髋关节改良侧位摄影的实际应用

目的 设计一种既操作简便又与常规髋关节侧位同样拍摄效果的新体位.方法 采用不同摄影角度对骨骼模型进行X线摄影,测量股骨头、颈充分显示时中心线倾斜角度和骨骼模型倾斜角度,并对头、颈显示情况评分;对30例髋关节X线摄影患者加照新侧位,并与常规侧位的实际可操作性和图像质量进行对比.结果 模拟摄影得出中心线向头侧倾斜35°~45°,身体冠状面与探测器角度60°~70°,评分为3分;新侧位具有可行性,对关节面、间隙显示率均为96.7%,股骨头、颈均为100%,大粗隆为80%,小粗隆为100%.结论 改良髋关节侧位摄影方法同样可以显示股骨头、颈和其余诸组成骨情况.     

Chondrolysis of the glenohumeral joint after arthroscopy: findings on radiography and low-field-strength MRI

OBJECTIVE: The purpose of this report is to describe the clinical and imaging findings of chondrolysis of the glenohumeral joint. CONCLUSION: In the appropriate clinical setting, both radiographs and MR images of the shoulder can be used to establish the diagnosis of chondrolysis of the glenohumeral joint.     

MDCT demonstration of intraarticular gas in the glenohumeral joint and sternoclavicular joint with reference to arm position

PURPOSE: Our purpose was to investigate the frequency of intraarticular gas in the glenohumeral joint and sternoclavicular joint, along with the influence of the patient's arm position. MATERIALS AND METHODS: Multidetector-row computed tomography (MDCT) scan on a total of 104 healthy subjects was investigated retrospectively. Raised-arm and lowered-arm positions were used sequentially, and the presence of intraarticular gas was investigated. RESULTS: While the arms were in a raised position, intraarticular gas was observed in the glenohumeral joint about 9% of all subjects and in the sternoclavicular joint about 20% of all subjects. Intraarticular gas in the most subjects disappeared when the arms were lowered. CONCLUSION: When scanning with the arms in a raised position, intraarticular gas was seen in the glenohumeral and/or and sternoclavicular joint, and disappeared in most cases when the body position was changed. Such intraarticular gas is thought to result from traction of the limbs and is considered clinically insignificant.     

Articular nodular fasciitis in the glenohumeral joint

We describe a case of multiple intra-articular masses in the glenohumeral joint of a 15-year-old patient. The patient was treated with arthroscopic excision of the masses and synovectomy. Histological and immunohistochemical studies were consistent with those of a nodular fasciitis. Follow-up examination did not reveal recurrence at 6 months. In this article we report the first case of articular nodular fasciitis in the glenohumeral joint with unusual imaging findings.     

Histologic evaluation of the glenohumeral joint capsule after the laser-assisted capsular shift procedure for glenohumeral instability

Glenohumeral joint capsule obtained from 42 patients who had undergone an arthroscopic laser-assisted capsular shift procedure was evaluated histologically. A total of 53 samples from the anterior inferior glenohumeral ligament of the joint capsule were collected before and at various times after the procedure (range, 0 to 38 months). Despite glenohumeral instability, joint capsule of the patients before the procedure showed no significant histologic lesions. Laser treatment significantly altered the histologic properties of the tissue as evidenced by hyalinization of collagen and necrotic cells (time 0). Tissues sampled during the short-term period (3 to 6 months) after the procedure demonstrated fibrous connective tissue with reactive cells and vasculature. Collagen and cell morphology returned to normal in the middle- to long-term period (7 to 38 months) after the procedure, while the number of fibroblasts remained elevated. Joint capsule collected from the shoulders of six patients who experienced stiffness after the procedure showed persistent synovial, cellular, and vascular reaction even after 1 year postoperatively, the cause of which is unclear. This study revealed histologic evidence of robust tissue healing and maturation after thermal treatment by the laser-assisted capsular shift procedure, although mechanical and biochemical characterization of the tissue was not evaluated. Correlation with clinical follow-up must be performed to further clarify the advantages and disadvantages of this procedure.     

Changes in joint position sense after surgically treated chronic lateral ankle instability

Background: A search of the literature shows that the effect of surgery on ankle proprioception has been hardly investigated. Objective: To examine the effect of anatomical reconstruction of the anterolateral capsuloligamentous complex on ankle joint position sense. Methods: A prospective study using the "slope box" test. Ten consecutive patients were included in the study, and 10 healthy athletes represented the control group. Results: Similar test-retest reliability rates (overall reliability 0.92; p = 0.0013) were obtained to those of the original designers of the method. There were no significant differences with respect to side dominance (p = 0.9216). Investigation of the characteristics of mean absolute estimate errors showed that the controls tested became error prone in the range of slope altitudes 7.5–25° in every direction, compared with the range 0–5° (range of p values 0.00003–0.00072). The results of the intervention group showed that, for the two main directions of interest (anterior and lateral), preoperative differences in mean absolute estimate errors between injured (anterior 3.91 (2.81)°; lateral 4.06 (2.85)°) and healthy (anterior 2.94 (2.21)°, lateral 3.19 (2.64)°) sides (anterior, p = 0.0124; lateral, p = 0.0250) had disappeared (postoperative differences: anterior, p = 0.6906; lateral, p = 0.4491). The afflicted ankle had improved significantly after surgery in both important directions (anterior, p<0.0001; lateral, p = 0.0023). Conclusions: The study shows that differences in joint position sense between healthy and injured ankles disappeared as the result of surgery. Preoperative data show that proprioceptive malfunction is a cause of functional instability. If treatment is by means of surgery, the retensioning of the original anterolateral structures is inevitable, even if other grafting or surgical techniques are used.     

Changes in joint position sense after conservatively treated chronic lateral ankle instability

Improvement of ankle proprioception through physiotherapy (a.k.a. proprioceptive training) is a widely accepted conservative treatment modality of chronic functional lateral ankle instability. Clinical studies provided controversial data on its proprioceptive effect. Aim of this study was to gain evidence on the efficacy of proprioceptive training on ankle joint position sense. Ten patients (five males and five females, aged 23.3±5.4 years) were treated conservatively for chronic lateral ankle instability with a special training programme over 6 weeks. For the assessment of joint position sense we used the slope-box test, first applied and described by Robbins et al. (Br J Sports Med 29:242–247, 1995). The test was performed before the start and after the end of the training programme, measuring joint position sense on 11 different slope amplitudes in four directions (anterior, posterior, lateral and medial) in random order each on both ankles. Comparisons were made between pre- and post-training results as well as versus a control-group of ten healthy athletes. Overall the proprioceptive sensory function of the studied group has improved, but this improvement was not significant in all directions. Only two patients have shown significant improvement of joint position sense in all directions (mean estimate error improvement: 2.47°), while conservative treatment was partially successful in five others (mean estimate error improvement: 0.73°). The follow-up results of these seven patients were comparable with the values measured in the control-group. Three patients did not show any improvements (mean estimate error improvement: −0.55°) (overall difference between improving and non-improving patients: P<0.0001). Mean absolute estimate error profiles of the seven improving patients became similar to the profiles of healthy athletes, while these changes could not be observed in the case of the three non-improving participants. Proprioceptive rehabilitation programme can be an effective method in order to improve impaired joint position sense function. After 6 weeks non-responding patients can be well identified, and considered for other treatment modalities. The determination of the effective length of the programme however needs further evaluation. Still, changes in the proprioceptive sensory function of the ankle plantarflectors indicate the preventive effect of the training programme. Furthermore, our results support the theory of simultaneous function of different mechanoreceptor-systems.     

Comparison of dynamic sonography to stress radiography for assessing glenohumeral laxity in asymptomatic shoulders

BACKGROUND: Stress radiography has been the established imaging method for quantifying glenohumeral joint laxity. Dynamic ultrasound is an alternative imaging method that may be used to measure glenohumeral laxity; however, validity and repeatability have not been examined. OBJECTIVE: To determine criterion-related validity and repeatability of a sonographic imaging method for measuring glenohumeral laxity in asymptomatic shoulders. STUDY DESIGN: Controlled laboratory study. METHODS: In experiment 1, 20 subjects were assessed for glenohumeral laxity using stress radiography and dynamic ultrasound. In the second experiment, 13 subjects were assessed for laxity in 2 separate test sessions using the dynamic ultrasound technique. RESULTS: Correlational analysis between the sonographic and radiographic measures revealed an r = 0.79 (r(2) = 0.62), indicating excellent criterion-related validity for the sonographic imaging method. Test-retest repeatability was 0.72 and 0.85 for anterior and posterior translation, respectively, and interrater repeatability was 0.96 and 0.99 for anterior and posterior translation, respectively. CONCLUSIONS: Dynamic ultrasound appears to be a valid and repeatable method for assessing glenohumeral laxity in a clinical setting. CLINICAL RELEVANCE: Based on the results of this study, dynamic ultrasound is a repeatable and valid method for measuring glenohumeral laxity and therefore may be used as a viable replacement for stress radiography during assessments of glenohumeral laxity.     

Positioning of the painful patient for the axial view of the glenohumeral joint

A method of positioning a patient with recent injury of the shoulder girdle for the axial glenohumeral view is described. No forced movement of the affected joint is needed and the patient may lie on his uninjured side.     

Magnetic resonance imaging of glenohumeral joint instability

Shoulder instability is common, especially anterior subluxation and dislocation. The sequelae are well seen on magnetic resonance imaging and include tears of the labrum, glenohumeral ligaments, capsule, tendons, and muscles. This article seeks to discuss and illustrate common pitfalls and lesions associated with instability. Anatomic and technical considerations, including the use of magnetic resonance arthrography, are also addressed.     

Magnetic resonance imaging of glenohumeral joint diseases

Through the application of oblique planes and flexible surface coil techniques, magnetic resonance imaging (MRI) promises to be of great clinical value in the evaluation of a variety of pathologic conditions affecting the shoulder. In patients with joint effusions, the tendinous portion of the rotator cuff, glenoid labrum, and bicipital tendon can be readily visualized. This capability has particular relevance in patients with inflammatory disease and traumatic conditions. Rotator cuff atrophy and impingement of the coracoacromial arc upon the supraspinatus muscle and tendon can also be demonstrated. MRI is also useful in the evaluation of shoulder instability.     

Osteoarthritis of the glenohumeral joint: a radiologic-pathologic study

Cadaveric specimens and patient radiographs were examined in order to establish the pattern and the distribution of degenerative alterations of the glenohumeral joint. Characteristic osseous changes occur in response to alterations in the articular cartilage and rotator cuff. The extent of these changes is underestimated by plain-film radiography. A strong association was found between the changes of osteoarthritis (OA) and those related to deterioration of the rotator cuff. Idiopathic OA of the glenohumeral joint was discovered in 10 (20%) of 50 symptomatic patients age 60 years and over. Theories regarding the pathomechanics and interrelations between glenohumeral joint OA and rotator cuff deterioration are discussed.