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At least 793 records · Page 44Linked to original sources
PubMed2001

[MRI in dislocation and instability of the shoulder joint].

The value of magnetic resonance imaging (MRI) in shoulder instability depends on its ability to demonstrate pathologic lesions within the joint. Traumatic dislocation in particular often results in capsulo-labral-avulsion, stretching of the joint capsule and impression fracture at the humeral head. Various MR weightings, including spin echo and gradient echo, are useful at the shoulder. A surface coil should be used. Image planes are oriented at the scapula. A capsulo-labral-avulsion can not be reliably demonstrated on non-contrast imaging in the absence of intra-articular effusion. With indirect arthrography, gadolinium is intravenously injected and enhances the articular space. With direct arthrography, gadolinium or saline are injected into the joint, optimising the demonstration of labral lesions. In grade I lesions, fluid enters the lesion without deformation or detachment of the labrum. In grade II lesions, the labrum is of abnormal size or shape, but still attached to the glenoid. In grade III lesions, the labrum is completely detached. Sensitivity of magnetic resonance arthrography for labral lesions is 90% and specificity is 95%. Impression fractures at the humeral head are well demonstrated but avulsion fractures at the glenoid are not. Lesions at the joint capsule cannot be seen. Decisions relating to shoulder instability are primarily based on patient history and physical examination. MRI adds valuable information, particular in unclear clinical settings.

Acute Disease↗
PubMed2004

Post-traumatic instability of the trapeziometacarpal joint of the thumb. Diagnosis and the results of reconstruction of the beak ligament.

In 28 patients with a solitary diagnosis of instability of the trapeziometacarpal joint because of a rupture of the anterior oblique ligament, reconstruction was carried out using a slip of the tendon of flexor carpi radialis. We were able to review 26 patients. The results after a follow-up of four years seven months showed that most (87%) had significant relief from pain and symptoms. Seventeen were graded as good to excellent. The mean grip strength recovered to 86% of the contralateral side. Most patients (81%) felt that they had subjective improvement and would have undergone the operation again. A lesser functional result was seen in those who developed a flexion deformity because of overtightening of the reconstruction. Increased awareness of this lesion can lead to an early and clear diagnosis so that the patient may be advised adequately. We describe a specific, diagnostic, clinical test which we have used consistently and successfully.

Adolescent↗
PubMed1979

Recurrent instability of the ankle joint. Surgical repair by the Watson-Jones method.

Twenty-one ankle joints with recurrent lateral instability, treated with surgical repair by the Watson-Jones method, were included in a follow-up study 1--5 years after operation. Good results were achieved in 80 per cent. However, the results were not better than those after free dissection and direct suture of the ligamentous ruptures. It is therefore recommended that the more extensive Watson-Jones procedure be reserved for selected cases.

Adolescent↗
PubMed1993

Treatment of volar instability of the metacarpophalangeal joint of the thumb by volar capsulodesis.

The metacarpophalangeal joint bears most of the stresses to which the thumb ray is subjected. Instability of this joint results in considerable functional impairment of the hand. Volar instability may be secondary to trauma, rheumatoid arthritis, or adduction spasms in cerebral palsy. The resulting hyperextension causes pain and weakness of pinch (Fig. 1). Various techniques have been described to correct this deformity. We prefer a volar capsulodesis as first described by Filler (1976), in which the whole volar plate is reinserted. Detailed knowledge of the complicated volar anatomy is essential. We have treated eight patients (two bilaterally) with this technique, all with satisfactory results.

Adolescent↗
PubMed2001

Thermal capsulorrhaphy treatment of shoulder instability: basic science.

Thermal capsulorrhaphy is a new treatment modality for shoulder instability, where the joint capsular tissue is heated and reduced in length by laser or radiofrequency energy to regain joint stability. Experimental studies have shown that (1) joint capsular tissue can be modified significantly (shortened) by thermal energy at the temperature range of 70 degrees to 80 degrees C; (2) thermal energy causes immediate deleterious effects such as loss of the mechanical properties, collagen denaturation, and cell necrosis; (3) thermally treated tissue is repaired actively by a residual population of fibroblasts and vascular cells, with concomitant improvement of mechanical properties; (4) the shrunken tissue stretches with time if the tissue is subjected to physiologic loading immediately after surgery; and (5) leaving viable tissue between treated regions significantly improves the healing process. Therefore, the application of thermal energy to achieve joint stability relies on an initial effect (shrinkage), and to a great extent the tissue's healing response to regain the tissue's mechanical properties. Particularly, induction of active repair and joint capsular thickening with tissue remodeling regulated by functional demand seem to be essential factors for a successful outcome. Thermal treatment causes an initial deleterious effect on the tissue's properties, and overtreatment can lead to severe immediate and permanent tissue damage. In addition, scientific data of newly developed devices are limited, and the information from manufacturers often is unreliable and misleading. Carefully controlled long-term clinical and scientific studies should be done to additionally clarify the advantages and disadvantages of this technique.

Animals↗
PubMed1992

Ligamentous reconstruction for posterolateral rotatory instability of the elbow.

Eleven consecutively seen patients who had posterolateral rotatory instability of the elbow joint were managed operatively. The radial collateral-ligament complex was advanced and imbricated in three of them. In seven patients, the ulnar band of the radial collateral ligament (the lateral ulnar collateral ligament) was reconstructed with the palmaris longus tendon and in two of the seven, the reconstruction was augmented with a prosthetic ligament. The ligament was reconstructed with the lateral one-third of the triceps fascia in the remaining patient. Stability was obtained in ten patients, and seven patients had an excellent functional result. There was one failure in one of the patients in whom the ulnar band of the radial collateral ligament had been reconstructed with the palmaris longus tendon and augmented with a prosthetic ligament.

Adolescent↗
PubMed1989

[Treatment of instability of the knee joint].

The authors present a study of problems of the surgical treatment of acute and chronic instabilities of the knee joint. In cases of recent injuries 32 operations of restoration of the cruciate ligaments and the bursal and ligamentous apparatus were made: in most cases the long-term results were good. The authors believe that timely and adequate treatment of the patients during the acute stage of the disease will allow to bring the problem of the treatment of chronic instability of the knee joint in most patients closer to its practical solution. In primarily anterior and posterior chronic instability associated with a light degree of lateral instability an operation after Augustino is advised, particularly as modified by the authors, as an independent operation or as one of the elements in complex reconstructive operations in the multiplane forms of instability of the knee joint. A detailed description of the surgical technique is given.

Adult↗
PubMed2005

Plantar pressure distribution during gait in athletes with functional instability of the ankle joint: preliminary report.

This study addressed the hypothesis that gait characteristics differ between normal subjects and athletes suffering from functional instability (FI) of the ankle joint. FI of the ankle joint is one of the most common residual disabilities after an acute ankle sprain. However, the influences of the FI of the ankle joint on the gait characteristics are not well understood. Athletes suffering from FI of the ankle joint and healthy control subjects were examined. Pressure, area, and force during gait were measured using a pressure measuring system. These in vivo plantar pressure measurements were performed during free walking. The foot angle and the pronation-supination index were calculated. Those in the FI group were found to exhibit a significantly lower dynamic foot angle and a greater pronation-supination index at the midsupport phase of gait than those in the control group. The results showed increased adduction-supination of the foot at the stance phase of gait in those with FI of the ankle joint.

Adult↗
PubMed1993

Impingement of the rotator cuff in athletes caused by instability of the shoulder joint.

An impingement of the rotator cuff can be caused by chronic anterior instability of the shoulder joint. This particular disease is often found in athletes engaged in overhead motion in abduction/external rotation of the arm, such as in ball sports like volleyball or European handball, racket sports like tennis or badminton, or swimming. For those patients that cannot be cured by conservative treatment such as muscular stabilization, surgical treatment is indicated: anterior reconstruction of the capsule and/or the glenoid labrum, and in addition--if necessary--subacromial decompression and revision of the rotator cuff. Between October 1988 and April 1992, we operated on 66 shoulders in 64 top athletes suffering from chronic anterior or multidirectional instability of the shoulder joint that had caused an impingement syndrome of the rotator cuff. In all cases, the athlete was unaware of the instability. Conservative treatment had been unsuccessful. Surgical treatment was successful in close to 90% of the athletes.

Arthroscopy↗
PubMed1989

[Functional anatomy, diagnosis and treatment of chronic instability of the knee joint].

On the basis of results of anatomical experimental, biomechanical investigations and 285 clinical observations, a new approach to the understanding of the problem of instability of the knee joint is suggested. It was proved, that instability of a joint developed in damage to a number of its structures. A classification of the anteromedial and anterolateral instability has been developed.

Adolescent↗
PubMed1991

[Treatment of bilateral dysplastic instability of the hip joints].

In the article are described the peculiarities of the treatment tactics and presented an integral assessment of treatment efficiency of 563 patients with bilateral dysplastic instability of the hip joints (bilateral dislocation, bilateral primary subluxation, dislocation of one and subluxation of the other joint), carried out in the hospital of the institute named after M. I. Sitenko in 1955-1989. There is noted a necessity of achievement of anatomo-functional symmetry of the hip joints as a strategic aim of treatment and an expediency of application of "anticipation estimate" principle while planning the treatment measures for these patients.

Adolescent↗
PubMed1988

Effect of ankle disk training on postural control in patients with functional instability of the ankle joint.

The postural control of ten male soccer players with functional instability (FI) of the ankle joint, i.e., recurrent sprains and/or a feeling of giving way, was studied before and after ankle disk training. Postural control was studied by means of stabilometry and an optoelectronic movement recording system. In the present study, we found increased postural sway in men with functional instability, which is in line with previous studies. We found improved postural control after ankle disk training as shown by stabilometry. Postural correction patterns were restored, and segmental displacement amplitudes reached even supranormal values. A subgroup of players with unilateral FI also decreased postural sway when standing on the non-symptomatic, untrained foot after ankle disk training. This bilateral improvement and the restored postural correction pattern do not tally with Freemans proprioceptive theory for postural control, but stresses the importance of central motor programs.

Adult↗
PubMed1980

Biomechanic studies reinserting the medial collateral ligament to correct a chronic anteromedial instability of the knee joint.

One possibility to correct a chronic anteromedial instability of the knee joint is the osseous reinsertion and tightening of the medial collateral ligament. In experiments with a string model and strain gauges attached to the ligaments we investigated the advantages and/or disadvantages of the femoral and tibial reinsertion. Regarding the tension mechanism the medial collateral ligament reacts considerably more sensitivity to the femoral reinsection in proximal-dorsal direction than to the tibial-reinsertion in distal-ventral direction. An accurate knee flexion between 40 and 60 degrees has to be provided reinserting the ligament in proximal-dorsal direction to avoid excessive tension and resulting destruction of the ligament. However the reinsertion of the ligament in distal-ventral direction, independently from the flexion of the knee, always approximates the natural tension of the anterior and posterior margin of the untreated ligament. Biomechanically the reinsertion in distal-ventral direction to tighten the loose ligament seems to be preferable to the reinsertion in proximal-dorsal direction.

Biomechanical Phenomena↗
PubMed1992

Autotraction stress roentgenography for demonstration anterior and inferior instability of the shoulder joint.

A form of stress roentgenography is presented for the diagnosis of anterior and inferior shoulder instabilities. Stress is induced by anterioinferior traction concentrated on the shoulder during extension of the flexed hip, when patients hold their legs on the side being examined, with both hands. The anterior and inferior shifts of the humeral head in relation to the glenoid fossa then are measured from anteroposterior and modified axillary roentgenograms. This method was employed in 16 shoulders with recurrent anterior dislocation, 11 recurrent anterior subluxations, nine multidirectional instabilities, and 19 control shoulders. Mean anterior translations were 3 mm and 5 mm, and inferior translations were 7 mm and 10 mm for the control and recurrent dislocation groups, respectively. There were statistically no significant differences between those groups. In the recurrent anterior subluxations, the corresponding translations were of a completely different order, 21 mm and 19 mm, respectively, allowing the distinction from the controls and recurrent anterior dislocations in most cases. The shifts found in multidirectional instabilities, averaging 27 mm and 26 mm, respectively, were significantly greater than for the recurrent subluxations, but the differences were not great enough for accurate differential diagnosis in individual cases. Autotraction stress roentgenography of the shoulder may be of use in the diagnosis of recurrent anterior subluxations and anteroinferior multidirectional instabilities. It also gives good general views of the looseness of the glenohumeral joint.

Adolescent↗
PubMed1993

Post-traumatic ligamentous instability of the atlantoaxial joint: a comparison between the Gallie and Brooks fusions.

We reviewed 37 patients following a posterior spinal fusion for traumatic ligamentous instability of the atlanto-axial joint. All patients were neurologically intact and the atlanto-dental interval ranged from 5 to 9 mm. A Gallie fusion was performed in 19 patients, a Brooks fusion in 16 patients and an occipitocervical fusion in two patients. A SOMI brace was used postoperatively for 12 weeks. Bony fusion was obtained in 32 patients. Displacement occurred in 11 patients, five of whom developed non-union.

Adult↗
PubMed2004

Changes in ground reaction force during jump landing in subjects with functional instability of the ankle joint.

OBJECTIVE: To identify changes in ground reaction force during jump landing in subjects with functional instability of the ankle joint. DESIGN: Comparison of ground reaction force during jump landing between subjects with functional instability and healthy controls. BACKGROUND: We have recently demonstrated significantly altered patterns of ankle and knee movement immediately pre- and post-impact in subjects with functional instability compared to healthy controls. We now examine the changes in timing and magnitude of forces sustained by the unstable ankle during jump landing. METHODS: Fourteen subjects with unstable ankles and 10 age, sex and activity matched controls performed five single leg jumps onto a force platform whilst ground reaction forces were sampled. Timing and magnitudes of forces during the first 150 ms following impact were analysed and compared between groups. RESULTS: Lateral and anterior force peaks occurred significantly earlier in subjects with functional instability. Significant differences were seen between groups' time-averaged vertical, frontal and sagittal components of ground reaction force. These ranged from 5% (frontal force) to 100% (vertical force) of body mass. These changes occur immediately post-impact and too early for reflex correction/modification. CONCLUSIONS: The disordered force patterns observed in subjects with functional instability are likely to result in repeated injury due to significant increase in stress on ankle joint structures during jump landing. We suggest that they are most likely to result from deficits in feed-forward motor control. RELEVANCE: These results identify the potentially injurious nature of the changes in the forces applied to the unstable ankle joint during jump landing. The timing of these changes suggests that they are caused by a motor control deficit. Treatment approaches aimed at retraining feed-forward control of ankle joint movement could succeed in restoring more normal patterns of force absorption and reduce the occurrence of repeated micro-trauma to ankle structures.

Adaptation, Physiological↗
PubMed2001

[Modified collateral ligament reconstruction with the tendon of the abductor pollicis tendon in treatment of chronic radial instability of the basal thumb joint].

Injuries to the radial collateral ligament of the MP joint of the thumb occur much less frequently than injuries to the ulnar collateral ligament. Ligament injury is usually a result of direct trauma. The resultant instability to the thumb usually impairs hand function. In acute lesions to the radial collateral ligament, direct repair is often possible. In cases of chronic radial joint instability, secondary ligament reconstruction with a free tendon graft, most commonly the palmaris longus tendon, is usually recommended. We describe another technique using the tendon insertion of the abductor pollicis brevis muscle. The tendon inserting distally can be used as a stable ligament after dividing it at the border to the muscle and attaching it to the head of the metacarpal bone with a wire. The follow-up for six patients treated by this method showed good and painless stability and function of the thumb in a time span of one year.

Chronic Disease↗