of chondrocyte proteoglycan synthesis and proteoglycan degradation were on the average higher in the IL-6-deficient mice. Together this resulted in a more pronounced proteoglycan depletion in the IL-6-deficient mice as compared with the wild-type mice during the first week of arthritis. Injection of recombinant IL-6 into the joint cavity corrected the IL-6 deficiency and significantly reduced cartilage destruction. Inflammation was more chronic in the wild-type mice, and these mice also showed a higher prevalence for osteophyte formation. In ZIA, IL-6 plays a dual role in connective tissue pathology, reducing proteoglycan loss in the acute phase and enhancing osteophyte formation in the chronic phase. The latter could be related to the more severe joint inflammation as seen in the normal (IL-6-producing) animals during the chronic phase of arthritis.

Animals↗
PubMed1990

Fourier analysis of the relation between the discharge of quadriceps motor units and periodic mechanical stimulation of cat knee joint receptors.

It has been widely assumed that joint receptors contribute to the reflex regulation of movement and posture, although there have been few clear demonstrations of joint-mediated reflex actions on alpha-motoneurones other than those attributable to flexor reflex afferents. The present study extends our recent work on joint-mediated reflexes by using Fourier analysis of spike train interactions to demonstrate that restricted mechanical activation of a small number (one to five) of knee joint receptors by localized indentation of the joint capsule can modify the firing pattern of quadriceps motoneurones in decerebrated cats. The modulation of this discharge pattern can be reversibly abolished by application of droplets of lignocaine directly to the joint nerve and consequently can be attributed unambiguously to articular afferents. Activation of single joint afferents could on occasion produce changes in motor unit firing patterns, but usually activation of two or more was required before secure effects were observed. Increasing the intensity of indentation (resulting in activation of greater numbers of joint receptors) increases the strength of coupling between joint afferent input and motor unit responses, although the relationship is not linear. The relation between the discharge patterns of pairs of motor units was also examined, and it was found that significant coupling occurred at the stimulus frequency, superimposed on a 'background' coupling from unidentified sources. The phase relationship between pairs of motor units was not affected by the periodic stimulus. However, it was observed that if two motor units were firing independently of one another in the absence of capsule probing, maintained capsular indentation produced a striking synchronization between the discharges of the two motor units. These experiments show strong joint-mediated reflex effects on motor unit firing indicating that joint receptors may have an important role to play in motor control.

Action Potentials↗