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Physical Medicine and Rehabilitation... Nov 2021Detailed understanding of the course and location of articular nerves supplying the shoulder joint is paramount to the successful utilization of image-guided... (Review)
Review
Detailed understanding of the course and location of articular nerves supplying the shoulder joint is paramount to the successful utilization of image-guided radiofrequency ablation to manage chronic shoulder pain. In this article, the origin, course, and relationship to anatomic landmarks of articular nerves supplying the shoulder and acromioclavicular joints are discussed. The shoulder joint capsule was consistently reported to receive innervation from multiple sources including the suprascapular, axillary, subscapular, and lateral pectoral nerves. The acromioclavicular joint received innervation from suprascapular and lateral pectoral nerves. The consistent relationship of articular branches to anatomic landmarks provides the basis for specific image-guided targeting.
Topics: Acromioclavicular Joint; Cadaver; Humans; Joint Capsule; Shoulder; Shoulder Joint
PubMed: 34593135
DOI: 10.1016/j.pmr.2021.05.005 -
Current Rheumatology Reports Aug 2019This review provides a summary of recent molecular findings that have refined our understanding of the cell types that constitute human synovial tissue, particularly in... (Review)
Review
PURPOSE OF REVIEW
This review provides a summary of recent molecular findings that have refined our understanding of the cell types that constitute human synovial tissue, particularly in patients with rheumatoid arthritis (RA).
RECENT FINDINGS
Recent advances in high-dimensional and single-cell assays have elucidated upwards of 20 cell subsets in the RA synovium. This includes novel fibroblast populations and lymphocyte phenotypes, which in many cases exhibit features that have not been found in other tissues thus far. Molecular profiling studies over the past several years have rapidly generated a comprehensive and detailed outline of the cellular phenotypes in synovial tissue affected by RA. Molecular features of these newly identified cell subsets immediately represent reasonable therapeutic targets and provide the opportunity to design the most clinically relevant mechanistic experiments. Broadly speaking, the ~ 20 cell types thus far identified in RA synovium seem to be fairly well conserved across patients, despite extensive heterogeneity in patient clinical features, stage of disease, and treatment responses. Thus, a next phase in molecular profiling may benefit from quantifying patient samples in terms of the ratios of cell types, with the rationale that certain cellular interactions will predominate in an individual and medications targeting these interactions may be more efficacious for that individual. Such cellular profiling in tissues combined with studies examining how the compendium of these cells interact in their three-dimensional tissue ultrastructures will be important in understanding how collectively these cells drive the disease process and ultimately how best to treat patients.
Topics: Arthritis, Rheumatoid; Fibroblasts; Humans; Phenotype; Synovial Membrane
PubMed: 31468238
DOI: 10.1007/s11926-019-0858-1 -
Journal of Shoulder and Elbow Surgery Dec 2020Painful shoulders create a substantial socioeconomic burden and significant diagnostic challenge for shoulder surgeons. Consensus with respect to the anatomic location... (Review)
Review
BACKGROUND
Painful shoulders create a substantial socioeconomic burden and significant diagnostic challenge for shoulder surgeons. Consensus with respect to the anatomic location of sensory nerve branches is lacking. The aim of this literature review was to establish consensus with respect to the anatomic features of the articular branches (ABs) (1) innervating the shoulder joint and (2) the distribution of sensory receptors about its capsule and bursae.
MATERIALS AND METHODS
Four electronic databases were queried, between January 1945 and June 2019. Thirty original articles providing a detailed description of the distribution of sensory receptors about the shoulder joint capsule (13) and its ABs (22) were reviewed.
RESULTS
The suprascapular, lateral pectoral, axillary, and lower subscapular nerves were found to provide ABs to the shoulder joint. The highest density of nociceptors was found in the subacromial bursa. The highest density of mechanoreceptors was identified within the insertion of the glenohumeral ligaments. The most frequently identified innervation pattern comprised 3 nerve bridges (consisting of ABs from suprascapular, axillary, and lateral pectoral nerves) connecting the trigger and the identified pain generator areas rich in nociceptors.
CONCLUSION
Current literature supports the presence of a common sensory innervation pattern for the human shoulder joint. Anatomic studies have demonstrated that the most common parent nerves supplying ABs to the shoulder joint are the suprascapular, lateral pectoral, and axillary nerves. Further studies are needed to assess both the safety and efficacy of selective denervation of the painful shoulders, while limiting the loss of proprioceptive function.
Topics: Bursa, Synovial; Humans; Joint Capsule; Peripheral Nervous System; Sensory Receptor Cells; Shoulder Joint; Shoulder Pain
PubMed: 32712453
DOI: 10.1016/j.jse.2020.07.017 -
Arthritis Research & Therapy Feb 2023Osteoarthritis (OA) is a chronic, progressive degenerative whole joint disease that affects the articular cartilage, subchondral bone, ligaments, capsule, and synovium.... (Review)
Review
Osteoarthritis (OA) is a chronic, progressive degenerative whole joint disease that affects the articular cartilage, subchondral bone, ligaments, capsule, and synovium. While it is still believed to be a mechanically driven disease, the role of underlying co-existing inflammatory processes and mediators in the onset of OA and its progression is now more appreciated. Post-traumatic osteoarthritis (PTOA) is a subtype of OA that occurs secondary to traumatic joint insults and is widely used in pre-clinical models to help understand OA in general. There is an urgent need to develop new treatments as the global burden is considerable and expanding. In this review, we focus on the recent pharmacological advances in the treatment of OA and summarize the most significant promising agents based on their molecular effects. Those are classified here into broad categories: anti-inflammatory, modulation of the activity of matrix metalloproteases, anabolic, and unconventional pleiotropic agents. We provide a comprehensive analysis of the pharmacological advances in each of these areas and highlight future insights and directions in the OA field.
Topics: Humans; Osteoarthritis; Cartilage, Articular; Bone and Bones; Synovial Membrane; Disease Management
PubMed: 36800974
DOI: 10.1186/s13075-023-03006-w -
Anatomia, Histologia, Embryologia Nov 2020Both cats and dogs belong to animals with the same type of limb support but have different nature of movement. Despite belonging to digitigrade animals, cats and dogs...
Both cats and dogs belong to animals with the same type of limb support but have different nature of movement. Despite belonging to digitigrade animals, cats and dogs have a different nature of motion. While moving, the medial joint surface in cats and lateral surface in dogs carry the larger pressure. The aim of the study was to compare the similar surfaces of the cat's and dog's tarsal joint capsule and to detect differences in its histostructure and vascularisation. For the study, we used the capsule of the tarsal joint of five cats and five dogs dissected with accordance to anatomical surfaces. Sections of the capsule joint were stained with haematoxylin-eosin. The sections were examined with a microscope at magnification ×250 and ×400. The statistical analysis of the results was done using Student's t test. During the research, a difference in histostructure and vascularisation of tarsal joint capsule in cats and dogs on respective surfaces were found. The medial surface of the tarsal joint capsule was the most saturated with hemomicrocirculatory bed structures in cats, whereas this was the lateral surface in dogs. The most active metabolic processes also take place in these areas of the joint capsule, which is important to know when prescribing therapeutic procedures and determining an optimal surgical access.
Topics: Animals; Cats; Dogs; Joint Capsule; Movement; Tarsal Joints
PubMed: 32602572
DOI: 10.1111/ahe.12589 -
Clinical Anatomy (New York, N.Y.) Oct 2020Based on the currently available literature, total denervation of the elbow joint is considered impossible. However, consensus with respect to the anatomic location of... (Review)
Review
Based on the currently available literature, total denervation of the elbow joint is considered impossible. However, consensus with respect to the anatomic location of sensory branches is lacking. The aim of this literature review was to establish consensus with respect to the anatomic features of the articular branches innervating the elbow joint, as well as the distribution of sensory receptors about its capsule. Four electronic databases were queried, between January 1945 and June 2019. Twenty-one original articles providing a detailed description of the distribution of sensory receptors about the elbow joint capsule (5) and its articular branches (16) were reviewed. The posterior capsule was found to be primarily innervated by the ulnar and radial nerves via combined articular branches and sensory branches of the medial antebrachial cutaneous nerve. The anterior capsule was found to be primarily innervated by a plexus of articular ramifications from muscular branches of mixed nerves (ulnar, musculocutaneous, radial, and median nerves). A higher density of nociceptors and mechano-receptors was identified within the posterior and anterior capsules, respectively. Thorough denervation, via the technique proposed herein, is likely to be sufficient in eliminating pain from degenerative conditions of the elbow joint.
Topics: Elbow Joint; Humans; Joint Capsule; Ligaments, Articular
PubMed: 31883143
DOI: 10.1002/ca.23538 -
ACS Biomaterials Science & Engineering Nov 2020Osteoarthritis (OA) is the fourth leading cause of disability in adults. Yet, few viable pharmaceutical options exist for pain abatement and joint restoration, aside... (Review)
Review
Osteoarthritis (OA) is the fourth leading cause of disability in adults. Yet, few viable pharmaceutical options exist for pain abatement and joint restoration, aside from joint replacement at late and irreversible stages of the disease. From the first onset of OA, as joint pain increases, individuals with arthritis increasingly reach for drug delivery solutions, from taking oral glycosaminoglycans (GAGs) bought over the counter from retail stores (e.g., Costco) to getting injections of viscous, GAG-containing synovial fluid supplement in the doctor's office. Little is known regarding the efficacy of delivery mode and/or treatment by such disease-modulating agents. This Review addresses the interplay of mechanics and biology on drug delivery to affected joints, which has profound implications for molecular transport in joint health and (patho)physiology. Multiscale systems biology approaches lend themselves to understand the relationship between the cell and joint health in OA and other joint (patho)physiologies. This Review first describes OA-related structural and functional changes in the context of the multilength scale anatomy of articular joints. It then summarizes and categorizes, by size and charge, published molecular transport studies, considering changes in permeability induced through inflammatory pathways. Finally, pharmacological interventions for OA are outlined in the context of molecular weights and modes of drug delivery. Taken together, the current state-of-the-art points to a need for new drug delivery strategies that harness systems-based interactions underpinning molecular transport and maintenance of joint structure and function at multiple length scales from molecular agents to cells, tissues, and tissue compartments which together make up articular joints. Cutting edge and cross-length and -time scale imaging represents a key discovery enabling technology in this process.
Topics: Humans; Injections, Intra-Articular; Joints; Osteoarthritis; Pharmaceutical Preparations; Synovial Fluid
PubMed: 33449636
DOI: 10.1021/acsbiomaterials.0c01081 -
FEBS Open Bio Nov 2020Joint contracture (also known as arthrofibrosis) is a fibrotic joint disorder characterized by excessive collagen production to form fibrotic scar tissue and adhesions...
Joint contracture (also known as arthrofibrosis) is a fibrotic joint disorder characterized by excessive collagen production to form fibrotic scar tissue and adhesions within joint capsules. This can severely affect day-to-day activities and quality of life because of a restricted range of motion in affected joints. The precise pathogenic mechanism underlying joint contractures is not fully understood. Lumican belongs to the class II small leucine-rich repeat proteoglycan superfamily, which makes up collagen fibrils in the extracellular matrix. Lumican is ubiquitously expressed in the skin, liver, heart, uterus and articular cartilage and has reported roles in cell migration, proliferation, angiogenesis and Toll-like receptor 4 signaling. Previous research has suggested that lumican is involved in the pathogenesis of several fibrotic diseases. Because joint contracture resembles a fibrotic disease, we aimed to investigate the role of lumican in the development of joint contracture in vitro. Here, we showed that protein levels were up-regulated in the fibrotic joint capsule versus control. We observed that lumican significantly enhanced the proliferation, migration and fibroblast-myofibroblast transition of synovial fibroblasts. Moreover, lumican led to increased transcription of alpha-smooth muscle actin, matrix metallopeptidase 9, Collagen I, plasminogen activator inhibitor 1 and transforming growth factor-β in vitro. Lumican treatment promoted collagen lattice contraction in a dose-dependent manner as early as 24 h after treatment. Thus, our studies reveal that lumican could promote fibroblast-myofibroblast transition and joint contracture.
Topics: Actins; Cell Movement; Cell Proliferation; Collagen; Female; Fibrosis; Humans; Joint Capsule; Joints; Lumican; Male; Matrix Metalloproteinase 9; Middle Aged; Myofibroblasts; Plasminogen Activator Inhibitor 1; RNA, Messenger; Signal Transduction; Synovial Membrane; Transforming Growth Factor beta; Up-Regulation
PubMed: 32910552
DOI: 10.1002/2211-5463.12974 -
Anatomical Record (Hoboken, N.J. : 2007) Sep 2022We continued direct morphological studies of the canid coxofemoral joint, considering early-life spatial relationships around the locus of the proximocaudal joint...
We continued direct morphological studies of the canid coxofemoral joint, considering early-life spatial relationships around the locus of the proximocaudal joint capsule insertion. Our primary goal was to elucidate the postnatal developmental gross anatomy of the proximocaudal femur, among juveniles across Canidae. From an original database of 267 independent (museum) specimens from 11 canid taxa and 1 hybrid taxon, we identified 29 ancient or modern candidate juvenile specimens (nine taxa and one hybrid taxon). Based on optimal ability to recognize landmarks, the best photographic data were categorized into five groups of four each (n = 20). The data groups approximated early juvenile, early-mid juvenile, mid-juvenile, mid-late juvenile; and young adult stages. In this descriptive photographic essay, we demonstrate the developmental spatial proximity among (a) the dorsal meeting of the respective lateral and medial extensions from the growth centers of the femoral head and greater trochanter; (b) the caudodorsal aspect of the coxofemoral joint capsule attachment; (c) a segment of the proximocaudal femoral shaft physis; and (d) an eventual associated mineralized prominence. The latter occurs frequently but not universally, suggesting natural population variability across taxa. Across taxa and juvenile age categories, the morphology thus supports developmental conservation among ancient and modern Canidae. The biomechanical and biological cause-effect implications are not yet clear. For zoological purposes, we apply the term postdevelopmental mineralized prominence to the residual caudolateral surface feature. We extend the original anatomical work of Morgan in zoological and phylogenic arenas, using direct observation of cleared skeletal specimens.
Topics: Animals; Canidae; Femur; Femur Head; Hip Joint; Joint Capsule
PubMed: 34854568
DOI: 10.1002/ar.24848 -
Arthroscopy : the Journal of... Apr 2021Surgical management of chronic acromioclavicular joint (ACJ) dislocations is a matter of controversy. In the acute setting of high-grade acromioclavicular separation, if...
Editorial Commentary: Acute Repair of the Acromioclavicular Joint Capsule and Ligaments and Deltotrapezial Fascia Could Allow Biological Healing of High-Grade Acromioclavicular Separation-Coracoclavicular Ligament Graft Augmentation Could Be Indicated if Time to Surgery Is Greater Than 3 Weeks.
Surgical management of chronic acromioclavicular joint (ACJ) dislocations is a matter of controversy. In the acute setting of high-grade acromioclavicular separation, if a surgical repair of the ACJ capsule and ligaments and deltotrapezial fascia could allow biological healing of the ligaments themselves, this could be enough to restore the functional biomechanics of the joint; unfortunately, this is not true for chronic cases. In the latter situation, a surgical technique using biological augmentation such as autograft or allograft should be preferred. Time is very important for this injury, and a chronic lesion should be considered when treatment is being performed 3 weeks after trauma. The graft should be passed around the base of the coracoid or through a tunnel at the base of the coracoid itself and then at the level of the clavicle as anatomically possible to reproduce the function of the native ligaments. However, some studies have shown that passing the graft at the base of the coracoid and wrapping it around the clavicle could also achieve satisfactory outcomes. An arthroscopic technique, when used in combination, could be great to treat the associated lesions, which have a reported percentage between 30% and 49%. Finally, to restore the biomechanics of the ACJ, however, reconstruction of the acromioclavicular superior and posterior capsules together with the deltotrapezial fascia seems to be very important.
Topics: Acromioclavicular Joint; Fascia; Follow-Up Studies; Humans; Joint Capsule; Ligaments, Articular
PubMed: 33812514
DOI: 10.1016/j.arthro.2021.02.001