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OBJECTIVE: To describe the osteologic findings associated with osteoarthritis (OA) of a variety of joints. METHODS: We performed visual examination of 563 skeletons of which >/=80% of the skeleton was available, from an archaeologic site in England. The surfaces and margins of several different joints (shoulders, elbows, wrists, hips, hands, knees, and ankles) were studied for evidence of eburnation and osteophytes, respectively, and the entire skeleton was examined for evidence of generalized enthesophyte formation. Associations between changes in different joint sites and between enthesophyte formation and evidence of OA were sought. RESULTS: Eburnation and osteophyte formation at the hand, hip, and knee were strongly associated with eburnation and osteophytes at other joint sites not commonly thought to be prone to OA, including the elbow and wrist. Only the ankle was rarely involved. There was also a strong relationship between both bone eburnation and osteophytes and generalized enthesophyte formation. These findings remained statistically significant after adjustment for the age, sex, and historical period of the skeletons. CONCLUSION: Our findings indicate that skeletal OA is more widespread in the body than is apparent from clinical studies and are consistent with other data suggesting that OA is a disease that is primarily dependent on systemic predisposition to a particular type of bone response to mechanical stress.
Joint surface grafting has evolved from use of cadaveric materials preserved chemically and physically, to viable allogeneic and autogenic grafts in nearly a century of surgical history. Technical problems arising at the interface between foreign substances and living tissues has limited engineering arthroplasty such that a biological grafting process is eagerly sought. If successful with long periods of joint functioning, the scope of application to human victims of trauma, disease, and tumors of joints is wide. Whereas rabbits and dogs have been extensively used as models, primates have not. Whereas osteochondral allografts in Papio ursinus (the South African baboon) have been quite successful in hip, knee and shoulder joints, but the follow-up has been no more than a few years. Human autografts have been successful with periods of 10 and 15 years, but the present series is inadequate for statistical assessment. Further investigations of allografts and autografts in human joints are warranted.
EMG of 6 shoulder and arm muscles was measured in nine good frontcrawl swimmers using active electrodes and a telemetric EMG data acquisition system. The raw EMG was low pass filtered, rectified and the integrated values were used as a measure of muscular intensity. The selection of muscles combined 2 mono-articular and 2 bi-articular shoulder muscles and 2 muscular primarily acting on elbow & wrist. Kinematic analysis allowed for a detailed time and movement pattern fractionation and the muscle activity within these phases was analysed for 4 x 100 m at maximum effort up to exhaustion. The combination of time distribution and muscular activity suggested that the downsweep is the longest in time but with the lowest intensity of all 4 transient phases of the cyclic arm movement. This is assumed to be effective for decreasing the load of the shoulder joint. However, it could also be considered that if the insweep with its higher muscular participation could start earlier in the pull phase while shortening the downsweep. The higher, but more constant loading of the shoulder might improve performance.
OBJECTIVES: To investigate (1) the characteristics of shoulder pain following discharge from rehabilitation for tetraplegia, (2) the relationship between pain and any associated risk factors and (3) the relationship between pain and functional activities, and pain and quality of life. DESIGN: Longitudinal study. SETTING: Spinal Injuries Unit, Australia. METHODS: Participants (n=27) were surveyed between 2 and 4 years postinjury. Prospective data on shoulder pain during rehabilitation had been collected previously and allowed comparison with the follow-up data. Data collected included pain intensity and quality, the Wheelchair User's Shoulder Pain Index (WUSPI) and perceived effect of pain on quality of life. RESULTS: Shoulder pain prevalence was 70%. Pain was associated with discharge motor level of C6-T1 (P=0.003). Pain was most commonly located in the shoulder joint. Pain was primarily aggravated by movement and cold weather and relieved by rest. The most painful activity was lifting an object from overhead. Quality of life was affected by pain in 68.4% of participants. CONCLUSION: Shoulder pain is common following rehabilitation for tetraplegia and is associated with injury level. Pain is reported during daily tasks and adversely affects quality of life. Areas for further research are identified.
In view of poor regeneration potential of the articular cartilage, in-vitro engineering of cartilage tissue offers a promising option for progressive joint disease. This study aims to develop a biologically engineered articular cartilage for autologous transplantation. The initial work involved determination of chondrocyte yield and viability, and morphological analysis. Cartilage was harvested from the knee, hip and shoulder joints of adult New Zealand white rabbits and chondrocytes were isolated by enzymatic digestion of the extra-cellular matrix before serial cultivation in DMEM/Ham's F12 media as monolayer cultures. No differences were noted in cell yield. Although chondrocytes viability was optimal (>93%) following harvest from native cartilage, their viability tended to be lowered on passaging. Chondrocytes aggregated in isogenous colonies comprising ovoid cells with intimate intracellular contacts and readily exhibited Safranin-O positive matrix; features typically associated with articular cartilage in-vivo. However, chondrocytes also existed concurrently in scattered bipolar/multipolar forms lacking Safranin-O expression. Therefore, early data demonstrated successful serial culture of adult chondrocytes with differentiated morphology seen in established chondrocyte colonies synthesizing matrix proteoglycans.
Twenty juvenile New Zealand white rabbits were dosed orally once daily with 1,000 mg of nalidixic acid/kg for 3, 7, and 14 consecutive days, then for 14 days followed by a 14-day recovery period. Eighteen age-matched rabbits were allotted to four groups and given corn oil vehicle to serve as controls for the various treatment durations. The articular cartilage from the stifle joints, shoulders, and elbows was studied by gross examination, light microscopy, and toluidine blue histochemistry, and the hips were studied by gross examination and transmission electron microscopy. When examined grossly, raised vesicles could be detected in the joints of some animals after 3 days of treatment. The distal portion of the femur and proximal portion of the ulna were predilection sites for gross lesions. Histologically, the vesicles were fluid-filled clefts in the intermediate layer of the articular cartilage. After 14 days, many of the lacunae in the areas of the defects contained chondrocyte clusters. When treated for 14 days and allowed a 14-day recovery period, territorial matrix had been deposited around individual chondrocytes within the clusters, compressing the matrix between the chondrocyte clusters into thin collagenous bands. For all treatment groups, decreased metachromasia, when stained with toluidine blue, provided histochemical evidence of loss of glycosaminoglycans in the matrix around the clefts.(ABSTRACT TRUNCATED AT 250 WORDS)
The aim of the work is to outline a procedure of finding force-velocity (F-V) characteristics (F = f(V)) of individual skeletal muscles of the human locomotor system. The presentation is based on an example concerning extensors of the elbow joint: the lateral and long heads of triceps brachii (TBClat and TBClong). The experimental part of the procedure involves a natural movement of using the upper extremity to push an external object of variable, adjustable load, engaging both the elbow and shoulder joint. Five men aged 23 took part in the experiment. Their task was to push the handle of a physical pendulum whose moment of inertia could be adjusted within the range of 58 kg.m(2)-450 kg.m(2), so as to give it maximum angular velocity. During each trial the movement of the trunk, of the upper extremity and of the pendulum was video recorded and the force applied with the hand to the handle of the pendulum was measured. In order to find the F-V characteristics a simulation model SHOULDER was used, which is capable of solving the synergy problem for muscles of the arm and the shoulder girdle. It was found that despite considerable dispersion of experimental points the respective regression lines revealed a clear tendency of decreasing muscle force for increased shortening velocity of the monoarticular head (TBClat) and of increasing muscle force for increased lengthening velocity of the biarticular head (TBClong) of the triceps brachii muscle.
UNLABELLED: To assess the iodine-123-labelled serum amyloid P component (SAP) scintigraphy in patients with haemodialysis-associated amyloidosis. PATIENTS: Eight patients with histologically proven beta 2-microglobulin amyloidosis. METHODS: Purified SAP was iodinated by a modified iodogen method. Whole body data were acquired with a large rectangular field gamma-camera. RESULTS: In 7 cases, articular uptake was observed in the symptomatic joints (shoulders, wrists, knees) or in view of bone cysts (wrists). Among the 3 patients with erosive arthropathy of the hands, only one had positive scintigraphy. None positive scintigraphic image was obtained in the spine or the hip joint. In one patient with multifocal amyloid joint disease, no positive image was noted. No abnormal visceral uptake was observed and particularly of the spleen except in one patient with liver uptake. CONCLUSION: I-123 SAP scintigraphy might be not very sensitive in diagnosing beta 2 amyloid deposits. This method needs further investigations and particularly in patients undergoing haemodialysis for more than 20 years.
Pathology influencing the serratus anterior muscle contributes to classical medial winging of the scapula. Serratus anterior weakness or injury interferes with regular shoulder movement as this muscle stabilizes the medial border of the scapula against the thorax and rotates the scapula upward and laterally with arm elevation. Traumatic injury to the serratus anterior muscle without electrodiagnostic evidence of neurogenic involvement has only been reported once previously. We report an unusual case of disruption of the serratus anterior as a complication of rheumatoid arthritis. Involvement of the long thoracic nerve was ruled out by electromyography and nerve conduction studies. The injury occurred during routine activities of daily living and was complicated by a recurring subscapular hematoma. Contributing factors of shoulder joint contractures and coagulation abnormalities were associated with the course and treatment of rheumatoid arthritis. Initial treatment was by joint immobilization and reversal of coagulation abnormalities. Later treatment was directed toward joint protection and gradually increasing range of motion exercises.
A morphocline in the organization of the shoulder joint is demonstrated among anthropoid primates. This metrical test supports the view that hominoid distinctions are monophyletic in origin. The primates that are behaviorally and functionally convergent on hominoids are only partially convergent or are not convergent in shoulder morphology.
A modified technique of reinsertion of the capsule to the bony rim of the glenoid was developed and performed in 57 patients with recurrent anterior dislocation of the shoulder joint. The technique is described in detail. The principal idea of this modified technique is to suture the lateral flap of the capsule into a small sulcus, which is chiselled into the transition zone between the cartilage of the joint and the bony rim of the glenoid. From the bottom of the sulcus four holes are drilled just below the corticalis of the glenoid rim with a dental drill. The capsule is fixed by two U-sutures transosseously. The advantages of this technique are: (1) stable capsular barrier along the rim of the glenoid reinserted by two strong U-sutures; (2) no step between the cartilage of the joint and the reinserted capsule (a Hill-Sachs lesion cannot hook in at the Bankart lesion); (3) the sutures are extra-articular; (4) the lateral flap of the capsule must not be shortened, and therefore full shoulder motion can be obtained; (5) the tendon of the subscapularis muscle is restored to its original position on the lesser tuberosity; (6) a short period of postoperative immobilization. In accordance with the standard rating scale of Rowe, 31 patients were graded as having excellent results, 8 good, none fair, and none poor.
Axial MR images of the shoulder joint reveal a central linear band within the supraspinatus muscle void of signal which seems not to represent the only tendon of this muscle. Due to the importance of the supraspinatus muscle for the painful impingement syndrome of the shoulder we studied the fibrous architecture of this muscle comparing 30 MR images and 49 cadaver dissections. We found the supraspinatus muscle to be composed of two distinct portions. The mean length of the ventral portion is 88 mm and of the dorsal portion 106 mm. The angle of the central tendon which is formed by fibers of both muscle portions relative to the frontal plane is 50 degrees. Both muscle portions probably act differently in moving the arm. This finding seems to be important for the pathophysiology of rotator cuff tears which are mainly located anteriorly within the ventral muscle portion and the eccentric central tendon.
Shoulder pain and stiffness is a serious problem in patients following stroke. The purpose of this study was to investigate the effect of a shoulder positioning protocol on shoulder joint pain and range in the affected upper limb. Twenty-eight subjects were randomly assigned to the experimental or control groups and participated in a multidisciplinary rehabilitation program. In addition, the experimental group received prolonged positioning of the shoulder daily for six weeks. Resting pain, pain on dressing, pain-free active abduction and passive external rotation range were measured on entry to the study and after six weeks. Twenty-three subjects completed the study. The differences between the groups were not statistically significant (p < 0.05), however, because of low statistical power the results are inconclusive.
Prolonged static posture has been identified as a major risk factor for work-related neck and upper limb disorders (WRNULD) in computer users. Previous research has mainly examined working postures in healthy pain-free individuals. The present study examined whether symptomatic subjects exhibited the same kinematic patterns as asymptomatic controls during a prolonged computer task. In a Case-Control comparison, female office workers performed the same computer task using the same adjustable computer workstation for 1h. Three-dimensional (3D) kinematics were measured in the head-neck, thorax and shoulder (upper arm) segments. Case Group subjects (n=21) displayed trends for increased head-neck flexion angles and greater ranges of movements than the Control Group (n=17). There were also small but significant differences between groups in side flexion and rotation angles of the head-neck region. The shoulder joints displayed significantly greater flexion and abduction angles on the right in both groups, although no group differences were observed. The increased neck flexion angles were associated with significantly higher activity in the upper trapezius muscle and with neck and shoulder discomfort. The individual differences in postural habits appeared to be independent of the physical environment. These results suggest motor control changes are associated with the presence of WRNULD.
Nineteen outpatients, nine women and ten men, all right-handed, ranging in age from 33 to 87 yrs, with an average age of 53.5 yrs, presented with complaints of lateral epicondylitis (i.e., tennis elbow). Each was subsequently identified as having a heretofore unrecognized loss of ipsilateral shoulder internal rotation. The authors suggest that in this scenario the occult shoulder periarthrosis is interlinked in a pathokinetic chain potentially predisposing to the presenting symptoms of tennis elbow. During a tennis serve, excessive wrist flexion may be substituted as to compensate for a restricted arc of shoulder internal rotation. The extensor carpi radialis longus and brevis cross both the elbow and wrist. Functionally, they have the capacity of reversing their osseous attachments, both at their origin and insertion, as these muscles cycle under load from a concentric/shortening to an eccentric/elongating contraction. Aging muscle, with its increased viscoelastic stiffness, may be "too slow" to accommodate this transition recoil, especially when repetitive. Instead, it is pathomechanically absorbed at the proximal elbow extensor tendon insertion.
We previously demonstrated that the hand orientation for grasping (azimuth) is strongly coupled to arm movement direction in the horizontal plane. The question is whether this coupling is directly controlled or secondary to a regulation of the arm angular configuration. To this purpose, we quantified hand orientation and arm joint rotations during unconstrained reaching movements in healthy subjects and in patients with hemiparesis due to stroke since they use altered joint rotation patterns for reaching. Seven healthy subjects and eight patients with a right hemiparesis participated (four had a moderate and four had a mild disorder). Four electromagnetic sensors were used to measure hand orientation and to compute the wrist, elbow and shoulder joint angles. Hand azimuth at the time of grasping was correlated to arm movement direction in all the healthy and hemiparetic individuals. In healthy subjects, a regression analysis of the arm joint rotations suggested that the coupling between hand azimuth and movement direction was not due to a correlation with a particular degree of freedom. Patients used different hand orientations for grasping and different joint rotation patterns that varied according to their level of disability and the use of compensatory strategies. The findings observed in both healthy subjects and patients with stroke show that the coupling of hand azimuth for grasping to movement direction was controlled independently of the set of joint rotations used for reaching. This suggests that it is a basic synergy directly controlled by the motor system.