-
The Kaohsiung Journal of Medical... Apr 2018Temporomandibular joint (TMJ) is one of the most complex joints of the human body. Due to its unique movement, in terms of combination of rotation and translator... (Review)
Review
Temporomandibular joint (TMJ) is one of the most complex joints of the human body. Due to its unique movement, in terms of combination of rotation and translator movement, disc of the joint plays an important role to maintain its normal function. In order to sustain the normal function of the TMJ, disc must be kept in proper position as well as maintain normal shape in all circumstances. Once the disc is not any more in its normal position during function of the joint, disturbance of the joint can be occurred which will lead to subsequent distortion of the disc. Shape of the disc can be influenced by many factors i.e.: abnormal function or composition of the disc itself. Etiology of the internal derangement of the disc remains controversial. Multifactorial theory has been postulated in most of previous manuscripts. Disc is composed of mainly extracellular matrix. Abnormal proportion of collagen type I & III may also leads to joint hypermobility which may be also a predisposing factor of this disorder. Thus it can be recognized as local manifestation of a systemic disorder. Different treatment modalities with from conservative treatment to surgical intervention distinct success rate have been reported. Recently treatment with extracellular matrix injection becomes more and more popular to strengthen the joint itself. Since multifactorial in character, the best solution of the treatment modalities should be aimed to resolve possible etiology from different aspects. Team work may be indication to reach satisfied results.
Topics: Arthrocentesis; Arthroscopy; Collagen Type I; Collagen Type III; Extracellular Matrix; Humans; Hyaluronic Acid; Orthopedic Equipment; Physical Therapy Modalities; Synovial Fluid; Temporomandibular Joint; Temporomandibular Joint Disorders
PubMed: 29655411
DOI: 10.1016/j.kjms.2018.01.004 -
Journal of Maxillofacial and Oral... Dec 2022The aim of this clinical study was to evaluate the level of Interleukine-6 (IL-6), pre and post arthrocentesis to validate it as a biomarker in the Internal Derangement...
PURPOSE
The aim of this clinical study was to evaluate the level of Interleukine-6 (IL-6), pre and post arthrocentesis to validate it as a biomarker in the Internal Derangement (ID) of TMJ.
MATERIAL AND METHODS
This study included 30 patients (20 females and 10 males) of Temporo-Mandibular Dysfunction (TMD) with Disc displacement without reduction (DDwoR) Wilkes stage III, who were refractory to conservative management. Arthrocentesis was performed as a therapeutic modality. Synovial fluid aspirates were obtained prior to arthrocentesis and post arthrocentesis with 300 ml of Ringer Lactate solution into the superior joint compartment for the assessment of level of IL-6. The clinical parameters used for correlating the level of IL-6 were degree of pain (VAS I), chewing ability (VAS II), Maximal Mouth Opening (MMO) in both pre and post op phase with the follow-up period of 01 day, 01 week, 01 month, 03 month and 06 month and the results were compared. ELISA was performed to analyze the levels of IL-6 in the aspirates. The clinical parameters and the level of IL-6 were recorded and analyzed statistically.
RESULTS
The study showed ID of TMJ (Wilkes stage III) s are more prevalent in females especially in the fourth decades of life with the mean age of 38.4 years. The post operative assessment in terms of pain, maximum mouth opening, lateral movements of the mandible and the levels of IL-6 were found to be statistically significant with a value <0.01.
CONCLUSION
This study validates the role of IL-6 as a definitive biomarker for the pathogenesis of ID of TMJ Wilkes stage III and arthrocentesis proved to be a minimally invasive therapeutic modality for its management.
PubMed: 36896078
DOI: 10.1007/s12663-021-01533-0 -
Canadian Family Physician Medecin de... Feb 2002To review current standards of practice of arthrocentesis and corticosteroid injections in soft tissue and joints in managing common musculoskeletal conditions. To... (Review)
Review
OBJECTIVE
To review current standards of practice of arthrocentesis and corticosteroid injections in soft tissue and joints in managing common musculoskeletal conditions. To outline common indications, contraindications, and possible complications of these therapeutic modalities and to describe common techniques used in them.
QUALITY OF EVIDENCE
Many of our recommendations are based on expert opinion and surveys of clinical practice by experts in the field. Where appropriate, randomized controlled trials are used to support various aspects of corticosteroid injection and joint aspiration.
MAIN MESSAGE
Many complaints to primary care physicians are musculoskeletal in origin, and many are related to infectious or inflammatory conditions of joints or soft tissues. Arthrocentesis and intra-articular and soft tissue corticosteroid injection are therapeutic techniques readily available to family practitioners. There is no consensus on best practice for patient preparation, choice of corticosteroid, or specific injection technique. There are, however, accepted standards of practice and universal precautions.
CONCLUSION
Family physicians have an important role in managing many common musculoskeletal conditions.
Topics: Adrenal Cortex Hormones; Evidence-Based Medicine; Family Practice; Humans; Inhalation; Joints; Musculoskeletal Diseases
PubMed: 11889888
DOI: No ID Found -
European Journal of Rheumatology Jun 2017Many conditions may affect the temporomandibular joint (TMJ), but its incidence in individual joint diseases is low. However, inflammatory arthropathies, particularly... (Review)
Review
Many conditions may affect the temporomandibular joint (TMJ), but its incidence in individual joint diseases is low. However, inflammatory arthropathies, particularly rheumatoid and psoriatic arthritis and ankylosing spondylitis, appear to have a propensity for affecting the joint. Symptoms include pain, restriction in mouth opening, locking, and noises, which together can lead to significant impairment. Jaw rest, a soft diet, a bite splint, and medical therapy, including disease-modifying antirheumatic drugs (DMARDs) and simple analgesia, are the bedrock of initial treatment and will improve most symptoms in most patients. Symptom deterioration does not necessarily follow disease progression, but when it does, TMJ arthroscopy and arthrocentesis can help modulate pain, increase mouth opening, and relieve locking. These minimally invasive procedures have few complications and can be repeated. Operations to repair or remove a damaged intra-articular disc or to refine joint anatomy are used in select cases. Total TMJ replacement is reserved for patients where joint collapse or fusion has occurred or in whom other treatments have failed to provide adequate symptomatic control. It yields excellent outcomes and is approved by the National Institute of Health and Care Excellence (NICE), UK. Knowledge of the assessment and treatment of the TMJ, which differs from other joints affected by inflammatory arthritis due to its unique anatomy and function, is not widespread outside of the field of oral and maxillofacial surgery. The aim of this article is to highlight the peculiarities of TMJ disease secondary to rheumatoid arthritis, psoriatic arthritis, and ankylosing spondylitis and how to best manage these ailments, which should help guide when referral to a specialist TMJ surgeon is appropriate.
PubMed: 28638693
DOI: 10.5152/eurjrheum.2016.035 -
Cureus Sep 2023Septic arthritis of the knee is the most common form of septic arthritis in children and can lead to irreversible damage to the joint. is the primary pathogen... (Review)
Review
Septic arthritis of the knee is the most common form of septic arthritis in children and can lead to irreversible damage to the joint. is the primary pathogen associated with septic arthritis, although other causative pathogens may be isolate in children with specific risk factors. The diagnosis of knee septic arthritis is based on comprehensive evaluation, including the patient's medical history, physical examination, blood tests, and arthrocentesis. Empirical treatment typically involves anti-staphylococcal penicillin or a first-generation cephalosporin, although modifications may be made based on local resistance patterns and clinical culture data. Surgical debridement, either through open surgery or arthroscopy, involving extensive debridement of the joint, is effective in eliminating the infection. In most cases, additional surgical intervention is not necessary.
PubMed: 37868524
DOI: 10.7759/cureus.45659 -
Stomatologija 2021The article presents a systematic overview of single- and double-puncture techniques of arthrocentesis methods published in the Scopus database during 2016-2020,... (Review)
Review
OBJECTIVE
The article presents a systematic overview of single- and double-puncture techniques of arthrocentesis methods published in the Scopus database during 2016-2020, highlighting the advantages and shortcomings of different methods.
MATERIALS AND METHODS
A search was conducted in the Scopus database using the terms "TMJ OR temporomandibular OR mandibular OR jaw AND arthrocentesis". Arthrocentesis techniques were described and categorized mostly as single- or double-needle ones.
RESULTS
The literature reviewed in the article represents studies of arthrocentesis treatment in 2675 patients involving 2740 joints. Arthrocentesis techniques can mainly be divided into single- and double-needle techniques. Single-needle techniques are subcategorized into type 1 and type 2, of which the first is a single-needle cannula technique where inflow and outflow pass through the same lumen, while the second uses a Y-shaped device, which has two ports and two lumens. Double needle techniques use two needles - one for the inflow and the other for the outflow. The literature found in the Scopus database during the period investigated presents 28% of single-puncture (type 1 - 10%, type 2 - 15%, single puncture with distention of the upper joint compartment - 3%), 69% of double-puncture, 1% of ancillary second-puncture methods and 1% employing a CBCT-based tragus-supported guide with 3 needles.
CONCLUSION
All of the arthrocentesis techniques described in the literature are effective as treatment modalities, none appears to be superior to others. The selection of the method to be used depends on the surgeon´s choice and experience.
Topics: Arthrocentesis; Humans; Needles; Punctures; Temporomandibular Joint; Temporomandibular Joint Disorders
PubMed: 35635520
DOI: No ID Found