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Emergency Radiology Jun 2019Terrible triad injury of the elbow is a complex injury that is classically defined as elbow dislocation along with fractures of the coronoid process of the ulna and the... (Review)
Review
Terrible triad injury of the elbow is a complex injury that is classically defined as elbow dislocation along with fractures of the coronoid process of the ulna and the radial head. The injury is usually associated with typical soft-tissue disruptions (with common involvement of the lateral collateral ligament complex, elbow joint capsule, as well as the common extensor and flexor-pronator tendons) that are best understood in the context of injury mechanism as well as the role and relevance of the various elbow stabilizers. The goals of this article are to review the pertinent anatomy, mechanism of injury, classification and imaging of terrible triad injuries of the elbow with brief descriptions of treatment, and complications of this complex injury.
Topics: Elbow; Humans; Joint Capsule; Joint Dislocations; Ligaments, Articular; Postoperative Complications; Radius Fractures; Tendon Injuries; Ulna Fractures; Elbow Injuries
PubMed: 30690677
DOI: 10.1007/s10140-019-01676-1 -
Sports Medicine and Arthroscopy Review Mar 2021There has been an increased emphasis on capsular management during hip arthroscopy in the literature in recent years. The capsule plays a significant role in the hip... (Review)
Review
There has been an increased emphasis on capsular management during hip arthroscopy in the literature in recent years. The capsule plays a significant role in the hip joint stability and studies have demonstrated that capsular closure can restore the biomechanics of the hip back to the native state. Capsular management also affects functional outcomes with capsular repair resulting in better clinical outcomes in some studies. Management of the capsule has evolved in recent years with more surgeons performing routine capsular closure. Management techniques and degree of capsular closure, however, can be quite variable between surgeons. This review will discuss hip capsular anatomy, the importance of the capsule in hip biomechanics, management of the capsule during arthroscopy, and functional outcomes as it relates to the various capsular closure techniques versus leaving the capsulotomy unrepaired.
Topics: Arthroscopy; Biomechanical Phenomena; Hip Injuries; Hip Joint; Humans; Joint Capsule; Joint Diseases; Range of Motion, Articular
PubMed: 33395226
DOI: 10.1097/JSA.0000000000000272 -
Anesthesia and Analgesia Jan 2000Impaired movement of the cricoarytenoid joint with hoarseness and immobility of the vocal ligament may occur as a consequence of endotracheal intubation. Little is known... (Clinical Trial)
Clinical Trial
UNLABELLED
Impaired movement of the cricoarytenoid joint with hoarseness and immobility of the vocal ligament may occur as a consequence of endotracheal intubation. Little is known about the cricoarytenoid joint capsule and its role in intubation. We investigated the joint capsules of 48 cricoarytenoid joints by means of gross anatomy microscopy, histology, and scanning electron microscopy; 30 unfixed cadaver larynges were also subjected to attempts to simulate traumata such as those that may occur during intubation trials. The larynges were intubated with the arytenoid tip entering the lumen of the tracheal tube or extubated with the cuff of the tube only partially deflated. Subsequently, i.e., after dissecting the left and right cricoarytenoid joint from each larynx, the morphologic changes induced experimentally were analyzed by using histologic methods. The cricoarytenoid joint was found to be lined by a wide joint capsule. Unexpectedly large and intensively vascularized synovial folds projected into the joint cavity. After simulation of intubation and extubation, histologic analysis revealed injuries to the synovial folds and joint surface impressions, but no trauma or rupture of the outer joint capsule. We conclude that laxity of the joint capsule and the large synovial folds are predisposing factors for intubation trauma of the cricoarytenoid joint, potentially leading to hemarthros and finally to cricoarytenoid joint dysfunction.
IMPLICATIONS
The present study illustrates by morphological investigations and intubation experiments that laxity of the joint capsule and large synovial folds are predisposing factors for intubation trauma of the cricoarytenoid joint, potentially leading to hemarthrosis and finally to cricoarytenoid joint dysfunction.
Topics: Adult; Aged; Aged, 80 and over; Chondrocytes; Female; Humans; Intubation, Intratracheal; Joint Capsule; Larynx; Male; Microscopy, Electron, Scanning; Middle Aged
PubMed: 10625001
DOI: 10.1097/00000539-200001000-00037 -
Scientific Reports Apr 2022Although the flexion abduction external rotation (FABER) test is a useful hip provocation test, hip soft tissue characteristics in the FABER position remain unclear....
Although the flexion abduction external rotation (FABER) test is a useful hip provocation test, hip soft tissue characteristics in the FABER position remain unclear. This study investigated the in-vivo joint capsule characteristics, including its articular cavity area and relation to the fat pad surrounded by the joint capsule and pericapsular muscles, in the FABER position using magnetic resonance imaging. Thirteen hips from 13 healthy volunteers were analyzed. The images were obtained, with the participant hips at 15°-extension, 45°-flexion, and in the FABER position, to analyze the articular cavity size and fat pad and calculate these ratios to size of the femoral neck. The articular cavity area and its ratio to the femoral neck were significantly greatest in the FABER position, followed by those in the hip flexion and extension. Additionally, the area of the fat pad in the inter-pericapsular muscle space and its ratio to the femoral neck in the FABER position were significantly larger than those in the hip flexion and, as a tendency, larger than those in hip extension. To the best of our knowledge, this is the first in-vivo study to show the interrelationship among the joint capsule, pericapsular muscles, and fat pad in the FABER position.
Topics: Hip; Hip Joint; Humans; Joint Capsule; Magnetic Resonance Imaging; Range of Motion, Articular
PubMed: 35459931
DOI: 10.1038/s41598-022-10718-7 -
Arthroscopy : the Journal of... Dec 2016Tears of the rotator cuff are frequent. An estimated 250,000 to 500,000 repairs are performed annually in the United States. Rotator cuff repairs have been successful... (Review)
Review
Tears of the rotator cuff are frequent. An estimated 250,000 to 500,000 repairs are performed annually in the United States. Rotator cuff repairs have been successful despite fatty infiltration and atrophy of the rotator cuff muscles. Although the emphasis in rotator cuff repair has historically focused on re-establishing the tendon attachment, there is growing interest in and understanding of the role of the superior capsule. The superior capsule is attached to the undersurface of the supraspinatus and infraspinatus muscle-tendon units, and it resists superior translation of the humeral head. Herein, we propose that it is the defect in the superior capsule that is the "essential lesion" in a superior rotator cuff tear, as opposed to the defect in the rotator cuff itself. We propose that rotator cuff repair must restore the normal capsular anatomy to provide normal biomechanics of the joint and thus a positive clinical outcome.
Topics: Arthroplasty; Arthroscopy; Humans; Humeral Head; Joint Capsule; Rotator Cuff; Rotator Cuff Injuries; Shoulder Joint; Tendons
PubMed: 27916191
DOI: 10.1016/j.arthro.2016.08.011 -
The Tohoku Journal of Experimental... May 2012Joint immobilization, which is used in orthopaedic treatments and observed in bedridden people, usually causes restricted joint motion. Decreased joint motion diminishes...
Joint immobilization, which is used in orthopaedic treatments and observed in bedridden people, usually causes restricted joint motion. Decreased joint motion diminishes activities of daily living and increases burden of nursing-care. The purpose of this study was to clarify the reversibility of immobilization-induced capsular changes and restricted joint motion in rat knee joints. The unilateral knee joints of adult male rats were immobilized with an internal fixator for 1, 2, 4, 8, and 16 weeks as a model of immobilization after surgery or disuse of the joint. After the fixation devices were removed, the rats were allowed to move freely for 16 weeks. Sham-operated rats were used as controls. Sagittal sections at medial midcondylar regions were made and assessed with histological, histomorphometric, and immunohistochemical methods. Joint motion was measured using a custom-made device under x-ray control after removal of the periarticular muscles. In the 1/16-week and 2/16-week immobilization-remobilization (Im-Rm) groups, cord-like structures connecting the superior and inferior portions of the posterior capsule (partial adhesion) were observed without restricted joint motion. In the 4/16-, 8/16-, and 16/16-week Im-Rm groups, global adhesion of the posterior capsule and restricted joint motion were observed. The restricted joint motion was not completely restored after incision of the posterior capsule. These data indicate that immobilization alone causes irreversible capsular changes and arthrogenic restricted joint motion. Besides the joint capsule, other arthrogenic factors such as ligaments might influence the restricted joint motion. Prolonged immobilization over 4 weeks should be avoided to prevent irreversible joint contracture.
Topics: Animals; Biomarkers; Contracture; Fluorescent Antibody Technique, Indirect; Hindlimb Suspension; Image Processing, Computer-Assisted; Joint Capsule; Joint Capsule Release; Male; Range of Motion, Articular; Rats; Rats, Sprague-Dawley; Stifle; Time Factors; Tissue Adhesions
PubMed: 22510696
DOI: 10.1620/tjem.227.13 -
Regional Anesthesia and Pain Medicine Feb 2019Peripheral nerve block is an important component of the multimodal analgesia for total knee arthroplasty. Novel interventional techniques of ultrasound-guided nerve...
BACKGROUND AND OBJECTIVES
Peripheral nerve block is an important component of the multimodal analgesia for total knee arthroplasty. Novel interventional techniques of ultrasound-guided nerve block supplying the posterior knee joint capsule require knowledge of the innervation of the posterior capsule. The objectives of this cadaveric study were to determine the course, frequency, and distribution of the articular branches innervating the posterior knee joint capsule and their relationships to anatomical landmarks.
METHODS
Fifteen lightly embalmed specimens were meticulously dissected. The origin of articular branches was identified, their frequency recorded, and the course documented in relation to anatomical landmarks. The capsular distribution of articular branches was documented and a frequency map generated.
RESULTS
In all specimens, articular branches from the posterior division of the obturator and tibial nerves were found to supply the posterior capsule. Additionally, articular branches from common fibular nerve and sciatic nerve were found in eight (53%) and three (20%) specimens, respectively. The capsular distribution of tibial nerve spanned the entire posterior capsule. The posterior division of obturator nerve supplied the superomedial aspect of the posterior capsule overlapping with the tibial nerve. The superolateral aspect of the posterior capsule was innervated by the tibial nerve and, when present, the common fibular/sciatic nerves.
CONCLUSIONS
Frequency map of the course and distribution of the articular branches and their relationship to anatomical landmarks form an anatomical basis for peripheral nerve block approaches that provide analgesia to the posterior knee joint capsule.
Topics: Aged; Aged, 80 and over; Anatomic Landmarks; Cadaver; Female; Humans; Joint Capsule; Knee Joint; Male; Middle Aged; Obturator Nerve; Sciatic Nerve; Tibial Nerve; Ultrasonography, Interventional
PubMed: 30700618
DOI: 10.1136/rapm-2018-000015 -
Radiology Feb 1999To study the anatomic components of the anterior joint capsule of the normal hip and in children with transient synovitis.
PURPOSE
To study the anatomic components of the anterior joint capsule of the normal hip and in children with transient synovitis.
MATERIALS AND METHODS
Six cadaveric specimens were imaged with ultrasonography (US) with special attention to the anterior joint capsule. Subsequently, two specimens were analyzed histologically. These anatomic findings were correlated with the US findings in 58 healthy children and 105 children with unilateral transient synovitis.
RESULTS
The anterior joint capsule comprises an anterior and posterior layer, mainly composed of fibrous tissue, lined by only a minute synovial membrane. Both fibrous layers were identified separately at US in 98 of 116 (84%) hips of healthy subjects and in all hips with transient synovitis. Overall, the anterior layer was thicker than the posterior layer. In transient synovitis compared with normal hips, no significant thickening of both layers was present (P = .24 and .57 for the anterior and posterior layers, respectively). Normal variants include plicae, local thickening of the capsule, and pseudodiverticula.
CONCLUSION
Increased thickness of the anterior joint capsule in transient synovitis is caused entirely by effusion. There is no US evidence for additional capsule swelling or synovial hypertrophy.
Topics: Adult; Cadaver; Child; Female; Hip Joint; Humans; Joint Capsule; Male; Synovitis; Ultrasonography
PubMed: 10207436
DOI: 10.1148/radiology.210.2.r99fe52499 -
Spine Jul 2011A novel noninvasive approach to measure facet joint pressure in the cervical spine was investigated using a tip-mounted transducer that can be inserted through a hole in...
STUDY DESIGN
A novel noninvasive approach to measure facet joint pressure in the cervical spine was investigated using a tip-mounted transducer that can be inserted through a hole in the bony lateral mass. This technique is advantageous because it does not require resection of the joint capsule, but there are potential issues regarding its applicability that are addressed.
OBJECTIVE
The objective was to evaluate the effect of a tip-mounted pressure probe's position and orientation on contact pressure measurements in biomechanical experiments.
SUMMARY OF BACKGROUND DATA
Measurements of direct contact pressure in the facet joint of cadaveric spines have been obtained via pressure-sensitive films. However, that method requires the resection of the facet capsule, which can alter the overall joint's mechanical behavior and can affect the measured contact pressures.
METHODS
Influence of position and orientation on probe measurements was evaluated in companion surrogate and cadaveric investigations. The probe was placed in the facet of an anatomic vertebral C4/5 surrogate undergoing sagittal bending moments. Pressure-sensitive paper was used to map contact regions in the joint of the surrogate and cadaveric cervical segments (n = 3) during extension. The probe also underwent uniaxial compression in cadaveric facets to evaluate the effect of orientation relative to the contact surface on the probe signal.
RESULTS
Although experimental and theoretical pressure profiles followed the same trends, measured maximum pressures were half of the theoretical ones. In the orientation study, maximum pressures were not different for probe orientations of 0° and 5°, but no signal was recorded at orientations greater than 15°.
CONCLUSION
This approach to measure pressure was selected to provide a minimally-invasive method to quantify facet joint pressures during clinically relevant applications. Both the position and orientation of the probe are critical factors in monitoring local pressure profiles in this mobile synovial joint.
Topics: Aged; Biomechanical Phenomena; Bone Screws; Cadaver; Cervical Vertebrae; Humans; Joint Capsule; Orthopedic Procedures; Pressure; Range of Motion, Articular; Zygapophyseal Joint
PubMed: 21224762
DOI: 10.1097/BRS.0b013e3181ee7de2 -
Journal of Oral and Maxillofacial... Apr 1997Attachments of the medial capsule of the temporomandibular joint (TMJ) to structures other than the medial fossa wall are thought to exist and to have functional...
PURPOSE
Attachments of the medial capsule of the temporomandibular joint (TMJ) to structures other than the medial fossa wall are thought to exist and to have functional significance. This study evaluated these relationships.
MATERIALS AND METHODS
The anatomic relationships between the medial capsule and other medial structures, the sphenomandibular ligament, discomalleolar ligament, and auriculotemporal nerve, were examined in 14 cadaver heads.
RESULTS
The results showed that the sphenomandibular ligament attaches separately from the medial capsule of the TMJ and therefore has no functional significance to the biomechanics of the joint. The discomalleolar ligament was found to be a continuation of the retrodiscal tissues and minimally associated with the medial capsule. The auriculotemporal nerve was not found to be in a relationship with the medial aspect of the condyle to the extent that mechanical irritation is possible during TMJ movement or disc displacement.
Topics: Aged; Humans; Joint Capsule; Ligaments, Articular; Pterygoid Muscles; Sphenoid Bone; Temporal Bone; Temporomandibular Joint
PubMed: 9120699
DOI: 10.1016/s0278-2391(97)90126-9