Suprascapular Nerve Entrapment Caused by Protrusion of an Intraosseous Ganglion of the Glenoid into the Spinoglenoid Notch: A Rare Cause of Posterior Shoulder Pain

We describe a case of suprascapular nerve entrapment caused by protrusion of an intraosseous ganglion of the glenoid into the spinoglenoid notch. A 47-year-old man with left shoulder pain developed an intraosseous cyst in the left glenoid, which came into contact with the suprascapular nerve. The area at which the patient experienced spontaneous shoulder pain was innervated by the suprascapular nerve, and 1% xylocaine injection into the spinoglenoid notch under ultrasonographic guidance relieved the pain. Therefore, we concluded that the protrusion of an intraosseous cyst of the glenoid into the spinoglenoid notch was a cause of the pain, and performed curettage. Consequently, the shoulder pain was resolved promptly without suprascapular nerve complications, and the cyst was histologically diagnosed as an intraosseous ganglion. This case demonstrated that the intraosseous ganglion of the glenoid was a benign lesion but could be a cause of suprascapular nerve entrapment syndrome. Curettage is a useful treatment option for a ganglion inside bone and very close to the suprascapular nerve

Multifocal Osteonecrosis Secondary to Chronic Alcohol Ingestion

Multifocal osteonecrosis is a relatively rare disorder with an estimated incidence of around 3% among patients diagnosed as having osteonecrosis. Multifocal osteonecrosis is caused by the several conditions including corticosteroid treatment, coagulation disorders, connective tissue disorders including systemic lupus erythematosus (SLE), inflammatory bowel disease, renal transplantation, and underlying malignancies. Alcohol abuse is one of the risk factors for osteonecrosis, and alcohol-induced osteonecrosis is 5% among all the osteonecrosis. Furthermore, the overall incidence of alcohol-induced multifocal osteonecrosis was approximately 6% among all the osteonecrosis induced by the alcohol. Therefore, here, we report an extremely rare case of alcohol-induced multifocal osteonecrosis involving three joints (two knees and one hip) and review the related literature

Strategies for increasing gait speed in patients with hip osteoarthritis: their clinical significance and effects on hip loading

BACKGROUND: Changes in gait speed are required in various situations and can be achieved by changing stride length, cadence, or both. Differences in strategies for increasing gait speed may have different effects on hip joint and physical function. The purpose of this study was to determine the effects of strategies for increasing gait speed on hip pain, physical function, and changes in hip loading during gait in patients with hip osteoarthritis (OA). We hypothesized that patients who increase gait speed mainly by increasing cadence would have lesser hip pain, a higher physical function, and a lower rate of increase in hip moments with increasing gait speed. METHODS: Forty-seven patients with secondary hip OA (age, 48.3 ± 11.0 years) were included. Gait speed, stride length, cadence, and peak and impulse of the hip moments were measured during gait at self-selected normal and fast gait speeds. The patients were classified as types S (with mainly increasing stride length, n = 11 [23.4%]), C (with mainly increasing cadence, n = 23 [48.9%]), and SC (with increasing stride length and cadence, n = 13 [27.7%]) according to whether they used changes in stride length and/or cadence to transition from normal to fast gait. Hip pain, physical function, and hip moment changes during gait were compared between types. RESULTS: The physical function was higher in types C (38.0 ± 8.8, P = 0.018) and SC (40.6 ± 8.5, P = 0.015) than in type S (28.2 ± 7.8), even after adjustment for age and minimum joint space width. Hip pain was not significantly different between types. The robustness of these results was confirmed with sensitivity analysis. The rates of increases in peak external hip adduction (P = 0.003) and internal rotation moments (P = 0.009) were lower in type C than in type SC. CONCLUSIONS: Type C tended to suppress the increase in hip moments during fast gait. Types C and SC, which included increased cadence, maintained higher physical function levels than type S. Encouraging the use of cadence-increasing strategy may be useful for reducing hip loading and maintaining physical function in patients with hip OA

Gait- and Posture-Related Factors Associated With Changes in Hip Pain and Physical Function in Patients With Secondary Hip Osteoarthritis: A Prospective Cohort Study

Objective: To identify gait- and posture-related factors associated with changes in hip pain and physical function in patients with hip osteoarthritis (OA). Design: Prospective cohort study. Setting: Clinical biomechanics laboratory of a university. Participants: Consecutive sampling of female patients with mild-to-moderate secondary hip OA (N=30). Main Outocome Measures: Hip pain (visual analog scale) and physical function (physical component summary of the Medical Outcomes Study 36-Item Short-Form Health Survey) were measured at baseline and 12 months later. With changes in hip pain and physical function as dependent variables, linear regression analyses were performed with gait- and posture-related factors as independent variables with and without adjustment for age, joint space width, and hip pain or physical function at baseline. Posture-related factors included angles of thoracic kyphosis, lumbar lordosis, sacral inclination, spinal inclination, and spinal mobility. Gait-related factors were walking speed, steps per day, joint angles, external hip joint moment impulses, and daily cumulative hip moments. Results: Multiple linear regression analyses showed that limited hip extension (adjusted standardized B coefficient [95% confidence interval]: −0.52 [−0.88 to −0.17]) and limited external rotation angles (−0.51 [−0.85 to −0.18]) during walking were associated with the worsening of hip pain. An increased thoracic kyphosis (−0.54 [−0.99 to −0.09]), less sacral anterior tilt (0.40 [0.01-0.79]), reduced thoracic spine mobility (0.59 [0.23-0.94]), less steps per day (0.53 [0.13-0.92]), and a slower walking speed (0.45 [0.04-0.86]) were associated with deterioration in physical function. Conclusions: Gait- and posture-related factors should be considered when assessing risk and designing preventive interventions for the clinical progression of secondary hip OA

Comparison between alkali heat treatment and sprayed hydroxyapatite coating on thermally-sprayed rough Ti surface in rabbit model: Effects on bone-bonding ability and osteoconductivity.

In this study, we investigated the effect of different surface treatments (hydroxyapatite (HA) coating, alkali heat treatment, and no treatment) on the ability of bone to bond to a rough arc-sprayed Ti metal surface, using rabbit models. The bone-to-implant contacts for untreated, HA-coated, and alkali heat-treated implants were 21.2%, 72.1%, and 33.8% at 4 weeks, 21.8%, 70.9%, and 30.0% at 8 weeks, and 16.3%, 70.2%, and 29.9% at 16 weeks, respectively (n = 8). HA -coated implants showed significantly higher bone-to-implant contacts than the untreated and alkali heat-treated implants at all the time point, whereas alkali heat-treated implants showed significantly higher bone-to-implant contacts than untreated implants at 4 and 16 weeks. The failure loads in a mechanical test for untreated, HA coated, alkali heat-treated plates were 65.4 N, 70.7 N, and 90.8 N at 4 weeks, 76.1 N, 64.7 N, and 104.8 N at 8 weeks and 88.7 N, 92.6 N, and 118.5 N at 16 weeks, respectively (n = 8). The alkali heat-treated plates showed significantly higher failure loads than HA-coated plates at 8 and 16 weeks. The difference between HA-coated plates and untreated plates were not statistically significant at any time point. Thus HA coating, although it enables high bone-to-implant contact, may not enhance the bone-bonding properties of thermally-sprayed rough Ti metal surfaces. In contrast, alkali heat treatment can be successfully applied to thermally-sprayed Ti metal to enhance both bone-to-implant contact and bone-bonding strength

Transient development of ovotestes in XX Sox9 transgenic mice

AbstractThe sex of an individual results from the paternal transmission of the SRY gene located on the Y chromosome. In turn, SRY initiates Sox9 expression, a transcription factor required for testicular differentiation. Ectopic activation of SOX9 in XX Wt1:Sox9 transgenic mice induces female-to-male sex reversal in adult mice. Here we show that complete sex reversal is preceded by a transient phase of ovotestis differentiation with XX Wt1:Sox9 transgenic gonads containing a testicular central region and one or both ovarian poles indicating that Wt1:Sox9 is not as efficient as Sry to induce male development. In XX Wt1:Sox9Tg/+ gonads, transgenic Sox9 is expressed earlier than Sox9 in XY gonads and is able to induce the expression of EGFP, knocked into the 3′ UTR of Sox9 indicating that SOX9 is involved in the initiation and maintenance of its own expression. However, the delayed onset of expression of endogenous Sox9–EGFP suggests that this activation requires other factors, whose expression depends on SOX9. In the testicular regions of the XX Wt1:Sox9 ovotestes, proliferation of the XX fetal germ cells is hampered and they differentiate as pro-spermatogonia. This indicates that XX germ cells are not competent to respond to proliferative signals released from a testicular environment. In the ovarian regions, despite the continuous mRNA expression of the WT1:Sox9 transgene, the SOX9 protein does not accumulate suggesting that regulation of this gene in ovarian cells involves post-transcriptional mechanisms. Finally, ovarian cells of the XX Wt1:Sox9 ovotestis undergo apoptosis during late embryogenesis leading to complete female-to-male sex reversal of the transgenic mice at birth

Immature articular cartilage and subchondral bone covered by menisci are potentially susceptive to mechanical load

BACKGROUND: The differences of mechanical and histological properties between cartilage covered by menisci and uncovered by menisci may contribute to the osteoarthritis after meniscectomy and these differences are not fully understood. The purpose of this study is to investigate potential differences in the mechanical and histological properties, and in particular the collagen architecture, of the superficial cartilage layer and subchondral bone between regions covered and uncovered by menisci using immature knee. METHODS: Osteochondral plugs were obtained from porcine tibial cartilage that was either covered or uncovered by menisci. Investigation of the thickness, mechanical properties, histology, and water content of the cartilage as well as micro-computed tomography analysis of the subchondral bone was performed to compare these regions. Collagen architecture was also assessed by using scanning electron microscopy. RESULTS: Compared to the cartilage uncovered by menisci, that covered by menisci was thinner and showed a higher deformity to compression loading and higher water content. In the superficial layer of cartilage in the uncovered regions, collagen fibers showed high density, whereas they showed low density in covered regions. Furthermore, subchondral bone architecture varied between the 2 regions, and showed low bone density in covered regions. CONCLUSIONS: Cartilage covered by menisci differed from that uncovered in both its mechanical and histological properties, especially with regards to the density of the superficial collagen layer. These regional differences may be related to local mechanical environment in normal condition and indicate that cartilage covered by menisci is tightly guarded by menisci from extreme mechanical loading. Our results indicate that immature cartilage degeneration and subchondral microfracture may occur easily to extreme direct mechanical loading in covered region after meniscectomy

Contributions of biarticular myogenic components to the limitation of the range of motion after immobilization of rat knee joint

BACKGROUND: Muscle atrophy caused by immobilization in the shortened position is characterized by a decrease in the size or cross-sectional area (CSA) of myofibers and decreased muscle length. Few studies have addressed the relationship between limitation of the range of motion (ROM) and the changes in CSA specifically in biarticular muscles after atrophy because of immobilization. We aimed to determine the contribution of 2 distinct muscle groups, the biarticular muscles of the post thigh (PT) and those of the post leg (PL), to the limitation of ROM as well as changes in the myofiber CSAs after joint immobilization surgery. METHODS: Male Wistar rats (n = 40) were randomly divided into experimental and control groups. In the experimental group, the left knee was surgically immobilized by external fixation for 1, 2, 4, 8, or 16 weeks (n = 5 each) and sham surgery was performed on the right knee. The rats in the control groups (n = 3 per time point) did not undergo surgery. After the indicated immobilization periods, myotomy of the PT or PL biarticular muscles was performed and the ROM was measured. The hamstrings and gastrocnemius muscles from the animals operated for 1 or 16 weeks were subjected to morphological analysis. RESULTS: In immobilized knees, the relative contribution of the PT biarticular myogenic components to the total restriction reached 80% throughout the first 4 weeks and decreased thereafter. The relative contribution of the PL biarticular myogenic components remained <20% throughout the immobilization period. The ratio of the myofiber CSA of the immobilized to that of the sham-operated knees was significantly lower at 16 weeks after surgery than at 1 week after surgery only in the hamstrings. CONCLUSIONS: The relative contribution of the PT and PL components to myogenic contracture did not significantly change during the experimental period. However, the ratio of hamstrings CSAs to the sham side was larger than the ratio of medial gastrocnemius CSAs to the sham side after complete atrophy because of immobilization

Sagittal alignment and mobility of the thoracolumbar spine are associated with radiographic progression of secondary hip osteoarthritis

姿勢の悪化と脊柱の柔軟性低下が変形性股関節症の進行に影響. 京都大学プレスリリース. 2017-12-26.Objective: To identify predictors of radiographic progression of hip osteoarthritis (OA) over 12 months among functional hip impairments and spinal alignment and mobility. Design: Fifty female patients with secondary hip OA, excluding those with end-stage hip OA, participated in this prospective cohort study. Joint space width (JSW) of the hip was measured at baseline and 12 months later. With radiographic progression of hip OA over 12 months (>0.5 mm in JSW) as dependent variable, logistic regression analyses were performed to identify predictors for hip OA progression among functional impairments of the hip and spine with and without adjustment for age, body mass index (BMI), and minimum JSW at baseline. The independent variables were hip pain, Harris hip score, hip morphological parameters, hip passive range of motion and muscle strength, and alignment and mobility of the thoracolumbar spine at baseline. Results: Twenty-one (42.0%) patients demonstrated radiographic progression of hip OA. Multivariable logistic regression analysis showed that larger anterior inclination of the spine in standing position (adjusted OR [95% CI], 1.37 [1.04–1.80]; P = 0.028) and less thoracolumbar spine mobility (adjusted OR [95% CI], 0.96 [0.92–0.99]; P = 0.037) at baseline were statistically significantly associated with radiographic progression of hip OA, even after adjustment for age, BMI, and minimum JSW. Conclusions: The findings suggest that spinal alignment and mobility should be considered when assessing risk and designing preventive intervention for radiographic progression of secondary hip OA