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Physical Medicine and Rehabilitation... May 2023Adhesive capsulitis, colloquially known as "frozen shoulder," is a relatively common disorder, affecting approximately 2% to 5% of the general population. The incidence... (Review)
Review
Adhesive capsulitis, colloquially known as "frozen shoulder," is a relatively common disorder, affecting approximately 2% to 5% of the general population. The incidence may be higher as the condition can be relatively mild and self-limited and thus many patients who experience it may never present for treatment. It involves a pathologic process of gradual fibrosis of the glenohumeral joint that leads to limited active and passive range of motion, contracture of the joint capsule, and shoulder pain.
Topics: Humans; Range of Motion, Articular; Bursitis; Shoulder Joint; Joint Capsule; Shoulder Pain; Treatment Outcome
PubMed: 37003663
DOI: 10.1016/j.pmr.2022.12.009 -
The Journal of Bone and Joint Surgery.... Dec 2019➤. Hip joint capsular ligaments (iliofemoral, ischiofemoral, and pubofemoral) play a predominant role in functional mobility and joint stability. ➤. The zona... (Review)
Review
➤. Hip joint capsular ligaments (iliofemoral, ischiofemoral, and pubofemoral) play a predominant role in functional mobility and joint stability. ➤. The zona orbicularis resists joint distraction (during neutral positions), and its aperture mechanism stabilizes the hip from adverse edge-loading (during extreme hip flexion-extension). ➤. To preserve joint function and stability, it is important to minimize capsulotomy size and avoid disrupting the zona orbicularis, preserve the femoral head size and neck length, and only repair when or as necessary without altering capsular tensions. ➤. It is not fully understood what the role of capsular tightness is in patients who have cam femoroacetabular impingement and if partial capsular release could be beneficial and/or therapeutic. ➤. During arthroplasty surgery, a femoral head implant that is nearly equivalent to the native head size with an optimal neck-length offset can optimize capsular tension and decrease dislocation risk where an intact posterior hip capsule plays a critical role in maintaining hip stability.
Topics: Arthroplasty, Replacement, Hip; Cadaver; Dissection; Female; Hip Joint; Humans; Imaging, Three-Dimensional; Joint Capsule; Joint Instability; Male; Orthopedic Procedures; Range of Motion, Articular
PubMed: 31800428
DOI: 10.2106/JBJS.19.00346 -
Physical Medicine and Rehabilitation... Nov 2021Image-guided diagnostic block and radiofrequency ablation of the knee joint to manage pain require detailed understanding of joint innervation in relation to soft tissue... (Review)
Review
Image-guided diagnostic block and radiofrequency ablation of the knee joint to manage pain require detailed understanding of joint innervation in relation to soft tissue and bony landmarks. In this article, the origin, course, and relationship to anatomic landmarks of articular nerves supplying the knee joint are discussed. The innervation pattern of the anterior and posterior aspects of the knee joint capsule is relatively consistent, with some variation in supply by the saphenous, anterior division of obturator, and common fibular nerves. To improve nerve capture rates for diagnostic block and radiofrequency ablation, multiple target sites could be beneficial.
Topics: Anatomic Landmarks; Humans; Joint Capsule; Knee Joint; Musculoskeletal Physiological Phenomena; Pain
PubMed: 34593142
DOI: 10.1016/j.pmr.2021.05.011 -
Anatomical Science International Mar 2022Although the hip joint is regarded as inherently stable, hip pain and injuries caused by traumatic/non-traumatic hip instability are relatively common in active... (Review)
Review
Although the hip joint is regarded as inherently stable, hip pain and injuries caused by traumatic/non-traumatic hip instability are relatively common in active individuals. A comprehensive understanding of hip anatomy may provide better insight into the relationships between hip stability and clinical problems. In this review, we present our recent findings on the hip morphological characteristics, especially focusing on the intramuscular tendon of the gluteus medius tendon and its insertion sites, hip capsular attachment on the anterosuperior region of the acetabular margin, and composition of the iliofemoral ligament. We further discussed the hip stabilization mechanism based on these findings. The characteristics of the gluteus medius tendon suggest that even a single muscle has multiple functional subunits within the muscle. In addition, the characteristics of the hip capsular attachment suggest that the width of the capsular attachment is wider than previously reported, and its wide area shows adaptive morphology to mechanical stress, such as bony impression and distribution of the fibrocartilage. The composition of the iliofemoral ligament and its relation to periarticular structures suggest that some ligaments should be defined based on the pericapsular structures, such as the joint capsule, tendon, and aponeurosis, and also have the ability to dynamically coordinate joint stability. These anatomical perspectives provide a better understanding of the hip stabilization mechanism, and a biomechanical study or an in vivo imaging study, considering these perspectives, is expected in the future.
Topics: Buttocks; Hip Joint; Humans; Joint Capsule; Ligaments, Articular; Tendons
PubMed: 34686966
DOI: 10.1007/s12565-021-00638-3 -
Pain Medicine (Malden, Mass.) May 2021The aim of this literature review was to establish consensus with respect to the anatomic features of the articular branches innervating the hip joint and the...
OBJECTIVES
The aim of this literature review was to establish consensus with respect to the anatomic features of the articular branches innervating the hip joint and the distribution of sensory receptors within its capsule.
METHODS
Five electronic databases were queried, with the search encompassing articles published between January 1945 and June 2019. Twenty-one original articles providing a detailed description of sensory receptors around the hip joint capsule (n=13) and its articular branches (n=8) were reviewed.
RESULTS
The superior portions of the anterior capsule and the labrum were found to be the area of densest nociceptive innervation. Similar to the distribution of nociceptors, mechanoreceptor density was found to be higher anteriorly than posteriorly. Hip joint capsular innervation was found to consistently involve the femoral and obturator nerves, which supply the anterior capsule, and the nerve to the quadratus femoris, which supplies the posterior capsule. The femoral, obturator, and superior gluteal nerves supply articular branches to the most nociceptor-rich region of the hip capsule.
CONCLUSIONS
The femoral and obturator nerves and the nerve to the quadratus femoris were found to consistently supply articular branches to both the anterior and posterior capsule of the hip joint. The anterior capsule, primarily supplied by the femoral and obturator nerves, and the superior labrum appear to be the primary pain generators of the hip joint, given their higher density of nociceptors and mechanoreceptors.
LEVEL OF EVIDENCE
Anatomy study, literature review.
Topics: Hip Joint; Humans; Joint Capsule; Obturator Nerve; Pain
PubMed: 33565587
DOI: 10.1093/pm/pnab061 -
Surgical and Radiologic Anatomy : SRA Dec 2019Despite their emerging therapeutic relevance, there are many discrepancies in anatomical description and terminology of the articular nerves supplying the human knee...
BACKGROUND
Despite their emerging therapeutic relevance, there are many discrepancies in anatomical description and terminology of the articular nerves supplying the human knee capsule. This cadaveric study aimed to determine their origin, trajectory, relationship and landmarks for therapeutic purpose.
METHODS
We dissected 21 lower limbs from 21 cadavers, to investigate the anatomical distribution of all the articular nerves supplying the knee joint capsule. We identified constant genicular nerves according to their anatomical landmarks at their entering point to knee capsule and inserted Kirschner wires through the nerves in underlying bone at those target points. Measurements were taken, and both antero-posterior and lateral radiographs were obtained.
RESULTS
The nerve to vastus medialis, saphenous nerve, anterior branch of obturator nerve and a branch from sciatic nerve provide substantial innervation to the medial knee capsule and retinaculum. The sciatic nerve and the nerve to the vastus lateralis supply sensory innervation to the supero-lateral aspect of the knee joint while the fibular nerve supplies its infero-lateral quadrant. Tibial nerve and posterior branch of obturator nerve supply posterior aspect of knee capsule. According to our findings, five constant genicular nerves with accurate landmarks could be targeted for therapeutic purpose.
CONCLUSION
The pattern of distribution of sensitive nerves supplying the knee joint capsule allows accurate and safe targeting of five constant genicular nerves for therapeutic purpose. This study provides robust anatomical foundations for genicular nerve blockade and radiofrequency ablation.
Topics: Aged; Aged, 80 and over; Anatomic Landmarks; Arthralgia; Cadaver; Catheter Ablation; Dissection; Female; Humans; Joint Capsule; Knee Joint; Male; Nerve Block; Obturator Nerve; Peroneal Nerve; Quadriceps Muscle; Radiography; Sciatic Nerve; Ultrasonography, Interventional
PubMed: 31338537
DOI: 10.1007/s00276-019-02291-y -
Regional Anesthesia and Pain Medicine May 2018The knee joint is the most common site of osteoarthritis. While joint replacement is considered an ultimate solution, radiofrequency denervation may be contemplated in...
BACKGROUND AND OBJECTIVES
The knee joint is the most common site of osteoarthritis. While joint replacement is considered an ultimate solution, radiofrequency denervation may be contemplated in some cases. Radiofrequency ablation requires precise localization of the articular branches innervating the joint capsule. The objective of this cadaveric study was to determine the source, course, relationships, and frequency of articular branches innervating the anterior knee joint capsule.
METHODS
Fifteen knees were meticulously dissected. The number and origin of the articular branches were recorded, and their distribution defined by quadrants. Their relationships to anatomical landmarks were identified.
RESULTS
The articular branches terminated in 1 of the 4 quadrants with minimal overlap. In all specimens, the superolateral quadrant was innervated by the nerve to vastus lateralis, nerve to vastus intermedius, superior lateral genicular and common fibular nerves; inferolateral by the inferior lateral genicular and recurrent fibular nerves; superomedial by the nerve to vastus medialis, nerve to vastus intermedius and superior medial genicular nerve; and inferomedial by the inferior medial genicular nerve. In 3 specimens, the inferomedial quadrant also received innervation from the infrapatellar branch of saphenous nerve. All articular branches except the nerves to vastus lateralis and medialis course at the periosteal level.
CONCLUSIONS
The frequency map of the articular branches provides an anatomical basis for the development of new clinical protocols for knee radiofrequency denervation and perioperative pain management.
Topics: Aged; Aged, 80 and over; Anatomic Landmarks; Female; Humans; Joint Capsule; Knee Joint; Male; Radiofrequency Ablation; Ultrasonography, Interventional
PubMed: 29557887
DOI: 10.1097/AAP.0000000000000778 -
Sports Medicine and Arthroscopy Review Sep 2018Multidirectional instability (MDI) is a debilitating condition that involves chronic subluxation or dislocation of the shoulder in >1 direction. Numerous proposed... (Review)
Review
Multidirectional instability (MDI) is a debilitating condition that involves chronic subluxation or dislocation of the shoulder in >1 direction. Numerous proposed mechanisms of MDI exist, which occurs in the setting of redundant capsular tissue. Symptoms can range from recurrent dislocations or subluxations to vague aching pain that disrupts activities of daily living. Magnetic resonance imaging is often performed during evaluation of this condition, although magnetic resonance arthrography may provide more detailed images of the patulous capsule. In the absence of a well-defined traumatic cause, such as a labral tear, initial treatment for MDI is a structured rehabilitation program with exercises aimed at strengthening the rotator cuff and periscapular muscles to improve scapular kinematics. Patients with recalcitrant symptoms may benefit from surgical stabilization, including open capsular shift or arthroscopic capsular plication, aimed at decreasing capsular volume and improving stability.
Topics: Activities of Daily Living; Arthroscopy; Humans; Joint Capsule; Joint Instability; Magnetic Resonance Imaging; Physical Examination; Recurrence; Rotator Cuff; Shoulder; Shoulder Dislocation; Shoulder Pain
PubMed: 30059445
DOI: 10.1097/JSA.0000000000000199 -
Seminars in Musculoskeletal Radiology Jul 2015The glenohumeral joint is an inherently unstable articulation and consequently the most frequently subluxed and frankly dislocated joint in the body. Shoulder... (Review)
Review
The glenohumeral joint is an inherently unstable articulation and consequently the most frequently subluxed and frankly dislocated joint in the body. Shoulder instability can be uni- or multidirectional related to acute or repetitive stress and is occasionally secondary to congenital or developmental abnormalities such as a lax joint capsule or glenoid dysplasia. The clinical diagnosis of instability can be difficult, and knowledge of the imaging findings of anterior, posterior, multidirectional, and microinstability is essential to guide the correct treatment of these patients. This requires the appropriate use of many different imaging modalities as well as specific positioning and directed protocols. This review article explains the clinical scenarios associated with shoulder instability and how they relate to the choice of imaging techniques. The imaging findings of the most common soft tissue and osseous pathology are reviewed and explained with specific attention to anterior and posterior instability.
Topics: Humans; Joint Capsule; Joint Instability; Ligaments, Articular; Magnetic Resonance Imaging; Rotator Cuff; Shoulder Joint
PubMed: 26021586
DOI: 10.1055/s-0035-1549319 -
The Orthopedic Clinics of North America Jul 2014Throwers, or athletes who engage in repetitive overhead motions, are a unique subset of athletes that experience distinct shoulder injuries. Athletes engaged in baseball... (Review)
Review
Throwers, or athletes who engage in repetitive overhead motions, are a unique subset of athletes that experience distinct shoulder injuries. Athletes engaged in baseball comprise the majority of patients seeking orthopedic care for throwing related injuries. Injuries specific to throwers most commonly involve the labrum and the undersurface of the rotator cuff. In addition, tissue changes in both the anterior and posterior glenohumeral capsule are common with repetitive overhead motions. These capsular changes alter. This article will examine the pathomechanics of injuries to throwers, elaborate means of diagnoses of cuff and labral injury and discuss recent advances in both non-operative and operative interventions, including preventative principles.
Topics: Arm; Athletic Injuries; Biomechanical Phenomena; Bone Retroversion; Contracture; Hip; Humans; Joint Capsule; Rotation; Rotator Cuff Injuries; Shoulder Injuries; Shoulder Joint
PubMed: 24975765
DOI: 10.1016/j.ocl.2014.04.003