OBJECTIVE: To investigate the ultrasonographic findings in knee OA patients and to examine the possible causes of pain in osteoarthritis by ultrasonography. METHODS: Ultrasonography was performed with 7.5 MHz linear probe in 64 knee OA patients who fulfilled the ACR criteria. All patients were graded according to the Kellgren-Lawrence grades and then classified into group 1 (K/L I and II) and Group 2 (K/L III and IV). Also WOMAC score, BMI, laboratory finding (ESR, CRP) were checked. Ultrasonographic findings was examined; effusion, thickening of synovium, vertical length of medial and lateral osteophyte (longitudinal view), length of capsular distension (medial longitudinal view), evidence of bursitis and articular cartilage. RESULTS: 50.0% of patients had effusion, among whom 68.7% patients also had synovial thickening. In all patients, the severity of pain was correlated with 4 variables; the presence of effusion, disease duration, the length of medial osteophyte, the length of capsular distension (r=0.279, r=0.415, r=0.537, r=0.608, respectively, p<0.05). The length of medial osteophyte, the degree of capsular distension and disease duration were significantly correlated with WOMAC pain score in Group 1 (p<0.05). After multiple regression analysis, the length of medial osteophyte alone had correlation with the pain severity in Group 1 (r2= 0.396 p<0.05) and the only length of capsular distension was significantly correlated with WOMAC pain score in Group 2 (r=0.609, p<0.05). CONCLUSION: The length of osteophyte may be more related with pain severity in mild cases (K/L score I and II) while capsular distension could be an important factor causing knee pain in more advanced knee OA (K/L score III and IV).
Bursitis ; Cartilage, Articular ; Humans ; Joint Capsule ; Knee Joint* ; Knee* ; Osteoarthritis ; Osteoarthritis, Knee* ; Osteophyte ; Synovial Membrane ; Ultrasonography*

Gout is characterized by hyperuricemia and recurrent attacks of acute arthritis. Gout is a clinical syndrome resulting from the deposition of urate (monosodium urate monohydrate) crystals. Urate deposition occurs in articular cartilage, subchondral bone, synovial membrane, joint capsule and periarticular tissues, with articular cartilage being especially susceptible. The first metatarsophalangeal joint is commonly involved at presentation and other commonly affected joints are the ankle, knee and tarsal area. Gouty tophus located on the tibial tuberosity has never been reported in korea. We report a case of gouty tophus on the tibial tuberosity with (chemical) cellulitis occurred at the upper tibial area in a 46- year-old man.
Ankle ; Arthritis ; Cartilage, Articular ; Cellulitis* ; Gout ; Hyperuricemia ; Joint Capsule ; Joints ; Knee ; Korea ; Metatarsophalangeal Joint ; Synovial Membrane ; Tibia* ; Uric Acid

No abstract available.
Joint Capsule* ; Joints* ; Thumb*

We report on the case of double-layered medial meniscus, which was overlying anterior to mid portion of the medial meniscus. The upper accessory meniscus was connected to the anterior portion of the normal medial meniscus. And its periphery was connected to the joint capsule. The posterior portion of the upper accessory meniscus was connected to the joint capsule. This case demonstrates an interesting and rare anatomical abnormality of the medial meniscus. We report on the case with a review of the literature.
Joint Capsule ; Menisci, Tibial*

Gout is a clinical syndrome resulting from the deposition of monosodium urate monohydrate. Gouty arthritis is characterized by hyperuricemia and recurrent attacks of typical mono-or polyarthritis. Urate deposition frequently involves the articular cartilage, subchondral bone, synovial membrane, joint capsule, and periarticular tissues. The first metatarsophalangeal joint is most commonly involved, and other frequently affected joints include the ankle, knee, and tarsal area. However, the hip joint is very rarely affected. We herein report a case of gouty arthritis presenting with hip synovitis diagnosed using ultrasonography.
Animals ; Ankle ; Arthritis ; Arthritis, Gouty ; Cartilage, Articular ; Gout ; Hip ; Hip Joint ; Hyperuricemia ; Joint Capsule ; Joints ; Knee ; Metatarsophalangeal Joint ; Synovial Membrane ; Synovitis ; Uric Acid

The author has studied 33 cases of Korean embryos of Carnegie stage 11 ~23 and 18 cases of fetuses to demonstrate the development of the hip joint. The external feature of the lower extremity was observed by stereoscope and digital camera, and the internal structures were studied by light microscopic observation. The results obtained were as follows: In stage 13 lowerlimb buds were appeared. In stage 17 mesenchymal condensation for femur and hip bone, and one -layered interzone were observed. In stage 18 cartilage models for ilium and ischium were visible. In stage 22 three -layered interzone between the head of femur and hip bone was formed. In stage 23 acetabular labrum and distinct three -layered interzone was visible. In the 9th weeks mesenchymal ligamentum capitis femoris and transverse acetabular ligament are appeared, and acetabular labrum was reacted tracely to trichrome stain. In the 10th week the joint space was formed between the femoral head and hip bone, and shallow depression in acetabulum is found. In the 12th week the articular capsule was directed lateral to acetabular labrum, and numerous blood vessels were found in acetabular fossa and ligamentum capitis femoris, and cartilage canal were developed in femoral neck. In the 14th week cartilage canal was found in middle of femoral head, and synovial fold were developed, and ligamentum capitis femoris was shown strongly positive reaction. In the 16th week cartilage canals were more found, and numerous blood vessels were observed in fovea capitis. In the 18nd week the neck of femur was narrow, and femoral head was lied deeply in acetabulum with acetabular labrum. Consequently the lower extremity of Korean embryos and fetuses was first appeared in stage 13, and hip joint development was started at stage 17. The articular cavity was first formed at the 9th week of development, the acetabulum labrum was developed at stage 23. The mesenchymal ligamentum capitis femoris was appeared at the 9th week. At the same time the transverse acetabular ligament fully encircled the femoral head. The articular capsule has lined the articular cavity at the 12th week, and synovium was formed at the 14th week of development. At the 18th week the hip joint has attained its final shape.
Acetabulum ; Blood Vessels ; Cartilage ; Depression ; Embryonic Structures* ; Femur ; Femur Neck ; Fetus* ; Head ; Hip Joint* ; Hip* ; Humans* ; Ilium ; Ischium ; Joint Capsule ; Joints ; Ligaments ; Lower Extremity ; Neck ; Synovial Membrane

Degenerative involution of the spine causes destruction of spinal stabilizer which consists of bone, ligament, joint capsule, and disc, which substantially leads to hypermobility and instability of the spine. Generally the hard fixation system has been used for the treatment of lumbar instability. However, it has many complications, including screw loosening, screw fracture, and instability on, above, and below the fusion segment. These complications of the hard fixation system has brought to the invention of a more physiologic fixation device, the soft fixation system. We have used the Graf soft fixation system as an instrument for degenerative lumbar disease. 106 cases were operated between August, 1993 and March, 1996. The clinical assessments, radiologic findings, and operative results were analyzed. The height of disc space significantly increased from 8.84mm to 9.84mm on L3/4, 9.28mm to 10.13mm on L4/5, and 9.44mm to 10.47mm on L5/S1. Flexion instability changed from -6.9 degrees to 5.5degrees on L3/4, -7.45 degrees to 5.04 degrees on L4/5, -2.09degrees to 10.81degrees on L5/S1, translation instability was corrected from 16.8% to 14.9% on L3/4, 19.9% to 12.4% on L4/5, 27.1% to 20.1% on L5/S1 after Graf soft fixation. The clinical results were as follows: excellent in 56%, 27% good, 9% fair, and 8% poor. These results suggest that Graf soft fixation system for degenerative lumbar disease would not only be useful and effective, but also be safer in terms of unwanted complications of the hard fixation system.
Inventions ; Joint Capsule ; Ligaments ; Spine

PURPOSE: Pain control after total knee arthroplasty reduces total admission days and is important in improving post operative range of motion. This study evaluates the efficacy of intrasynovial injection of morphine and ropivacaine after total knee arthroplasty. MATERIALS AND METHODS: A prospective, double blinded and randomized study was performed in thirty two patients with American society of anesthesiology stage I or II who underwent one staged total knee arthroplasty for both knees simultaneously under spinal anesthesia. Demographic data (age, height, weight, gender distribution, Hospital for Special Surgery knee score, Knee society score, visual analogue scores (VAS) and range of motion were evaluated in all patients preoperatively. Before closure of the joint capsule, a local injective analgesia of 50mL including 0.5 ml 5 mg of HCL morphine, 40 mL 0.6% 300 mg ropivacaine and 0.25 mL of 1:200,000 epinephrine was injected into the synovium of one knee and 50 mL of normal saline was injected into the synovium of the opposite knee. Analgesic efficacy was evaluated by visual analogue scores (VAS) at intervals of 2, 4, 6, 12, 24, 32, 40 and 48 hours after operation. During this period, the amount of postoperative bleeding and range of motion were compared between both knees in the same patient. RESULTS: There were no statistically significant differences among both knees in regard to VAS at intervals of 2, 4, 6, 12, 24, 32, 40 and 48 hours after surgery (p>0.05). There were no statistically significant differences between the range of motion among both knees (p>0.05). CONCLUSION: On the basis of the results of this study, we do not recommend the routine use of postoperative intrasy-novial ropivacaine and morphine injection for the purpose of reducing pain in patients undergoing knee arthroplasty under spinal anesthesia with epidural patient controlled anesthesia.
Analgesia ; Anesthesia ; Anesthesia, Spinal ; Anesthesiology ; Arthroplasty* ; Epinephrine ; Hemorrhage ; Humans ; Joint Capsule ; Knee* ; Morphine* ; Pain, Postoperative* ; Prospective Studies ; Range of Motion, Articular ; Synovial Membrane

Adhesive capsulitis was described initially as periarthritis, and then frozen shoulder. Adhesive capsulitis of the shoulder is an insidious, painful condition that results in a gradual restriction of movements. Adhesive capsulitis can be classified into primary or secondary. Primary adhesive capsulitis is an insidious condition, whereas secondary adhesive capsulitis is associated with a known pathology. The pathogenesis remains unclear. Gross pathological changes include thickening and constriction of the capsule, especially anterioinferiorly with a very little amount of synovial fluid in the joint space. Many patients continue to have a significant long-term restriction in their range of motion, although few are functionally restricted. Classically adhesive capsulitis is divided into three phases : the painful phase, the stiff phase, and the resolution phase. The diagnosis of adhesive capsulitis is based on a thorough history taking and physical examination. Radiographs of the shoulder are usually negative. An arthrogram may show a decrease in the intraarticular volume and an absence of the axillary recess. The final confirmation of the diagnosis is made by an experience of relief of pain following an intra-articular anesthetic. Prevention is the ideal treatment. The goals of treatment are to relieve pain, to restore motion, and to restore function. Treatment modalities include anti-inflammatory medications, physical therapy including therapeutic exercise, corticosteroid injection, suprascapular nerve block, capsular distension, manipulation under anesthesia, and arthroscopic capsular release. It is necessary to refine the selection of treatment for individual patients according to the phase of the disease.
Anesthesia ; Bursitis* ; Constriction ; Diagnosis* ; Humans ; Joint Capsule Release ; Joints ; Nerve Block ; Pathology ; Periarthritis ; Physical Examination ; Range of Motion, Articular ; Rehabilitation* ; Shoulder* ; Synovial Fluid

PURPOSE: To determine the MR imaging findings of synovial sarcoma, with emphasis on the signal characteristicsof pathologically correlated T2-weighted images. MATERIALS AND METHODS: MR images of 14 cases ofpathologically-proven synovial sarcomas were retrospectively reviewed and correlated with the histopathologicfindings. We analyzed the signal intensity of T1- and T2-weighted images and the incidence of triple signalintensity, and evaluated the frequency of fluid-fluid levels, internal fibrous septa, calcification, the invasionof bone or neurovascular bundles and the involvement of joint capsules, as well as the size, location and marginof the tumors and pattern of contrast enhancement. RESULTS: Necrosis, cystic change or hemorrhage was suggested in11 cases, ten of which showed triple signal intensity, and in all cases, was pathologically confirmed. Fluid-fluidlevels were found in three cases and internal septa in ten. In four cases, maximum diameter was less than 5cm, andin nine, was greater than this. No mass was detected in one case. The tumor was located in the low extremity(n=9),pelvic girdle and hip joint area(n=2), scapular(n=1), shoulder joint area(n=1), and scalp(n=1). Eleven casesshowed a relatively well-defined margin and nine showed lobulation. Except in the area of necrosis and cysticchange, the pattern of contrast enhancement was diffuse and inhomogenous. Bony invasion was detected in two cases,neurovascular encasement in four, calcification in four, and joint capsule invasion in four. CONCLUSION: OnT2-weighted images, synovial sarcoma frequently showed triple signal intensity and internal septa with fluid-fluidlevels ; this was induced by cystic changes due to necrosis and hemorrhage.
Hemorrhage ; Hip Joint ; Incidence ; Joint Capsule ; Magnetic Resonance Imaging* ; Necrosis ; Retrospective Studies ; Sarcoma, Synovial* ; Shoulder Joint