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At least 883 records · Page 49Linked to original sources
PubMed1998

Surgical treatment of patients with painful instability of the second metatarsophalangeal joint.

An unstable second metatarsophalangeal joint may produce pain in the forefoot. Eighteen patients (20 feet) had a transfer of the flexor digitorum longus to the extensor side of the base of the proximal phalanx performed as the primary procedure to stabilize this painful joint. Most patients had a hallux valgus deformity that also required correction, because it either was also symptomatic or was preventing adequate reduction of the second toe. A ruptured plantar plate of the second metatarsophalangeal joint was demonstrated in 13 feet and in these joints appeared to be the cause of the vertical instability. However, all feet showed an unstable joint upon clinical examination. A vertical-stress test almost always reproduced the patient's pain while demonstrating instability in the joint; this was the most prominent physical finding in these patients. Eleven patients (13 feet) had an excellent result. Seven patients (seven feet) had a fair result, but they complained only of mild and occasional pain at the joint on exertion. Although difficult to quantify, it appears that postoperative stiffness in the joint provided some of the joint stability seen in our patients. The flexor tendon transfer appears to be a satisfactory method to treating the unstable metatarsophalangeal joint and of relieving patients' pain, but may not, however, restore a normal alignment of the second toe. Correction of other forefoot deformities as hallux valgus and hammertoes may also be important in restoring metatarsophalangeal stability.

Adult↗
PubMed2004

Factors for the presence of anteromedial rotatory instability of the knee.

Anteromedial rotatory instability (AMRI) of the knee joint was investigated with an instrument newly designed to simulate the manual AMRI test and to quantify its magnitude. Thirty healthy subjects, 20 patients with anterior cruciate ligament (ACL) injury, and 10 with both ACL and medial collateral ligament (MCL) injuries were examined. Using the instrument, 100 N of anterior force was applied to the proximal part of the tibia with the foot in neutral rotation, 30 degrees of internal rotation, and 30 degrees of external rotation, and the magnitude of anterior displacement was recorded. The measurement was carried out at 20 degrees and 90 degrees of flexion. A significant increase in anterior laxity was observed in all three rotation positions in the injured patients. However, the magnitude of laxity in external rotation was less than that in neutral rotation in the ACL injured patients, whereas it was the greatest in external rotation in ACL + MCL injured patients. Thus, we conclude that an injury involving both the ACL and MCL causes AMRI.

Adolescent↗
PubMed1990

Arthroscopy of the wrist: anatomy and classification of carpal instability.

Carpal instability can be defined as the lack of ligamentous and skeletal support adequate to maintain a wrist stable to external forces of pinch and grasp. This instability may be static or dynamic. It has been classified as (a) carpal instability, dissociated (CID), a situation in which one or more of the ligaments are torn, and (b) carpal instability, nondissociative (CIND), a situation in which the ligaments are intact but stretched. Carpal instability can also be the result of carpal bone malalignment from various causes. Arthroscopy can be particularly useful in assessing carpal instability, however arthrography with contrast medium, fluoroscopy, and stress loading should precede this arthroscopic assessment. Arthroscopy allows visualization of the volar radiocarpal and ulnocarpal ligaments of the wrist, and the arthroscopic examination can be combined with manual manipulation of the carpal bones to detect laxity of those ligaments, to examine stability of the scapholunate and lunotriquetral interosseous ligaments, and to show instability of the distal radioulnar joint.

Arthroscopy↗
PubMedDate not supplied

Dynamic assessment of shoulder and patellofemoral pathology using limited-volume gas arthroscopy.

Subtle instability problems of the glenohumeral joint and patellofemoral joint are difficult to assess and accurately diagnose with current methods of preoperative imaging and physical examination. A simple technique is described that provides objective information for diagnosing dynamic problems of the shoulder and patellofemoral joint. Limited-volume gas arthroscopy avoids many of the potential risks and complications of pressure-based gas arthroscopy. In addition to assessing joint dynamics, it allows for initial arthroscopic inspection of joints during open surgical cases, eliminating the additional morbidity and expense of fluid arthroscopy. Objective intraoperative assessments of completed reconstructions can also be made to insure that stabilizing procedures are adequate but not overzealous. The technique requires no special equipment, adds little time to an arthroscopic procedure, and requires only basic arthroscopic skills.

Air↗
PubMed1994

Indications for surgical treatment of tibial condyle fractures.

The residual radioanatomic changes influencing the functional, subjective, and clinical outcome of 131 tibial condyle fractures were studied. Clinical function was found to deteriorate rapidly with increasing values of residual medial tilt of the tibial plateau, whereas lateral tilt of the plateau was well tolerated up to 5 degrees. Articular step-off up to 3 mm and condylar widening up to 5 mm had no adverse effects. Seventy percent of knees with moderate or severe instability were functionally unacceptable. It was concluded that a medial unicondylar fracture with any displacement, and all medially tilted bicondylar fractures, should be operated upon. In fracture of the lateral condyle, open reduction and internal fixation is indicated when lateral tilt or valgus malalignment exceeds 5 degrees, articular step-off exceeds 3 mm, or condylar widening exceeds 5 mm. The same limits apply to laterally tilted bicondylar fractures, provided that the medial condyle is undisplaced. Any displacement seen in the axial bicondylar fracture is an indication for surgical treatment. If there is any mediolateral instability in the extended knee joint after rigid internal fixation, repair of a collateral ligament should be considered. An avulsed anterior cruciate ligament should be fixed, if pathologic laxity exists, but the torn ligament can be ignored and reconstructed later if needed.

Adolescent↗
PubMed1996

Correlation of MR imaging, CT arthrography, and arthroscopy of the shoulder.

Rotator cuff tears and instability of the glenohumeral joint are a common cause of chronic shoulder pain and disability. Currently CT arthrography is the method of choice to evaluate the extent of osseous and soft tissue abnormalities. This study was undertaken to determine if magnetic resonance imaging was able to depict post-dislocation abnormalities and rotator cuff pathology and if MRI can replace CT arthrography. Sixty four patients, who were operated on for the first time (arthroscopy or arthrotomy) between November 1986 and July 1991, were compared in a blinded fashion with the results of MR imaging in 40 cases and of CT arthrographies in 24 cases. For the evaluation of rotator cuff tears MRI proved to have a sensitivity of 83.3% and an accuracy of 90.3%. Labral pathology was depicted with a sensitivity of 69.2% and an accuracy of 87.1%. In cases involving a Hill-Sachs lesion the sensitivity of MRI was 90% and the accuracy 95%. MR imaging is an accurate method in the evaluation of rotator cuff pathology and to some extent labral abnormalities.

Adolescent↗
PubMed1994

Carpal instability non-dissociative.

A retrospective study of 45 patients with symptoms of wrist pain and weakness with clinical evidence of instability is presented. These patients had normal intrinsic interosseous ligaments demonstrated arthrographically or surgically. They were followed for a minimum of 18 months and an average of 5.8 years. All patients demonstrated instability of the proximal carpal row which is referred to as carpal instability non-dissociative (CIND). Seven patients were treated non-operatively and 38 were treated operatively. Surgical management consisted of soft tissue reconstruction directed at the area of instability in 34 cases, joint levelling osteotomy in six, three of whom also had soft tissue reconstructions, and mid-carpal fusion in one. The overall good and excellent results were a disappointing 56% and there was no significant difference between the non-surgical and surgical groups. The best results were found in the ulna-minus CIND patients who underwent a joint levelling osteotomy, with 83% good and excellent results. CIND is associated with extrinsic ligamentous laxity; however, significant difficulty exists in locating the precise areas of maximum pathology. This accounts for the unpredictable results of treatment. As our understanding of the pathomechanics of CIND improves, the treatment will become more specific and the results should improve.

Adolescent↗
PubMedDate not supplied

[Migration of shoulder prosthesis as a consequence of hemi- or total arthroplasty].

BACKGROUND: Migration after shoulder arthroplasty can induce muscular dysbalance and instability of the shoulder joint. The aim of this study was to analyse the frequency, causes and consequences of secondary migration after shoulder arthroplasty. METHODS: 107 shoulder arthroplasties in patients with primary osteoarthritis (OA, n = 83) or avascular necrosis of the humeral head (AVN, n = 24), were followed clinically and radiographically over a period of 1 to 10 years. RESULTS: 17 Patients (16 %) developed secondary migration of the prosthesis. These were determined after a mean period of 33 months after shoulder arthroplasty. Patients with secondary migration of the prosthesis showed a worse function with a mean Constant score (CS) of 52.3 points in comparison to the patient group without migrated shoulder arthroplasties (62 points) (p = 0.038). In patients with total shoulder arthroplasty (TSA, n = 75), migration was observed in 13 % of cases during follow-up. Lucent lines at the glenoid were found in radiographs in 55 % of migrated shoulders and in 52 % of non-migrated shoulders (p = 0.633). The Constant score showed no significant difference between the groups (non-migrated shoulders 63 points, migrated shoulders 61 points, p > 0.5). Migration was seen in 22 % (7/32 patients) after hemiarthroplasty, however, no significant difference could be found between the respective Constant scores for migrated (47.7 points) or non-migrated (55.1 points) shoulders (p = 0.447). In patients with OA there was no significant difference in Constant score between migrated and non-migrated shoulders (p = 0.331), whereas patients with AVN showed significantly worse function after migrated shoulder arthroplasty (p = 0.007). CONCLUSION: Migration after total shoulder arthroplasty leads in the medium term neither to an increased frequency of lucent lines at the glenoid nor to a worsening of the functional score in comparison to non-migrated prosthesis. In patients with AVN, migration is accompanied by a worsening of the functional score and can consequently be regarded as a negative prognostic factor.

Arthroplasty, Replacement↗
PubMed1999

Instability-induced osteoarthritis in the metacarpophalangeal joint of horses.

OBJECTIVE: To establish an instability model of osteoarthritis (OA) that mimics the early changes of naturally acquired OA. ANIMALS: 6 mature radiographically normal horses. Procedure-The collateral and lateral collateral sesamoidean ligaments were transected in a metacarpophalangeal (MCP) joint in each horse. Lameness examinations were performed every 7 days after surgery for 8 weeks. Radiographs were taken immediately before and after desmotomy and 8 weeks after surgery. Eight weeks after surgery, bilateral MCP joints were grossly evaluated, specimens of articular cartilage were harvested for histologic examination and tissue culture, and synovial membrane was harvested for histologic examination. RESULTS: Lameness scores significantly increased over time (mean score of 1.6 for the 8-week study period). Joint circumference was significantly greater and range of motion significantly less in OA joints, compared with contralateral joints. Number and size of osteophytes were significantly greater in OA joints. Amount of newly synthesized proteoglycan (PG) was significantly greater at 18 and 72 hours of cartilage explant culture for OA joints, compared with contralateral joints. Total PG content and PG degradation did not differ between OA and contralateral joints. IMPLICATIONS FOR HUMAN MEDICINE: This instability model in horses may be useful in the study of OA in humans. CONCLUSION: Desmotomy of the lateral collateral and lateral collateral sesamoidean ligaments induced instability similar to that of naturally acquired OA in horses, as documented by lameness, clinical signs of OA, osteophyte formation, and erosions of articular cartilage surfaces and score lines in OA joints.

Animals↗
PubMed2005

[Scaphocapitate arthrodesis for chronic scapholunate instability: a retrospective study of 13 cases].

The management of chronic instability of the scapholunate joint is controversial. We have opted for scaphocapitate arthrodesis in such cases. The aim of this study was to analyse the clinical and radiological results of this procedure. Between 1997 and 2001, 13 scaphocapitate arthrodesis were performed for this indication. Eleven using two screws, one using a single screw plus a staple, and one using a single staple alone. The average age of the patients was 40 years. There were 8 sport accidents and 5 work accidents. The average follow-up was 26 months. We analysed the functional results and measured the height of the carpus and the radio-lunar angle radiographically. We noticed a mobility loss of between 20 and 40%, especially for radial tilt and flexion. The grip strength was improved. All the patients except one have some residual pain. We noted three non-unions which required revision with eventual final consolidation. The height of the carpus was improved. The average radio-lunar angle at follow-up was 16 degrees. Only one wrist remained in DISI. The mobility of the wrist was decreased by this procedure. In all these cases the dorsal approach to the wrist which we employed was bound to decrease the mobility. The radial tilt was decreased due to the partial arthrodesis. This procedure restore the height of the carpus and partially corrects the DISI. As we were not able to obtain a pain free wrist through our procedure, we raise the question as to whether a total neurectomy of the wrist should be performed at the same time.

Adult↗
PubMed1995

[Outcome of total arthrodesis of the hand].

In cases of degeneration combined with pain and instability of a wrist joint, fusion of the joint is clearly indicated. A retrospective review of 39 patients a mean of 7 years after operation suggested that radiocarpal arthrodesis had been successful. Fusion of the 39 wrist joints was accomplished by means of an AO plate and cancellous bone grafting. Most patients achieved good function and were completely free of symptoms even during heavy work. Especially for patients with rheumatoid wrist joints and those engaged in hard manual labour subtotal arthrodesis cannot be recommended since the functional results are only negligibly better than those obtained with total arthrodesis.

Adult↗
PubMed1993

[Arthrosis of the wrist joint due to carpal instability. Therapeutic alternatives].

A kinematic analysis of the movement of the scaphoid, the lunatum and the triquetrum has shown that their turning axes do not correspond with each other. Without arthritis, and within the range of normal motion, the bones move without imposing any appreciable load on the ligaments. They merely guide the bones and hold them together. In the case of arthritic disorders and in states where abnormal frictional resistance occurs, or following trauma, the ligaments are highly loaded. This could lead to increased wear and ruptured ligaments. A series of 20 arthroscopies has shown that LT and SC ligaments are very prone to this, and are often affected simultaneously. Therefore, there may be certain predisposed sites or "weak points", which should definitely not be further aggravated by inappropriate therapeutic measures. The clinician can classify the carpal dysfunction into five main groups; however, the therapy options cannot be classified in the same way. On the basis of clinical experience and the kinematic study, the following statements can be made: scapho-lunatum (SC) arthrodesis can be considered kinematically unsuitable, while scapho-capitatum (SC) and lunato-capitatum (LC) arthrodeses are both clinically and kinematically acceptable. LC arthrodesis has given good results in cases with advanced carpal collapse. From a mechanical point of view, SC arthrodesis is probably better than scapho-trapezo-trapezoid arthrodesis. In the case of ulnar translocation, radio-ulna-to-scaphoid arthrodesis could be an acceptable alternative to total fusion. Proximal row carpectomy can only be a temporary solution, as can prostheses. Partial prostheses, whether of Silastic or titanium, are also not suitable for permanent use.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1999

Diacerhein treatment reduces the severity of osteoarthritis in the canine cruciate-deficiency model of osteoarthritis.

OBJECTIVE: To determine if diacerhein protects against the early stages of joint damage in a canine model of osteoarthritis (OA). METHODS: OA was induced in 20 adult mongrel dogs by transection of the anterior cruciate ligament of the left knee. Beginning the day after surgery, dogs in the active treatment group were dosed twice a day with capsules of diacerhein, providing a total daily dose of 40 mg/kg, for 32 weeks. Dogs in the control group received placebo capsules on the same schedule. Pathology in the unstable knee was assessed arthroscopically 16 weeks after surgery and by direct observation when the dogs were killed 32 weeks after surgery. The severity of gross joint pathology was recorded, and samples of the medial femoral condyle cartilage and the synovial tissue adjacent to the central portion of the medial meniscus were collected for histologic evaluation. Water content and uronic acid concentration of the articular cartilage from the femoral condyle were determined, and collagenolytic activity in extracts of cartilage pooled from the medial and lateral tibial plateaus was assayed against 14C-labeled collagen fibers. RESULTS: Diacerhein treatment slowed the progression of OA, as measured by grading of gross changes in the unstable knee at arthroscopy 16 weeks after cruciate ligament transection (P = 0.04) and at the time the animals were killed, 32 weeks after surgery (P = 0.05). However, 32 weeks after ACL transection, the mean proteoglycan concentration and water content of the OA cartilage and the level of collagenolytic activity in extracts of the cartilage were not significantly different in the diacerhein treatment group than in the placebo treatment group. CONCLUSION: Diacerhein treatment significantly reduced the severity of morphologic changes of OA compared with placebo. These findings support the view that diacerhein may be a disease-modifying drug for OA.

Animals↗
PubMed1994

Spondyloepimetaphyseal dysplasia (SEMD) Shohat type.

Recently a distinct spondyloepimetaphyseal dysplasia (SEMD) was reported in three members of a Jewish family. We present a 3.5-year-old Mexican boy with disproportionate short stature, peculiar face, short neck, small chest, abdominal distension, lumbar lordosis, short limbs, marked genua vara, and joint laxity. Roentgenologic findings include short long bones, wide and flared metaphyses with irregularities, delayed epiphyseal ossification, platyspondyly and morphological changes of vertebral bodies and fibular overgrowth. The striking resemblance of this patient to those previously reported confirms this form of SEMD as a distinct entity. Autosomal recessive inheritance is supported and the designation SEMD Shohat type is proposed.

Abnormalities, Multiple↗
PubMed2003

Spondyloepimetaphyseal dysplasia with joint laxity leptodactylic form: clinical course and phenotypic variations in four patients.

We describe a 5-year-old boy and a 33-year-old woman with spondyloepimetaphyseal dysplasia with joint laxity leptodactylic form (spondyloepimetaphyseal dysplasia with multiple dislocations) (MIM 6003546), and two 12-year-old girls with the disorder who were previously reported as examples of a variant of sponatrime dysplasia. Their clinical manifestations included midface hypoplasia, micromelic short stature, and generalized joint laxity that caused multiple joint problems, including thoracolumbar scoliosis, hip subluxation, progressive genu valgum with knee and patellar subluxation, elbow subluxation, and malalignment of the wrist. Laryngotracheomalacia was present in two individuals, and myopathy was noted in one. The radiological findings in the four individuals included mild platyspondyly most conspicuous in infancy, narrow interpediculate distances of the lumbar spine evident in infancy, retarded epiphyseal ossification that evolved to epiphyseal dysplasia and later to degenerative joint disease, metaphyseal irregularities and striations present in early childhood, and leptodactylic appearance (slender short tubular bones) of the hand.

Adult↗
PubMed1993

Sensory nerves only temporarily protect the unstable canine knee joint from osteoarthritis. Evidence that sensory nerves reprogram the central nervous system after cruciate ligament transection.

OBJECTIVE: The slow rate at which articular cartilage degrades in dogs after transection of the anterior cruciate ligament (ACLT) has been attributed to capsular thickening and buttressing by osteophytes. We investigated the roles of the peripheral and central nervous systems in protecting knee joints with chronic ACL deficiency from breakdown. METHODS: Five groups of dogs were studied; all were killed 72 weeks after left knee surgery. Group A had ACLT, group B had ACLT followed 52 weeks later by ipsilateral L4-S1 dorsal root ganglionectomy (DRG), group C had DRG followed 2 weeks later by ACLT, group D had sham DRG followed 2 weeks later by ACLT, and group E had DRG followed 2 weeks later by sham ACTL. RESULTS: Group E dogs did not develop knee pathology. All cruciate-deficient knees were lax at the end of the study. The osteoarthritis (OA) that developed in groups A, B, and D was comparable (P > 0.05), and was significantly greater than that in group E (P < 0.05). Group C developed much more severe OA than any of the other groups (P < 0.05). CONCLUSION: Ipsilateral sensory input is temporarily important in protecting the unstable joint from rapid breakdown. Over time, the central nervous system apparently acquires the ability to protect the unstable joint without continued ipsilateral sensory input.

Animals↗
PubMed2004

Amelioration of symptoms by enhancement of proprioception in patients with joint hypermobility syndrome.

OBJECTIVE: Joint hypermobility syndrome (JHS) is characterized by an association between joint hypermobility and musculoskeletal pains, the latter occurring in the absence of any objective indicator of rheumatic disease. The lack of a recognizable disease marker makes this condition difficult to identify and manage. We previously observed that patients with JHS have impaired proprioception compared with that of a matched control group. The purpose of this study was to investigate whether a home-based exercise program could produce objective enhancement of proprioception as well as alleviate symptoms in JHS. METHODS: A threshold detection paradigm was used to assess knee joint proprioception, balance was assessed using a balance board, and quadriceps and hamstring strength were measured by an isokinetic dynamometer. A visual analog scale was used to assess musculoskeletal pain, and quality of life was evaluated by a Short Form 36 questionnaire. Assessments were performed before and after an 8-week program of progressive closed kinetic chain exercises. RESULTS: Following the exercise program, proprioceptive acuity increased in 16 of 18 subjects and was very significantly improved overall (P < 0.001). There was a comparable improvement in performance on the balance board (P < 0.001), and quadriceps and hamstring strength also increased significantly. Symptomatic improvement also occurred, in terms of both pain (P = 0.003) and quality-of-life (P = 0.029 for physical functioning; P = 0.008 for mental health) scores. CONCLUSION: Appropriate exercises lead not only to symptomatic improvement, but also to demonstrable enhancement of objective parameters such as proprioception.

Adolescent↗