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Background: Scapulohumeral periarthritis (SP) is a very common painful shoulder disorder. Several systematic reviews (SRs) and meta-analyses have reported the effectiveness of acupuncture for patients with SP. However, the evidence has not been systematically synthesized. This overview aims to map, synthesize, and assess the reliability of evidence generated from these SRs and meta-analyses of acupuncture for SP., Methods: We will electronically search the following databases for literature, regardless of publication status and language: the Cochrane Central Register of Controlled Trials (CENTRAL); PubMed; EMBASE; China National Knowledge Infrastructure (CNKI); Chinese Biomedical Literature Database (CBM); Chinese Scientific Journal Database (VIPdatabase); and Wan-Fang Database. In order to ensure the comprehensiveness and accuracy of the literature retrieval, we will combine the Suggestions of evidence-based medicine experts with the actual situation in the literature retrieval process to formulate the retrieval strategy, and make corresponding records to find the most appropriate retrieval strategy. The reference lists and the citation lists of studies meeting the inclusion criteria and relevant SRs will also be searched to identify further studies for inclusion. Before this review completed, the two reviewers will conduct the searching once again to ensure the latest studies could be included., Ethics and Dissemination: Ethical approval is not required for overviews. We plan to publish results in peer-reviewed journals and present at international and national academic, clinical, and patient conferences., Results: The results will be published in a peer-reviewed journal., Conclusion: This overview will provide comprehensive evidence of acupuncture for patients with SP., Inplasy Registration Number: INPLASY202060020.

Rationale: Periprosthetic osteolysis secondary to septic loosening and aseptic loosening is a well-described phenomenon associated with artificial hip arthroplasty. Periprosthetic bone loss as a result of metastatic infiltration is an uncommon cause of early, progressive loosening of joint replacement prosthesis and is rarely described in the literature., Patient Concerns: The present study describes a 70-year-old male patient who was diagnosed with pulmonary squamous cell carcinoma 5 years after total hip arthroplasty (THA) and developed a metastasis from squamous cell carcinoma in the periprosthetic neosynovial tissue 1 year after formal chemotherapy. The main complaint was hip pain with limited activity for about 3 months., Diagnoses: Expansive bone destruction and periprosthetic osteolysis at the right femoral trochanter were identified through X-ray and Tc bone scan. The diagnosis of pulmonary squamous cell carcinoma metastasis was finally confirmed on the basis of postoperative pathological examination., Interventions: The patient underwent open surgery with proximal femoral prosthesis revision and tumor prosthesis resection to completely remove the tumor tissue and relieve pain., Outcomes: The patient was completely relieved of pain at discharge 2 weeks after surgery and experienced no complications. However, the patient died of respiratory failure due to disease progression 3 months after surgery., Lessons: We believe that clinicians should maintain a high index of suspicion and consider metastatic disease in differential diagnosis of cases of aseptic loosening, particularly if the patient has a history of malignant disease and the osteolytic lesion involves the outer cortex. In addition, patients with a known history of malignancy should be screened with a pre-operative bone scan to rule out any metastatic infiltration and regularly followed up at short intervals to detect any early bone loss.

Introduction: Knee injuries are common in sports, and postinjury immobilization is often required to protect healing tissues and alleviate pain, but both the injury and the immobilization can lead to a knee contracture. Knee flexion contractures limit performance. Previous research has identified posterior knee capsule fibrosis as a contributor to immobility-induced knee flexion contractures. This study aims to measure posterior knee capsule length at various durations of remobilization after knee immobilization and to correlate with the recovery of knee range of motion., Methods: Two hundred fifty-nine male Sprague-Dawley rats had one knee extra-articularly immobilized in flexion with a Delrin® plate at a 45° angle for one of six durations: 1, 2, 4, 8, 16, or 32 wk, followed by spontaneous remobilization after plate removal, which lasted zero, one, two, and four times the duration of immobilization. The contralateral knees served as controls. The posterior knee capsule length was measured by histomorphometry. These measures were correlated with previously published range of motion data from the same cohort of specimens., Results: Knees immobilized for 1 and 2 wk partially recovered posterior capsule length (P > 0.05). Knees immobilized beyond 2 wk failed to recover posterior capsule length, irrespective of the duration of remobilization (P < 0.05). The residual posterior capsule shortening correlated with the lack of knee extension (P < 0.003)., Conclusions: For knee injuries requiring more than 2 wk of immobilization, unassisted remobilization will not restore posterior knee capsule shortening and the reduction in knee extension. These results support the role of the posterior capsule in knee joint contracture and the need to minimize the duration of immobility and to assist the recovery of the range of knee extension after a sport injury.

Background: An unstable slipped capital femoral epiphysis (SCFE) is associated with a high rate of avascular necrosis (AVN). Etiology of the AVN is not completely known and likely multifactorial. Potential causes are a tear/anatomic disruption of the retinacular vessels to the epiphysis, kinking of the retinacular vessels, or vascular tamponade due to increased intracapsular pressure., Methods: A review of the recent literature of unstable SCFE was performed to abstract various potential causes of AVN., Results: The overall rate of AVN was 21% (88 of 417). Kinking of the retinacular vessels was demonstrated angiographically in 5 unstable SCFEs where the vessels did not fill in 3; in 1 the vascularity returned after reduction. Intracapsular joint pressure was measured in 13 unstable SCFEs with an average of 48 mm Hg on the unstable side compared with 23 mm Hg in the opposite normal hip. After manipulative reduction the pressures increased to 75 mm Hg, and dropped markedly to 17 mm Hg after capsulotomy and decompression. Although a complete tear of the vessels is another possibility, there are no described cases in the literature. Means to lower AVN depends upon its etiology. In 28 unstable SCFEs urgent reduction, internal fixation and decompressive arthrotomy resulted in a rate of 14% (4 of 28). Urgent open reduction through an anterior approach with smooth Kirschner wire fixation resulted in a rate of 5% (3 of 64). The modified Dunn procedure using a surgical dislocation resulted in a rate of 8% (2 of 26)., Conclusions: Larger and combined series will be needed to determine the best treatment to minimize the rate of AVN in the unstable SCFE. With today's present techniques, AVN in the unstable SCFE will never be a "never" event.

Presentations of sequelae of septic hip in infants have been classified by various researchers, depending on the presence or absence of femoral capital epiphysis in acetabulum. This case report describes an unusual presentation of sequelae of septic arthritis of hip in which femoral capital epiphysis had extruded outside the capsule of hip joint in a 1 year and 6-months-old boy.

The aim of this work was to ascertain the different kinds of insertion of the upper head of the lateral pterygoid muscle (LPM) on the temporomandibular joint and to clarify its physiology to understand its possible role in the dysfunction at the temporomandibular joint. Magnetic resonance imaging examinations were used in this work to achieve a direct view of the LPM on a large number of selected patients with dysfunction at the temporomandibular joint.The study population was composed of 92 patients, of whom 74 were women and 18 were men. Their age range was from 19 to 53 years (mean age, 31 years). The images were analyzed using the following parameters: symmetry of morphologic insertions of the upper head of the LPM, types of muscular insertion divided into 3 groups (A, single bundle on the capsule and condyle; B, one bundle on the disk and a second bundle on the condyle; and C, one bundle only on the disk), and relationship between disk position regarding the condyle in patients with disk dislocations with or without reduction and upper head of the LPM. The chi-square test was used to measure the magnitude of the results.It is possible to impute to the C-type insertion morphology a negative prognostic value for a long-term improvement of disk pathology and to consider the possibility that this muscle may contribute to dislocating the disk when its insertion was directed only on the disk itself. When the upper head of the LPM was inserted on the disk, the percentage of disk dislocation without reduction was greater.

Objective: To assess the rotator interval of patients on long-term hemodialysis with magnetic resonance imaging (MRI) for the presence of adhesive capsulitis and to correlate these findings with shoulder motions., Methods: Seventeen shoulders in 16 patients (mean age, 53.8 years) on hemodialysis (range of duration, 4-28 years) who had pain and limited range of shoulder motion underwent MRI. Rotator interval was inspected in 3 regions (subcoracoid area, above the subscapularis muscle, and around the biceps tendon) on sagittal magnetic resonance images with regard to increased nonfatty soft tissue intensity as none, mild, moderate, and marked. Magnetic resonance images were evaluated by 2 musculoskeletal radiologists with consensus. Ranges of motion for external and internal rotation and abduction and forward flexion were assessed either normal or mildly, moderately, and severely limited., Results: Increased nonfatty soft tissue intensity within the rotator interval fat was observed in 11 shoulders (65%). Very strong positive correlation was found between the limitation of external rotation and the presence of nonfatty soft tissue infiltrating all 3 areas of the rotator interval fat (rs, between 0.81 and 0.96; P < 0.001). Strong positive correlation was found between the hemodialysis duration and the presence of nonfatty soft tissue infiltrating all 3 areas of the rotator interval fat (rs, between 0.68 and 0.71; P

A conflict exists on whether the ligamentum capitis femoris has the neuro-morphological structures required for nociception or proprioception of the hip joint. Therefore, we investigated the morphological features and the presence of mechanoreceptors in 24 ligamentum capitis femoris biopsies obtained at open reduction in patients with developmental dysplasia of the hip. Of these 24 hips, 16 were completely dislocated and eight were subluxated. The mean age was 33.8 months (range 13-52 months) at the time of surgery. En bloc ligamentum capitis femoris and pulvinar were taken for biopsy specimen. Ligamentum capitis femoris was dissected and the weight of each ligament was determined using a highly sensitive balance. Specimens were stained with hematoxylin and eosin and Masson trichrome for routine histolopathological evaluation and examined immunohistochemically using monoclonal antibody against S-100 protein. All specimens were graded on a four-grade system according to the amount of coarse-thick collagen bundles and hyalinization. The mean number and type of mechanoreceptors of each specimen were recorded. When the mean age, the patient's weight and the ligamentum capitis femoris weight of each group (completely dislocated vs. subluxated) were compared, there were no significant differences. In the ligamentum capitis femoris of the dislocated hips, the cells were irregularly distributed, had different shapes, and appeared to be in different stages of functional activity. The collagen fiber bundles were thicker than in the subluxated hips, distributed and of varied thickness. The elastic fibers of the dislocated hips were thicker and more numerous than those in the subluxated hips. We found a significant difference between the two groups with regard to the grade of collagen and hyalinization of ligamentum capitis femoris (P<0.004). We found type IVa, free nerve endings in 16 of 24 samples of ligamentum capitis femoris. The 66.6% presence of free nerve endings in the ligamentum capitis femoris suggests a role in nociception/proprioception of the hip in developmental dysplasia of the hip. Interestingly, the percentage and the mean numbers of free nerve endings containing ligamentum capitis femoris were similar in completely dislocated hip group and the subluxated group (62.5 vs. 75%, 12.13+/-9.07 vs. 9.37+/-9.24, respectively). We conclude that the morphological features of ligamentum capitis femoris are influenced by the severity of developmental dysplasia of the hip, whereas the distribution of free nerve endings are not influenced.

To compare the soft-tissue elasticity between the medial, lateral, and posterior aspects, the deltoid and calcaneofibular ligaments, and the medial, lateral, and posterior capsular tissues were collected from 27 feet of 16 congenital-clubfoot patients. The tissue sound speed, which closely correlates to the Young's modulus, was measured using a scanning acoustic microscope. Contrary to our expectations, lateral ligament showed a significantly higher sound speed than medial ligament (P=0.0023). Lateral capsule also showed a higher sound speed than the medial one (P=0.0338). The results of the study indicated that the lateral soft tissues including the ligaments and capsule underwent severe contracture in congenital clubfoot.

Aims: To analyse the extent, relationship and clinical significance of apoptosis and cell proliferation in synovial sarcoma., Methods: Apoptosis was detected by TUNEL, and expression of Ki-67, Bcl-2, Bax and p53 was examined immunohistochemically in 72 synovial sarcomas. Their relation and correlation with clinicopathological parameters and survival rate were analysed., Results: The average values of apoptosis index (AI) and Ki-67 labelling index (LI) were 0.76% and 28.30%, respectively. Both AI and Ki-67 LI in large-volume, high-grade and advanced-stage synovial sarcomas were significantly higher than those in small-volume, low-grade and early-stage ones (P<0.05 for all). And there was a linear relationship between AI and Ki-67 LI (r=0.751, P<0.001). All examined synovial sarcomas were positive for Bcl-2 and Bax, and only 20.8% cases showed expression of p53 protein. The expressions of Bcl-2, Bax and p53 were also significantly correlated with AI (P=0.005, P=0.002, P=0.037, respectively). In addition, patients with high AI (>0.76%) had poor prognosis (log-rank test; P=0.007)., Conclusions: Alterations in apoptosis and cell proliferation activity might be responsible for the pathogenesis and behaviour of synovial sarcoma. Increased rate of apoptosis in synovial sarcoma was considered to be an indicator of poor prognosis. In addition, apoptosis in synovial sarcoma may be controlled by multiple apoptosis-regulating mechanisms, including the Bcl-2 family and p53 protein.

We aimed to determine if there are mechanoreceptors in the hip joint capsule and ligamentum capitis femoris (LCF) of patients with developmental dysplasia of the hip (DDH). We took capsule and LCF biopsies from 20 hips of 20 patients who were operated on because of DDH. The mean age was 10.2 months (range 6-20 months) at the time of surgery. There were 12 girls and eight boys. Teratologic and secondary hip dislocations were not included in this study. Full thickness, 0.5 x 0.5 cm anterior capsule and LCF portions were taken for biopsy specimen. Specimens were stained with hemotoxylin eosin and examined immunohistochemically using monoclonal antibody against S-100 protein. In both analyses no mechanoreceptor was found in any samples of capsule or LCF. In this preliminary study we could not find mechanoreceptors in the local anterior joint capsule and LCF of the hip in children with DDH. We think that additional studies are necessary in order to understand the mechanoreceptor characteristics of the hip joint in children not only with DDH but also in children with healthy hips.

The most widely used system of grading Legg-Calvé-Perthes disease (LCPD) is still the radiographic grouping by Catterall, although it lacks interobserver reliability, especially in the early stages. The predictive value of Salter-Thompson classification and Herring's "lateral pillar" classification are still being studied. In Part 1, we demonstrated the good reliability and the predictive value of four magnetic resonance imaging (MRI) indices (extension of necrosis, lateral extrusion, physeal involvement, metaphyseal changes) through their correlation to clinical and radiographic conditions of the hips at follow-up. The same good results were obtained by submitting to statistical analysis a second group of 31 patients (French series). On the basis of these statistical studies, a new classification has been proposed. It takes into account the extent of necrosis and two MRI risk signs: lateral extrusion and physeal involvement. The extent of necrosis up to or more than 50% separates two main groups, A and B. The associated MRI risk factors distinguished six classes with different prognoses. Appropriated treatment also is suggested for each class. Our experience on MRI in LCPD led us to draw a pathomorphogenetic model called "packed capsule." According to this biomechanical model, the femoral head is considered a segment of a sphere made of viscoelastic material and hermetically sealed. The deformation of the head depends on the behavior of the necrotic fluid collected inside the capsule under the weight-bearing forces. Finally, our suggestion in the treatment of Perthes disease is to relieve weight bearing up to the fragmentation stage, whether the diagnosis has been made by the use of MRI or without it. During the fragmentation stage, MRI is extremely useful in performing prognosis; at this time our classification can be applied, and the corresponding treatment can be followed.

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.

In 21 clubfeet (17 children) of different types (idiopathic, spina bifida, syndromal), the authors analyzed modifications and crosslinks in collagen and their possible relations with clinical stiffness of clubfoot deformity, as measured by the Dimeglio/Bensahel method. In a biopsy of the capsule of the ankle joint, the number of hydroxylysine residues (mean +/- standard deviation; 27.1 +/- 3.4) and the number of pyridinium crosslinks per collagen molecule (0.41 +/- 0.12) were normal. This indicates normal processing of collagen molecules and normal alignment of collagen molecules within fibrils despite the variety of clubfeet, and even in scar tissue.

Because disability and pain may persist or recur after shoulder surgery, visualization of the postoperative shoulder before further treatment is of great interest. Postoperative status is reevaluated most frequently after rotator cuff repair, capsulorrhaphy in patients with chronic instability, and acromioplasty, where postoperative symptoms are clinically difficult to distinguish from rerupture or inadequate surgical results. Postoperative evaluation or follow-up after surgical treatment of tumors or surgical repair of shoulder injuries are other potential indications. Whereas surgical procedures for osseous components primarily will be evaluated by plain film radiographs, magnetic resonance imaging is a valuable tool for other sites of surgical treatment, such as soft-tissue components, with further potential indication for magnetic resonance arthrography. This article focuses on normal and abnormal postoperative findings in the shoulder, with emphasis of magnetic resonance imaging, and discusses specific findings based on magnetic resonance arthrography.

Study Design: This report illustrates a case of cervical myelopathy caused by degenerative changes of the facet joints in which calcium pyrophosphate dihydrate crystals were found histologically., Objectives: To evaluate the treatment of this patient, which involved the principles of laminoplasty and posterolateral fusion, and to analyze surgical specimens and preoperative radiographs taken after the patient's surgery., Summary of Background Data: Calcium pyrophosphate dihydrate deposition occurs in cartilage, ligaments, tendons, and joint capsules. Radiographic changes of the cervical facet joints caused by such deposition have already been reported in cadaveric studies. Cases with neurologic compromise rarely occur., Methods: Surgical specimens that were obtained from the cervical facet joints, i.e., capsule and synovium, were analyzed histopathologically., Results: The preoperative radiographic study showed severe degenerative changes of the cervical facet joints, and analysis of the surgical specimens indicated the presence of calcium pyrophosphate dihydrate crystals., Conclusions: The cervical facet joints can be involved in calcium pyrophosphate dihydrate crystal deposition and this involvement may accelerate the degenerative changes of the facet joints.