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Physical Therapy in Sport : Official... Nov 2018To assess the influence of posterior capsule tightness and humeral retroversion on shoulder motion measurements.
OBJECTIVES
To assess the influence of posterior capsule tightness and humeral retroversion on shoulder motion measurements.
DESIGN
Cross-Sectional study.
SETTING
Controlled university laboratory.
PARTICIPANTS
75 asymptomatic individuals were assigned to one of 4 groups: control (n = 28); posterior capsule tightness only (n = 17); humeral retroversion only (n = 15); and combined posterior capsule tightness and retroversion (n = 15).
MAIN OUTCOME MEASURES
Six clinical measurements were compared across groups: bicipital forearm angle, low flexion, glenohumeral internal and external rotation, horizontal adduction and extension with internal rotation.
RESULTS
The group with both adaptations had decreased internal rotation compared to the control and retroversion only groups, as well as increased external rotation compared to the control and posterior capsule only groups. There were no between group differences for the horizontal adduction or extension with internal rotation measurements. The retroversion only and combined groups showed decreased bicipital forearm angle compared with the control and posterior tightness groups. The posterior capsule tightness and combined groups demonstrated decreased low flexion compared to the other groups.
CONCLUSION
The combination of osseous and soft tissue adaptions alter shoulder motion measures more than a single adaption, making a comprehensive clinical assessment vital when managing individuals with shoulder pain.
Topics: Adult; Cross-Sectional Studies; Female; Humans; Joint Capsule; Male; Range of Motion, Articular; Rotation; Shoulder; Shoulder Joint; Shoulder Pain; Young Adult
PubMed: 30312776
DOI: 10.1016/j.ptsp.2018.10.003 -
Orthopaedic Surgery Oct 2021Irreparable massive rotator cuff tear (IMRCT) was one of the causes of shoulder dysfunction, despite technical improvement, the failure rate of IMRCT was still... (Review)
Review
Irreparable massive rotator cuff tear (IMRCT) was one of the causes of shoulder dysfunction, despite technical improvement, the failure rate of IMRCT was still demonstrated to be high. Traditional treatments like non-surgical treatments, partial rotator cuff repair, and tendon transfers could only achieve a slight improvement. A potential cause for high failure rate was the fact that traditional treatments cannot restore the superior stability of glenohumeral joint, and thus restricted the movement of shoulder joint severely. Superior capsular reconstruction (SCR) using a variety of grafts (autograft, allograft, xenograft, or synthetic grafts) provided a promising option for IMRCT. In surgery, graft was fixed medially to superior glenoid and laterally to the footprint of humeral greater tuberosity. SCR could increase the stability of the superior glenohumeral joint, decrease the subacromial pressure and acromiohumeral distance. This review summarized the relevant literature regarding the alternative grafts, surgery indications, operative techniques and clinical outcomes of SCR. we compared the different grafts, key surgical steps, the advantages and disadvantages of different surgical methods to provide clinicians with new surgical insights into the treatments of IMRCT. In conclusion, IMRCT without severe glenohumeral arthritis was the best suitable indication for SCR. The clinical outcomes were positive in the short-term and middle-term following-up. More studies were necessary to determine long-term results of this surgical procedure.
Topics: Arthroscopy; Humans; Joint Capsule; Plastic Surgery Procedures; Rotator Cuff Injuries
PubMed: 34585538
DOI: 10.1111/os.12976 -
Regional Anesthesia and Pain Medicine 2015Chronic knee pain is common in all age groups. Some patients who fail conservative therapy benefit from radiofrequency neurotomy. Knowledge of the anatomy is critical to... (Review)
Review
BACKGROUND AND OBJECTIVES
Chronic knee pain is common in all age groups. Some patients who fail conservative therapy benefit from radiofrequency neurotomy. Knowledge of the anatomy is critical to ensure a successful outcome. The purpose of this study was to reanalyze the innervation to the anterior knee capsule from the perspective of the interventional pain practitioner.
METHODS
The study included a comprehensive literature review followed by dissection of 8 human knees to identify the primary capsular innervation of the anterior knee joint. Photographs and measurements were obtained for each relevant nerve branch. Stainless-steel wires were placed along the course of each primary innervation, and radiographs were obtained.
RESULTS
Literature review revealed a lack of consensus on the number and origin of nerve branches innervating the anterior knee capsule. All dissections revealed the following 6 nerves: superolateral branch from the vastus lateralis, superomedial branch from the vastus medialis, middle branch from the vastus intermedius, inferolateral (recurrent) branch from the common peroneal nerve, inferomedial branch from the saphenous nerve, and a lateral articular nerve branch from the common peroneal nerve. Nerve branches showed variable proximal trajectories but constant distal points of contact with femur and tibia. The inferolateral peroneal nerve branch was found to be too close to the common peroneal nerve, making it inappropriate for radiofrequency neurotomy.
CONCLUSIONS
The innervation of the anterior capsule of the knee joint seems to follow a constant pattern making at least 3 of these nerves accessible to percutaneous ablation. To optimize clinical outcome, well-aligned radiographs are critical to guide lesion placement.
Topics: Anatomic Landmarks; Catheter Ablation; Dissection; Humans; Joint Capsule; Knee Joint; Peripheral Nerve Injuries; Radiography
PubMed: 26066383
DOI: 10.1097/AAP.0000000000000269 -
International Journal of Biological... 2021Joint capsule fibrosis caused by excessive inflammation results in post-traumatic joint contracture (PTJC). Transforming growth factor (TGF)-β1 plays a key role in PTJC...
Joint capsule fibrosis caused by excessive inflammation results in post-traumatic joint contracture (PTJC). Transforming growth factor (TGF)-β1 plays a key role in PTJC by regulating fibroblast functions, however, cytokine-induced TGF-β1 expression in specific cell types remains poorly characterized. Macrophage migration inhibitory factor (MIF) is a proinflammatory cytokine involved in inflammation- and fibrosis-associated pathophysiology. In this study, we investigated whether MIF can facilitate TGF-β1 production from fibroblasts and regulate joint capsule fibrosis following PTJC. Our data demonstrated that MIF and TGF-β1 significantly increased in fibroblasts of injured rat posterior joint capsules. Treatment the lesion sites with MIF inhibitor 4-Iodo-6-phenylpyrimidine (4-IPP) reduced TGF-β1 production and relieved joint capsule inflammation and fibrosis. , MIF facilitated TGF-β1 expression in primary joint capsule fibroblasts by activating mitogen-activated protein kinase (MAPK) (P38, ERK) signaling through coupling with membrane surface receptor CD74, which in turn affected fibroblast functions and promoted MIF production. Our results reveal a novel function of trauma-induced MIF in the occurrence and development of joint capsule fibrosis. Further investigation of the underlying mechanism may provide potential therapeutic targets for PTJC.
Topics: Animals; Cells, Cultured; Disease Models, Animal; Fibroblasts; Fibrosis; Intramolecular Oxidoreductases; Joint Capsule; Joint Diseases; Macrophage Migration-Inhibitory Factors; Macrophages; Male; RNA; Rats; Rats, Sprague-Dawley; Signal Transduction; Transforming Growth Factor beta1
PubMed: 33994866
DOI: 10.7150/ijbs.57025 -
Scientific Reports Mar 2021Detailed understanding of the innervation of the hip capsule (HC) helps inform surgeons' and anaesthetists' clinical practice. Post-interventional pain following... (Meta-Analysis)
Meta-Analysis
Detailed understanding of the innervation of the hip capsule (HC) helps inform surgeons' and anaesthetists' clinical practice. Post-interventional pain following radiofrequency nerve ablation (RFA) and dislocation following total hip arthroplasty (THA) remain poorly understood, highlighting the need for more knowledge on the topic. This systematic review and meta-analysis focuses on gross anatomical studies investigating HC innervation. The main outcomes were defined as the prevalence, course, density and distribution of the nerves innervating the HC and changes according to demographic variables. HC innervation is highly variable; its primary nerve supply seems to be from the nerve to quadratus femoris and obturator nerve. Many articular branches originated from muscular branches of the lumbosacral plexus. It remains unclear whether demographic or anthropometric variables may help predict potential differences in HC innervation. Consequently, primary targets for RFA should be the anterior inferomedial aspect of the HC. For THA performed on non-risk patients, the posterior approach with capsular repair appears to be most appropriate with the lowest risk of articular nerve damage. Care should also be taken to avoid damaging vessels and muscles of the hip joint. Further investigation is required to form a coherent map of HC innervation, utilizing combined gross and histological investigation.
Topics: Arthroplasty, Replacement, Hip; Cadaver; Femoral Nerve; Hip Joint; Humans; Joint Capsule; Obturator Nerve; Pain, Postoperative; Radiofrequency Ablation; Sciatic Nerve
PubMed: 33674621
DOI: 10.1038/s41598-021-84345-z -
The Orthopedic Clinics of North America Jan 2016Posterior shoulder instability in overhead athletes presents a unique and difficult challenge. Often, this group has an inherent capsular laxity and/or humeral... (Review)
Review
Posterior shoulder instability in overhead athletes presents a unique and difficult challenge. Often, this group has an inherent capsular laxity and/or humeral retroversion to accommodate the range of motion necessary to throw. This adaptation makes the diagnosis of posterior capsulolabral pathology challenging, as the examiner must differentiate between adaptive capsular laxity and pathologic instability. Further complicating matters, the intraoperative surgeon must find the delicate balance of achieving stability while still allowing the necessary range of motion.
Topics: Arthroscopy; Athletes; Humans; Joint Capsule; Joint Instability; Patient Positioning; Postoperative Care; Sports; Suture Techniques
PubMed: 26614932
DOI: 10.1016/j.ocl.2015.08.026 -
Journal of Biomechanical Engineering May 2022The facet capsule ligament (FCL) is a structure in the lumbar spine that constrains motions of the vertebrae. Subfailure loads can produce microdamage resulting in...
The facet capsule ligament (FCL) is a structure in the lumbar spine that constrains motions of the vertebrae. Subfailure loads can produce microdamage resulting in increased laxity, decreased stiffness, and altered viscoelastic responses. Therefore, the purpose of this investigation was to determine the mechanical and viscoelastic properties of the FCL under various magnitudes of strain from control samples and samples that had been through an impact protocol. Two hundred FCL tissue samples were tested (20 control and 180 impacted). Impacted FCL tissue samples were obtained from functional spinal units that had been exposed to one of nine subfailure impact conditions. All specimens underwent the following loading protocol: preconditioning with five cycles of 5% strain, followed by a 30 s rest period, five cycles of 10% strain, and 1 cycle of 10% strain with a hold duration at 10% strain for 240 s (4 min). The same protocol was followed for 30% and 50% strain. Measures of stiffness, hysteresis, and force-relaxation were computed. No significant differences in stiffness were observed for impacted specimens in comparison to control. Impacted specimens from the 8 g flexed and 11 g flexed and neutral conditions exhibited greater hysteresis during the cyclic-30% and cyclic-50% portion of the protocol in comparison to controls. In addition, specimens from the 8 g and 11 g flexed conditions resulted in greater stress decay for the 50%-hold conditions. Results from this study demonstrate viscoelastic changes in FCL samples exposed to moderate and highspeed single impacts in a flexed posture.
Topics: Animals; Biomechanical Phenomena; Joint Capsule; Ligaments, Articular; Lumbar Vertebrae; Stress, Mechanical; Swine; Zygapophyseal Joint
PubMed: 35244145
DOI: 10.1115/1.4054022 -
Clinical Radiology Apr 2017There is a myriad of potential mass lesions that occur in the popliteal fossa, which present as palpable masses or are found incidentally on imaging. With a thorough... (Review)
Review
There is a myriad of potential mass lesions that occur in the popliteal fossa, which present as palpable masses or are found incidentally on imaging. With a thorough knowledge and understanding of the appearances and locations of these different entities, one can narrow the differential diagnoses in the majority of cases. This will eliminate unnecessary additional investigations and enable a more rapid management. We present a review of frequently encountered and less common entities using an anatomical sieve, with the aim of providing a diagnostic approach to popliteal fossa masses.
Topics: Bursa, Synovial; Diagnosis, Differential; Diagnostic Imaging; Humans; Joint Capsule; Joint Diseases; Knee Joint; Neoplasms, Adipose Tissue; Neoplasms, Muscle Tissue; Osteochondroma; Popliteal Cyst; Soft Tissue Neoplasms
PubMed: 28007292
DOI: 10.1016/j.crad.2016.11.010 -
The Spine Journal : Official Journal of... Mar 2020Prior data about the modulating effects of lumbar spine posture on facet capsule strains are limited to small joint deviations. Knowledge of facet capsule strain during...
BACKGROUND CONTEXT
Prior data about the modulating effects of lumbar spine posture on facet capsule strains are limited to small joint deviations. Knowledge of facet capsule strain during rotational and translational intervertebral joint motion (ie, large joint deviations) under physiological loading could be useful as it may help explain why visually normal lumbar spinal joints become painful.
PURPOSE
This study quantified the strain tensor of the facet capsule during rotation and translation range-of-motion tests.
STUDY DESIGN/SETTING
Strain was calculated in isolated porcine functional spinal units. Following a preload, each specimen underwent a flexion/extension rotation (F/E) followed by an anterior/posterior translation (A/P) range-of-motion test while under a 300 N compression load.
METHODS
Twenty porcine spinal units (10 C3-C4, 10 C5-C6) were tested. Joint flexion/extension was imposed by applying a ±8 Nm moment at a rate of 0.5°/s, and translation was facilitated by loading the caudal vertebra with a ±400 N shear force at a rate of 0.2 mm/s. Points were drawn on the exposed capsule surface and their coordinates were optically tracked throughout each test. Strain was calculated as the displacement of the point configuration with respect to the configuration in a neutral joint position.
RESULTS
Compared to a neutral posture, superior-inferior strain increased and decreased systematically during flexion and extension, respectively. Posterior displacement of the caudal vertebra by more than 1.3 mm was associated with negative strains, which was significantly lower than the +4.6% strain observed during anterior displacement (p≥.199). The shear strain associated with anterior translation was, on average, -1.1% compared to a neutral joint posture.
CONCLUSIONS
These results demonstrate that there is a combination of strain types within the facet capsule when spinal units are rotated and translated. The strains documented in this study did not reach the thresholds associated with nociception.
CLINICAL RELEVANCE
The magnitude of flexion-extension rotation and anterior-translation may glean insight into the facet capsule deformation response under low compression (300 N) loading scenarios. Further, intervertebral joint motion alone, even under low compression loading, does not appear to initiate a clinically relevant pain response in the lumbar facet capsule of a nondegenerated spinal joint.
Topics: Animals; Biomechanical Phenomena; Humans; Joint Capsule; Lumbar Vertebrae; Range of Motion, Articular; Rotation; Swine; Weight-Bearing; Zygapophyseal Joint
PubMed: 31563579
DOI: 10.1016/j.spinee.2019.09.022 -
Knee Surgery, Sports Traumatology,... Feb 2016The glenohumeral joint with instability is a common diagnosis that often requires surgery. The aim of this review was to present an overview of the anatomy of the... (Review)
Review
The glenohumeral joint with instability is a common diagnosis that often requires surgery. The aim of this review was to present an overview of the anatomy of the glenohumeral joint with emphasis on instability based on the current literature and to describe the detailed anatomy and anatomical variants of the glenohumeral joint associated with anterior and posterior shoulder instability. A review was performed using PubMed/MEDLINE using key words: Search terms were "glenohumeral", "shoulder instability", "cadaver", "rotator interval", "anatomy", and "anatomical study". During the last decade, the interest in both arthroscopic repair techniques and surgical anatomy of the glenohumeral ligament (superior, middle, and inferior), labrum, and rotator interval has increased. Understanding of the rotator interval and attachment of the inferior glenohumeral ligament on the glenoid or humeral head have evolved significantly. The knowledge of the detailed anatomy and anatomical variations is essential for the surgeon in order to understand the pathology, make a correct diagnosis of instability, and select proper treatment options. Proper understanding of anatomical variants can help us avoid misdiagnosis. Level of evidence V.
Topics: Fibrocartilage; Humans; Humeral Head; Joint Capsule; Joint Instability; Ligaments, Articular; Rotator Cuff; Scapula; Shoulder Injuries; Shoulder Joint
PubMed: 26704796
DOI: 10.1007/s00167-015-3892-1