RESUMO
BACKGROUND: Posterior capsule tightness (PCT) and shoulder impingement syndrome (SIS) symptoms are both associated with altered shoulder biomechanics and impairments. However, their combined effect on kinematics, pain, range of motion (ROM), strength, and function remain unknown. OBJECTIVE: The purpose of this study was to determine if the combination of PCT and SIS affects scapular and humeral kinematics, glenohumeral joint ROM, glenohumeral joint external rotation strength, pain, and function differently than does either factor (PCT or SIS) alone. DESIGN: The design was a cross-sectional group comparison. METHODS: Participants were placed into 1 of 4 groups based on the presence or absence of SIS and PCT: control group (n = 28), PCT group (n = 27), SIS group (n = 25), and SIS + PCT group (n = 25). Scapular kinematics and humeral translations were quantified with an electromagnetic motion capture system. Shoulder internal rotation and external rotation ROM, external rotation strength, and pain and Shoulder Pain and Disabilities Index scores were compared between groups with ANOVA. RESULTS: The SIS group had greater scapular internal rotation (mean difference = 5.13°; 95% confidence interval [CI] = 1.53°-8.9°) and less humeral anterior translation (1.71 mm; 95% CI = 0.53-2.9 mm) than the other groups. Groups without PCT had greater internal rotation ROM (16.05°; 95% CI = 5.09°-28.28°). The SIS + PCT group had lower pain thresholds at the levator scapulae muscle (108.02 kPa; 95% CI = 30.15-185.88 kPa) and the highest Shoulder Pain and Disabilities Index score (â¼ 44.52; 95% CI = 33.41-55.63). LIMITATIONS: These results may be limited to individuals with impingement symptoms and cannot be generalized to other shoulder conditions. CONCLUSIONS: Decreased ROM and lower pain thresholds were found in individuals with both impingement symptoms and PCT. However, the combination of factors did not influence scapular and humeral kinematics.
Assuntos
Cápsula Articular/fisiopatologia , Síndrome de Colisão do Ombro/fisiopatologia , Articulação do Ombro/fisiopatologia , Adulto , Fenômenos Biomecânicos , Estudos Transversais , Avaliação da Deficiência , Feminino , Humanos , Masculino , Força Muscular , Medição da Dor , Amplitude de Movimento Articular , RotaçãoRESUMO
Shoulder dislocation occurs in 1-2% of the population. Capsular deformation is a key factor in shoulder dislocation; however, little is known about capsule biology. We evaluated, for the first time in literature, the expression of COL1A1, COL1A2, COL3A1 and COL5A1 in the antero-inferior, antero-superior and posterior regions of the glenohumeral capsule of 31 patients with anterior shoulder instability and eight controls. The expression of collagen genes was evaluated by quantitative reverse transcription-PCR. The expression of COL1A1, COL3A1 and the ratio of COL1A1/COL1A2 were increased in all three portions of the capsule in patients compared to controls (p < 0.05). COL1A2 expression was upregulated in the antero-superior and posterior sites of the capsule of patients (p < 0.05). The ratio of COL1A2/COL3A1 expression was reduced in capsule antero-inferior and posterior sites of patients compared to controls (p < 0.05). In the capsule antero-inferior site of patients, the ratios of COL1A1/COL5A1, CO1A2/COL5A1 and COL3A1/COL5A1 expression were increased (p < 0.05). In patients, COL1A1/COL5A1 was also increased in the posterior site (p < 0.05). We found deregulated expression of collagen genes across the capsule of shoulder instability patients. These molecular alterations may lead to modifications of collagen fibril structure and impairment of the healing process, possibly with a role in capsular deformation.
Assuntos
Colágeno/genética , Colágenos Fibrilares/antagonistas & inibidores , Colágenos Fibrilares/genética , Instabilidade Articular/genética , Luxação do Ombro/genética , Articulação do Ombro/metabolismo , Adulto , Estudos de Casos e Controles , Colágeno/antagonistas & inibidores , Feminino , Colágenos Fibrilares/biossíntese , Perfilação da Expressão Gênica , Humanos , Cápsula Articular/metabolismo , Cápsula Articular/fisiopatologia , Instabilidade Articular/metabolismo , Masculino , Luxação do Ombro/metabolismo , Articulação do Ombro/fisiopatologia , Adulto JovemRESUMO
STUDY DESIGN: Nonrandomized controlled cohort. OBJECTIVE: To characterize subaxial cervical facet joint kinematics and facet joint capsule (FJC) deformation during in vivo, dynamic flexion-extension. To assess the effect of single-level anterior arthrodesis on adjacent segment FJC deformation. SUMMARY OF BACKGROUND DATA: The cervical facet joint has been identified as the most common source of neck pain, and it is thought to play a role in chronic neck pain related to whiplash injury. Our current knowledge of cervical facet joint kinematics is based on cadaveric mechanical testing. METHODS: Fourteen asymptomatic controls and 9 C5-C6 arthrodesis patients performed full range of motion flexion-extension while biplane radiographs were collected at 30 Hz. A volumetric model-based tracking process determined 3-dimensional vertebral position with submillimeter accuracy. FJC fibers were modeled and grouped into anterior, lateral, posterior-lateral, posterior, and posterior-medial regions. FJC fiber deformations (total, shear, and compression-distraction) relative to the static position were determined for each cervical motion segment (C2-C3 through C6-C7) during flexion-extension. RESULTS: No significant differences in the rate of fiber deformation in flexion were identified among motion segments (P = 0.159); however, significant differences were observed among fiber regions (P < 0.001). Significant differences in the rate of fiber deformation in extension were identified among motion segments (P < 0.001) and among fiber regions (P = 0.001). The rate of FJC deformation in extension adjacent to the arthrodesis was 45% less than that in corresponding motion segments in control subjects (P = 0.001). CONCLUSION: In control subjects, FJC deformations are significantly different among vertebral levels and capsule regions when vertebrae are in an extended orientation. In a flexed orientation, FJC deformations are different only among capsule regions. Single-level anterior arthrodesis is associated with significantly less FJC deformation adjacent to the arthrodesis when the spine is in an extended orientation. LEVEL OF EVIDENCE: 4.
Assuntos
Vértebras Cervicais/fisiopatologia , Cápsula Articular/fisiopatologia , Doenças da Coluna Vertebral/fisiopatologia , Articulação Zigapofisária/fisiopatologia , Adulto , Fenômenos Biomecânicos , Estudos de Casos e Controles , Vértebras Cervicais/diagnóstico por imagem , Vértebras Cervicais/cirurgia , Feminino , Humanos , Imageamento Tridimensional , Cápsula Articular/diagnóstico por imagem , Cápsula Articular/cirurgia , Masculino , Pessoa de Meia-Idade , Interpretação de Imagem Radiográfica Assistida por Computador , Amplitude de Movimento Articular , Doenças da Coluna Vertebral/diagnóstico por imagem , Doenças da Coluna Vertebral/cirurgia , Fusão Vertebral , Tomografia Computadorizada por Raios X , Resultado do Tratamento , Articulação Zigapofisária/diagnóstico por imagem , Articulação Zigapofisária/cirurgiaRESUMO
BACKGROUND AND PURPOSE: Matrix metalloproteinases (MMPs) have been implicated in joint tissue destruction in arthritis. However, MMPs have not been assigned a role in joint pain. We investigated the ability of BaP1, a metalloproteinase from Bothrops asper snake venom, with structural homology to MMPs, to induce joint hypernociception. EXPERIMENTAL APPROACH: Animals received intra-articular (i.art.) BaP1. Hypernociception was assessed using the rat-knee joint articular incapacitation test. Cell influx, prostaglandin E(2) (PGE(2)), and TNF-alpha levels were assessed in joint exudates following BaP1 injection. KEY RESULTS: BaP1 (5 microg per joint) provoked hypernociception between 1 and 6 h after i.art. injection. Cell influx, mostly neutrophils, was maximal 3 h after BaP1 i.art. injection. BaP1 also led to increase in PGE(2) and TNF-alpha levels in the joint exudates. Pretreatment with either indomethacin (4 mg.kg(-1) i.p.) or with an anti-TNF-alpha antiserum (i.art.) significantly inhibited both BaP1-induced joint hypernociception and cell influx. In isolated rat peritoneal macrophages, BaP1 increased cyclooxygenase (COX)-2 expression, while not altering that of COX-1. CONCLUSIONS AND IMPLICATIONS: This is the first demonstration that a metalloproteinase promotes joint hypernociception. This effect involves local release of PGE(2) and TNF-alpha. BaP1-induced increase in PGE(2) is associated to increased COX-2 expression in macrophages. Blocking PGE(2) or TNF-alpha inhibits BaP1-induced hypernociception. In addition to unravelling a hitherto unknown mechanism whereby TNF blockade provides analgesia in arthritis, the data show, for the first time that MMPs are involved in inflammatory joint hypernociception and induce COX-2 expression.
Assuntos
Artrite Experimental/fisiopatologia , Venenos de Crotalídeos/toxicidade , Metaloendopeptidases/toxicidade , Dor/induzido quimicamente , Animais , Anti-Inflamatórios não Esteroides/uso terapêutico , Bothrops , Ciclo-Oxigenase 1/efeitos dos fármacos , Ciclo-Oxigenase 1/metabolismo , Ciclo-Oxigenase 2/efeitos dos fármacos , Ciclo-Oxigenase 2/metabolismo , Dinoprostona/metabolismo , Exsudatos e Transudatos/metabolismo , Soros Imunes , Indometacina/uso terapêutico , Injeções Intra-Articulares , Cápsula Articular/efeitos dos fármacos , Cápsula Articular/fisiopatologia , Articulação do Joelho/efeitos dos fármacos , Articulação do Joelho/fisiopatologia , Macrófagos Peritoneais/efeitos dos fármacos , Macrófagos Peritoneais/metabolismo , Masculino , Neutrófilos , Ratos , Ratos Wistar , Fator de Necrose Tumoral alfa/efeitos dos fármacos , Fator de Necrose Tumoral alfa/metabolismoRESUMO
Ensayo clínico realizado entre 1987 y 1992; la muestra estuvo conformada por 22 pacientes que reunieron los criterios de inclusión (inestabilidad glenohumeral multidireccional), las variables de estudios fueron: signos de hiperelasticidad, de inestabilidad glenohumeral, y de alamiento escapular. En todos se realizó tratamiento quirúrgico, y posteriormente llevaron a cabo tratamiento de rehabilitación. Se estudiaron 22 pacientes, 14 de sexo masculino y 8 de sexo femenino; rango de edad de 16 a 35 años; todos mostraron signos de alamiento escapular y en 20 se identificaron signos de alamiento escapular y en 20 se identificaron signos positivos de hiperelasticidad e inestabilidad anterior e inferior. Se mostró negativización de los signos clínicos a las 12 semanas del postoperatorio y hubo reintegración a las actividades deportivas al 5º mes de la cirugía. La técnica quirúrgica utilizada es un procedimiento sencillo, que no limita la movilidad articular y permite una rápida reintegración a las actividades ocupacionales y deportivas. No se registraron complicaciones
Assuntos
Humanos , Masculino , Feminino , Adolescente , Adulto , Ligamentos Articulares/cirurgia , Cápsula Articular/cirurgia , Cápsula Articular/fisiopatologia , Escápula/fisiopatologia , Instabilidade Articular/cirurgia , Instabilidade Articular/fisiopatologia , Instabilidade Articular , Luxação do Ombro/cirurgia , Luxação do Ombro/fisiopatologia , Úmero/fisiopatologiaRESUMO
The objective of this study was to assess and compare the frequency of some joint disorders in 130 CMD + bruxing behavior patients, 66 CMD/nonbruxing behaviors patients referred for diagnosis and treatment to the Center for the Study of Craniomandibular Disorders and 130 control subjects seeking routine dental care. Both patients and controls were consecutive referrals to the clinic occurring over a five year period. The mean age of the CMD + bruxing behavior group was about 35.48 years (range 14-54, SD = 8.45), and 36.84 years (range 17-60, SD = 9.30) in the 66 CMD nonbruxing behavior group, and 34.34 years (range 14-62, SD = 9.92) in the control group of 130 subjects. Information gathered included a questionnaire, history of signs and symptoms, and a clinical examination. Different types of joint disorders, muscle signs and symptoms and bruxing behavior were assessed in the CMD groups and in the corresponding control group. The study concluded that capsulitis/synovitis, retrodiskal pain and disk-attachment pain predominated in CMD + bruxing behavior patients. The data reinforces the need to assess CMD + bruxing behavior patients to evaluate signs and symptoms of such disorders in order to obtain additional information about the true source of pain and the need for proper management.