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Hand Surgery & Rehabilitation Oct 2018This lecture will focus on posttraumatic finger contractures affecting the metacarpophalangeal (MCP) and proximal interphalangeal (PIP) joints in adults. The... (Review)
Review
This lecture will focus on posttraumatic finger contractures affecting the metacarpophalangeal (MCP) and proximal interphalangeal (PIP) joints in adults. The pathophysiology, main causes and essential rehabilitation methods that can be used before resorting to surgical treatment are described, along with the clinical examination. The goal is to define the surgical indications, even though the literature shows the functional outcomes are disappointing. While there is little to no change in a joint's angular amplitude, the functional range of motion can be improved. There is practically no functional improvement except in cases of MCP extension contracture. For the PIP joint, the aim is to shift the range of motion into the functional range. Surgical approaches, surgical techniques and rehabilitation protocols are described in detail.
Topics: Contracture; External Fixators; Finger Injuries; Finger Joint; Humans; Metacarpophalangeal Joint; Occupational Therapy; Physical Therapy Modalities; Range of Motion, Articular; Splints
PubMed: 30033359
DOI: 10.1016/j.hansur.2018.06.003 -
Current Topics in Membranes 2017Cartilage is an intrinsically mechanically sensitive tissue composed of chondrocytes as the only cell type. Chondrocyte mechanotransduction is not well understood, but... (Review)
Review
Cartilage is an intrinsically mechanically sensitive tissue composed of chondrocytes as the only cell type. Chondrocyte mechanotransduction is not well understood, but recently we identified critical components of the mechanotransduction machinery demonstrating how mechanical stimulation of these cells can be converted into cellular calcium signals. Physiologic mechanical cues induce anabolic responses of (post-mitotic) chondrocytes via transient receptor potential vanilloid 4 ion channels, whereas injurious mechanical stress is transduced by Piezo1 jointly with Piezo2 ion channels. This chapter sheds light on the latter discovery and provides a rationale for follow-up questions, such as the nature of interaction between Piezo1 and Piezo2, and their tethering to the cytoskeleton. These recent insights can be leveraged toward translational medical progress to benefit diagnosis and treatment of osteoarthritis, representing a large and growing unmet medical need in the United States and large parts of the world.
Topics: Animals; Chondrocytes; Health; Humans; Ion Channels; Joints; Mechanotransduction, Cellular; Stress, Mechanical
PubMed: 28728820
DOI: 10.1016/bs.ctm.2016.10.003 -
Seminars in Cell & Developmental Biology Feb 2017The synovium constitutes the envelope of articular joints and is a critical provider of synovial fluid components and articular cartilage nutrients. Its inflammation is... (Review)
Review
The synovium constitutes the envelope of articular joints and is a critical provider of synovial fluid components and articular cartilage nutrients. Its inflammation is a predominant feature and cause of joint degeneration in diseases as diverse as rheumatoid, psoriatic, juvenile and idiopathic arthritis, and lupus, gout and lyme disease. These inflammatory joint diseases (IJDs) are due to a wide variety of genetic, epigenetic and environmental factors that trigger, promote, and perpetuate joint destabilization. In spite of this variety of causes, IJDs share main pathological features, namely inflammation of the joint synovium (synovitis) and progressive degeneration of articular cartilage. In addition to being a driving force behind the destruction of articular cartilage in IJD, synovitis is also increasingly being recognized as a significant contributor of articular cartilage degeneration in osteoarthritis, a disease primarily due to aging- or trauma-related wear and tear of cartilage surfaces. In view of this important role of the synovium in determining the fate of articular cartilage, this review focuses on its underlying mechanisms in the pathology of IJD. We address the roles of synovial fibroblasts, macrophages and endothelial cells in the maintenance of joint health and in the destruction of articular cartilage integrity during IJD. Molecular mechanisms that have been recently shown to govern the pathological activities of the resident synovial cells are highlighted. Finally, advantages and disadvantages of targeting these new molecular mechanisms for preventing cartilage degeneration due to chronic inflammation are also discussed.
Topics: Animals; Cartilage, Articular; Humans; Inflammation; Joint Diseases; Joints; Macrophages; Synovial Membrane
PubMed: 27212252
DOI: 10.1016/j.semcdb.2016.05.009 -
Seminars in Musculoskeletal Radiology Apr 2019Arthritis involving the hand and wrist can significantly impair functions of daily living. Although arthrodesis provides pain relief, it limits range of motion at the... (Review)
Review
Arthritis involving the hand and wrist can significantly impair functions of daily living. Although arthrodesis provides pain relief, it limits range of motion at the affected joint. Arthroplasty is an alternative surgical treatment for hand and wrist arthritis, providing both pain relief and restoration of a range of motion. Over the past decade, several advances have occurred in hand and wrist arthroplasty designs. This article reviews component design, normal imaging appearance, and common complications of arthroplasty used in the wrist and hand. It also introduces readers to newer arthroplasty designs.
Topics: Arthroplasty, Replacement; Hand Joints; Humans; Joint Prosthesis; Wrist Joint
PubMed: 30925628
DOI: 10.1055/s-0038-1677464 -
American Journal of Physical... Aug 2021The competing functional demands of diarthrodial joints, permitting mobility while retaining enough stability to transmit forces across the joint, have been linked with...
OBJECTIVES
The competing functional demands of diarthrodial joints, permitting mobility while retaining enough stability to transmit forces across the joint, have been linked with the shape and size of the joint's articular surfaces. A clear understanding of the relationship between joint morphology and joint movement potential is important for reconstructing locomotor behaviors in fossil taxa.
METHODS
In a sample of matched tali and calcanei of lorisids (n = 28) and cheirogaleids (n = 38), we quantify the surface areas of the talar and calcaneal ectal (=posterior talocalcaneal) articular surfaces and model the principal curvatures of these surfaces with quadric formulas. These two taxonomic groups have similar body masses, but differ substantially in positional behavior, so that differences in joint surface morphology should reflect adaptive demands of their locomotor behavior.
RESULTS
Compared with cheirogaleids, lorisids exhibit: (a) a significantly greater area difference between their paired joint surfaces; and (b) a more pronounced saddle shape for the talar ectal facet.
CONCLUSION
The increased subtalar joint mobility observed in lorisids may be achieved by increasing the amount of sliding and rolling that can occur at the subtalar joint. The subtalar joint morphology observed in two fossil euarchontans, the plesiadapiforms Purgatorius sp. and Plesiadapis cookei, compares favorably with the morphology observed among lorisids, potentially suggesting antipronograde postures within these extinct taxa.
Topics: Ankle; Calcaneus; Fossils; Posture; Subtalar Joint
PubMed: 33931869
DOI: 10.1002/ajpa.24298 -
Gait & Posture Oct 2021Adaptation of the walking pattern to uphill walking demands immediate coordination between the lower limb segments. Nonetheless, knowledge about individual joints'...
BACKGROUND
Adaptation of the walking pattern to uphill walking demands immediate coordination between the lower limb segments. Nonetheless, knowledge about individual joints' responses and variability in response to the new slope angles are missing.
AIMS
This study investigated the impacts of uphill walking on the ankle, the knee and the hip joints angles and their variability.
METHODS
Twenty-three collegiate athletes (age: 22.04 ± 3.43years, body mass: 62.14 ± 9.26Kg, height: 168.29 ± 7.06 cm) walked on an inclined treadmill at 0 ° (level walking -LW), 5 ° (low-slope-walking -LSW), and 10 ° (high-slope-walking -HSW) slopes at their preferred walking speed (4.2 ± 0.51 km.h). The ankle, knee and hip joints angles and their variability (standard deviations) were calculated and analysed throughout the gait cycles in LW, LSW, and HSW.
RESULTS
Repeated measure ANOVA portrayed significant differences between the ankle joint angles in sagittal (p < .001, η>.14), frontal (p < .05, η>.14), and transverse (p < .005, .14 < η>.01) planes. In the knee joint, the sagittal (p < .001, η>.14), frontal (p < .05, η>.14), and transverse (p < .05, η>.14) angles were significantly different (p < 0.05). Similarly, in the hip joint, the sagittal (p < .05, η>.14), frontal (p < .05, η>.14), and transverse (p < .05, η>.14) angles were significantly different. Ankle angle variability was significantly different in sagittal (P < .001, η>.14), frontal (p = .002, η>.14) and horizontal (P < .001, η>.14) planes, as well as knee joint angle variability in sagittal, frontal and horizontal planes p < 0.001, η>.14. The hip joint variability was considerably different in sagittal (p = .031, η>.14) and horizontal (p < .05, η>.14) planes.
CONCLUSION
Uphill walking involves further modifications in the ankle, knee and hip joints angle to adjust the whole-body movements to a new slope. This adjustment resulted in a firm base of support, provided by the ankle, to regulate the knee and hip joints modifications. Nevertheless, it caused less ankle movement variability and could end up with injuries over long-term uphill walking.
Topics: Adolescent; Adult; Ankle Joint; Biomechanical Phenomena; Gait; Hip Joint; Humans; Knee Joint; Lower Extremity; Walking; Young Adult
PubMed: 34597985
DOI: 10.1016/j.gaitpost.2021.09.195 -
Nature Reviews. Rheumatology Mar 2017Transforming growth factor-β (TGFβ) is a pleiotropic cytokine that is important in the regulation of joint homeostasis and disease. TGFβ signalling is induced by... (Review)
Review
Transforming growth factor-β (TGFβ) is a pleiotropic cytokine that is important in the regulation of joint homeostasis and disease. TGFβ signalling is induced by loading and has an important function in maintaining the differentiated phenotype of articular chondrocytes. Concentrations of active TGFβ differ greatly between healthy and osteoarthritic joints, being low in healthy joints and high in osteoarthritic joints, leading to the activation of different signalling pathways in joint cells. The characteristic pathology of osteoarthritic joints, such as cartilage damage, osteophyte formation and synovial fibrosis, seems to be stimulated or even caused by the high levels of active TGFβ, in combination with altered chondrocyte signalling pathways (which are also observed in ageing joints). In this Review, the changing role of TGFβ in normal joint homeostasis, ageing and osteoarthritis is discussed: TGFβ counteracts pathological changes in a young healthy joint, alters its signalling during ageing and is a driving force of pathology in osteoarthritic joints.
Topics: Aging; Animals; Humans; Joints; Osteoarthritis; Signal Transduction; Transforming Growth Factor beta
PubMed: 28148919
DOI: 10.1038/nrrheum.2016.219 -
Journal of Strength and Conditioning... Feb 2020Dvir, Z and Müller, S. Multiple-joint isokinetic dynamometry: a critical review. J Strength Cond Res 34(2): 587-601, 2020-Angular isokinetic dynamometry (AID) is widely...
Dvir, Z and Müller, S. Multiple-joint isokinetic dynamometry: a critical review. J Strength Cond Res 34(2): 587-601, 2020-Angular isokinetic dynamometry (AID) is widely regarded as the gold standard for dynamic muscle performance testing. Based on the rotational movement of its actuator, AID targets "single-joint" (knee, shoulder, hip, etc.) configurations namely measurement of muscle potential while it moves the lever arm-limb assembly ostensibly around a single fixed axis. On the other hand, the application of multiple-joint isokinetic dynamometry (MID) is relatively narrow, both in research and in practice. This situation is due, possibly, to the fact that these dynamometers are generally more limited in scope namely to testing/conditioning of combined hip, knee, ankle motion (leg press), combined shoulder, elbow motion, and lifting motion patterns, despite the fact that all 3 are associated with higher functionality. However, with the emerging importance of MID, this critical review takes a fresh look at its various aspects including the terminology and classification of multiple-joint isokinetic dynamometers; the problem of scaling namely the need to adjust the range of motion and linear velocities to subjective anthropometric measures; specific technical and methodological issues that underlie the valid application of these dynamometers; available reference values; and the reproducibility of MID-based test findings. Analysis of these topics indicates that MID may validly and effectively be applied for the assessment and conditioning of specific muscle action patterns. However, there is a clear need for standardization of tests and for conditioning protocols alongside research into the use of this method in various clinical cohorts.
Topics: Adult; Ankle Joint; Elbow Joint; Female; Humans; Joints; Knee Joint; Male; Movement; Muscle Strength Dynamometer; Muscle, Skeletal; Range of Motion, Articular; Reproducibility of Results; Shoulder
PubMed: 30789571
DOI: 10.1519/JSC.0000000000002982 -
The Journal of Hand Surgery Nov 2023Injuries to the scapholunate joint are the most frequent cause of carpal instability. The sequelae of these injuries account for considerable morbidity, and if left... (Review)
Review
Injuries to the scapholunate joint are the most frequent cause of carpal instability. The sequelae of these injuries account for considerable morbidity, and if left untreated, may lead to scapholunate advanced collapse and progressive deterioration of the carpus. Rupture of the scapholunate interosseous ligament and its critical stabilizers causes dyssynchronous motion between the scaphoid and lunate. Additional ligament injury or attenuation leads to rotary subluxation of the scaphoid and increased scapholunate gap. Intervention for scapholunate instability is aimed at halting the degenerative process by restoring ligament integrity and normalizing carpal kinematics. In the first section of this review, we discuss the anatomy, kinematics, and biomechanical properties of the scapholunate ligament as well as its critical ligament stabilizers. We provide a foundation for understanding the spectrum of scapholunate ligament instability and incorporate meaningful new anatomical insights that influence treatment considerations. The purpose is to provide an update regarding the anatomy of the scapholunate ligament complex, importance of the critical ligament stabilizers of the proximal carpal row, introduction of safe technique to surgically expose the scaphoid and lunate, as well as pathoanatomy as it pertains to the treatment of scapholunate dissociation. In the second section of this review, we propose a novel ligament-based treatment algorithm based on the stage of injury, degree and nature of ligament damage, and presence of arthritic changes.
Topics: Humans; Biomechanical Phenomena; Carpal Joints; Wrist Joint; Wrist; Lunate Bone; Scaphoid Bone; Ligaments, Articular; Joint Instability
PubMed: 37452815
DOI: 10.1016/j.jhsa.2023.05.013 -
IEEE Transactions on Neural Systems and... 2022Research and the commercial use of exoskeletons that augment human activities are rapidly growing. However, the progress of the two is hindered by the time-consuming and...
Research and the commercial use of exoskeletons that augment human activities are rapidly growing. However, the progress of the two is hindered by the time-consuming and costly process of designing and evaluating the exoskeleton. One of the solutions to reduce both is the use of simulations that model the users, exoskeleton, and their interaction. At the same time, most simulations focus on continuous tasks, such as walking, running, and industrial activities. The augmentation of human capability is essential in fast motion tasks (i.e., jumping, throwing), where the muscles are producing their maximum force. Thus, this study implemented a simulation of passive exoskeleton-human interactions using OpenSim and Moco software for optimal control to find muscle excitation that maximizes vertical jump height. The models include a planar human model with ankle, knee, and hip joints. The muscles were modeled as torque actuators for each joint, with a flexor and an extensor, and passive torques representing each joint's ligaments. The simulation was used to study: a) the effect of different spring stiffness at the knee, hip, and ankle joints and combinations of these joints; b) multi-joints vs. single joints; c) the effect of an elliptic pulley and different initial engagement angle for springs. The results revealed that the jump height increased as the spring became stiffer, up to a maximum point. For a single joint, the knee exoskeleton was the most effective, compared with the hip and ankle joint exoskeletons. The multi-joint exoskeleton was slightly better than the single knee joint. If maximum spring tension is a limiting factor, an elliptic pulley has an advantage relative to a round pulley. An initial angle of engagement (with equal work) other than zero up to approximately 50 degrees does not decrease the jump height.
Topics: Ankle Joint; Biomechanical Phenomena; Exoskeleton Device; Hip Joint; Humans; Torque; Walking
PubMed: 36155480
DOI: 10.1109/TNSRE.2022.3209575