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At least 19 recordsLinked to original sources
PubMed1999

Relationship between joint effusion, joint pain, and protein levels in joint lavage fluid of patients with internal derangement and osteoarthritis of the temporomandibular joint.

PURPOSE: The purpose of this study was to investigate the relationship between the presence of joint effusion, joint pain, and protein levels in joint lavage fluid (JL) of patients with internal derangement (ID) and osteoarthritis (OA) of the temporomandibular joint (TMJ). PATIENTS AND METHODS: Thirty-eight joints in 26 patients with ID and OA of the TMJ were studied. Magnetic resonance imaging (MRI) evidence of joint effusion was evaluated in T2-weighted images. Samples of JL were collected from the superior joint space during pumping manipulation, and the protein concentration was measured. The presence of pain was based on joint tenderness or a complaint of pain in the preauricular region during mouth opening or closing. RESULTS: Joint effusion was demonstrated in 20 of 25 (80%) painful joints; a significantly higher incidence than in pain-free joints (5 of 13, 38.5%). The mean protein concentration (2.15 mg/mL) in JL from painful joints was significantly higher than in pain-free joints (1.22 mg/mL) (P < .05). Furthermore, the mean protein concentration (2.12 mg/mL) in JL from joints with effusion was significantly higher than in joints without joint effusion (1.27 mg/mL) (P < .05). CONCLUSIONS: These data demonstrate that painful joints are more likely to show joint effusion on MRI, and the protein levels in JL recovered from these joints is higher than in pain-free joints. These data also suggested that joint effusion may be related to the inflammatory changes seen in patients with ID and OA.

Adolescent↗
PubMed2005

Temporomandibular joint internal derangement: relationship between joint pain and MR grading of effusion and total protein concentration in the joint fluid.

OBJECTIVES: The objective of this study was to determine whether there is any association between the protein concentration in the synovial fluid and (i) the amount of articular hydrops, as graded in magnetic resonance (MR) images, and (ii) joint pain in temporomandibular joints (TMJs) with and without displacement of the disc. PATIENTS AND METHODS: This study involved 16 joints in 16 patients referred to our clinic with the complaint of pain and limited mouth opening. The control group consisted of 15 joints in 15 patients with unilaterally normal disc and condyle relationship and no pain while the opposite side had a non-painful joint with disc displacement without reduction (DDwoR). The subjects and controls were different individuals and only a single joint was used for each. Pain and dysfunction were evaluated by visual analogue scale. Bilateral proton density and T2 weighted images of the TMJs of the 31 subjects were analysed for fluid and condyle bony changes as well as disc position. The amount of fluid, identified as an area of high signal intensity in the region of the upper and lower joint spaces, was characterized as none, minimal, moderate or marked. Arthrocentesis was performed both for synovial fluid analysis of total protein concentration and the treatment of the joints with DDwoR. Total protein concentration was measured by using protein dye binding on spectrophotometry. RESULTS: All patients experienced a significant (P<0.01) increase in maximal mouth opening immediately post-arthrocentesis. In the study group, the disc was displaced most frequently in an anteriormedial direction (75%) and deformation of disc form was seen in 13 joints. Condylar bony changes were seen in 27% of joints in the control group and in 81% of joints in the study group. A statistically significant association was found between joints with disc displacement, disc form and condylar bony changes (P<0.05). In the control group, only one joint, which had an osteophyte, showed joint effusion (JE) with moderate fluid. In the study group, only four joints had no fluid (25%). JE was found in 10 (63%) joints with disc displacement on anteromedial direction, in 10 (63%) joints with disc deformation and in 10 (63%) joints with osteophytes and erosion. Mean total protein concentration was 16.87+/-7.9 (range 7.4-34.1 mg dl-1) in control joints, 55.08+/-35.16 (range 21.5-153.9 mg dl-1) in study joints. There were significant differences in the mean total protein concentration between the control and study groups (P<0.01). Significant positive correlation was found between the total protein concentration and JE (r=0.65, P<0.01). No significant correlation was found between the level of pain and dysfunction and JE and total protein concentration in either control or study groups (P>0.05). CONCLUSION: Pain in the TMJ was not related to MR findings of effusion in internal derangement and synovial fluid aspirate findings of total protein concentration. However, total protein concentration was related to the amount of JE in DDwoR joints and painful joints were more likely to demonstrate the JE.

Adolescent↗
PubMed2005

Uncertainty of knee joint muscle activity during knee joint torque exertion: the significance of controlling adjacent joint torque.

In the single-joint torque exertion task, which has been widely used to control muscle activity, only the relevant joint torque is specified. However, the neglect of the neighboring joint could make the procedure unreliable, considering our previous result that even monoarticular muscle activity level is indefinite without specifying the adjacent joint torque. Here we examined the amount of hip joint torque generated with knee joint torque and its influence on the activity of the knee joint muscles. Twelve healthy subjects were requested to exert various levels of isometric knee joint torque. The knee and hip joint torques were obtained by using a custom-made device. Because no information about hip joint torque was provided to the subjects, the hip joint torque measured here was a secondary one associated with the task. The amount of hip joint torque varied among subjects, indicating that they adopted various strategies to achieve the task. In some subjects, there was a considerable internal variability in the hip joint torque. Such variability was not negligible, because the knee joint muscle activity level with respect to the knee joint torque, as quantified by surface electromyography (EMG), changed significantly when the subjects were requested to change the strategy. This change occurred in a very systematic manner: in the case of the knee extension, as the hip flexion torque was larger, the activity of mono- and biarticular knee extensors decreased and increased, respectively. These results indicate that the conventional single knee joint torque exertion has the drawback that the intersubject and/or intertrial variability is inevitable in the relative contribution among mono- and biarticular muscles because of the uncertainty of the hip joint torque. We discuss that the viewpoint that both joint torques need to be considered will bring insights into various controversial problems such as the shape of the EMG-force relationship, neural factors that help determine the effect of muscle strength training, and so on.

Adult↗
PubMed2005

The smallest detectable difference and sensitivity to change of magnetic resonance imaging and radiographic scoring of structural joint damage in rheumatoid arthritis finger, wrist, and toe joints: a comparison of the OMERACT rheumatoid arthritis magnetic resonance imaging score applied to different joint combinations and the Sharp/van der Heijde radiographic score.

OBJECTIVE: To compare 2 magnetic resonance imaging (MRI) approaches and radiographic evaluation according to the Sharp/van der Heijde method with respect to sensitivity to change in joint destruction in patients with rheumatoid arthritis (RA). METHODS: Thirty-five RA patients and 9 healthy controls underwent MRI and radiography on 2 occasions 1 year apart. Conventional radiographs of the hands, wrists, and forefeet were evaluated according to the Sharp/van der Heijde method. MRIs of unilateral wrist and second through fifth metacarpophalangeal (MCP) joints ("few-joints approach") and of bilateral wrist and MCP joints plus unilateral metatarsophalangeal (MTP) joints ("many-joints approach") were assessed for bone erosions according to the scoring system recommended by the OMERACT (Outcome Measures in Rheumatology Clinical Trials) group. The smallest detectable differences (SDDs) of the radiography and MRI scores were computed based on reevaluation of one-third of the study population. RESULTS: Progressive joint destruction, i.e., an increase in score after the followup period, was observed more frequently with the MRI "many-joints approach" (30 subjects) and "few-joints approach" (25 subjects) than with the Sharp/van der Heijde radiographic method (9 subjects) (P < 0.001 by chi-square analysis). No significant difference between the MRI approaches was observed. When only subjects with a change greater than the SDD were considered, progression was revealed with the MRI "many-joints approach," the MRI "few-joints approach," and radiography in 15, 13, and 5 RA subjects, respectively. With both MRI approaches, significantly more subjects with progression were detected than were detected by radiography (P < 0.05). CONCLUSION: MRI, regardless of whether it covers unilateral wrist and MCP joints or bilateral wrist and MCP joints plus unilateral MTP joints, is significantly superior to radiography of the hands, wrists, and forefeet with respect to detection of progressive joint destruction in RA.

Adult↗
PubMed1998

Weighting for joint surface area improves the information provided by a reduced 28-joint articular index of swollen joints.

The objective of our study was to examine whether weighting for joint surface area or recording of simultaneously tender and swollen joints increases the association of a reduced 28-joint articular index with clinical and outcome parameters. In a cross-sectional study we examined 61 consecutive outpatients with RA fulfilling the American Rheumatism Association 1987 revised criteria. Tender, swollen, and simultaneously tender and swollen joints were recorded. The association of 28- and 68-joint articular indices with clinical and outcome parameters were estimated with nonparametric correlation analyses. Weighting for joint surface yielded consistently increased correlation of clinical and outcome parameters with swollen and tender and swollen but not with tender joint counts. The correlation of the 28-joint articular and 68-articular indices with these parameters were similar. In conclusion, weighting for joint surface notably improves the information provided by swollen joint counts, whereas it does not appear to improve the information provided by tender joint counts.

Adult↗
PubMed1977

Bone-to-bone, joint-to-bone and joint-to-joint ratios in normal and diseased skeletal states using region-of-interest technique and bone-seeking radiopharmaceuticals.

Bone-to-bone, iliosacral joint-to-os sacrum and joint-to-joint ratios were computed using the region-of-interest technique 2 to 3 hrs. after injection of 99mTc Sn-methylene-diphosphonate or 99mTc Sn-pyrophosphate in 139 patients with skeletal diseases (bone tumours, degenerative changes of the spine and joints, inflammatory changes of joints) as well as in 123 patients with normal skeletal states. In the latter group, iliosacral joint-to-os sacrum ratios decreased with increasing age of the patients. In patients with osseous metastases of the spine ratios of 0.80 to 4.0 occurred ( reference area second vertebra below or above the affected vertebra). In degenerative changes of the spine values of 0.80 to 1.69 were computed. These results show, that 74% of the spine metastases could not be differentiated from benign changes of the spine by determining their relative amounts of bone uptake. In bone tumours of the extremities and in rheumatoid or gouty arthritis of the small joints (hands and feet) the highest ratios, i.e. contrasts, occurred referring to a contralateral reference area. Osteoarthritic and inflammatory alterations of the big joints could not be differentiated because of percentual distribution of the increased joint-to-joint ratios turned out to be nearly identical.

Adult↗
PubMed2002

ISB recommendation on definitions of joint coordinate system of various joints for the reporting of human joint motion--part I: ankle, hip, and spine. International Society of Biomechanics.

The Standardization and Terminology Committee (STC) of the International Society of Biomechanics (ISB) proposes a general reporting standard for joint kinematics based on the Joint Coordinate System (JCS), first proposed by Grood and Suntay for the knee joint in 1983 (J. Biomech. Eng. 105 (1983) 136). There is currently a lack of standard for reporting joint motion in the field of biomechanics for human movement, and the JCS as proposed by Grood and Suntay has the advantage of reporting joint motions in clinically relevant terms. In this communication, the STC proposes definitions of JCS for the ankle, hip, and spine. Definitions for other joints (such as shoulder, elbow, hand and wrist, temporomandibular joint (TMJ), and whole body) will be reported in later parts of the series. The STC is publishing these recommendations so as to encourage their use, to stimulate feedback and discussion, and to facilitate further revisions. For each joint, a standard for the local axis system in each articulating bone is generated. These axes then standardize the JCS. Adopting these standards will lead to better communication among researchers and clinicians.

Biomechanical Phenomena↗
PubMed1992

[Biomechanics of the joints of the large toe. Shape and movement of the first tarsometatarsal joint and of the medial cuneonavicular joint].

90% of the first (hallucal) tarsometatarsal joints are screw-shaped; the axis is directed upwards to the front touching the lateral edge of the joint. Thus the plantar flexion is inevitably accompanied by an adduction and a pronation, and vice versa a dorsiflexion is consequently accompanied by an abduction and a supination, when the articular surfaces exactly slide along each other. 10% of these joints, however, are ellipsoid-shaped; in this case the distal articular surface of the medial cuneiform bone has the form of an ovoid head, and a strong ligament situated next to the lateral edge of the joint effects the same kind of motion described above. The medial cuneonavicular joint is always ellipsoid-shaped, the head of which is made up by the medial facet of the distal articular surface of the navicular bone. Each of the two joints mentioned has a considerable range of mobility.

Biomechanical Phenomena↗
PubMed2006

Provocative sacroiliac joint maneuvers and sacroiliac joint block are unreliable for diagnosing sacroiliac joint pain.

Mapping studies of pain elicited by injections into the sacroiliac joints (SIJs) suggest that sacroiliac joint syndrome (SIJS) may manifest as low back pain, sciatica, or trochanteric pain. Neither patient-reported symptoms nor provocative SIJ maneuvers are sensitive or specific for SIJS when SIJ block is used as the diagnostic gold standard. This has led to increasing diagnostic use of SIJ block, a procedure in which an anesthetic is injected into the joint under arthrographic guidance. However, several arguments cast doubt on the validity of SIJ block as a diagnostic gold standard. Thus, the effects of two consecutive blocks are identical in only 60% of cases, and the anesthetic diffuses out of the joint in 61% of cases, often coming into contact with the sheaths of the adjacent nerve trunks or roots, including the lumbosacral trunk (which may contribute to pain in the groin or thigh) and the L5 and S1 nerve roots. These data partly explain the limited specificity of SIJ block for the diagnosis of SIJS and the discordance between the pain elicited by the arthrography injection and the response to the block. The limitations of provocative maneuvers and SIJ blocks may stem in part from a contribution of extraarticular ligaments to the genesis of pain believed to originate within the SIJs. These ligaments include the expansion of the iliolumbar ligaments, the dorsal and ventral sacroiliac ligaments, the sacrospinous ligaments, and the sacrotuberous ligaments (sacroiliac joint lato-sensu). They play a role in locking or in allowing motion of the SIJs. Glucocorticoids may diffuse better than anesthetics within these ligaments. Furthermore, joint fusion may result in ligament unloading.

Diagnosis, Differential↗
PubMed1988

Systemic joint laxity (the hypermobile joint syndrome) is associated with temporomandibular joint dysfunction.

A consecutive series of 37 individuals admitted to the hospital for elective temporomandibular joint (TMJ) reconstructive surgery and 3 seen as outpatients with TMJ disease were evaluated for rheumatic disease or for another etiologic factor that might account for this problem. These 40 patients were screened by history, physical examination, and laboratory study. We soon noticed that many patients had generalized joint laxity. Eighteen of the first 40 individuals satisfied established criteria for the hypermobile joint syndrome. An additional 3 were found to have Ehlers-Danlos syndrome or a forme fruste of this disorder. Many were markedly hypermobile and could perform a number of flexible maneuvers. Although excessive joint laxity is known to be associated with a variety of rheumatic conditions, TMJ disease has not been recognized as one of them. No patient in this series had a systemic inflammatory disorder or any other apparent etiologic factor for TMJ disease. We suggest that there is a cause-and-effect relationship between generalized joint laxity and TMJ disease.

Adolescent↗
PubMed2005

ISB recommendation on definitions of joint coordinate systems of various joints for the reporting of human joint motion--Part II: shoulder, elbow, wrist and hand.

In this communication, the Standardization and Terminology Committee (STC) of the International Society of Biomechanics proposes a definition of a joint coordinate system (JCS) for the shoulder, elbow, wrist, and hand. For each joint, a standard for the local axis system in each articulating segment or bone is generated. These axes then standardize the JCS. The STC is publishing these recommendations so as to encourage their use, to stimulate feedback and discussion, and to facilitate further revisions. Adopting these standards will lead to better communication among researchers and clinicians.

Anthropometry↗
PubMed1991

Temporomandibular joint dysfunction syndrome: a close association with systemic joint laxity (the hypermobile joint syndrome)

Sixty-two patients admitted for elective reconstructive surgery of the temporomandibular joint (TMJ) and eight seen as outpatients with a chief complaint of TMJ dysfunction during the same time interval were evaluated for possible etiologic factors contributing to the disease. All hospitalized patients had severe, end-stage degenerative changes within the TMJ, whereas outpatients had less severe disease and did not require surgery. TMJ dysfunction in some patients was said to be a result of established causes including bruxism, malocclusion, and trauma. No patient in this series had evidence of a systemic inflammatory polyarthritis. Of the 70 patients, 38 (54%) met criteria, based on those of Carter and Wilkinson, as modified by Beighton et al., sufficient to warrant a diagnosis of the hypermobile joint syndrome. Five patients had classic Ehlers-Danlos syndrome and therefore were not patients with "benign hypermobility," and an additional two cases were described as "marfanoid" and as possible Ehlers-Danlos syndrome, respectively. Radiographs showed TMJ hyperextensibility in four hypermobile patients. Long-term surgical outcome was identical in the hypermobile and nonhypermobile groups. The incidence of hypermobility in this series is strikingly higher than the expected incidence in an otherwise population. Magnetic resonance images of the TMJs on separate groups of asymptomatic normal and hypermobile women identified excessive anterior movement in the hypermobile group, together with abnormal anterior disk position in some. We hypothesize that hypermobility within the TMJ may cause accelerated disk destruction and degenerative disease.

Adolescent↗
PubMed1999

Knee joint simulator: an anatomical reconstruction of the joint surfaces and of the ligamentous structures of the knee joint for teaching purposes.

A knee joint simulator with anatomical reconstruction of the joint surfaces and of the ligamentous structures was built for teaching purposes. With this simulator it is possible to demonstrate the anatomy, physiology and kinematics of knee ligaments, to teach and learn how to conduct ligamentous instability tests and to demonstrate the effect of knee ligament reconstructive surgery.

Education, Medical↗