The pattern of involvement of appendicular degenerative joint disease

Patterns of degenerative joint disease are investigated in the shoulder, elbow, hip, and knee joints of the macerated remains of approximately 800 individuals from 20th century American and two prehistoric populations. Age is an important contributory factor in all joints, but its effects are seen most directly in the shoulder and hip. Patterns of right-left involvement also indicate the elbow is the most susceptible area to local factors. Multiple joint involvement is seen more often in females from contemporary populations but more often in males from archeological groups. No significant association is found between degenerative involvement and osteometric measurements, and cause of death is probably only incidentally associated with degenerative disease.     

Paleoepidemiology of a central California prehistoric population from Ca-Ala-329: II. Degenerative disease

Degenerative lesions are scored and frequencies of involvement are computed for a skeletal collection from Ca-Ala-329, a prehistoric site on the southeastern side of San Francisco Bay, dating from 500 A.D. up to European contact. A large earthmound site, excavations conducted there by San Jose State University retrieved close to 300 burials. For this epidemiological analysis, reasonably complete and aged skeletons representing 77 adult females and 90 adult males are available. Degenerative changes are scored macroscopically in an ordinal fashion for the large fibro-cartilagenous joints between adjacent vertebral bodies (vertebral osteophytosis) as well as the small apophyseal articulations of the spine. In addition, in the peripheral skeleton degenerative changes are scored in the temporo-mandibular, shoulder, elbow, hip, and knee joints as well as the small articulations of the hands and feet. The most common degenerative changes in the spine are seen between the vertebral bodies of the lower lumbar region. In the peripheral skeleton the highest involvement of degenerative disease is seen in the hands and feet. Compared to other relevant osteological samples, this group of hunting-gathering California Indians shows more degenerative changes than settled agriculturists (from Pecos Pueblo, New Mexico) but substantially less frequent involvement than in arctic hunters (Alaskan Eskimos).     

Degenerative joint disease in hunter-gatherers and agriculturalists from the Southeastern United States

This study examines degenerative joint disease of the major appendicular joints in hunter-gatherers and agriculturalists from northwestern Alabama. Arthritis is highest at the shoulder, elbow, and knee and lower at the hip and ankle. There are virtually no sex differences in the hunter-gatherer group, but in the agriculturalists, males have more severe osteoarthritis than females. The hunters-gatherers have a somewhat greater prevalence of arthritis than the agriculturalists, but the differences are rarely significant. The similarity in osteoarthritis levels over time conflicts with biomechanical evidence, which indicates an increase in usual activities in the agricultural period. Several possible reasons for this are explored, including the suggestion that arthritis is a response to intensive or infrequent activities. Whatever the cause, it is clear that biomechanical data and osteoarthritis are responding to different factors and do not equally represent the level of usual activities.     

Degenerative joint disease in African great apes: an evolutionary perspective

Degenerative joint disease is investigated in the spine and major peripheral joints (shoulder, elbow, hip and knee) in samples of chimpanzees (Pan troglodytes schweinfurthii; P. troglodytes troglodytes), lowland gorillas (Gorilla gorilla gorilla), and bonobos (P. paniscus). The P. troglodytes schweinfurthii sample comes from Gombe National Park, Tanzania, while the other samples are derived from museum materials originally collected in west/central Africa. Total data for African ape samples include 5807 surfaces for ascertainment of vertebral osteophytosis, 12,479 surfaces for determination of spinal osteoarthritis, and 1211 joints for evaluation of peripheral joint osteoarthritis. All apes display significantly less spinal disease than in a comparable human sample, and these differences are most likely a consequence of human biomechanical adaptations for bipedal locomotion. Apes are also generally less involved in the major peripheral joints than are humans, but human groups are themselves highly variable in prevalence of peripheral osteoarthritis. These data agree with other findings of low prevalence of degenerative joint prevalence in free-ranging apes, but contrast markedly with evidence derived from colony-reared Old World monkeys.     

Perlecan immunolocalizes to perichondrial vessels and canals in human fetal cartilaginous primordia in early vascular and matrix remodeling events associated with diarthrodial joint development.

The aim of this study was to ascertain how perlecan was localized in human fetal cartilaginous joint rudiment tissues. Perlecan was immunolocalized in human fetal (12-14-week-old) toe, finger, knee, elbow, shoulder, and hip joint rudiments using a monoclonal antibody to domain-1 of perlecan (MAb A76). Perlecan had a widespread distribution in the cartilaginous joint rudiments and growth plates and was also prominent in a network of convoluted hairpin loop-type vessels at the presumptive articulating surfaces of joints. Perlecan was also present in small perichondrial venules and arterioles along the shaft of the developing long bones, small blood vessels in the synovial lining and joint capsules, and in distinctive arrangements of cartilage canals in the knee, elbow, shoulder, and hip joint rudiments. Perlecan was notably absent from CD-31-positive metaphyseal vessels in the hip, knee, shoulder, and fingers. These vessels may have a role in the nutrition of the expanding cell populations in these developing joint tissues and in the establishment of the secondary centers of ossification in the long bones, which is essential for endochondral ossification.     

Arthroscopy.

Arthroscopy has reduced the morbidity and period of hospitalisation associated with orthopaedic surgery and has increased the range of procedures that may be performed. From early operations on the knee it has expanded to include procedures for the shoulder, elbow, wrist, hip, ankle, and foot. For some joints the indications for surgery are clear, for others the clinical advantages are still being assessed. This expansion has also led to the recognition of complications, though the incidence is low. Specialist instrumentation has allowed a wide variety of operations previously needing open surgery to be carried out arthroscopically. The repertoire of arthroscopic procedures will undoubtedly continue to expand, and controlled studies are required to validate their efficacy, particularly in the management of degenerative joint diseases.     

Age structure and selected pathological aspects of a series of skeletons of late medieval Bernau (Brandenburg,Germany)

The age distribution of an excavation site from the late Middle Ages (beginning of the 13th century until 1598) in Bernau (Brandenburg, Germany) that contained 252 skeletons shows a mortality maximum at the age classes infants I and mature. The lowest mortality was calculated for the adult age class. 51.6% of the individuals died before the age of 20 years. The mortality rate of young women was higher than that of young men. The life expectancy of the total population was 25 years. Altogether, 87 adult skeletons were examined for degenerative joint diseases. Many of the examined joints showed indications of beginning osteoarthritis; the intensity of the disease was low or medium severe. The highest values were found for the hip joint, followed by the elbow and the knee. For all joints examined, women were less often and to a lesser extent affected than men, which was noticeable best in the upper extremity. Harris lines were found in 75% of the children, 4.7 per average individual. No such lines were found by the age of one year, the peak value of the frequency being recorded at the age between 2 and 3 years. This can be correlated to the weaning period. The comparison to a rural population yielded a higher load with Harris lines in the small village, which, however, was not correlated to a higher mortality. Altogether, the population of Bernau is characterised by good living conditions and a considerable chance of survival for the children, as well as by a labour system, dominated by crafts and farming.     

Upper extremity kinematic and kinetic adaptations during a fatiguing repetitive task

Repetitive low-force contractions are common in the workplace and yet can lead to muscle fatigue and work-related musculoskeletal disorders. The current study aimed to investigate potential motion adaptations during a simulated repetitive light assembly work task designed to fatigue the shoulder region, focusing on changes over time and age-related group differences. Ten younger and ten older participants performed four 20-min task sessions separated by short breaks. Mean and variability of joint angles and scapular elevation, joint net moments for the shoulder, elbow, and wrist were calculated from upper extremity kinematics recorded by a motion tracking system. Results showed that joint angle and joint torque decreased across sessions and across multiple joints and segments. Increased kinematic variability over time was observed in the shoulder joint; however, decreased kinematic variability over time was seen in the more distal part of the upper limb. The changes of motion adaptations were sensitive to the task-break schedule. The results suggested that kinematic and kinetic adaptations occurred to reduce the biomechanical loading on the fatigued shoulder region. In addition, the kinematic and kinetic responses at the elbow and wrist joints also changed, possibly to compensate for the increased variability caused by the shoulder joint while still maintaining task requirements. These motion strategies in responses to muscle fatigue were similar between two age groups although the older group showed more effort in adaptation than the younger in terms of magnitude and affected body parts.     

Periarticular Osteophytes as an Appendicular Joint Stress Marker (JSM): Analysis in a Contemporary Japanese Skeletal Collection

Objective

The aim of this study was to investigate the possibility that periarticular osteophytes plays a role as a appendicular joint stress marker (JSM) which reflects the biomechanical stresses on individuals and populations.

Methods

A total of 366 contemporary Japanese skeletons (231 males, 135 females) were examined closely to evaluate the periarticular osteophytes of six major joints, the shoulder, elbow, wrist, hip, knee, and ankle and osteophyte scores (OS) were determined using an original grading system. These scores were aggregated and analyzed statistically from some viewpoints.

Results

All of the OS for the respective joints were correlated logarithmically with the age-at-death of the individuals. For 70 individuals, in whom both sides of all six joints were evaluated without missing values, the age-standardized OS were calculated. A right side dominancy was recognized in the joints of the upper extremities, shoulder and wrist joints, and the bilateral correlations were large in the three joints on the lower extremity. For the shoulder joint and the hip joint, it was inferred by some distinctions that systemic factors were relatively large. All of these six joints could be assorted by the extent of systemic and local factors on osteophytes formation. Moreover, when the age-standardized OS of all the joints was summed up, some individuals had significantly high total scores, and others had significantly low total scores; namely, all of the individuals varied greatly in their systemic predisposition for osteophytes formation.

Conclusions

This study demonstrated the significance of periarticular osteophytes; the evaluating system for OS could be used to detect differences among joints and individuals. Periarticular osteophytes could be applied as an appendicular joint stress marker (JSM); by applying OS evaluating system for skeletal populations, intra-skeletal and inter-skeletal variations in biomechanical stresses throughout the lives could be clarified.     

Gait and neuromuscular pattern changes are associated with differences in knee osteoarthritis severity levels

Knee osteoarthritis (OA) is a multifactoral, progressive disease process of the musculoskeletal system. Mechanical factors have been implicated in the progression of knee OA, but the role of altered joint mechanics and neuromuscular control strategies in progressive mechanisms of the disease have not been fully explored. Previous biomechanical studies of knee OA have characterized changes in joint kinematics and kinetics with the disease, but it has been difficult to determine if these biomechanical changes are involved in the development of disease, are in response to degenerative changes in the joint, or are compensatory mechanisms in response to these degenerative changes or other related factors as joint pain. The goal of this study was to explore the association between biomechanical changes and knee OA severity in an effort to understand the changing role of biomechanical factors in the progression of knee OA. A three-group cross-sectional model was used that included asymptomatic subjects, subjects clinically diagnosed with moderate knee OA and severe knee OA subjects just prior to total joint replacement surgery. Principal component analysis and discriminant analysis were used to determine the combinations of electromyography, kinematic and kinetic waveform pattern changes at the knee, hip and ankle joints during gait that optimally separated the three levels of severity. Different biomechanical mechanisms were important in discriminating between severity levels. Changes in knee and hip kinetic patterns and rectus femoris activation were important in separating the asymptomatic and moderate OA gait patterns. In contrast, changes in knee kinematics, hip and ankle kinetics and medial gastrocnemius activity were important in discriminating between the moderate and severe OA gait patterns.     

Peripheral organ doses from radiotherapy for heterotopic ossification of non-hip joints: Is there a risk for radiation-induced malignancies?

Radiotherapy, used for heterotopic ossification (HO) management, may increase radiation risk to patients. This study aimed to determine the peripheral dose to radiosensitive organs and the associated cancer risks due to radiotherapy of HO in common non-hip joints. A Monte Carlo model of a medical linear accelerator combined with a mathematical phantom representing an average adult patient were employed to simulate radiotherapy for HO with standard AP and PA fields in the regions of shoulder, elbow and knee. Radiation dose to all out-of-field radiosensitive organs defined by the International Commission on Radiological Protection was calculated. Cancer induction risk was estimated using organ-specific risk coefficients. Organ dose change with increased field dimensions was also evaluated. Radiation therapy for HO with a 7 Gy target dose in the sites of shoulder, elbow and knee, resulted in the following equivalent organ dose ranges of 0.85–62 mSv, 0.28–1.6 mSv and 0.04–1.6 mSv, respectively. Respective ranges for cancer risk were 0–5.1, 0–0.6 and 0–1.3 cases per 10⁴ persons. Increasing the field size caused an average increase of peripheral doses by 15–20%. Individual organ dose increase depends upon the primary treatment site and the distance between organ of interest and treatment volume. Relatively increased risks of more than 1 case per 10,000 patients were found for skin, breast and thyroid malignancies after treatment in the region of shoulder and for skin cancer following elbow irradiation. The estimated risk for inducing any other malignant disease ranges from negligible to low.     

Spondylolysis and its relationship to degenerative joint disease in the prehistoric southeastern United States

Spondylolysis, a fatigue fracture in the neural arch of lumbar vertebrae, is common in Eskimos and some athletes. In Archaic Indians from northwestern Alabama, 17% of males and 20% of females with complete lumbar regions showed this defect. It is found at a fairly early age in adult males in this group, but in females it does not appear until after age 40 years. Spondylolysis is associated with higher levels of osteoarthritis around the fifth lumbar vertebra, where this defect typically occurs. Otherwise, there is little relationship between its presence and degenerative joint disease, especially in the weight-bearing joints. The incidence in young males may be related to activities necessitating a high level of mobility around the lumbar spine. The late occurrence in females suggests that osteoporosis may have been a contributing factor.     

Similarities in the Neural Control of the Shoulder and Elbow Joints Belie Their Structural Differences

Movement of the hand in three dimensional space is primarily controlled by the orientation of the shoulder and elbow complexes. Due to discrepancies in proprioceptive acuity, overlap in motor cortex representation and grossly different anatomies between these joints, we hypothesized that there would be differences in the accuracy of aimed movements between the two joints. Fifteen healthy young adults were tested under four conditions – shoulder motion with the elbow constrained and unconstrained, and elbow motion with the shoulder constrained and unconstrained. End point target locations for each joint were set to coincide with joint excursions of 10, 20 or 30 degrees of either the shoulder or elbow joint. Targets were presented in a virtual reality environment. For the constrained condition, there were no significant differences in angular errors between the two joints, suggesting that the central nervous system represents linked segment models of the limb in planning and controlling movements. For the unconstrained condition, although angle errors were higher, hand position errors remained the same as those of the constrained trials. These results support the idea that the CNS utilizes abundant degrees of freedom to compensate for the potentially different contributions to end-point errors introduced by each joint.     

Aging in the musculoskeletal system of rhesus monkeys: I. Passive joint excursion

In order to describe ontogenetic change in the musculoskeletal system of rhesus monkeys, 126 Macaca mulatta from Cayo Santiago, ranging in age from 7 months to 21 years, were examined under anesthesia. Passive joint excursions were measured at the wrist, elbow, shoulder, hip, and knee. Mean ranges of excursion at these joints differed significantly between age groups and by sex. The potential for most movements appeared to decrease approximately 25 degrees over the first two decades of the macaque life span, and males generally showed less potential for movement than females in all age groups. These results are similar to those obtained for humans and are consistent with patterns of positional behavior, trauma, and osteoarthritis observed in this rhesus monkey population. Thus, to fully describe the locomotor strategy of rhesus monkeys, age- and sex-related variation in locomotor anatomy and functional capacity must be considered.     

Kinematic Analysis of the Neck and Upper Extremities During Walking in Healthy Young Adults

The objective of this paper is to quantify the local stabilities of the neck and upper extremities (right/left shoulders and right/left elbows), and investigate differences between linear and nonlinear measurements of the associated joint motions and differences in the local stability between the upper and lower extremities. This attempt involves the calculation of a nonlinear parameter, Lyapunov Exponent (LE), and a linear parameter, Range of Motion (ROM), during treadmill walking in conjunction with a large population of healthy subjects. Joint motions of subjects were captured using a three-dimensional motion-capture system. Then mathematical chaos theory and the Rosenstein algorithm were employed to calculate LE of joints as the extent of logarithmic divergence between the neighboring state-space trajectories of flexion-extension angles. LEs computed over twenty males and twenty females were 0.037±0.023 for the neck, 0.043±0.021 for the right shoulder, 0.045±0.030 for the left shoulder, 0.032±0.021 for the right elbow, and 0.034±0.026 for the left elbow. Although statistically significant difference in the ROM was observed between all pairs of the neck and upper extremity joints, differences in the LE between all pairs of the joints as well as between males and females were not statistically significant. Between the upper and lower extremities, LEs of the neck, shoulder, and elbow were significantly smaller than those of the hip (∼0.064) and the knee (∼0.062). These results indicate that a statistical difference in the local stability between the upper extremity joints is not significant. However, the different result between the ROM and LE gives a strong rationale for applying both linear and nonlinear tools together to the evaluation of joint movement. The LEs of the joints calculated from a large population of healthy subjects could provide normative values for the associated joints and can be used to evaluate the recovery progress of patients with joint related diseases.     

Peculiarities of Activation of Muscles of the Shoulder Belt in Voluntary Two-Joint Movements of the Upper Limb

We studied coordination of central motor commands (СMCs) coming to muscles of the shoulder and shoulder belt in the course of single-joint and two-joint movements including flexion and extension of the elbow and shoulder joints. Characteristics of rectified and averaged EMGs recorded from a few muscles of the upper limb were considered correlates of the CMC parameters. Special attention was paid to coordination of CMCs coming to two-joint muscles that are able to function as common flexors (m. biceps brachii, caput breve, BBcb) and common extensors (m. triceps brachii, caput longum, TBcl) of the elbow and shoulder joints. Upper limb movements used in the tests included planar shifts of the arm from one spatial point to another resulting from either simultaneous changes in the angles of the shoulder and elbow joints or isolated sequential (two-stage) changes in these joint angles. As was found, shoulder muscles providing movements of the elbow with changes in the angle of the elbow joint, i.e., BBcb and TBcl, were also intensely involved in the performance of single-joint movements in the shoulder joint. The CMCs coming to two-joint muscles in the course of two-joint movements appeared, in the first approximation, as sums of the commands received by these muscles in the course of corresponding single-joint movements in the elbow and shoulder joints. Therefore, if we interpret the isolated forearm movement performed due to a change in the angle of the elbow joint as the main motor event, while the shoulder movement is considered the accessory one, we can conclude that realization of a two-joint movement of the upper-limb distal part is based on superposition of CMCs related to basic movements (main and accessory). Neirofiziologiya/Neurophysiology, Vol. 41, No. 1, pp. 48–56, January–February, 2009.     

Distinct horizontal patterns in the spatial organization of superficial zone chondrocytes of human joints

A better understanding of the unique cellular and functional properties of the superficial zone of articular cartilage may aid current strategies in tissue engineering which attempts a layered design for the repair of cartilage lesions to avert or postpone the onset of osteoarthritis. However, data pertaining to the cellular organization of non-degenerated superficial zone of articular cartilage is not available for most human joints. The present study analyzed the arrangement of chondrocytes of non-degenerated human joints (shoulder, elbow, knee, and ankle) by using fluorescence microscopy of the superficial zone in a top-down view. The resulting horizontal chondrocyte arrangements were tested for randomness, homogeneity or a significant grouping via point pattern analysis and were correlated with the joint type in which they occurred. The present study demonstrated that human superficial chondrocytes occurred in four distinct patterns of strings, clusters, pairs or single chondrocytes. Those patterns represented a significant grouping (p < 0.0001) with horizontal alignment. Each articular joint surface was dominated by only one of these four patterns (p < 0.001). Specific patterns correlated with specific diarthrodial joint types (p < 0.001). Further studies need to establish whether these organizational patterns are a consequence of their surrounding environment or whether they are linked to a functional purpose.