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Sample records for facet joint syndrome

  1. [Lumbosacral facet syndrome: functional and organic disorders of lumbosacral facet joints].

    PubMed

    Grgić, Vjekoslav

    2011-01-01

    Disorders of lumbosacral (LS) facet joints are manifested by low back pain with or without referred leg pain and decreased mobility of the LS spine (LS facet syndrome). The most frequent causes of LS facet syndrome are functional disorders (functional blockade or dysfunction of facet joint=reversible restriction of facet joint movements caused by meniscoid entrapment) and degenerative changes of facet joints while the others are less frequent (spondyloarthropathies, infection, tuberculosis, synovial cyst, injury). Although it has been proven that the facet joints are one of the most frequent sources of chronic low back pain (15-45%), the fact is that the facet syndrome has been frequently overlooked in patients with chronic low back pain. Following are the main reasons for explaining why the facet syndrome has been overlooked in patients with chronic low back pain: 1. Facet joints disorders are manifested by non-specific clinical picture, 2.Diagnosis of facet syndrome cannot be established by either the conventional clinical examination or radiological examinations, 3. A very small number of doctors are practicing manual functional examination which can establish the diagnosis of facet joint dysfunction and 4. Diagnostic anesthetic block which can confirm the facet syndrome diagnosis is not a widely accessible method. There is a lack of research in frequency of facet syndrome in patients with acute low back pain. Chronic mechanical low back pain caused by dysfunction of several structurally unchanged facet joints can have the same features as the inflammatory pain which can result in misdiagnosis of spondyloarthropathy. Acute LS facet syndrome caused by dysfunction of facet joints responds very well to manual therapy. The most important therapeutic options in patients with chronic LS facet syndrome caused by degenerative changes and/or dysfunction of facet joints are manual therapy, kinesiotherapy (flexion exercises), therapeutic blocks and radiofrequency

  2. Image-guided facet joint injection

    PubMed Central

    Peh, WCG

    2011-01-01

    Chronic spine pain poses a peculiar diagnostic and therapeutic challenge due to multiple pain sources, overlapping clinical features and nonspecific radiological findings. Facet joint injection is an interventional pain management tool for facet-related spinal pain that can be effectively administered by a radiologist. This technique is the gold standard for identifying facet joints as the source of spinal pain. The major indications for facet injections include strong clinical suspicion of the facet syndrome, focal tenderness over the facet joints, low back pain with normal radiological findings, post-laminectomy syndrome with no evidence of arachnoiditis or recurrent disc disease, and persistent low back pain after spinal fusion. The contraindications are more ancillary, with none being absolute. Like any synovial joint degeneration, inflammation and injury can lead to pain on motion, initiating a vicious cycle of physical deconditioning, irritation of facet innervations and muscle spasm. Image-guided injection of local anesthetic and steroid into or around the facet joint aims to break this vicious cycle and thereby provide pain relief. This outpatient procedure has high diagnostic accuracy, safety and reproducibility but the therapeutic outcome is variable. PMID:21655113

  3. An investigation on the effect of improved X-rays-guided radiofrequency thermocoagulation denervation on lumbar facet joint syndrome.

    PubMed

    Zhou, Qin; Zhou, Fang; Wang, Long; Liu, Kang

    2016-09-01

    This study aims to observe the clinical efficacy and feasibility of improved X-rays-guided radiofrequency thermocoagulation denervation for treating low back pain secondary to lumbar facet joint syndrome (LFJS). Eighty LFJS patients were randomly assigned into two groups: the denervation group (n=40), treated with percutaneous radiofrequency thermocoagulation denervation on the lumbar facet joint, and the control group (n=40), injected with betamethasone and lidocaine into the lumbar facet joint. All patients underwent pain scoring using the visual analogous scale (VAS) before treatment, and again at 30 min, 1 d, 1 week, 1 month, and 6 months after treatment. The Schober index was also evaluated at 1 week, 1 month, and 6 months after treatment. The efficacy and adverse effects were also recorded. The denervation group had significantly lower VAS scores at each time point than before treatment (P<0.01). The VAS scores in the control group at 30min, 1d, 1 week, and 1 month after treatment were also significantly lower, but they returned to the pre-treatment level at 6 months after treatment. The VAS scores in the denervation group were significantly lower than that in the control group at 1 month and at 6 months after treatment (P<0.05 and P<0.01), whereas the Schober index was significantly higher (P<0.01). Moreover, the excellent to good efficacy rate in the denervation group was higher than that in the control group (P<0.01). The patients in both treatments had no side effects. Improved X-rays-guided radiofrequency thermocoagulation denervation is an effective, minimally invasive and convenient method for treating low back pain secondary to lumbar facet syndrome. Copyright © 2016 Elsevier B.V. All rights reserved.

  4. Pain generation in lumbar and cervical facet joints.

    PubMed

    Cavanaugh, John M; Lu, Ying; Chen, Chaoyang; Kallakuri, Srinivasu

    2006-04-01

    Facet joints are implicated as a major source of neck and low-back pain. Both cervical and lumbar facet syndromes have been described in the medical literature. Biomechanical studies have shown that lumbar and cervical facet-joint capsules can undergo high strains during spine-loading. Neuroanatomic studies have demonstrated free and encapsulated nerve endings in facet joints as well as nerves containing substance P and calcitonin gene-related peptide. Neurophysiologic studies have shown that facet-joint capsules contain low-threshold mechanoreceptors, mechanically sensitive nociceptors, and silent nociceptors. Inflammation leads to decreased thresholds of nerve endings in facet capsules as well as elevated baseline discharge rates. Recent biomechanical studies suggest that rear-end motor-vehicle impacts give rise to excessive deformation of the capsules of lower cervical facet joints. Still unresolved is whether this stretch is sufficient to activate nociceptors in the joint capsule. To answer this question, recent studies indicate that low stretch levels activate proprioceptors in the facet-joint capsule. Excessive capsule stretch activates nociceptors, leads to prolonged neural afterdischarges, and can cause damage to the capsule and to axons in the capsule. In instances in which a whiplash event is severe enough to injure the joint capsule, facet capsule overstretch is a possible cause of persistent neck pain.

  5. Facet joint laser radiation: tissue effects of a new clinical laser application

    NASA Astrophysics Data System (ADS)

    Werkmann, Klaus; Thal, Dietmar R.

    1996-01-01

    Chronic unilateral and bilateral back pain with pseudoradicular symptoms, is a common clinical syndrome, which in many cases can be related to the facet joint syndrome. The pain is caused by mechanical affection of synovial and capsular nerve terminals. Therefore, current therapeutical attempts including physical therapy, intra-articular injection of local anesthetics and steroids and thermocoagulation of the facet joint with a thermocoagulator, are performed. We confirmed laser coagulation of the facet joint. Porcine cadaveric spines were treated immediately after death by intra-articular facet joint laser radiation. With the pulsed Nd:YAG laser (1064 nm) altogether 600 J were applied in three different places 4 mm apart at the top of the facet joint. The results showed that facet joint laser radiation leads to a small (about 1 - 2 mm diameter) lesion restricted to the facet joint cavity and its synovia. Histologically, we found a central carbonization zone and necrosis, including almost the whole cartilage and approximately 0.2 mm of the adjacent bone. These changes are similar to Nd:Yag-laser applications in other skeletal regions. It is suggested that these changes may lead to facet joint denervation by coagulation of the synovial nerve terminals. Cicatration of the laser lesion might cause ankylosis of this joint. In sum, facet joint laser radiation could be an alternative therapeutical tool for lower back pain of the facet joint syndrome type. Therefore, future clinical application of this technique seems to be very promising.

  6. Osteoarthritis of the spine: the facet joints.

    PubMed

    Gellhorn, Alfred C; Katz, Jeffrey N; Suri, Pradeep

    2013-04-01

    Osteoarthritis (OA) of the spine involves the facet joints, which are located in the posterior aspect of the vertebral column and, in humans, are the only true synovial joints between adjacent spinal levels. Facet joint osteoarthritis (FJ OA) is widely prevalent in older adults, and is thought to be a common cause of back and neck pain. The prevalence of facet-mediated pain in clinical populations increases with increasing age, suggesting that FJ OA might have a particularly important role in older adults with spinal pain. Nevertheless, to date FJ OA has received far less study than other important OA phenotypes such as knee OA, and other features of spine pathoanatomy such as degenerative disc disease. This Review presents the current state of knowledge of FJ OA, including relevant anatomy, biomechanics, epidemiology, and clinical manifestations. We present the view that the modern concept of FJ OA is consonant with the concept of OA as a failure of the whole joint, and not simply of facet joint cartilage.

  7. Osteoarthritis of the spine: the facet joints

    PubMed Central

    Gellhorn, Alfred C.; Katz, Jeffrey N.; Suri, Pradeep

    2014-01-01

    Osteoarthritis (OA) of the spine involves the facet joints, which are located in the posterior aspect of the vertebral column and, in humans, are the only true synovial joints between adjacent spinal levels. Facet joint osteoarthritis (FJ OA) is widely prevalent in older adults, and is thought to be a common cause of back and neck pain. The prevalence of facet-mediated pain in clinical populations increases with increasing age, suggesting that FJ OA might have a particularly important role in older adults with spinal pain. Nevertheless, to date FJ OA has received far less study than other important OA phenotypes such as knee OA, and other features of spine pathoanatomy such as degenerative disc disease. This Review presents the current state of knowledge of FJ OA, including relevant anatomy, biomechanics, epidemiology, and clinical manifestations. We present the view that the modern concept of FJ OA is consonant with the concept of OA as a failure of the whole joint, and not simply of facet joint cartilage. PMID:23147891

  8. [Interventions on facet joints. Techniques of facet joint injection, medial branch block and radiofrequency ablation].

    PubMed

    Artner, J; Klessinger, S

    2015-10-01

    Fluoroscopy-guided interventions on facet joints have been used for decades for the symptomatic management of pain in spinal disorders. A large number of imaging techniques are used to achieve a precise and safe needle placement in interventional procedures. Pulsed fluoroscopy is one of the most widely used and well-accepted tools for these procedures. This article presents a technical overview of commonly used fluoroscopy-guided interventions on the facet joints of the cervical and lumbar spine, such as facet joint injection, blockade of the medial nerve branches and radiofrequency ablation.

  9. Management of lumbar zygapophysial (facet) joint pain

    PubMed Central

    Manchikanti, Laxmaiah; Hirsch, Joshua A; Falco, Frank JE; Boswell, Mark V

    2016-01-01

    AIM: To investigate the diagnostic validity and therapeutic value of lumbar facet joint interventions in managing chronic low back pain. METHODS: The review process applied systematic evidence-based assessment methodology of controlled trials of diagnostic validity and randomized controlled trials of therapeutic efficacy. Inclusion criteria encompassed all facet joint interventions performed in a controlled fashion. The pain relief of greater than 50% was the outcome measure for diagnostic accuracy assessment of the controlled studies with ability to perform previously painful movements, whereas, for randomized controlled therapeutic efficacy studies, the primary outcome was significant pain relief and the secondary outcome was a positive change in functional status. For the inclusion of the diagnostic controlled studies, all studies must have utilized either placebo controlled facet joint blocks or comparative local anesthetic blocks. In assessing therapeutic interventions, short-term and long-term reliefs were defined as either up to 6 mo or greater than 6 mo of relief. The literature search was extensive utilizing various types of electronic search media including PubMed from 1966 onwards, Cochrane library, National Guideline Clearinghouse, clinicaltrials.gov, along with other sources including previous systematic reviews, non-indexed journals, and abstracts until March 2015. Each manuscript included in the assessment was assessed for methodologic quality or risk of bias assessment utilizing the Quality Appraisal of Reliability Studies checklist for diagnostic interventions, and Cochrane review criteria and the Interventional Pain Management Techniques - Quality Appraisal of Reliability and Risk of Bias Assessment tool for therapeutic interventions. Evidence based on the review of the systematic assessment of controlled studies was graded utilizing a modified schema of qualitative evidence with best evidence synthesis, variable from level I to level V

  10. Three-dimensional evaluation of the facet joints

    NASA Astrophysics Data System (ADS)

    Folio, Les R.

    1990-04-01

    Computerized tomography and magnetic resonance imaging nave revolurionalized analysis of vertebral anatomy and pathology. Further advances with 3-dimensional imaging have recently become an important adjunct for diagnosis and treatment in structural abnormalities. Facets are intimately related to their surrounding musculature and malalignment may cause pain directly or indirectly. High resolution 3-dimensional reformations of CT Scans give us new insight on structure and function of facet joints, since their motion and architecture are ever complex. It is well documented in the literature that facet joint biomecnanics is a partial contributor to the myriad at causes of low back The term "facet Joint syndrome" was coined in 1933 by GhorMley.3 The osteopathic lesion complex is well defined by LeRoy and McCole and comparison of roentgenographic findings before and after manipulation has teen described by Long and Lioyd.4,5 since alterations in facet biamechanics are an important aspect of osteopathic manipulative therapy (OT), 3-dimensional hign resolution imaging will prove to be a great asset in osteopathic research. Rotating the spine allows for different viewing perspectives to provide optimal and consistent measurements of the facet joint. Rotations are performed on the X, Y and 7, axis and measurements pre and post-manipulation are performed and compared on matching axis and perspectives. Rotation about the X, Y and Z axis help appreciate the 3-dimensionality of the vertebral column to project to the viewer a feeling that the spine is floating in space before them. This does give the viewer a 3-D understanding of the object however, only at a perspective at a Lime.

  11. Relationship between facet tropism and facet joint degeneration in the sub-axial cervical spine.

    PubMed

    Rong, Xin; Liu, Ziyang; Wang, Beiyu; Pan, Xuelin; Liu, Hao

    2017-02-20

    Facet tropism is the angular asymmetry between the left and right facet joint orientation. Although debatable, facet tropism was suggested to be associated with disc degeneration, facet degeneration and degenerative spondylolisthesis in the lumbar spine. The purpose of this study was to explore the relationship between facet tropism and facet degeneration in the sub-axial cervical spine. A total of 200 patients with cervical spondylosis were retrospectively analyzed. Facet degeneration was categorized into 4 grade: grade I, normal; grade II, degenerative changes including joint space narrowing, cyst formation, small osteophytes (<3 mm) without joint hypertrophy; grade III, joint hypertrophy secondary to large osteophytes (>3 mm) without fusion of the joint; grade IV, bony fusion of the facet joints. Facet orientations and facet tropisms with respect to the transverse, sagittal and coronal plane were calculated from the reconstructed cervical spine, which was based on the axial CT scan images. The paired facet joints were then categorized into three types: symmetric, moderated tropism and severe tropism. Univariate and multivariate analysis were performed to evaluate the relationship between any demographic and anatomical factor and facet degeneration. The mean age of enrolled patients was 46.23 years old (ranging from 30 to 64 years old). There were 114 males and 86 females. The degrees of facet degeneration varied according to cervical levels and ages. Degenerated facet joints were most common at C2-C3 level and more common in patients above 50 years old. The facet orientations were also different from level to level. By univariate analysis, genders, ages, cervical levels, facet orientations and facet tropisms were all significantly different between the normal facets and degenerated facets. However, results from multivariate logistic regression suggested only age and facet tropism with respect to the sagittal plane were related to facet degeneration. Facet

  12. The effects of orientation of lumbar facet joints on the facet joint contact forces: an in vitro biomechanical study.

    PubMed

    Liu, Xiang; Huang, Zhiping; Zhou, Ruozhou; Zhu, Qingan; Ji, Wei; Long, Yaowu; Wang, Jixing

    2017-07-28

    A biomechanical human cadaveric study. The aim of this study was to measure L2-L3 facet joint contact forces in a flexibility test using thin film electroresistive sensors, and facet joint orientation on CT scan images, to examine the effects of orientation of lumbar facet joint on the facet joint contact forces. Biomechanically the bilateral facet joints play a critical role in maintaining stability of the lumbar spine by sharing load. The effect of orientation of lumbar facet joints on the contact forces remains unknown. Eight human cadaveric lumbar spine specimens (L2-L3) were tested by applying a pure moment of ± 7.5 Nm in 3 directions of loading(flexion-extension, lateral bending and axial rotation) with and without a follower preload of 300 N. The orientation of the lumbar facet joints at the L2-L3 was measured on axial CT scans. Bilateral facet contact forces were measured during flexibility tests using thin film electroresistive sensors (Tekscan 6900). The average total peak facet loads was 66 N in axial rotation, 27 N in extension and 20 N in lateral bending under a pure moment. Under a pure moment and with a follower preload of 300N, the average total peak facet loads was 53 N in axial rotation, 43 N in extension and 24 N in lateral bending. The facet joint forces were correlated positively and significantly with the orientation in all directions with and without a compressive follower preload (P < 0.05). In addition, the facet joint contact forces at neutral position with a follower preload were correlated positively with the orientation (rs = 0.759, P = 0.001). This study identified that the greater coronal orientation of lumbar facet joints are, the higher the facet joint contact forces are. 3.

  13. Facet joint disturbance induced by miniscrews in plated cervical laminoplasty

    PubMed Central

    Chen, Hua; Li, Huibo; Wang, Beiyu; Li, Tao; Gong, Quan; Song, Yueming; Liu, Hao

    2016-01-01

    Abstract A retrospective cohort study. Plated cervical laminoplasty is an increasingly common technique. A unique facet joint disturbance induced by lateral mass miniscrews penetrating articular surface was noticed. Facet joints are important to maintain cervical spine stability and kinetic balance. Whether this facet joint disturbance could affect clinical and radiologic results is still unknown. The objective of this study is to investigate the clinical and radiologic outcomes of patients with facet joints disturbance induced by miniscrews in plated cervical laminoplasty. A total of 105 patients who underwent cervical laminoplasty with miniplate fixation between May 2010 and February 2014 were comprised. Postoperative CT images were used to identify whether facet joints destroyed by miniscrews. According to facet joints destroyed number, all the patients were divided into: group A (none facet joint destroyed), group B (1–2 facet joints destroyed), and group C (≥3 facet joints destroyed). Clinical data (JOA, VAS, and NDI scores), radiologic data (anteroposterior diameter and Palov ratio), and complications (axial symptoms and C5 palsy) were evaluated and compared among the groups. There were 38, 40, and 27 patients in group A, B, and C, respectively. The overall facet joints destroyed rate was 30.7%. All groups gained significant JOA and NDI scores improvement postoperatively. The preoperative JOA, VAS, NDI scores, and postoperative JOA scores did not differ significantly among the groups. The group C recorded significant higher postoperative VAS scores than group A (P = 0.002) and B (P = 0.014) and had significant higher postoperative NDI scores than group A (P = 0.002). The pre- and postoperative radiologic data were not significant different among the groups. The group C had a significant higher axial symptoms incidence than group A (12/27 vs 8/38, P = 0.041). Facet joints disturbance caused by miniscrews in plated cervical laminoplasty may not influence

  14. Effect of facet joint injection versus systemic steroids in low back pain: a randomized controlled trial.

    PubMed

    Ribeiro, Luiza Helena; Furtado, Rita Nely Vilar; Konai, Monique Sayuri; Andreo, Ana Beatriz; Rosenfeld, Andre; Natour, Jamil

    2013-11-01

    Randomized clinical trial. To compare the effectiveness of facet joint injection versus systemic steroid in patients with a diagnosis of facet joint syndrome. The term facet joint syndrome has been used to define back pain originating from the facet joints. Treatment is mainly conservative, although interventions, including intra-articular injections and medial branch nerve blocks are used to manage facet-mediated pain. Several studies have evaluated the effectiveness of these interventions. Results of facet joint injection, however, are conflicting. Sixty subjects with a diagnosis of facet joint syndrome were enrolled in the study. They were randomized into experimental and control groups. The experimental group was administered with intra-articular injection of 6 lumbar facet joints with triamcinolone hexacetonide; the control group was administered with triamcinolone acetonide intramuscular injection of 6 lumbar paravertebral points. Visits were taken at baseline and at 1, 4, 12, and 24 weeks after interventions. Outcome measures were used: pain visual analogue scale, pain visual analogue scale during extension of the spine, Likert scale, improvement percentage scale, Roland-Morris, 36-Item Short Form Health Survey, and accountability of medications taken.Homogeneity was tested using the Student t, Pearson χ, and Mann-Whitney tests. Analysis of variance was used to analyze differences in the groups over time and the Student t test to analyze differences between groups at each time evaluation. The groups were similar at baseline. Comparisons between the groups showed, in analysis of variance analysis, an improvement in the experimental group regarding diclofenac intake and quality of life, in the "role physical" profile, assessed by 36-Item Short Form Health Survey.In the analysis at each time point, an improvement in the experimental group was also found in the Roland-Morris questionnaire, in the improvement percentage scale and in the response to treatment

  15. Characterization of degenerative human facet joints and facet joint capsular tissues

    PubMed Central

    Kim, Jae-Sung; Ali, Mir H.; Wydra, Frank; Li, Xin; Hamilton, John L.; An, Howard S.; Cs-Szabo, Gabriella; Andrews, Steven; Moric, Mario; Xiao, Guozhi; Wang, James H-C; Chen, Di; Cavanaugh, John M.; Im, Hee-Jeong

    2015-01-01

    SUMMARY Objective Lumbar facet joint degeneration (FJD) may be an important cause of low back pain (LBP) and sciatica. The goal of this study was to characterize cellular alterations of inflammatory factor expression and neovascularization in human degenerative facet joint capsular (FJC) tissue, defined as the fibrous connective tissue lined with synovium that surrounds the joint. The role of these alterations in FJC tissues in pain stimulation was also assessed. Design Lumbar facet joints (FJs) were obtained from consented patients undergoing spinal reconstruction surgery and cadaveric donors with no medical history of back pain. Histological analyses of the FJ were performed to assess general structure, cellular morphology, and proteoglycan content; immunohistochemistry was used to reveal inflammatory factors and neovascularization. Cytokine antibody array and quantitative real- time polymerase chain reaction (qPCR) were used to determine the production of multiple pro- and anti- inflammatory cytokines, and western blotting (WB) was used to assay for cartilage-degrading enzymes and pain mediators. Studies using ex vivo rat dorsal root ganglion (DRG) co-culture with human FJC tissues were also performed. Results Increased neovascularization, infiltration of inflammatory cells, and pain-related axonal-promoting factors were observed in degenerative FJC tissues surgically obtained from symptomatic subjects; this was not seen in normal donor tissues. Increased angiogenic factor, VEGF, axonal promoting factor (NGF/TrkA) and sensory neuronal distribution were also detected in degenerative FJC tissues from subjects with LBP. qPCR and WB results demonstrated highly upregulated inflammatory cytokines, pain mediators, and cartilage-degrading enzymes in degenerative FJCs compared to normal. The DRG and FJC tissue ex vivo co-culture results demonstrated that degenerative FJCs from subjects reporting severe LBP altered the functional properties of DRG sensory neurons, as

  16. Characterization of degenerative human facet joints and facet joint capsular tissues.

    PubMed

    Kim, J-S; Ali, M H; Wydra, F; Li, X; Hamilton, J L; An, H S; Cs-Szabo, G; Andrews, S; Moric, M; Xiao, G; Wang, J H-C; Chen, Di; Cavanaugh, J M; Im, H-J

    2015-12-01

    Lumbar facet joint degeneration (FJD) may be an important cause of low back pain (LBP) and sciatica. The goal of this study was to characterize cellular alterations of inflammatory factor expression and neovascularization in human degenerative facet joint capsular (FJC) tissue. These alterations in FJC tissues in pain stimulation were also assessed. FJs were obtained from consented patients undergoing spinal reconstruction surgery and cadaveric donors with no history of back pain. Histological analyses of the FJs were performed. Cytokine antibody array and quantitative real-time polymerase chain reaction (qPCR) were used to determine the production of inflammatory cytokines, and western blotting analyses (WB) were used to assay for cartilage-degrading enzymes and pain mediators. Ex vivo rat dorsal root ganglion (DRG) co-culture with human FJC tissues was also performed. Increased neovascularization, inflammatory cell infiltration, and pain-related axonal-promoting factors were observed in degenerative FJCs surgically obtained from symptomatic subjects. Increased VEGF, (NGF/TrkA), and sensory neuronal distribution were also detected in degenerative FJC tissues from subjects with LBP. qPCR and WB results demonstrated highly upregulated inflammatory cytokines, pain mediators, and cartilage-degrading enzymes in degenerative FJCs. Results from ex vivo co-culture of the DRG and FJC tissue demonstrated that degenerative FJCs increased the expression of inflammatory pain molecules in the sensory neurons. Degenerative FJCs possess greatly increased inflammatory and angiogenic features, suggesting that these factors play an important role in the progression of FJD and serve as a link between joint degeneration and neurological stimulation of afferent pain fibers. Copyright © 2015 Osteoarthritis Research Society International. Published by Elsevier Ltd. All rights reserved.

  17. Value of (18) F-FDG PET/MRI for the outcome of CT-guided facet block therapy in cervical facet syndrome: initial results.

    PubMed

    Sawicki, Lino M; Schaarschmidt, Benedikt M; Heusch, Philipp; Buchbender, Christian; Rosenbaum-Krumme, Sandra; Umutlu, Lale; Eicker, Sven O; Bockisch, Andreas; Antoch, Gerald; Floeth, Frank W

    2017-06-01

    The aim of this study was to evaluate the ability of (18) F-fluorodeoxyglucose positron emission tomography/magnetic resonance imaging ((18) F-FDG PET/MRI) to detect PET-positive cervical facet arthropathy and identify patients who benefit from facet block therapy. Ten patients with cervical facet syndrome (mean age: 65 ± 12 years) underwent (18) F-FDG PET/MRI of the neck. Focal (18) F-FDG uptake in PET-positive facet joints served as target for computed tomography (CT)-guided facet blocks. In PET-negative patients, the target joint for facet block therapy was selected by current clinical standards considering the level of maximum facet arthrosis and pain. Neck pain was measured on visual analogue scale (VAS) before and after therapy. Bone marrow signal intensity (SI) ratio on turbo inversion recovery magnitude (TIRM) images and maximum standard uptake values (SUVmax) was calculated for each facet joint. Pearson's correlation coefficient (r) was calculated between bone marrow SI ratios on TIRM and SUVmax. (18) F-FDG PET/MRI detected PET-positive facet arthropathy in six patients. Patients with PET-positive facet arthropathy had significantly less pain compared with the pretreatment pain 3 h (P = 0.002), 4 weeks (P = 0.002) and 3 months (P = 0.026) after facet block therapy. Pain did not change significantly in patients with PET-negative facet arthropathy. TIRM SI ratio was higher in PET-positive facet arthropathy than in PET-negative facet arthropathy (P < 0.001). Correlation was strong between bone marrow SI ratio on TIRM images and SUVmax (r = 0.7; P < 0.001). (18) F-FDG PET/MRI can detect PET-positive cervical facet arthropathy and help to identify patients benefitting from facet block therapy. Bone marrow TIRM SI ratio might be a surrogate for PET-positive facet arthropathy. © 2016 The Royal Australian and New Zealand College of Radiologists.

  18. Lumbar Facet Joint Motion in Patients with Degenerative Spondylolisthesis

    PubMed Central

    Yao, Qi; Wang, Shaobai; Shin, Jae-Hyuk; Li, Guoan; Wood, Kirkham B.

    2012-01-01

    Study Design Controlled laboratory study. Objective To investigate the in vivo biomechanical effect of degenerative lumbar spondylolisthesis (DLS) on the motion of the facet joint during various functional weight-bearing activities. Summary of Background Data Although the morphological changes of the facet joints in patients with DLS have been reported in a few studies, no data has been reported on the kinematics of these facet joints. Methods Ten patients with DLS at L4–L5 were studied. Each patient underwent a magnetic resonance imaging (MRI) scan to obtain three-dimensional (3D) models of the lumbar vertebrae from L2–L5 as well as a dual fluoroscopic imaging scan in different postures: flexion-extension, left-right bending and left-right torsion. The positions of the vertebrae were reproduced by matching the MRI-based vertebral models to the fluoroscopic images. The kinematics of the facet joint and the ranges of motion (ROMs) were compared with those of healthy subjects and those of patients with degenerative disc diseases (DDD) previously published. Results In DLS patients, the range of rotation of the facet joints was significantly less at the DLS level (L4–L5) than that at the adjacent levels (L2–L3 and L3–L4), while the range of translation was similar at all levels. The range of rotation at the facet joints of the DLS level decreased compared to those of both the DDD patients and healthy subjects at the corresponding vertebral level (L4–L5), while no significant difference was found in the range of translation. The ROM of facet joints in DLS and in DDD patients was similar at the adjacent levels (L2–L3 and L3–L4). Conclusion The range of rotation decreased at the facet joints at the DLS level (L4–L5) in patients compared to those in healthy subjects and DDD patients. This decrease in range of rotation implies that the DLS disease may cause restabilization of the joint. The data may help the selection of conservative treatment or different

  19. Augmented reality needle guidance improves facet joint injection training

    NASA Astrophysics Data System (ADS)

    Ungi, Tamas; Yeo, Caitlin T.; U-Thainual, Paweena; McGraw, Robert C.; Fichtinger, Gabor

    2011-03-01

    PURPOSE: The purpose of this study was to determine if medical trainees would benefit from augmented reality image overlay and laser guidance in learning how to set the correct orientation of a needle for percutaneous facet joint injection. METHODS: A total of 28 medical students were randomized into two groups: (1) The Overlay group received a training session of four insertions with image and laser guidance followed by two insertions with laser overlay only; (2) The Control group was trained by carrying out six freehand insertions. After the training session, needle trajectories of two facet joint injections without any guidance were recorded by an electromagnetic tracker and were analyzed. Number of successful needle placements, distance covered by needle tip inside the phantom and procedural time were measured to evaluate performance. RESULTS: Number of successful placements was significantly higher in the Overlay group compared to the Control group (85.7% vs. 57.1%, p = 0.038). Procedure time and distance covered inside phantom have both been found to be less in the Overlay group, although not significantly. CONCLUSION: Training with augmented reality image overlay and laser guidance improves the accuracy of facet joint injections in medical students learning image-guided facet joint needle placement.

  20. 1988 Volvo award in clinical sciences. Facet joint injection in low-back pain. A prospective statistical study.

    PubMed

    Jackson, R P; Jacobs, R R; Montesano, P X

    1988-09-01

    From January 1980 through December 1984, 454 patients were evaluated with facet joint injections. All had the chief complaint of low-back pain, normal neurologic examinations and no root tension signs. Three hundred and ninety completed the protocol, which included a lumbar motion pain assessment before and after facet injection. A total of 127 variables were studied. There were 229 males and 161 females with a median age of 38. Facet joint arthrograms were performed prior to intra-articular injection of local anesthetic and cortisone. Initial mean pain relief was only 29%. Variables correlating significantly (P less than 0.05) with more postinjection pain relief were older age, prior history of low-back pain, normal gait, maximum pain on extension following forward flexion in the standing position, and the absence of leg pain, muscle spasm and aggravation of pain on Valsalva. Greatest pain relief immediately after injection was seen with lumbar extension and rotation, motions reported to stress the facet joints or aggravate pain of facet joint origin. Patients with more pain on lumbar extension and rotation as a group, however, did not get more pain relief. From this study we were not able to identify clinical facet joint syndromes or predict patients responding better to this procedure. The facet joints were not commonly the single or primary source for low-back pain in the great majority (greater than 90%) of patients studied.

  1. MR findings of exaggerated fluid in facet joints predicts instability.

    PubMed

    Schinnerer, Kimberly A; Katz, Lee D; Grauer, Jonathan N

    2008-10-01

    Retrospective radiographic review. To determine the incidence of exaggerated fluid signal in lumbar facet joints on magnetic resonance imaging (MRI) and evaluate the correlation of this finding with radiographic evidence of instability. Lumbar spine MRI is routinely used to evaluate low back pain. The presence of exaggerated fluid in the facets joints on MRI has been correlated with dynamic instability. To our knowledge, this correlation has never been evaluated in an objective fashion. One hundred thirty-four consecutive lumbar MRIs obtained by a single surgeon were selected for review. Studies were evaluated for exaggerated fluid in the facets on axial views. Standing plain films of all patients were then evaluated to determine the incidence of spondylolisthesis for patients with and without exaggerated fluid in the facets on MRI. Of 134 consecutive MRIs, 118 were available for review. Sixteen had exaggerated fluid in the facets on axial images (13.6%). Only 2 of these 16 (12.5%) had spondylolisthesis appreciable on the MRI at that level. In contrast, 8 of the 16 (50.0%) had spondylolisthesis at the level of exaggerated fluid when the corresponding radiographs were reviewed. Thus, spondylolisthesis was suggested in 6 of 14 cases (42.9%) when the exaggerated fluid sign was present but spondylolisthesis was not evident on the supine MRI. In comparison, in the population without exaggerated fluid, only 1 in 102 (0.9%) showed a slip on plain film that was not observed on MRI. This difference was statistically significant (P<0.001). Exaggerated fluid in the facets seen on axial MRI is significantly suggestive of spondylolisthesis on standing films, even if this is not appreciated on the supine sagittal MRI sequences. This is the first time that the relative incidence of subtle instability with and without this finding has been evaluated to our knowledge.

  2. Facet joint pain--advances in patient selection and treatment.

    PubMed

    Cohen, Steven P; Huang, Julie H Y; Brummett, Chad

    2013-02-01

    Facetogenic pain, also known as zygapophysial joint pain, is a frequent cause of mechanical spine pain. Diagnostic blocks (for example, medial branch blocks [MBBs]) are the only reliable approach to identify facet joints as the source of neck or back pain. In the absence of a reference standard, MBBs actually serve more of a prognostic than diagnostic role, enabling the selection of patients who might respond to radiofrequency denervation treatment--the standard treatment for facet joint pain. Using double blocks reduces the false-positive rate of MBBs, but will invariably reduce the overall treatment success rate. No studies have evaluated non-interventional treatments for confirmed facetogenic pain, but data from studies in non-specific back pain suggest a modest, short-term beneficial effect for pharmacotherapy and some non-traditional treatments. Trials of intra-articular steroid injections for lumbar and cervical facet joint pain have yielded disappointing results, but evidence suggests that a subpopulation of patients with acute inflammation derive intermediate-term benefit from this therapy. Radiofrequency denervation provides some benefit for up to a year in approximately 60% of individuals. Increasing this success rate might involve enhancing diagnostic specificity and phenotyping, as well as techniques that increase the likelihood of successful nerve ablation, such as maximizing lesion size.

  3. Mechanoreceptor endings in human thoracic and lumbar facet joints.

    PubMed

    McLain, R F; Pickar, J G

    1998-01-15

    Histologic analysis of normal human facet capsules to determine the density and distribution of encapsulated nerve endings in the thoracic and lumbar spine. To quantify the extent of mechanoreceptor innervation in normal facet tissues and determine the relative distribution of three specific receptor types with respect to thoracic and lumbar segments. Ongoing studies of spinal innervation have shown that human facet tissues contain mechanoreceptive endings capable of detecting motion and tissue distortion. The hypothesis has been advanced that spinal proprioception may play a role in modulating protective muscular reflexes that prevent injury or facilitate healing. Whole facet capsules harvested from seven healthy adult patients were processed using a gold chloride staining method and cut into 35-micron sections for histologic analysis. No sampling was performed; all sections were analyzed. Receptor endings were classified by the method of Freeman and Wyke if they met the following three criteria: 1) encapsulation, 2) identifiable morphometry, and 3) consistent morphometry on serial sections. One Type 1 and four Type 2 endings were identified among 10 thoracic facet capsules. Five Type 1, six Type 2, and one Type 3 ending were identified among 13 lumbar facet capsules. Occasional atypical receptive endings were noted that did not fit the established classification. Unencapsulated free nerve endings were seen in every specimen, but were not quantified. Encapsulated nerve endings are believed to be primarily mechanosensitive and may provide proprioceptive and protective information to the central nervous system regarding joint function and position. A consistent, but small population of receptors has been found previously in cervical facets, but innervation of the thoracic and lumbar levels is less consistent. This suggests that proprioceptive function in the thoracic and lumbar spine is less refined and, perhaps, less critical than in the cervical spine.

  4. Percutaneous radiofrequency facet capsule denervation as an alternative target in lumbar facet syndrome.

    PubMed

    Moussa, Wael Mohamed Mohamed; Khedr, Wael

    2016-11-01

    Percutaneous radiofrequency denervation of the medial dorsal branch is often used in chronic low back pain of intervertebral facet etiology, which is sometimes difficult to perform and recurrence of pain often ensues. We theorized that shifting the target of RF coagulation to the facet joint capsule would provide an easier target and a longer-lived pain relieving response. A prospective randomized controlled trial where 120 patients diagnosed with CLBP of a confirmed facet origin were randomly divided into three equal groups, the first was submitted to percutaneous radiofrequency coagulation of the facet joint capsule, the second underwent percuataneous denervation of the medial dorsal branch and the third did not receive radiofrequency lesioning. All the three groups received local injection of a mixture of local anesthetic and steroid. Cases were followed for up to 3 years. 87(72.5%) patients were females. By 3 months' post procedure, improvement in VAS was significantly better than pretreatment levels in all groups (p<0.05). The control group lost improvement by 1-year follow-up (p=0.017). At 2 years' follow-up, the joint capsule denervation group maintained significant improvement (p=0.033) whereas the medial branch denervation group lost its significant effect (p=0.479). By the end of follow-up period, only joint capsule denervation group kept significant improvement (p=0.026). In CLBP of facet origin, shifting the target of percutaneous radiofrequency to the facet joint capsule provides an easier technique with an extended period of pain relief compared to the medial dorsal branch of the facet joint. Copyright © 2016 Elsevier B.V. All rights reserved.

  5. Lumbar facet injection for the treatment of chronic piriformis myofascial pain syndrome: 52 case studies.

    PubMed

    Huang, Jen-Ting; Chen, Han-Yu; Hong, Chang-Zern; Lin, Ming-Ta; Chou, Li-Wei; Chen, Hsin-Shui; Tsai, Chien-Tsung; Chang, Wen-Dien

    2014-01-01

    The aim of this study was to demonstrate the effectiveness of lumbar facet joint injection for piriformis myofascial pain syndrome. Fifty-two patients with chronic myofascial pain in the piriformis muscle each received a lumbar facet injection into the ipsilateral L5-S1 facet joint region, using the multiple insertion technique. Subjective pain intensity, trunk extension range, and lumbar facet signs were measured before, immediately after, and 2 weeks after injection. Thirty-six patients received follow-up for 6 months. Immediately after the injection, 27 patients (51.9%) had complete pain subsidence, 19 patients (36.5%) had pain reduction to a tolerable level, and only 6 patients (11.5%) had no pain relief to a tolerable level. Mean pain intensity was reduced from 7.4±0.9 to 1.6±2.1 after injection (P<0.01). This effectiveness lasted for 2 weeks in 49 patients (94.2%), and lasted for approximately 6 months in 35 (97.2%) of 36 patients. The mean range of motion increased from 13.4±6.8 degrees to 22.1±6.0 degrees immediately after injection, and further increased 2 weeks and 6 months later. Immediately after injection, 45 patients (86.5%) had no facet sign. In addition, 90.4% and 94.4% of patients had no facet sign after 2 weeks and after 6 months, respectively. It is important to identify the possible cause of piriformis myofascial pain syndrome. If this pain is related to lumbar facet lesions, lumbar facet joint injection can immediately suppress piriformis myofascial pain symptoms. This effectiveness may last for at least 6 months in most patients. This study further supports the importance of eliminating the underlying etiological lesion for complete and effective relief of myofascial pain syndrome.

  6. Lumbar facet injection for the treatment of chronic piriformis myofascial pain syndrome: 52 case studies

    PubMed Central

    Huang, Jen-Ting; Chen, Han-Yu; Hong, Chang-Zern; Lin, Ming-Ta; Chou, Li-Wei; Chen, Hsin-Shui; Tsai, Chien-Tsung; Chang, Wen-Dien

    2014-01-01

    Background and aims The aim of this study was to demonstrate the effectiveness of lumbar facet joint injection for piriformis myofascial pain syndrome. Methods Fifty-two patients with chronic myofascial pain in the piriformis muscle each received a lumbar facet injection into the ipsilateral L5–S1 facet joint region, using the multiple insertion technique. Subjective pain intensity, trunk extension range, and lumbar facet signs were measured before, immediately after, and 2 weeks after injection. Thirty-six patients received follow-up for 6 months. Results Immediately after the injection, 27 patients (51.9%) had complete pain subsidence, 19 patients (36.5%) had pain reduction to a tolerable level, and only 6 patients (11.5%) had no pain relief to a tolerable level. Mean pain intensity was reduced from 7.4±0.9 to 1.6±2.1 after injection (P<0.01). This effectiveness lasted for 2 weeks in 49 patients (94.2%), and lasted for approximately 6 months in 35 (97.2%) of 36 patients. The mean range of motion increased from 13.4±6.8 degrees to 22.1±6.0 degrees immediately after injection, and further increased 2 weeks and 6 months later. Immediately after injection, 45 patients (86.5%) had no facet sign. In addition, 90.4% and 94.4% of patients had no facet sign after 2 weeks and after 6 months, respectively. Conclusions It is important to identify the possible cause of piriformis myofascial pain syndrome. If this pain is related to lumbar facet lesions, lumbar facet joint injection can immediately suppress piriformis myofascial pain symptoms. This effectiveness may last for at least 6 months in most patients. This study further supports the importance of eliminating the underlying etiological lesion for complete and effective relief of myofascial pain syndrome. PMID:25170256

  7. Utilization of Facet Joint and Sacroiliac Joint Interventions in Medicare Population from 2000 to 2014: Explosive Growth Continues!

    PubMed

    Manchikanti, Laxmaiah; Hirsch, Joshua A; Pampati, Vidyasagar; Boswell, Mark V

    2016-10-01

    Increasing utilization of interventional techniques in managing chronic spinal pain, specifically facet joint interventions and sacroiliac joint injections, is a major concern of healthcare policy makers. We analyzed the patterns of utilization of facet and sacroiliac joint interventions in managing chronic spinal pain. The results showed significant increase of facet joint interventions and sacroiliac joint injections from 2000 to 2014 in Medicare FFS service beneficiaries. Overall, the Medicare population increased 35 %, whereas facet joint and sacroiliac joint interventions increased 313.3 % per 100,000 Medicare population with an annual increase of 10.7 %. While the increases were uniform from 2000 to 2014, there were some decreases noted for facet joint interventions in 2007, 2010, and 2013, whereas for sacroiliac joint injections, the decreases were noted in 2007 and 2013. The increases were for cervical and thoracic facet neurolysis at 911.5 % compared to lumbosacral facet neurolysis of 567.8 %, 362.9 % of cervical and thoracic facet joint blocks, 316.9 % of sacroiliac joints injections, and finally 227.3 % of lumbosacral facet joint blocks.

  8. The biomechanical impact of facet tropism on the intervertebral disc and facet joints in the cervical spine.

    PubMed

    Rong, Xin; Wang, Beiyu; Ding, Chen; Deng, Yuxiao; Chen, Hua; Meng, Yang; Yan, Weijie; Liu, Hao

    2017-07-13

    Facet tropism is defined as the angular difference between the left and the right facet orientation. Facet tropism was suggested to be associated with the disc degeneration and facet degeneration in the lumbar spine. However, little is known about the relationship between facet tropism and pathologic changes in the cervical spine and the mechanism behind. This study was conducted to investigate the biomechanical impact of facet tropism on the intervertebral disc and facet joints. A finite element analysis study. The computed tomography (CT) scans of a 28-year-old male volunteer was used to construct the finite element model. First, a symmetrical cervical model from C2 to C7 was constructed. The facet orientations at each level were simulated using the data from our previously published study. Second, the facet orientations at the C5-C6 level were altered to simulate facet tropism with respect to the sagittal plane. The angular difference of the moderate facet tropism model was set to be 7 degrees, whereas the severe facet tropism model was set to be 14 degrees. The inferior of the C7 vertebra was fixed. A 75 N follower loading was applied to simulate the weight of the head. A 1.0 N⋅m moments was applied on the odontoid process of the C2 to simulate flexion, extension, lateral bending, and axial rotation. The intradiscal pressure (IDP) at the C5-C6 level of the severe facet tropism model increased by 49.02%, 57.14%, 39.06%, and 30.67%, under flexion, extension, lateral bending, and axial rotation moments, in comparison with the symmetrical model. The contact force of the severe facet tropism model increased by 35.64%, 31.74%, 79.26%, and 59.47% from the symmetrical model under flexion, extension, lateral bending, and axial rotation, respectively. Facet tropism with respect to the sagittal plane at the C5-C6 level increased the IDP and facet contact force under flexion, extension, lateral bending, and axial rotation. The results suggested that facet tropism might

  9. Percutaneous Facet Screw Fixation in the Treatment of Symptomatic Recurrent Lumbar Facet Joint Cyst: A New Technique

    SciTech Connect

    Amoretti, Nicolas Gallo, Giacomo Bertrand, Anne-Sophie; Bard, Robert L.; Kelekis, Alexis

    2016-01-15

    We present a case of percutaneous treatment of symptomatic recurrent lumbar facet joint cyst resistant to all medical treatments including facet joint steroid injection. Percutaneous transfacet fixation was then performed at L4–L5 level with a cannulated screw using CT and fluoroscopy guidance. The procedure time was 30 min. Using the visual analog scale (VAS), pain decreased from 9.5, preoperatively, to 0 after the procedure. At 6-month follow-up, an asymptomatic cystic recurrence was observed, which further reduced at the 1-year follow-up. Pain remained stable (VAS at 0) during all follow-ups. CT- and fluoroscopy-guided percutaneous cyst rupture associated with facet screw fixation could be an alternative to surgery in patients suffering from a symptomatic recurrent lumbar facet joint cyst.

  10. Factors affecting results of fluoroscopy-guided facet joint injection: Probable differences in the outcome of treatment between pure facet joint hypertrophy and concomitant diseases

    PubMed Central

    Albayrak, Akif; Ozkul, Baris; Balioglu, Mehmet Bulent; Atici, Yunus; Gultekin, Muhammet Zeki; Albayrak, Merih Dilan

    2016-01-01

    Study Design: Retrospective cohort study. Purpose: Facet joints are considered a common source of chronic low-back pain. To determine whether pathogens related to the facet joint arthritis have any effect on treatment failure. Materials and Methods: Facet joint injection was applied to 94 patients treated at our hospital between 2011 and 2012 (mean age 59.5 years; 80 women and 14 men). For the purpose of analysis, the patients were divided into two groups. Patients who only had facet hypertrophy were placed in group A (47 patients, 41 women and 6 men, mean age 55.3 years) and patients who had any additional major pathology to facet hypertrophy were placed in group B (47 patients, 39 women and 8 men, mean age 58.9 years). Injections were applied around the facet joint under surgical conditions utilizing fluoroscopy device guidance. A mixture of methylprednisolone and lidocaine was used as the injection ingredient. Results: In terms of Oswestry Disability Index (ODI) and visual analog scale (VAS) scores, no significant difference was found between preinjection and immediate postinjection values in both groups, and the scores of group A patients were significantly lower (P < 0.005) compared with that of group B patients at the end of the third, sixth, and twelfth month. Conclusion: For low-back pain caused by facet hypertrophy, steroid injection around the facet joint is an effective treatment, but if there is an existing major pathology, it is not as effective. PMID:27041884

  11. Comparison of intra-articular lumbar facet joint pulsed radiofrequency and intra-articular lumbar facet joint corticosteroid injection for management of lumbar facet joint pain

    PubMed Central

    Do, Kyung Hee; Ahn, Sang Ho; Cho, Yun Woo; Chang, Min Cheol

    2017-01-01

    Abstract Background: This study aimed to demonstrate the effect of intra-articular (IA) lumbar facet joint (LFJ) pulsed radiofrequency (PRF) for the management of LFJ pain, and to compare the effect of IA LFJ PRF to IA corticosteroid injection (ICI). Pathology in the LFJ is a common source of lower back pain (LBP). It is responsible for chronic LBP in approximately 15% to 45% of patients. It has been reported that PRF stimulation can effectively reduce refractory joint pain. Methods: Sixty patients with LFJ pain were recruited and randomly assigned to 1 of 2 groups: the IA PRF group and the ICI group. There were 30 patients in each group. At pretreatment, 2 weeks, 1, 3, and 6 months after treatment, we assessed the severity of LBP using a numeric rating scale (NRS). Results: Compared with the pretreatment NRS scores, patients in both groups showed a significant decrease in NRS scores at 2 weeks, and 1, 3, and 6 months after each treatment. Between groups, changes in the NRS scores were significantly different over time. At 2 weeks and 1 month after each procedure, the NRS score after ICI was significantly lower than that after the PRF stimulation. However, at 3 and 6 months after the procedures, the decrements of NRS scores were not significantly different between the 2 groups. Six months after treatment, about half of patients in both groups reported successful pain relief (pain relief of ≥50%). Conclusion: In the current study, both IA PRF stimulation and ICI into the LFJ significantly relieved LFJ pain. Their effects persisted for at least 6 months after the procedure. Thus, IA PRF is a useful therapeutic option for the management of LFJ pain. PMID:28353611

  12. Calcium pyrophosphate dihydrate crystal deposition of multiple lumbar facet joints: a case report.

    PubMed

    Namazie, Mohamed Ridzwan bin Mohamed; Fosbender, Murray R

    2012-08-01

    Pseudogout of the lumbar facet joints is rare. We report on a 69-year-old woman with 2-level symptomatic synovial cysts of the facet joints caused by calcium pyrophosphate dihydrate crystal deposition. She underwent surgical decompression for sciatica and low back pain. At one-year follow-up, she had recovered completely.

  13. The relationship between lower neck shear force and facet joint kinematics during automotive rear impacts.

    PubMed

    Stemper, Brian D; Yoganandan, Narayan; Pintar, Frank A; Maiman, Dennis J

    2011-04-01

    A primary goal of biomechanical safety research is the definition of localized injury thresholds in terms of quantities that are repeatable and easily measureable during experimentation. Recent biomechanical experimentation using human cadavers has highlighted the role of lower cervical facet joints in the injury mechanism resulting from low-speed automotive rear impacts. The present study was conducted to correlate lower neck forces and moments with facet joint motions during simulated rear impacts in an effort to define facet joint injury tolerance thresholds that can be used to assess automobile safety. Four male and four female intact head-neck complexes were obtained from cadaveric specimens and subjected to simulated automotive rear impacts using a pendulum-minisled device. Cervical spine segmental angulations and localized facet joint kinematics were correlated to shear and axial forces, and bending moments at the cervico-thoracic junction using linear regression. R(2) coefficients indicated that spinal kinematics correlated well with lower neck shear force and bending moment. Correlation slope was steeper in female specimens, indicating greater facet joint motions for a given loading magnitude. This study demonstrated that lower neck loads can be used to predict lower cervical facet joint kinematics during automotive rear impacts. Higher correlation slope in female specimens corresponds to higher injury susceptibility in that population. Although lower neck shear force and bending moment demonstrated adequate correlation with lower cervical facet joint motions, shear force is likely the better predictor due to similarity in the timing of peak magnitudes with regard to maximum facet joint motions.

  14. Magnetic resonance-guided focused ultrasound treatment of facet joint pain: summary of preclinical phase

    PubMed Central

    2014-01-01

    Study design A phantom experiment, two thermocouple experiments, three in vivo pig experiments, and a simulated treatment on a healthy human volunteer were conducted to test the feasibility, safety, and efficacy of magnetic resonance-guided focused ultrasound (MRgFUS) for treating facet joint pain. Objective The goal of the current study was to develop a novel method for accurate and safe noninvasive facet joint ablation using MRgFUS. Summary of background data Facet joints are a common source of chronic back pain. Direct facet joint interventions include medial branch nerve ablation and intra-articular injections, which are widely used, but limited in the short and long term. MRgFUS is a breakthrough technology that enables accurate delivery of high-intensity focused ultrasound energy to create a localized temperature rise for tissue ablation, using MR guidance for treatment planning and real-time feedback. Methods We validated the feasibility, safety, and efficacy of MRgFUS for facet joint ablation using the ExAblate 2000® System (InSightec Ltd., Tirat Carmel, Israel) and confirmed the system's ability to ablate the edge of the facet joint and all terminal nerves innervating the joint. A phantom experiment, two thermocouple experiments, three in vivo pig experiments, and a simulated treatment on a healthy human volunteer were conducted. Results The experiments showed that targeting the facet joint with energies of 150–450 J provides controlled and accurate heating at the facet joint edge without penetration to the vertebral body, spinal canal, or root foramina. Treating with reduced diameter of the acoustic beam is recommended since a narrower beam improves access to the targeted areas. Conclusions MRgFUS can safely and effectively target and ablate the facet joint. These results are highly significant, given that this is the first study to demonstrate the potential of MRgFUS to treat facet joint pain. PMID:24921048

  15. Joint hypermobility syndrome.

    PubMed

    Fikree, Asma; Aziz, Qasim; Grahame, Rodney

    2013-05-01

    Although perceived as a rare condition, joint hypermobility syndrome is common. Its prevalence in rheumatology clinics is extremely high. Early estimates suggest that it may be the most common of all rheumatologic conditions. The problem lies in the general lack of awareness of the syndrome, its means of recognition, and the resultant failure to diagnose it correctly when present. It is a worldwide problem. This article provides an overview of hypermobility and hypermobility syndrome, stressing its multisystemic nature and the negative impact that it may have on quality of life, with particular reference to gastrointestinal involvement.

  16. [Synovial cyst in the lumbar facet joint. A rare cause of lumbar-sciatic pain].

    PubMed

    Villas, C; Leyes, M

    1997-01-01

    Synovial cysts of the facet joints are uncommon lesions which may be asymptomatic or present as low back pain, with or without radicular symptoms. They are considered to be secondary to trauma or degenerative joint disease, and they occur more frequently in patients with spondylolisthesis. Diagnosis is normally achieved with computed tomography or magnetic resonance, which show a cystic lesion located laterally adjacent to the facet joint. We review the literature and report a patient who presented with first sacral nerve root symptoms attributable to a ganglion cyst of the left L5 S1 facet joint. Treatment was curative and consisted in excision of the cyst.

  17. The Interface of Mechanics and Nociception in Joint Pathophysiology: Insights From the Facet and Temporomandibular Joints.

    PubMed

    Sperry, Megan M; Ita, Meagan E; Kartha, Sonia; Zhang, Sijia; Yu, Ya-Hsin; Winkelstein, Beth

    2017-02-01

    Chronic joint pain is a widespread problem that frequently occurs with aging and trauma. Pain occurs most often in synovial joints, the body's load bearing joints. The mechanical and molecular mechanisms contributing to synovial joint pain are reviewed using two examples, the cervical spinal facet joints and the temporomandibular joint (TMJ). Although much work has focused on the macroscale mechanics of joints in health and disease, the combined influence of tissue mechanics, molecular processes, and nociception in joint pain has only recently become a focus. Trauma and repeated loading can induce structural and biochemical changes in joints, altering their microenvironment and modifying the biomechanics of their constitutive tissues, which themselves are innervated. Peripheral pain sensors can become activated in response to changes in the joint microenvironment and relay pain signals to the spinal cord and brain where pain is processed and perceived. In some cases, pain circuitry is permanently changed, which may be a potential mechanism for sustained joint pain. However, it is most likely that alterations in both the joint microenvironment and the central nervous system (CNS) contribute to chronic pain. As such, the challenge of treating joint pain and degeneration is temporally and spatially complicated. This review summarizes anatomy, physiology, and pathophysiology of these joints and the sensory pain relays. Pain pathways are postulated to be sensitized by many factors, including degeneration and biochemical priming, with effects on thresholds for mechanical injury and/or dysfunction. Initiators of joint pain are discussed in the context of clinical challenges including the diagnosis and treatment of pain.

  18. Morphometric Study of Clavicular Facet of Coracoclavicular Joint in Adult Indian Population

    PubMed Central

    Mahajan, Anita; Vasudeva, Neelam

    2016-01-01

    Introduction Anthropologists have used Coracoclavicular Joint (CCJ), a non-metric anatomical variant in population, as a marker for population migration from prehistoric times to present. Aim The aim of this osteological study was to determine the incidence and morphometry of articular facet of CCJ on conoid tubercle of clavicle in Indian population, as Indian studies are scanty and incomplete. Materials and Methods The study was done on 144 adult human clavicles (76 right and 68 left; 93 males and 51 females) collected from osteology museum in Department of Anatomy, Maulana Azad Medical College, New Delhi, India. The presence of articular facet on the conoid tubercle was determined and Maximum Antero-Posterior (MAPD) and maximum transverse diameter (MTD) was measured by digital vernier calliper. The incidence was compared on the basis of sex, side and with other osteological studies in the world. Statistical analysis was done using the Chi-Square test for nominal categorical data and student’s t-test for normally distributed continuous variables in Microsoft Excel 2007 to assess the relationship between the examined variables. Results Articular facet on conoid tubercle was found in 8 cases (5.6%). Seven (9.2%) were present on the right side and one (1.5%) on the left side. Seven cases (7.5%) were present in males and one case (2%) was found in females. The facets were generally oval, with MAPD and MTD of 12.28 and 17.17 mm respectively. A significant side variation was present with right sided facet being more common. The left sided facet was more transversely elongated than right. In males, the facets were more elongated antero-posteriorly than in females. Conclusion The Indian population showed an incidence of 5.6%, which was comparable to other ethnic groups in world population. The morphometric and side differences could be attributed to the occupational factors and range of movements associated with the CCJ. The CCJ should be borne in mind as a differential

  19. Lumbar juxta-facet joint cysts in association with facet joint orientation, -tropism and -arthritis: A case-control study.

    PubMed

    Ening, Genevieve; Kowoll, Annika; Stricker, Ingo; Schmieder, Kirsten; Brenke, Christopher

    2015-12-01

    To assess the association between juxta-facet-joint cysts (JFC) occurrence at the lumbar spine and Facet Joint (FJ) orientation, -tropism and -arthritis. Study group, 36 consecutive patients with JFC and the same number of controls, with degenerative diseases without JFC were match paired for demographics and spine segment. Parameter assessment was by T2-weighted axial MRI scans. JFC diagnosis was confirmed histopathologically. Group comparison was by Student's t-test for continuous variables and X(2) for categorical variables. Nineteen female and 17 male patients, aged between 45 and 85 years (mean 67.19 ± 10.3 years) had a mean JFC size of 9.26 ± 4.8mm occurring most frequently in the segment L4-L5 (75% n=25) and on the left side (61%). Mean FJ orientation of the study group was significantly more coronal compared to controls (left side 42° vs 36°, p<0.02*, 95% confidence interval: 0.9-11.5 and right side 43° vs 37°, p<0.02*, 95% confidence interval: 0.6-10.6 respectively). However, individual intersegmental analysis for study group patients showed the JFC bearing side to be significantly more sagittally oriented 40° ± 11.2° compared to 45° ± 13.2° for the side without FJC (p<0.03*, 95% confidence interval: 8.1-1.7). 50% of the study group showed FJ asymmetry compared to 30% in controls, with a trend for FJ tropism (p<0.07). Severe (grade 3) FJ arthritis was significantly more predominant in the study group 23/33 (p<0.001*) as compared to controls. Compared to a control group, JFC occurrence is associated with significant higher rates of arthritis and coronally orientated FJ. At intersegment comparison within the same patient cysts located in more sagittally orientated FJ and the asymmetric segments show a trend for FJ tropism. Copyright © 2015 Elsevier B.V. All rights reserved.

  20. Subdural empyema following lumbar facet joint injection: An exceeding rare complication.

    PubMed

    Fayeye, Oluwafikayo; Silva, Adikarige Haritha Dulanka; Chavda, Swarupsinh; Furtado, Navin Raoul

    2016-01-01

    Chronic low back pain is extremely common with a life time prevalence estimated at greater than 70%. Facet joint arthrosis is thought to be the causative aetiological substrate in approximately 25% of chronic low back pain cases. Facet joint injection is a routine intervention in the armamentarium for both the diagnostic and therapeutic management of chronic low back pain. In fact, a study by Carrino et al. reported in excess of 94,000 facet joint injection procedures were carried out in the US in 1999. Although generally considered safe, the procedure is not entirely without risk. Complications including bleeding, infection, exacerbation of pain, dural puncture headache, and pneumothorax have been described. We report a rare case of a 47-year-old female patient who developed a left L4/5 facet septic arthrosis with an associated subdural empyema and meningitis following facet joint injection. This case is unique, as to the best of our knowledge no other case of subdural empyema following facet joint injection has been reported in the literature. Furthermore this case serves to highlight the potential serious adverse sequelae of a routine and apparently innocuous intervention. The need for medical practitioners to be alert to and respond rapidly to the infective complications of facet joint injection cannot be understated.

  1. Presence and Extent of Severe Facet Joint Osteoarthritis Are Associated with Back Pain in Older Adults

    PubMed Central

    Suri, Pradeep; Hunter, David J.; Rainville, James; Guermazi, Ali; Katz, Jeffrey N.

    2014-01-01

    Objective To determine whether the presence and extent of severe lumbar facet joint osteoarthritis (OA) is associated with back pain in older adults, accounting for disc height narrowing and other covariates. Design 252 older adults from the Framingham Offspring Cohort (mean age 67 years) were studied. Participants received standardized CT assessments of lumbar facet joint OA and disc height narrowing at the L2-S1 interspaces using 4-grade semi-quantitative scales. Severe facet joint OA was defined according to the presence and/or degree of joint space narrowing, osteophytosis, articular process hypertrophy, articular erosions, subchondral cysts, and intraarticular vacuum phenomenon. Severe disc height narrowing was defined as marked narrowing with endplates almost in contact. Back pain was defined as participant report of pain on most days or all days in the past 12 months. We used multivariable logistic regression to examine associations between severe facet joint OA and back pain, adjusting for key covariates including disc height narrowing, sociodemographics, anthropometrics, and health factors. Results Severe facet joint OA was more common in participants with back pain than those without (63.2% vs. 46.7%;p=0.03). In multivariable analyses, presence of any severe facet joint OA remained significantly associated with back pain (odds ratio[OR]2.15 (95% confidence interval [CI]1.13-4.08). Each additional joint with severe OA conferred greater odds of back pain (OR per joint 1.20 (95% CI;1.02-1.41). Conclusions The presence and extent of severe facet joint OA on CT imaging is associated with back pain in community-based older adults, independent of sociodemographics, health factors, and disc height narrowing. PMID:23973131

  2. The relation between the instantaneous center of rotation and facet joint forces - A finite element analysis.

    PubMed

    Schmidt, Hendrik; Heuer, Frank; Claes, Lutz; Wilke, Hans-Joachim

    2008-03-01

    The instantaneous center of rotation in a functional spinal unit is an indicator for mechanical disorders and is relevant for the development of motion preserving techniques. In addition to the intervertebral disc, the facet joints also play a major role for load transmission through the spine, providing stability to it. The relationship between the rotation center and facet joint forces is not fully understood, since previous studies have separated both; spinal motion and facet forces. A finite element model of a L4-5 lumbar spinal segment was exposed to an axial compression preload of 500 N. Pure unconstrained moments of 7.5 Nm were additionally applied in the three anatomical main planes. The instantaneous center of rotation and the facet joint forces were investigated. For small moments, the center of rotation was found to be almost in the center of the disc, no matter what motion direction. With an increasing flexion moment, the center of rotation moved anteriorly. The facet joints remained unloaded in flexion. With proceeding extension movement, the center of rotation moved posteriorly. The facet forces increased up to 50 N. In lateral bending, with increasing moment the center of rotation migrated posteriorly in the ipsilateral side of the disc. The forces in the facet joints rose to 36 N. In axial rotation, the center of rotation migrated towards the compressed facet joint with increasing moment. Axial rotation yielded the maximum facet forces with 105 N. The determination of the rotation center is highly sensible against measurement resolution obtained during in vivo and in vitro studies. This finite element method can be used to complement the knowledge of the rotation center location from former experimental findings.

  3. Lumbar facet joint arthritis is associated with more coronal orientation of the facet joints at the upper lumbar spine.

    PubMed

    Jentzsch, Thorsten; Geiger, James; Zimmermann, Stefan M; Slankamenac, Ksenija; Nguyen-Kim, Thi Dan Linh; Werner, Clément M L

    2013-01-01

    We retrospectively analyzed CT scans of 620 individuals, who presented to our traumatology department between 2008 and 2010. Facet joint (FJ) arthritis was present in 308 (49.7%) individuals with a mean grade of 1. It was seen in 27% of individuals ≤40 years and in 75% of individuals ≥41 years (P < 0.0001) as well as in 52% of females and 49% of males (P = 0.61). Mean FJ orientation was 30.4° at L2/3, 38.7° at L3/4, 47° at L4/5, and 47.3° at L5/S1. FJ arthritis was significantly associated with more coronal (increased degree) FJ orientation at L2/3 (P = 0.03) with a cutoff point at ≥32°. FJs were more coronally oriented (48.8°) in individuals ≤40 years and more sagittally oriented (45.6°) in individuals ≥41 years at L5/S1 (P = 0.01). Mean FJ asymmetry was 4.89° at L2/3, 6.01° at L3/4, 6.67° at L4/5, and 7.27° at L5/S1, without a significant difference for FJ arthritis. FJ arthritis is common, increases with age, and affects both genders equally. More coronally oriented FJs (≥32°) in the upper lumbar spine may be an individual risk factor for development of FJ arthritis.

  4. [CORRELATION OF LUMBAR FACET JOINT DEGENERATION AND SPINE-PELVIC SAGITTAL BALANCE].

    PubMed

    Lo, Xin; Zhang, Bin; Liu, Yuan; Dai, Min

    2015-08-01

    To investigate the relationship between lumbar facet joint degeneration of each segment and spine-pelvic sagittal balance parameters. A retrospective analysis was made the clinical data of 120 patients with lumbar degenerative disease, who accorded with the inclusion criteria between June and November 2014. There were 58 males and 62 females with an average age of 53 years (range, 24-77 years). The disease duration ranged from 3 to 96 months (mean, 6.6 months). Affected segments included L3,4 in 32 cases, L4,5 in 47 cases, and L5, S1 in 52 cases. The CT and X-ray films of the lumbar vertebrae were taken. The facet joint degeneration was graded based on the grading system of Pathria. The spine-pelvic sagittal balance parameters were measured, including lumbar lordosis (LL), upper lumbar lordosis (ULL), lower lumbar lordosis (LLL), pelvic incidence (PI), pelvic tilt (PT), and sacral slope (SS). According to normal range of PI, the patients were divided into 3 groups: group A (PI was less than normal range), group B (PI was within normal range), and group C (PI was more than normal range). The facet joint degeneration was compared; according to the facet joint degeneration degree, the patients were divided into group N (mild degeneration group) and group M (serious degeneration group) to observe the relationship of lumbar facet joint degeneration of each segment and spine-pelvic sagittal balance parameters. At L4,5 and L5, S1, facet joint degeneration showed significant difference among groups A, B, and C (P < 0.05), more serious facet joint degeneration was observed in group C; no significant difference was found in facet joint degeneration at L3,4 (P > 0.05). There was no significant difference in the other spine-pelvic sagittal balance parameters between groups N and M at each segment (P > 0.05) except for PT (P < 0.05). PI of more than normal range may lead to or aggravate lumbar facet joint degeneration at L4,5 and L5, Si; PT and PI are significantly associated

  5. Comparison of facet joint activity on 99mTc-MDP SPECT/CT with facet joint signal change on MRI with fat suppression.

    PubMed

    Lehman, Vance T; Murphy, Robert C; Schenck, Louis A; Carter, Rickey E; Johnson, Geoffrey B; Kotsenas, Amy L; Morris, Jonathan M; Nathan, Mark A; Wald, John T; Maus, Timothy P

    2016-01-01

    We compared signal change on magnetic resonance imaging (MRI) with fat suppression and bone scan activity of lumbar facet joints to determine if these two imaging findings are correlated. We retrospectively identified all patients who underwent imaging of the lumbar spine for pain evaluation using both technetium-99m methylene disphosphonate single-photon emission computed tomography/computed tomography (99mTc-MDP SPECT/CT) and MRI with at least one fat-suppressed T2- or T1-weighted sequence with gadolinium enhancement within a 180-day interval, at our institution between 1 January 2008 and 19 February 2013. Facet joint activity on 99mTc-MDP SPECT/CT and peri-facet signal change on MRI were rated as normal or increased. Agreement between the two examination types were determined with the κ and prevalence-adjusted bias-adjusted κ (PABAK) statistics. This study included 60 patients (28 male, 47%), with a mean age of 49±19.7 years (range, 12-93 years). The κ value indicated no agreement between 99mTc-MDP SPECT/CT and MRI (κ=-0.026; 95% confidence interval: -0.051, 0.000). The PABAK values were fair to high at each spinal level, which suggests that relatively low disease prevalence lowered the κ values. Together, the κ and PABAK values indicate that there is some degree of intermodality agreement, but that it is not consistent. Overall, facet joint signal change on fat-suppressed MRI did not always correlate with increased 99mTc-MDP SPECT/CT activity. MRI and 99mTc-MDP SPECT/CT for facet joint evaluation should not be considered interchangeable examinations in clinical practice or research.

  6. Pressure measurement in the cervical spinal facet joint: considerations for maintaining joint anatomy and an intact capsule.

    PubMed

    Jaumard, Nicolas V; Bauman, Joel A; Welch, William C; Winkelstein, Beth A

    2011-07-01

    A novel noninvasive approach to measure facet joint pressure in the cervical spine was investigated using a tip-mounted transducer that can be inserted through a hole in the bony lateral mass. This technique is advantageous because it does not require resection of the joint capsule, but there are potential issues regarding its applicability that are addressed. The objective was to evaluate the effect of a tip-mounted pressure probe's position and orientation on contact pressure measurements in biomechanical experiments. Measurements of direct contact pressure in the facet joint of cadaveric spines have been obtained via pressure-sensitive films. However, that method requires the resection of the facet capsule, which can alter the overall joint's mechanical behavior and can affect the measured contact pressures. Influence of position and orientation on probe measurements was evaluated in companion surrogate and cadaveric investigations. The probe was placed in the facet of an anatomic vertebral C4/5 surrogate undergoing sagittal bending moments. Pressure-sensitive paper was used to map contact regions in the joint of the surrogate and cadaveric cervical segments (n = 3) during extension. The probe also underwent uniaxial compression in cadaveric facets to evaluate the effect of orientation relative to the contact surface on the probe signal. Although experimental and theoretical pressure profiles followed the same trends, measured maximum pressures were half of the theoretical ones. In the orientation study, maximum pressures were not different for probe orientations of 0° and 5°, but no signal was recorded at orientations greater than 15°. This approach to measure pressure was selected to provide a minimally-invasive method to quantify facet joint pressures during clinically relevant applications. Both the position and orientation of the probe are critical factors in monitoring local pressure profiles in this mobile synovial joint.

  7. Radiological and Radionuclide Imaging of Degenerative Disease of the Facet Joints

    PubMed Central

    Shur, Natalie; Corrigan, Alexis; Agrawal, Kanhaiyalal; Desai, Amidevi; Gnanasegaran, Gopinath

    2015-01-01

    The facet joint has been increasingly implicated as a potential source of lower back pain. Diagnosis can be challenging as there is not a direct correlation between facet joint disease and clinical or radiological features. The purpose of this article is to review the diagnosis, treatment, and current imaging modality options in the context of degenerative facet joint disease. We describe each modality in turn with a pictorial review using current evidence. Newer hybrid imaging techniques such as single photon emission computed tomography/computed tomography (SPECT/CT) provide additional information relative to the historic gold standard magnetic resonance imaging. The diagnostic benefits of SPECT/CT include precise localization and characterization of spinal lesions and improved diagnosis for lower back pain. It may have a role in selecting patients for local therapeutic injections, as well as guiding their location with increased precision. PMID:26170560

  8. Radiological and Radionuclide Imaging of Degenerative Disease of the Facet Joints.

    PubMed

    Shur, Natalie; Corrigan, Alexis; Agrawal, Kanhaiyalal; Desai, Amidevi; Gnanasegaran, Gopinath

    2015-01-01

    The facet joint has been increasingly implicated as a potential source of lower back pain. Diagnosis can be challenging as there is not a direct correlation between facet joint disease and clinical or radiological features. The purpose of this article is to review the diagnosis, treatment, and current imaging modality options in the context of degenerative facet joint disease. We describe each modality in turn with a pictorial review using current evidence. Newer hybrid imaging techniques such as single photon emission computed tomography/computed tomography (SPECT/CT) provide additional information relative to the historic gold standard magnetic resonance imaging. The diagnostic benefits of SPECT/CT include precise localization and characterization of spinal lesions and improved diagnosis for lower back pain. It may have a role in selecting patients for local therapeutic injections, as well as guiding their location with increased precision.

  9. The Hip-Spine Effect: A Biomechanical Study of Ischiofemoral Impingement Effect on Lumbar Facet Joints.

    PubMed

    Gómez-Hoyos, Juan; Khoury, Anthony; Schröder, Ricardo; Johnson, Eric; Palmer, Ian J; Martin, Hal D

    2017-01-01

    To assess the relation between ischiofemoral impingement (IFI) and lumbar facet joint load during hip extension in cadavers. Twelve hips in 6 fresh T1-to-toes cadaveric specimens were tested. A complete pretesting imaging evaluation was performed using computed tomography scan. Cadavers were positioned in lateral decubitus and fixed to a dissection table. Both legs were placed on a frame in a simulated walking position. Through a posterior lumbar spine approach L3-4 and L4-5 facet joints were dissected bilaterally. In addition, through a posterolateral approach to the hip, the space between the ischium and the lesser trochanter was dissected and measured. Ultrasensitive, and previously validated, piezoresistive force sensors were placed in lumbar facet joints of L3-4 and L4-5. Lumbar facet loads during hip extension were measured in native hip conditions and after simulating IFI by performing lesser trochanter osteotomy and lengthening. Four paired t-tests were performed comparing normal and simulated IFI on the L3-L4 and L4-L5 facet joint loads. After simulating IFI, mean absolute differences of facet joint load were 10.8 N (standard error of the mean [SEM] ±4.53, P = .036) for L3-4 at 10° of hip extension, 13.71 N (SEM ±4.53, P = .012) for L3-4 at 20° of hip extension, 11.49 N (SEM ±4.33, P = .024) for L4-5 at 10° of hip extension, and 6.67 N (SEM ±5.43, P = .245) for L4-5 at 20° of hip extension. A statistically significant increase in L3-4 and L4-5 lumbar facet joint loads of 30.81% was found in the IFI state as compared with the native state during terminal hip extension. Limited terminal hip extension due to simulated IFI significantly increases L3-4 and L4-5 lumbar facet joint load when compared with non-IFI native hips. This biomechanical study directly links IFI to increased lumbar facet loads and supports the clinical findings of IFI causing lumbar pathology. Assessing and treating (open or endoscopic) hip disorders that limit extension

  10. Prevalence of facet joint pain in chronic spinal pain of cervical, thoracic, and lumbar regions

    PubMed Central

    Manchikanti, Laxmaiah; Boswell, Mark V; Singh, Vijay; Pampati, Vidyasagar; Damron, Kim S; Beyer, Carla D

    2004-01-01

    Background Facet joints are a clinically important source of chronic cervical, thoracic, and lumbar spine pain. The purpose of this study was to systematically evaluate the prevalence of facet joint pain by spinal region in patients with chronic spine pain referred to an interventional pain management practice. Methods Five hundred consecutive patients with chronic, non-specific spine pain were evaluated. The prevalence of facet joint pain was determined using controlled comparative local anesthetic blocks (1% lidocaine or 1% lidocaine followed by 0.25% bupivacaine), in accordance with the criteria established by the International Association for the Study of Pain (IASP). The study was performed in the United States in a non-university based ambulatory interventional pain management setting. Results The prevalence of facet joint pain in patients with chronic cervical spine pain was 55% 5(95% CI, 49% – 61%), with thoracic spine pain was 42% (95% CI, 30% – 53%), and in with lumbar spine pain was 31% (95% CI, 27% – 36%). The false-positive rate with single blocks with lidocaine was 63% (95% CI, 54% – 72%) in the cervical spine, 55% (95% CI, 39% – 78%) in the thoracic spine, and 27% (95% CI, 22% – 32%) in the lumbar spine. Conclusion This study demonstrated that in an interventional pain management setting, facet joints are clinically important spinal pain generators in a significant proportion of patients with chronic spinal pain. Because these patients typically have failed conservative management, including physical therapy, chiropractic treatment and analgesics, they may benefit from specific interventions designed to manage facet joint pain. PMID:15169547

  11. Characterization of a new animal model for evaluation and treatment of back pain due to lumbar facet joint osteoarthritis.

    PubMed

    Kim, Jae-Sung; Kroin, Jeffrey S; Buvanendran, Asokumar; Li, Xin; van Wijnen, Andre J; Tuman, Kenneth J; Im, Hee-Jeong

    2011-10-01

    Osteoarthritic (OA) degeneration of the lumbar facet joints has been implicated in low back pain. This study was undertaken to investigate the biologic links between cellular and structural alterations within facet joint components and the development of symptomatic chronic back pain. We generated an animal model of facet joint degeneration by intraarticular injection of monosodium iodoacetate (MIA) into facet joints (L3-L4, L4-L5, L5-L6) of Sprague-Dawley rats. Pain sensation due to pressure, which mimics a mechanical stimulus for facet joint injury, was measured using an algometer. Pain response was also assessed in a straight leg raising test. Cartilage alterations were assessed by biochemical evaluation and microfocal computed tomography (micro-CT). Therapeutic modulation of chronic facet joint pain with the use of various pharmacologic agents was investigated. MIA injection resulted in severely damaged facet joint cartilage, proteoglycan loss, and alterations of subchondral bone structure. Micro-CT analyses suggested that the behavioral hyperalgesia from facet joint degeneration was not associated with foraminal stenosis. The biologic and structural changes in facet joints were closely associated with sustained and robust chronic pain. Morphine and pregabalin markedly alleviated pressure hyperalgesia, while celecoxib (a selective inhibitor of cyclooxygenase 2 [COX-2]) produced moderate antihyperalgesic effects and the effect of ketorolac (an inhibitor of COX-1 and COX-2) was negligible. Our findings demonstrate that MIA injection provides a useful model for the study of OA changes in the facet joint and indicate that facet joint degeneration is a major cause of chronic low back pain. The treatment results suggest that classes of drugs that are widely used to treat OA, such as nonsteroidal antiinflammatory drugs, may have limited efficacy once joint destruction is complete. Copyright © 2011 by the American College of Rheumatology.

  12. Bipolar Intra-articular Radiofrequency Thermocoagulation of the Thoracic Facet Joints: A Case Series of a New Technique

    PubMed Central

    2014-01-01

    Background This study tests the hypothesis that of bipolar radiofrequency thermocoagulation of the thoracic facet joint capsule may provide a safe and effect method of pain control from thoracic facet origin. Methods Among patients suffering from localized mid back pain, nine patients with thoracic facet disease confirmed by magnetic resonance image and diagnostic thoracic facet block were enrolled. Bipolar radiofrequency ablation in the inferior aspect of the thoracic facet joint was done. Visual Analog Scale (VAS) was measured pre-intervention and 1 month post-intervention. Any complications and changes in amount of pain medication were recorded. Results Significant 47.6% reduction in VAS was noted at 1 month. There were no serious complications. Conclusions Intra-articular bipolarradiofrequency thermocoagulation of the thoracic facet joint may be a technically easier and valid method of treating mid back pain of thoracic facet origin. PMID:24478900

  13. Lumbar Facet Joint Motion in Patients with Degenerative Disc Disease at Affected and Adjacent Levels

    PubMed Central

    Li, Weishi; Wang, Shaobai; Xia, Qun; Passias, Peter; Kozanek, Michal; Wood, Kirkham; Li, Guoan

    2013-01-01

    Study Design Controlled laboratory study. Objective To evaluate the effect of lumbar degenerative disc diseases (DDDs) on motion of the facet joints during functional weight-bearing activities. Summary of Background Data It has been suggested that DDD adversely affects the biomechanical behavior of the facet joints. Altered facet joint motion, in turn, has been thought to associate with various types of lumbar spine pathology including facet degeneration, neural impingement, and DDD progression. However, to date, no data have been reported on the motion patterns of the lumbar facet joint in DDD patients. Methods Ten symptomatic patients of DDD at L4–S1 were studied. Each participant underwent magnetic resonance images to obtain three-dimensional models of the lumbar vertebrae (L2–S1) and dual fluoroscopic imaging during three characteristic trunk motions: left-right torsion, left-right bending, and flexion-extension. In vivo positions of the vertebrae were reproduced by matching the three-dimensional models of the vertebrae to their outlines on the fluoroscopic images. The kinematics of the facet joints and the ranges of motion (ROMs) were compared with a group of healthy participants reported in a previous study. Results In facet joints of the DDD patients, there was no predominant axis of rotation and no difference in ROMs was found between the different levels. During left-right torsion, the ROMs were similar between the DDD patients and the healthy participants. During left-right bending, the rotation around mediolateral axis at L4–L5, in the DDD patients, was significantly larger than that of the healthy participants. During flexion-extension, the rotations around anterioposterior axis at L4–L5 and around craniocaudal axis at the adjacent level (L3–L4), in the DDD patients, were also significantly larger, whereas the rotation around mediolateral axis at both L2–L3 and L3–L4 levels in the DDD patients were significantly smaller than those of the

  14. Qualitative and quantitative assessment of degeneration of cervical intervertebral discs and facet joints.

    PubMed

    Walraevens, Joris; Liu, Baoge; Meersschaert, Joke; Demaerel, Philippe; Delye, Hans; Depreitere, Bart; Vander Sloten, Jos; Goffin, Jan

    2009-03-01

    Degeneration of intervertebral discs and facet joints is one of the most frequently encountered spinal disorders. In order to describe and quantify degeneration and evaluate a possible relationship between degeneration and biomechanical parameters, e.g., the intervertebral range of motion and intradiscal pressure, a scoring system for degeneration is mandatory. However, few scoring systems for the assessment of degeneration of the cervical spine exist. Therefore, two separate objective scoring systems to qualitatively and quantitatively assess the degree of cervical intervertebral disc and facet joint degeneration were developed and validated. The scoring system for cervical disc degeneration consists of three variables which are individually scored on neutral lateral radiographs: "height loss" (0-4 points), "anterior osteophytes" (0-3 points) and "endplate sclerosis" (0-2 points). The scoring system for facet joint degeneration consists of four variables which are individually scored on neutral computed tomography scans: "hypertrophy" (0-2 points), "osteophytes" (0-1 point), "irregularity" on the articular surface (0-1 point) and "joint space narrowing" (0-1 point). Each variable contributes with varying importance to the overall degeneration score (max 9 points for the scoring system of cervical disc degeneration and max 5 points for facet joint degeneration). Degeneration of 20 discs and facet joints of 20 patients was blindly assessed by four raters: two neurosurgeons (one senior and one junior) and two radiologists (one senior and one junior), firstly based on first subjective impression and secondly using the scoring systems. Measurement errors and inter- and intra-rater agreement were determined. The measurement error of the scoring system for cervical disc degeneration was 11.1 versus 17.9% of the subjective impression results. This scoring system showed excellent intra-rater agreement (ICC = 0.86, 0.75-0.93) and excellent inter-rater agreement (ICC = 0

  15. Talocalcaneal Joint Middle Facet Coalition Resection With Interposition of a Juvenile Hyaline Cartilage Graft.

    PubMed

    Tower, Dyane E; Wood, Ryan W; Vaardahl, Michael D

    2015-01-01

    Talocalcaneal joint middle facet coalition is the most common tarsal coalition, occurring in ≤2% of the population. Fewer than 50% of involved feet obtain lasting relief of symptoms after nonoperative treatment, and surgical intervention is commonly used to relieve symptoms, increase the range of motion, improve function, reconstruct concomitant pes planovalgus, and prevent future arthrosis from occurring at the surrounding joints. Several approaches to surgical intervention are available for patients with middle facet coalitions, ranging from resection to hindfoot arthrodesis. We present a series of 4 cases, in 3 adolescent patients, of talocalcaneal joint middle facet coalition resection with interposition of a particulate juvenile hyaline cartilaginous allograft (DeNovo(®) NT Natural Tissue Graft, Zimmer, Inc., Warsaw, IN). With a mean follow-up period of 42.8 ± 2.9 (range 41 to 47) months, the 3 adolescent patients in the present series were doing well with improved subtalar joint motion and decreased pain, and 1 foot showed no bony regrowth on a follow-up computed tomography scan. The use of a particulate juvenile hyaline cartilaginous allograft as interposition material after talocalcaneal middle facet coalition resection combined with adjunct procedures to address concomitant pes planovalgus resulted in good short-term outcomes in 4 feet in 3 adolescent patients.

  16. Posterior Branches of Lumbar Spinal Nerves - part II: Lumbar Facet Syndrome - Pathomechanism, Symptomatology and Diagnostic Work-up.

    PubMed

    Kozera, Katarzyna; Ciszek, Bogdan; Szaro, Paweł

    2017-04-12

    Posterior branches of the lumbar spinal nerves are the anatomic substrate of pain in the lower back, sacrum and the gluteal area. Such pain may be associated with various pathologies which cause pain in the posterior branches of the lumbar spinal nerves due to entrapment, mechanical irritation or inflammatory reaction and/or degeneration. The posterior branches are of significant functional importance, which is related to the function of the structures they supply, including facet joints, which are the basic biomechanical units of the spine. Low back pain caused by facet joint pathology may be triggered e.g. by simple activities, such as body rotations, unnatural positions, lifting heavy weights or excessive bending as well as chronic overloading with spinal hyperextension. Pain usually presents at the level of the lumbosacral junction (L 5 -S 1 ) and in the lower lumbar spine (L 4-5 , L 3-4 ). In the absence of specific diagnostic criteria, it is only possible to conclude that patients display tenderness at the level of the affected facet joint and that the pain is triggered by extension. Differential diagnosis for low back pain is difficult, since the pain may originate from various structures. The most reliable method of identifying Lumbar Facet Syndrome has been found to be a positive response to an analgesic procedure in the form of a block of the medial branch or intraarticular injection. There appear to be good grounds for conducting further studies and developing unequivocal diagnostic tests.

  17. Characterization of subchondral bone histopathology of facet joint osteoarthritis in lumbar spinal stenosis.

    PubMed

    Netzer, Cordula; Urech, Karin; Hügle, Thomas; Benz, Robyn Melanie; Geurts, Jeroen; Schären, Stefan

    2016-08-01

    Facet joint osteoarthritis may be a cause of low back pain in degenerative spine diseases including lumbar spinal stenosis. Subchondral bone is regarded as a potential therapeutic target for osteoarthritis treatment. The goal of this study was to characterize subchondral bone histopathology in osteoarthritic facet joints from lumbar spinal stenosis patients. Fifteen patients with degenerative spinal stenosis scheduled for transforaminal lumbar interbody fusion surgery were recruited for this study. Osteoarthritis severity was graded on T1- and T2-weighted MRI images using Weishaupt scoring system. Dissected osteoarthritic facet joints were subjected to histological and immunohistochemistry analyses to study relative abundance of osteoblast, osteoclasts, and macrophages using van Gieson's, tartrate-resistant acid phosphatase and CD68-antibody staining, respectively. Presence of nerve fibers was evaluated by PGP9.5-antibody staining. Differential bone histopathology, independent from radiological osteoarthritis grade, was observed in facet joints. Extensive de novo bone formation was found in subchondral bone tissues of eight of fifteen specimens. Regions of bone formation showed high abundance of blood vessels and CD68-positive macrophages, but were devoid of multinucleated osteoclasts. Additional pathological changes in subchondral marrow spaces, including inflammatory infiltration and enhanced osteoclast activity, were characterized by macrophage-rich tissues. PGP9.5-positive nerve fibers were detected near arterioles, but not in regions displaying bone pathology. Individual histopathological parameters did not associate with clinical features or radiological osteoarthritis severity. Subchondral bone histopathology of facet joint osteoarthritis in lumbar spinal stenosis is characterized by marrow infiltration by macrophage-rich tissues and enhanced de novo bone formation. © 2016 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 34

  18. Arthrofibrosis involving the middle facet of the talocalcaneal joint in children and adolescents.

    PubMed

    El Rassi, George; Riddle, Eric C; Kumar, S Jay

    2005-10-01

    Pain over the anterolateral aspect of the ankle in a patient with a history of repeated ankle sprains and with restricted subtalar movement may be associated with a tarsal coalition. Nineteen patients presented with such a history, but conventional imaging did not reveal a cartilaginous or osseous coalition. Since symptoms persisted despite nonoperative treatment, the middle facet was explored surgically. The purpose of this study was to discuss the operative findings and to report the results of treatment. Nineteen patients (twenty-three feet) with pain over the anterolateral aspect of the ankle or a history of repeated ankle sprains had restricted subtalar joint motion and inconclusive findings on diagnostic imaging, except for bone-scanning. Their ages ranged from 9.1 to 18.5 years. The middle facet of the subtalar joint was explored surgically through a 3 to 4-cm-long incision centered over the sustentaculum tali. The results at a mean of 5.8 years were classified as good, fair, or poor on the basis of pain, talocalcaneal joint motion, and shoe wear. Routine radiographs, computed tomography, and magnetic resonance imaging revealed no major abnormality, whereas technetium-99m bone scintigraphy consistently showed slightly increased isotope uptake in the middle facet. Surgical removal of a hypervascular and thickened capsule and synovium in the area of the middle facet of the subtalar joint decreased pain and improved subtalar motion. The final result was good in seventeen patients (twenty feet) and fair in two patients (three feet). There were no poor results. A diagnosis of inflammatory arthrofibrosis should be considered when a patient with a painful rigid flatfoot has normal findings on radiographs and hematological studies but increased isotope uptake in the middle facet of the talocalcaneal joint on bone scintigraphy. Excision of the hypervascular capsule and synovium from this area can result in resolution of the symptoms. Therapeutic Level IV.

  19. In Vivo Cervical Facet Joint Capsule Deformation During Flexion-Extension

    PubMed Central

    Anderst, William J; Lee, Joon Y; Kang, James D

    2014-01-01

    Study Design Non-randomized 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 14 asymptomatic controls and 9 C5-C6 arthrodesis patients performed full range of motion (ROM) flexion-extension while biplane radiographs were collected at 30 Hz. A volumetric model-based tracking process determined 3D vertebral position with sub-millimeter 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 = .159), however, significant differences were observed among fiber regions (p < .001). Significant differences in the rate of fiber deformation in extension were identified among motion segments (p < .001) and among fiber regions (p = .001). The rate of FJC deformation in extension adjacent to the arthrodesis was 45% less than in corresponding motion segments in control subjects (p = .001). Conclusion In control subjects, facet joint capsule deformations are significantly different among vertebral levels and capsule regions when vertebrae are in an extended orientation. In a flexed orientation, FJC deformations are only different among capsule regions. Single-level anterior arthrodesis is

  20. Clinical significance of postdecompression facet joint effusion after minimally invasive decompression for degenerative lumbar spinal stenosis.

    PubMed

    Pao, Jwo-Luen; Chen, Wen-Chih; Chang, Chih-Hung; Chen, Chiang-Sang; Wang, Jaw-Lin

    2014-12-01

    A retrospective case series study. To investigate the clinical significance of postdecompression facet effusion (PDFE) after microendoscopic decompressive laminotomy (MEDL). The facet joint effusion noted on magnetic resonance imaging was considered as an indicator of degeneration of the facet joints and segmental instability. PDFE occurring after MEDL might imply postdecompression segmental instability. Its clinical significance has not yet been clarified. From 2005 to 2010, 165 patients with degenerative lumbar spinal stenosis (average age: 64.5, average follow-up: 25.8 mo) who received MEDL were reviewed. We investigated the incidence of PDFE with preoperative and repetitive magnetic resonance imaging at 6 months postoperatively. The clinical data and treatment courses were reviewed. The treatment outcomes were evaluated with Oswestry Disability Index and Japanese Orthopedic Association scores. The incidence of PDFE was 17.0% (n=28), which was significantly higher in patients receiving multilevel decompression and patients with scoliosis or spondylolisthesis. The intensity of low back pain was similar between patients with and without PDFE, but "mechanical" low back pain was only noted in patients with PDFE. Of the 28 patients with PDFE, only 9 symptomatic patients required invasive treatment (5 facet joint steroid injection, 3 revision MEDL, and 1 spinal fusion). Although the postoperative Oswestry Disability Index and Japanese Orthopedic Association scores were significantly worse these 9 patients, the final outcomes were good. Progression of spondylolisthesis was noted in 2 patients without PDFE but no patients with PDFE during the follow-up period. The relatively high incidence of PDFE after MEDL suggests that injury to the integrity of facet joint is inevitable during decompression of the stenosis, even using minimally invasive techniques. However, the overall stability is well preserved with very rare progression of spondylolisthesis. Most patients with

  1. Vertebral rotatory subluxation in degenerative scoliosis: facet joint tropism is related.

    PubMed

    Bao, Hongda; Zhu, Feng; Liu, Zhen; Bentley, Mark; Mao, Saihu; Zhu, Zezhang; Ding, Yitao; Qiu, Yong

    2014-12-15

    A cross-sectional study. To identify facet tropism as one of the possible risk factors leading to vertebral rotatory subluxation (VRS). VRS has been considered as one of the prognostic factors for degenerative scoliosis. Although several risk factors of VRS, including age and Cobb angle, have been investigated, few studies exist that have evaluated the correlation between VRS and anatomical structures of the vertebral column. This retrospective study recruited 23 patients diagnosed with degenerative lumbar scoliosis with VRS and 20 patients with degenerative scoliosis without VRS. The lateral translation on coronal radiographs was measured and 5 mm was used as the cutoff value to define rotatory subluxation. Computed tomographic scans for facet joints were made for all lumbar levels. The difference between right and left facet angles was recorded as ΔFA. Facet tropism was defined as a difference between the bilateral facet angles of more than 10°. In this study, VRS was most commonly found at the L3-L4 level (49%) and, with decreasing frequency at L2-L3 (24%), L4-L5 (20%), and L1-L2 (7%). On the convex side of the main curve, face joints at levels with VRS were more coronally oriented compared with those at levels without VRS (41.64° ± 11.65° vs. 36.30° ± 10.99°, P = 0.034). ΔFA was also significantly different between levels with and without VRS (P = 0.005). A strong correlation was found between ΔFA and lateral translation, with a coefficient of 0.33 (P < 0.001). In addition, ΔFA and a larger Cobb angle were found to be significantly associated with VRS based on binary regression analysis, with an odds ratio of 4.68 and 2.14, respectively. Facet tropism was more significantly observed at levels with VRS. On the convex side of the main curve, facet joints at levels with VRS were more coronally oriented. A larger Cobb angle and severe facet tropism in degenerative scoliosis should be considered to be related to VRS.

  2. Neuronal hyperexcitability in the dorsal horn after painful facet joint injury.

    PubMed

    Quinn, Kyle P; Dong, Ling; Golder, Francis J; Winkelstein, Beth A

    2010-11-01

    Excessive cervical facet capsular ligament stretch has been implicated as a cause of whiplash-associated disorders following rear-end impacts, but the pathophysiological mechanisms that produce chronic pain in these cases remain unclear. Using a rat model of C6-C7 cervical facet joint capsule stretch that produces sustained mechanical hyperalgesia, the presence of neuronal hyperexcitability was characterized 7 days after joint loading. Extracellular recordings of spinal dorsal horn neuronal activity between C6 and C8 (117 neurons) were obtained from anesthetized rats, with both painful and non-painful behavioral outcomes established by the magnitude of capsule stretch. The frequency of neuronal firing during noxious pinch (p<0.0182) and von Frey filaments applications (4-26g) to the forepaw was increased (p<0.0156) in the painful group compared to the non-painful and sham groups. In addition, the incidence and frequency of spontaneous and after discharge firing were greater in the painful group (p<0.0307) relative to sham. The proportion of cells in the deep laminae that responded as wide dynamic range neurons also was increased in the painful group relative to non-painful or sham groups (p<0.0348). These findings suggest that excessive facet capsule stretch, while not producing visible tearing, can produce functional plasticity of dorsal horn neuronal activity. The increase in neuronal firing across a range of stimulus magnitudes observed at day 7 post-injury provides the first direct evidence of neuronal modulation in the spinal cord following facet joint loading, and suggests that facet-mediated chronic pain following whiplash injury is driven, at least in part, by central sensitization. Copyright © 2010 International Association for the Study of Pain. Published by Elsevier B.V. All rights reserved.

  3. Spinal neuronal plasticity is evident within 1 day after a painful cervical facet joint injury.

    PubMed

    Crosby, Nathan D; Weisshaar, Christine L; Winkelstein, Beth A

    2013-05-10

    Excessive stretch of the cervical facet capsular ligament induces persistent pain and spinal plasticity at later time points. Yet, it is not known when such spinal modifications are initiated following this painful injury. This study investigates the development of hyperalgesia and neuronal hyperexcitability in the spinal cord after a facet joint injury. Behavioral sensitivity was measured in a model of painful C6/C7 facet joint injury in the rat, and neuronal hyperexcitability in the spinal cord was evaluated at 6h and 1 day after injury or a sham procedure, in separate groups. Extracellular recordings of C6/C7 dorsal horn neuronal activity (229 neurons) were used to quantify spontaneous and evoked firing. Rats exhibited no change in sensitivity to mechanical stimulation of the forepaw at 6h, but did exhibit increased sensitivity at 1 day after injury (p=0.012). At 6h, both spontaneous neuronal activity and firing evoked by light brushing, pinch, and von Frey filaments (1.4-26g) applied at the forepaw were not different between sham and injury. At 1 day, spontaneous firing was noted in a greater number of neurons after injury than sham (p<0.04). Evoked firing was also increased 1 day after injury compared to normal and sham (p<0.03). Dorsal horn hyperexcitability and increased spontaneous firing developed between 6 and 24h after painful facet injury, suggesting that the development of hyperalgesia parallels dorsal horn hyperexcitability following mechanical facet joint injury, and these spinal mechanisms are initiated as early as 1 day after injury.

  4. Navigated Pin-Point Approach to Osteoid Osteoma Adjacent to the Facet Joint of Spine

    PubMed Central

    Neo, Masashi; Takemoto, Mitsuru; Nishizawa, Kazuya; Imai, Shinji

    2016-01-01

    Osteoid osteoma (OO) is a benign osteoblastic tumor. Its curative treatment is complete removal of the nidus, where intraoperative localization of the nidus governs clinical results. However, treatment can be difficult since the lesion is often invisible over the bony surface. Accordingly, establishment of an ideal less invasive surgical strategy for spinal OO remains yet unsettled. We illustrate the efficacy of a computed tomography (CT)-based navigation system in excising OO located adjacent to the facet joint of spine. In our 2 cases, complete and pin-point removal of the nidus located close to the facet joint was successfully achieved, without excessive removal of the bone potentially leading to spinal instability and possible damage of nearby neurovascular structures. We advocate a less invasive approach to spinal OO, particularly in an environment with an available CT-based navigation system. PMID:26949472

  5. Intra-articular facet joint injections for low back pain: a systematic review.

    PubMed

    Vekaria, Rajni; Bhatt, Ree'thee; Ellard, David R; Henschke, Nicholas; Underwood, Martin; Sandhu, Harbinder

    2016-04-01

    Evidence supporting the use of therapeutic intra-articular facet joint injections for patients with suspected facet joint pain is sparse. A systematic review including a narrative synthesis was carried out to determine if intra-articular facet joint injections with active drug are more effective in reducing back pain and back pain-related disability than a sham procedure or a placebo/inactive injection. Secondly, to determine if intra-articular facet joint injections with active drug or placebo/inactive injection are more effective in reducing back pain and back pain-related disability than conservative treatment. Medline, EMBASE, CINAHL, CENTRAL, Index to Chiropractic Literature and the Cochrane Central Register of Controlled Trials were searched from inception through April 2015. Data were screened and single extraction with independent verification and risk of bias assessment was performed. A total of 391 records were screened, and six trials were included. The trials included were small (range 18-109 participants) and overall in terms of pain and disability outcomes most were inconclusive. Only two of the trials report any significant between-group differences in pain (mean difference -1.0, 95% CI -2.0 to -0.1) and (p = 0.032) or disability (mean difference -3.0, 95% CI -6.2 to 0.2) and (p = 0.013) outcomes. The studies found here were clinically diverse and precluded any meta-analysis. A number of methodological issues were identified. The positive results, whilst interpreted with caution, do suggest that there is a need for further high-quality work in this area.

  6. Lumbar facet joint nerve blocks in managing chronic facet joint pain: one-year follow-up of a randomized, double-blind controlled trial: Clinical Trial NCT00355914.

    PubMed

    Manchikanti, Laxmaiah; Singh, Vijay; Falco, Frank J E; Cash, Kimberly A; Pampati, Vidyasagar

    2008-01-01

    Lumbar facet joints have been implicated as the source of chronic pain in 15% to 45% of patients with chronic low back pain. Various therapeutic techniques including intraarticular injections, medial branch blocks, and radiofrequency neurotomy of lumbar facet joint nerves have been described in the alleviation of chronic low back pain of facet joint origin. The study was conducted to determine the clinical effectiveness of therapeutic local anesthetic lumbar facet joint nerve blocks with or without steroid in managing chronic function-limiting low back pain of facet joint origin. A randomized, double-blind, controlled trial. An interventional pain management setting in the United States. This study included 60 patients in Group I with local anesthetic and 60 patients in Group II with local anesthetic and steroid. The inclusion criteria was based on the positive response to the diagnostic controlled comparative local anesthetic lumbar facet joint blocks. Numeric pain scores, Oswestry Disability Index, opioid intake, and work status. All outcome assessments were performed at baseline, 3 months, 6 months, and 12 months. Significant improvement with significant pain relief (> 50%) and functional improvement (> 40%) were observed in 82% and 85% in Group I, with significant pain relief in over 82% of the patients and improvement in functional status in 78% of the patients. Based on the results of the present study, it appears that patients may experience significant pain relief 44 to 45 weeks of 1 year, requiring approximately 3 to 4 treatments with an average relief of 15 weeks per episode of treatment. Therapeutic lumbar facet joint nerve blocks, with or without steroid, may provide a management option for chronic function-limiting low back pain of facet joint origin.

  7. Unusual case of paediatric septic arthritis of the lumbar facet joints due to Kingella kingae.

    PubMed

    Le Hanneur, M; Vidal, C; Mallet, C; Mazda, K; Ilharreborde, B

    2016-11-01

    A 32-month-old boy presented with febrile limping that had developed over 6days, associated with right lumbosacral inflammatory swelling. Magnetic resonance imaging (MRI) showed joint effusion of the right L5-S1 zygapophyseal joint, complicated by destructive osteomyelitis of the L5 articular process and paraspinal abscess. Surgery was decided to evacuate the fluid accumulation and rule out differential diagnoses. The diagnosis of septic arthritis of the facet joint was confirmed intraoperatively; real-time quantitative PCR analysis identified Kingella kingae. This is the first substantiated paediatric case of zygapophyseal joint septic arthritis due to K. kingae. K. kingae is the most common pathogen responsible for invasive osteoarticular infection in children under 4years of age. Since empiric antibiotics are effective in early stages, physicians should consider the possibility of spinal infections due to K. kingae when a limping child under 4years of age presents with a fever.

  8. Melorheostosis of the tenth and eleventh thoracic vertebrae crossing the facet joint: a rare cause of back pain.

    PubMed

    McCarthy, M; Mehdian, H; Fairbairn, K J; Stevens, A

    2004-05-01

    Melorheostosis affecting the axial skeleton is a rare condition. We present a case affecting a single thoracic zygoapophyseal (facet) joint that proved to be a diagnostic challenge. CT, MRI and radionuclide imaging with surgical and histopathology findings are discussed.

  9. Early Afferent Activity from the Facet Joint after Painful Trauma to its Capsule Potentiates Neuronal Excitability and Glutamate Signaling in the Spinal Cord

    PubMed Central

    Crosby, Nathan D.; Gilliland, Taylor M.; Winkelstein, Beth A.

    2014-01-01

    Cervical facet joint injury induces persistent pain and central sensitization. Preventing the peripheral neuronal signals that initiate sensitization attenuates neuropathic pain. Yet, there is no clear relationship between facet joint afferent activity, development of central sensitization, and pain, which may be hindering effective treatments for this pain syndrome. This study investigates how afferent activity from the injured cervical facet joint affects induction of behavioral sensitivity and central sensitization. Intra-articular bupivacaine was administered to transiently suppress afferent activity immediately or 4 days after facet injury. Mechanical hyperalgesia was monitored after injury, and spinal neuronal hyperexcitability and spinal expression of proteins that promote neuronal excitability were measured on day 7. Facet injury with saline vehicle treatment induced significant mechanical hyperalgesia (p<0.027), dorsal horn neuronal hyperexcitability (p<0.026), upregulation of pERK1/2, pNR1, mGluR5, GLAST, and GFAP, and downregulation of GLT1 (p<0.032). However, intra-articular bupivacaine immediately after injury significantly attenuated hyperalgesia (p<0.0001), neuronal hyperexcitability (p<0.004), and dysregulation of excitatory signaling proteins (p<0.049). In contrast, intra-articular bupivacaine at day 4 had no effect on these outcomes. Silencing afferent activity during the development of neuronal hyperexcitability (4hr, 8hr, 1 day) attenuated hyperalgesia and neuronal hyperexcitability (p<0.045) only for the treatment given 4 hours after injury. This study suggests that early afferent activity from the injured facet induces development of spinal sensitization via spinal excitatory glutamatergic signaling. Peripheral intervention blocking afferent activity is only effective over a short period of time early after injury and before spinal modifications develop, and is independent of modulating spinal glial activation. PMID:24978827

  10. Evaluation of the stress distribution change at the adjacent facet joints after lumbar fusion surgery: a biomechanical study.

    PubMed

    Ma, Jianxiong; Jia, Haobo; Ma, Xinlong; Xu, Weiguo; Yu, Jingtao; Feng, Rui; Wang, Jie; Xing, Dan; Wang, Ying; Zhu, Shaowen; Yang, Yang; Chen, Yang; Ma, Baoyi

    2014-07-01

    Spinal fusion surgery has been widely applied in clinical treatment, and the spinal fusion rate has improved markedly. However, its postoperative complications, especially adjacent segment degeneration, have increasingly attracted the attention of spinal surgeons. The most common pathological condition at adjacent segments is hypertrophic degenerative arthritis of the facet joint. To study the stress distribution changes at the adjacent facet joint after lumbar fusion with pedicle screw fixation, human cadaver lumbar spines were used in the present study, and electrical resistance strain gauges were attached on L1-L4 articular processes parallel or perpendicular to the articular surface of facet joints. Subsequently, electrical resistance strain gauge data were measured using anYJ-33 static resistance strain indicator with three types of models: the intact model, the laminectomy model, and the fusion model with pedicle screw fixation. The strain changes in the measurement sites indirectly reflect the stress changes. Significant differences in strain were observed between the normal and laminectomy state at all facet joints. Significant differences in strain were observed between the normal and the pedicle screw fixation fusion state at the L1/2 and L3/4 facet joints. The increased stress on the facet joints after lumbar fusion with pedicle screw fixation may be the cause of adjacent segment degeneration.

  11. Does therapist’s attitude affect clinical outcome of lumbar facet joint injections?

    PubMed Central

    Middendorp, Marcus; Kollias, Konstantinos; Ackermann, Hanns; Splettstößer, Annina; Vogl, Thomas J; Khan, M Fawad; Maataoui, Adel

    2016-01-01

    AIM: To investigate if the clinical outcome of intra-articular lumbar facet joint injections is affected by the therapist’s attitude. METHODS: A total of 40 patients with facet joint-associated chronic low back pain were randomly divided into two groups. All patients received computed tomography-guided, monosegmental intra-articular facet joint injections. Following the therapeutic procedure, the patients of the experimental group (EG) held a conversation with the radiologist in a comfortable atmosphere. During the dialog, the patients were encouraged to ask questions and were shown four images. The patients of the control group (CG) left the clinic without any further contact with the radiologist. Outcome was assessed using a pain-based Verbal Numeric Scale at baseline, at 1 wk and at 1, 3, and 6 mo after first treatment. RESULTS: The patient demographics showed no differences between the groups. The patients of the EG received 57 interventional procedures in total, while the patients of the CG received 70 interventional procedures. In both groups, the pain scores decreased significantly over the entire observation period. Compared to the CG, the EG showed a statistically significant reduction of pain at 1 wk and 1 mo post-treatment, while at 3 and 6 mo after treatment, there were no significant differences between both groups. CONCLUSION: Our results show a significant effect on pain relief during the early post-interventional period in the EG as compared to the CG. The basic principle behind the higher efficacy might be the phenomenon of hetero-suggestion. PMID:27358691

  12. [Panlongqi tablet (Chinese characters) combined with lumbar facet joint release for the treatment of lumbar spinal stenosis of Fengshi Bizu (Chinese characters)].

    PubMed

    Deng, Xiao-chuan; Yang, Ao-fei; He, Cheng-jian

    2014-10-01

    To investigate the clinical efficacy of Panlongqi tablet (Chinese characters) combined with lumbar facet joint release for lumbar spinal stenosis of type Fengshi Bizu (Chinese characters). Since February 2012 to February 2013, 120 patients with lumbar spinal stenosis of Fengshi Bizu (Chinese characters) syndrome were retrospectively studied. According to different treatment methods, 120 patients with lumbar spinal stenosis were divided into Panlongqi tablet (Chinese characters)group and control groups, respectively. In Panlongqi tablet (Chinese characters)group, 60 patients were treated by Panlongqi tablet (Chinese characters) combined with lumbar facet joints release solution including 26 males and 34 females with an average age of (60.40±3.36) years old ranging from 46 to 65 ; the course of the disease was 2 to 15 years (averaged 7.6 years). In control group the other 60 patients were treated with lumbar facet joint release including 24 males and 36 females with an average age of (61.20±2.47) years old ranging from 48 to 63; the course was 3 to 14 years (averaged 6.9 years). The clinical effect of patients were evaluated by JOA and ODI score before treatment, at 4 weeks and 3 months after treatment. All patients were followed up for 4 to 7 months (means 5.6 months). After 3 months,7 cases in control group recurrenced symptoms,only 1 case in Panlongqi tablet (Chinese characters) group recurrenced. At 4 weeks and 3 months of follow-up, ODI score and JOA score of Panlongqi tablet group were much better than those of the control group. For lumbar spinal stenosis of type Fengshi Bizu (Chinese characters),which were treated with lumbar facet joint release with Panlongqi tablet(Chinese characters), supplemented by back muscle exercise, in relieving waist and low back pain symptoms and improving functional status of lower lumbar spine, can obtain satisfactory clinical outcome, is a good method of conservative treatment for such diseases.

  13. Pigmented villonodular synovitis originating from the lumbar facet joint: a case report

    PubMed Central

    Oe, Kenichi; Yoshida, Yugo; Ohnari, Hiroyuki; Iida, Hirokazu; Sakaida, Noriko; Uemura, Yoshiko

    2007-01-01

    The authors successfully treated a rare case of pigmented villonodular synovitis (PVNS) that originated from the lumbar facet joint (L4-5). A 43-year-old man presented with a complaint of left severe sciatica causing difficulty in walking. Magnetic resonance imaging (MRI) demonstrated an extradural mass on the left side at L4 and the mass compressed the dural tube and was continuous with the left L4-5 facet joint. A computed tomography myelogram revealed an extradural defect of contrast medium at the L4 level and an erosion of the L4 lamina. A total synovectomy with unilateral osteoplastic laminectomy was performed. The histological findings were a diagnosis of PVNS. The patient’s symptoms resolved completely and the MRI at postoperative 3 years demonstrated no recurrence of PVNS. It is important to totally remove the synovium, which is the origin of PVNS in order to prevent the recurrence. We think that our procedure is reasonable and adequate for lumbar PVNS. PMID:17566795

  14. Septic Arthritis of an Atlantoaxial Facet Joint with Normal Inflammatory Markers: Case Report and Literature Review.

    PubMed

    Kuyumcu, Gokhan; Simpfendorfer, Claus S; Babic, Maja; Kalfas, Iain H; Teixeira-Johnson, Lucileia; Winalski, Carl S

    2017-02-01

    Septic arthritis of the atlantoaxial facet joint is extremely rare. Contiguous spread to the median atlantoaxial joints with subsequent dens erosion can lead to atlantoaxial instability. Misleading normal inflammatory markers can result in delayed diagnosis and catastrophic consequences. A 56-year-old man presented with right-sided neck pain that had lasted for 2 days. He did not have fever or chills, and his serum C-reactive protein and erythrocyte sedimentation rate were normal. The patient was diagnosed with acute neck strain and treated conservatively. The pain continued for the next 3 weeks; cervical spine radiographs demonstrated normal findings with the exception of degenerative changes. The patient was treated with physical rehabilitation for the presumed neck strain and degenerative changes of the cervical vertebrae. Worsening neck pain and stiffness prompted a magnetic resonance imaging study obtained 5 weeks after the initial presentation, which showed an epidural collection with septic arthritis of the right facet and median atlantoaxial joints. Computed tomography demonstrated severe dens erosion. Surgical evacuation of the abscess and occipitocervical fusion were performed. Pathologic evaluation of tissue obtained during surgery demonstrated the presence of an infection, and Streptococcus anginosus grew from cultures. Infection must be considered in the differential diagnosis for neck pain when imaging findings are suggestive of an infectious process, even in an afebrile patient with normal C-reactive protein and erythrocyte sedimentation rate levels. Magnetic resonance imaging and computed tomography can play a critical role in such cases, potentially leading to a more timely diagnosis. Copyright © 2016 Elsevier Inc. All rights reserved.

  15. THE PROSTAGLANDIN E2 RECEPTOR, EP2, IS UPREGULATED IN THE DRG AFTER PAINFUL CERVICAL FACET JOINT INJURY IN THE RAT

    PubMed Central

    Kras, Jeffrey V.; Dong, Ling; Winkelstein, Beth A.

    2012-01-01

    Study Design This study implemented immunohistochemistry to assay prostaglandin E2 (PGE2) receptor EP2 expression in the dorsal root ganglion (DRG) of rats after painful cervical facet joint injury. Objective The objective of this study was to identify if inflammatory cascades are induced in association with cervical facet joint distraction-induced pain by investigating the time course of EP2 expression in the DRG. Summary of Background Data The cervical facet joint is a common source of neck pain and non-physiological stretch of the facet capsular ligament can initiate pain from the facet joint via mechanical injury. PGE2 levels are elevated in painful inflamed and arthritic joints, and PGE2 sensitizes joint afferents to mechanical stimulation. Although in vitro studies suggest the EP2 receptor subtype contributes to painful joint disease the EP2 response has not been investigated for any association with painful mechanical joint injury. Methods Separate groups of male Holtzman rats underwent either a painful cervical facet joint distraction injury or sham procedure. Bilateral forepaw mechanical allodynia was assessed, and immunohistochemical techniques were used to quantify EP2 expression in the DRG at days 1 and 7. Results Facet joint distraction induced mechanical allodynia that was significant (p<0.024) at all time points. Painful joint injury also significantly elevated total EP2 expression in the DRG at day 1 (p=0.009), which was maintained also at day 7 (p<0.001). Neuronal expression of EP2 in the DRG was only increased over sham levels at day 1 (p=0.013). Conclusions Painful cervical facet joint distraction induces an immediate and sustained increase of EP2 expression in the DRG, implicating peripheral inflammation in the initiation and maintenance of facet joint pain. The transient increase in neuronal EP2 suggests, as in other painful joint conditions, that after joint injury non-neuronal cells may migrate to the DRG, some of which likely express EP2

  16. Internal morphology of human facet joints: comparing cervical and lumbar spine with regard to age, gender and the vertebral core

    PubMed Central

    Wilke, Hans-Joachim; Zanker, Daniel; Wolfram, Uwe

    2012-01-01

    Back pain constitutes a major problem in modern societies. Facet joints are increasingly recognised as a source of such pain. Knowledge about the internal morphology and its changes with age may make it possible to include the facets more in therapeutic strategies, for instance joint replacements or immobilisation. In total, 168 facets from C6/7 and L4/5 segments were scanned in a micro-computed tomography. Image analysis was used to investigate the internal morphology with regard to donor age and gender. Additional data from trabecular bone of the vertebral core allowed a semi-quantitative comparison of the morphology of the vertebral core and the facets. Porosity and pore spacing of the cortical sub-chondral bone does not appear to change with age for either males or females. In contrast, bone volume fraction decreases in females from approximately 0.4 to 0.2 , whereas it is constant in males. Trabecular thickness decreases during the ageing process in females and stays constant in males , whereas trabecular separation increases during the ageing process in both genders. The results of this study may help to improve the understanding of pathophysiological changes in the facet joints. Such results could be of value for understanding back pain and its treatment. PMID:22257304

  17. In vivo feasibility of real-time MR-US fusion imaging lumbar facet joint injections.

    PubMed

    Sartoris, Riccardo; Orlandi, Davide; Corazza, Angelo; Sconfienza, Luca Maria; Arcidiacono, Alice; Bernardi, Silvia Perugin; Schiaffino, Simone; Turtulici, Giovanni; Caruso, Pietro; Silvestri, Enzo

    2017-03-01

    Traditionally, facet joint injections (FJI) are performed under fluoroscopic or computed tomography (CT) guidance, mainly due to the deep anatomical location and the presence of bony landmarks. Fusion imaging technology, which couples the ultrasound scan with the corresponding CT or magnetic resonance (MR) image obtained from the diagnostic examination and reformatted in real time according to the ultrasound scanning plane, allows to combine the panoramic view and the elevated anatomical detail of MR or CT with the ease of use of ultrasound without patient exposure to ionizing radiation. Thirty eight patients (24 females; mean age ± SD: 64 ± 9 years) received MR fusion-assisted ultrasound-guided FJI of 1 ml of a mixture of local anaesthetic and corticosteroid using a ultrasound machine (Logiq E9, GE Healthcare) equipped with a GPS-enhanced fusion imaging technology which couples real-time B-mode images with those of the previous recent diagnostic MR examination. Low-dose CT needle positioning confirmation was performed in the first 28 patients. Patients' pain was recorded using a visual analogue scale (VAS), at baseline and at 2, 4 and 8 weeks. All fusion imaging-guided injections were performed successfully. Out of 112, 96 FJI had optimal intra-articular needle positioning (accuracy: 85.7%). Patients VAS significantly decreases after the procedure with no differences among who received CT needle positioning control and who did not receive it. No major complications were observed. Ultrasound needle guidance with MR fusion assistance allows for safe and effective injection of degenerative facet joint disease.

  18. Facet joint pain in chronic spinal pain: an evaluation of prevalence and false-positive rate of diagnostic blocks.

    PubMed

    Manchukonda, Rajeev; Manchikanti, Kavita N; Cash, Kimberly A; Pampati, Vidyasagar; Manchikanti, Laxmaiah

    2007-10-01

    A retrospective review. Evaluation of the prevalence of facet or zygapophysial joint pain in chronic spinal pain of cervical, thoracic, and lumbar origin by using controlled, comparative local anesthetic blocks and evaluation of false-positive rates of single blocks in the diagnosis of chronic spinal pain of facet joint origin. Facet or zygapophysial joints are clinically important sources of chronic cervical, thoracic, and lumbar spine pain. The previous studies have demonstrated the value and validity of controlled, comparative local anesthetic blocks in the diagnosis of facet joint pain, with a prevalence of 15% to 67% variable in lumbar, thoracic, and cervical regions. False-positive rates of single diagnostic blocks also varied from 17% to 63%. Five hundred consecutive patients receiving controlled, comparative local anesthetic blocks of medial branches for the diagnosis of facet or zygapophysial joint pain were included. Patients were investigated with diagnostic blocks using 0.5 mL of 1% lidocaine per nerve. Patients with lidocaine-positive results were further studied using 0.5 mL of 0.25% bupivacaine per nerve on a separate occasion. Medial branch blocks were performed with intermittent fluoroscopic visualization, at 2 levels to block a single joint. A positive response was considered as one with at least 80% pain relief from a block of at least 2 hours duration when lidocaine was used, and at least 3 hours or longer than the duration of relief with lidocaine when bupivacaine was used, and also the ability to perform prior painful movements. A total of 438 patients met inclusion criteria. The prevalence of facet joint pain was 39% in the cervical spine [95% confidence interval (CI), 32%-45%]; 34% (95% CI, 22%-47%) in the thoracic pain; and 27% (95% CI, 22%-33%) in the lumbar spine. The false-positive rate with a single block in the cervical region was 45%, in the thoracic region was 42%, and in the lumbar region 45%. This retrospective review once again

  19. Physiotherapy and lumbar facet joint injections as a combination treatment for chronic low back pain. A narrative review of lumbar facet joint injections, lumbar spinal mobilizations, soft tissue massage and lower back mobility exercises.

    PubMed

    Chambers, Hannah

    2013-06-01

    The aim of this study was to summarize the available evidence on lumbar facet joint injections and the physiotherapy treatments, land-based lower back mobility exercise, soft tissue massage and lumbar spinal mobilizations for chronic low back pain (CLBP). The plausibility of physiotherapy and lumbar facet joint injections as a combination treatment is discussed. Using a systematic process, an online electronic search was performed using key words utilizing all available databases and hand searching reference lists. Using a critical appraisal tool from the Critical Appraisal Skills Programme (CASP), the literature was screened to include primary research. The main aspects of the research were summarized. The evidence for lumbar facet joint injections suggests an overall short-term positive effect on CLBP. Land-based lower back mobility exercise and soft tissue massage appear to have a positive effect on CLBP in the short term and possibly in the longer term. There is insufficient evidence to draw conclusions for lumbar spinal mobilizations. The review indicates that lumbar facet joint injections create a short period when pain is reduced. Physiotherapy treatments including land-based lower back mobility exercise and soft tissue massage may be of benefit during this time to improve the longer-term outcomes of patients with CLBP. It is not possible to make generalizations or firm conclusions. The current review highlights the need for further research. A randomized controlled trial is recommended to assess the impact of physiotherapy in combination with lumbar facet joint injections on CLBP. Copyright © 2013 John Wiley & Sons, Ltd.

  20. Micro-computed tomography, scanning electron microscopy and energy X-ray spectroscopy studies of facet joint degeneration: A comparison to clinical imaging.

    PubMed

    Goehre, Felix; Ludtka, Christopher; Hamperl, Melanie; Friedmann, Andrea; Straube, Anja; Mendel, Thomas; Heilmann, Andreas; Meisel, Hans Jörg; Schwan, Stefan

    2017-09-01

    Segmental degeneration in the human lumbar spine affects both the intervertebral discs and facet joints. Facet joint degeneration not only affects the cartilage surface, but also alters the cellular properties of the cartilage tissue and the structure of the subchondral bone. The primary focus of this study is the investigation of these microstructural changes that are caused by facet joint degeneration. Microstructural analyses of degenerated facet joint samples, obtained from patients following operative lumbar interbody fusion, have not previously been extensively investigated. This study analyzes human facet joint samples from the inferior articular process using scanning electron microscopy, micro-computed tomography, and energy dispersive X-ray spectroscopy to evaluate parameters of interest in facet joint degeneration such as elemental composition, cartilage layer thickness and cell density, calcification zone thickness, subchondral bone portion, and trabecular bone porosity. These microstructural analyses demonstrate fragmentation, cracking, and destruction of the cartilage layer, a thickened calcification zone, localized calcification areas, and cell cluster formation as pathological manifestations of facet joint degeneration. The detailed description of these microstructural changes is critical for a comprehensive understanding of the pathology of facet joint degeneration, as well as the subsequent development and efficacy analysis of regenerative treatment strategies. Copyright © 2017 Elsevier Ltd. All rights reserved.

  1. Ultrasound guided, painful electrical stimulation of lumbar facet joint structures: an experimental model of acute low back pain.

    PubMed

    O'Neill, Søren; Graven-Nielsen, Thomas; Manniche, Claus; Arendt-Nielsen, Lars

    2009-07-01

    Quantitative sensory testing has indicated generalized muscle hyperalgesia in patients with chronic low back pain. The temporal development of such hyperalgesia is not well understood. The aim of the present study was to demonstrate whether generalized muscle hyperalgesia can develop within minutes of acute low back pain using a new experimental model of lumbar facet joint pain. Thirteen healthy volunteers were included and baseline pressure pain thresholds were assessed at eight separate sites, outside the area of evoked low back and referred pain. Using ultrasonography, two electrode needles were placed either side of a lumbar facet joint (right L3-4) and used to induce experimental low back pain for 10 min with continuous stimulation. Thresholds, stimulus-response relationships, distribution and quality of the electrically induced pain were recorded. Electrical facet joint stimulation induced low back pain and pain referral into the anterior leg, ipsilaterally, proximal to the knee, similar to what is observed clinically. Pressure pain thresholds did not change significantly before, during and after facet joint stimulation. In conclusion, we describe a novel model of acute experimental low back pain and demonstrate that generalized hyperalgesia did not develop within minutes of acute low back pain.

  2. The influence of facet joint orientation and tropism on the stress at the adjacent segment after lumbar fusion surgery: a biomechanical analysis.

    PubMed

    Kim, Ho-Joong; Kang, Kyoung-Tak; Son, Juhyun; Lee, Choon-Ki; Chang, Bong-Soon; Yeom, Jin S

    2015-08-01

    Facet joint orientation and tropism influence the biomechanics of the corresponding segment. Therefore, the sagittal orientation or tropism of the facet joint adjacent to the fusion segment seems a potential risk factor for adjacent segment degeneration. However, there have been no biomechanical studies regarding this issue. To investigate the association between adjacent facet orientation and facet tropism and stress in adjacent disc/facet joints using finite element (FE) analysis. An FE analysis. Four intact (F50, F55, F60, and FT [facet tropism]) and matched L3-L4 fusion (F50, F55, F60, and FT fusion) models with different facet joint orientation (50°, 55°, 60° relative to the coronal plane, and facet tropism, respectively) at both L2-L3 facet joints were simulated. In each model, intradiscal pressures and facet contact force at the L2-L3 segment were investigated under pure moments and anterior shear force. Compared with the matched-intact model, the F60 fusion model yielded the highest and largest percentage increase of intradiscal pressure at the L2-L3 segment under flexion, torsion moment, and anterior shear force among the F50, F55, and F60 fusion models. F60 fusion model also demonstrated the largest facet contact force under torsion moment among the F50, F55, and F60 fusion models. In all conditions tested, the FT fusion model demonstrated the highest intradiscal pressure and facet contact force of all the models. Facet joint orientation and tropism at the adjacent segment influences the overstress of the adjacent segment, especially under the clinical circumstance of increased anterior shear force. Copyright © 2015 Elsevier Inc. All rights reserved.

  3. Intra-articular nerve growth factor regulates development, but not maintenance, of injury-induced facet joint pain & spinal neuronal hypersensitivity.

    PubMed

    Kras, J V; Kartha, S; Winkelstein, B A

    2015-11-01

    The objective of the current study is to define whether intra-articular nerve growth factor (NGF), an inflammatory mediator that contributes to osteoarthritic pain, is necessary and sufficient for the development or maintenance of injury-induced facet joint pain and its concomitant spinal neuronal hyperexcitability. Male Holtzman rats underwent painful cervical facet joint distraction (FJD) or sham procedures. Mechanical hyperalgesia was assessed in the forepaws, and NGF expression was quantified in the C6/C7 facet joint. An anti-NGF antibody was administered intra-articularly in additional rats immediately or 1 day following facet distraction or sham procedures to block intra-articular NGF and test its contribution to initiation and/or maintenance of facet joint pain and spinal neuronal hyperexcitability. NGF was injected into the bilateral C6/C7 facet joints in separate rats to determine if NGF alone is sufficient to induce these behavioral and neuronal responses. NGF expression increases in the cervical facet joint in association with behavioral sensitivity after that joint's mechanical injury. Intra-articular application of anti-NGF immediately after a joint distraction prevents the development of both injury-induced pain and hyperexcitability of spinal neurons. Yet, intra-articular anti-NGF applied after pain has developed does not attenuate either behavioral or neuronal hyperexcitability. Intra-articular NGF administered to the facet in naïve rats also induces behavioral hypersensitivity and spinal neuronal hyperexcitability. Findings demonstrate that NGF in the facet joint contributes to the development of injury-induced joint pain. Localized blocking of NGF signaling in the joint may provide potential treatment for joint pain. Copyright © 2015 Osteoarthritis Research Society International. Published by Elsevier Ltd. All rights reserved.

  4. Diagnostic Value of Lumbar Facet Joint Injection: A Prospective Triple Cross-Over Study

    PubMed Central

    Schütz, Uwe; Cakir, Balkan; Dreinhöfer, Karsten; Richter, Marcus; Koepp, Holger

    2011-01-01

    The diagnosis “lumbar facet syndrome” is common and often indicates severe lumbar spine surgery procedures. It is doubtful whether a painful facet joint (FJ) can be identified by a single FJ block. The aim of this study was to clarify the validity of a single and placebo controlled bilateral FJ blocks using local anesthetics. A prospective single blinded triple cross-over study was performed. 60 patients (31 f, 29 m, mean age 53.2 yrs (22–73)) with chronic low back pain (mean pain persistance 31 months, 6 months of conservative treatment without success) admitted to a local orthopaedic department for surgical or conservative therapy of chronic LBP, were included in the study. Effect on pain reduction (10 point rating scale) was measured. The 60 subjects were divided into six groups with three defined sequences of fluoroscopically guided bilateral monosegmental lumbar FJ test injections in “oblique needle” technique: verum-(local anaesthetic-), placebo-(sodium chloride-) and sham-injection. Carry-over and periodic effects were evaluated and a descriptive and statistical analysis regarding the effectiveness, difference and equality of the FJ injections and the different responses was performed. The results show a high rate of non-response, which documents the lack of reliable and valid predictors for a positive response towards FJ blocks. There was a high rate of placebo reactions noted, including subjects who previously or later reacted positively to verum injections. Equivalence was shown among verum vs. placebo and partly vs. sham also. With regard to test validity criteria, a single intraarticular FJ block with local anesthetics is not useful to detect the pain-responsible FJ and therefore is no valid and reliable diagostic tool to specify indication of lumbar spine surgery. Comparative FJ blocks with local anesthetics and placebo-controls have to be interpretated carefully also, because they solely give no proper diagnosis on FJ being main pain

  5. INTRA-ARTICULAR NERVE GROWTH FACTOR REGULATES DEVELOPMENT, BUT NOT MAINTENANCE, OF INJURY-INDUCED FACET JOINT PAIN & SPINAL NEURONAL HYPERSENSITIVITY

    PubMed Central

    Kras, Jeffrey V.; Kartha, Sonia; Winkelstein, Beth A.

    2015-01-01

    Objective The objective of the current study is to define whether intra-articular nerve growth factor (NGF), an inflammatory mediator that contributes to osteoarthritic pain, is necessary and sufficient for the development or maintenance of injury-induced facet joint pain and its concomitant spinal neuronal hyperexcitability. Method Male Holtzman rats underwent painful cervical facet joint distraction or sham procedures. Mechanical hyperalgesia was assessed in the forepaws, and NGF expression was quantified in the C6/C7 facet joint. An anti-NGF antibody was administered intra-articularly in additional rats immediately or 1 day following facet distraction or sham procedures to block intra-articular NGF and test its contribution to initiation and/or maintenance of facet joint pain and spinal neuronal hyperexcitability. NGF was injected into the bilateral C6/C7 facet joints in separate rats to determine if NGF alone is sufficient to induce these behavioral and neuronal responses. Results NGF expression increases in the cervical facet joint in association with behavioral sensitivity after that joint’s mechanical injury. Intra-articular application of anti-NGF immediately after a joint distraction prevents the development of both injury-induced pain and hyperexcitability of spinal neurons. Yet, intra-articular anti-NGF applied after pain has developed does not attenuate either behavioral or neuronal hyperexcitability. Intra-articular NGF administered to the facet in naïve rats also induces behavioral hypersensitivity and spinal neuronal hyperexcitability. Conclusion Findings demonstrate that NGF in the facet joint contributes to the development of injury-induced joint pain. Localized blocking of NGF signaling in the joint may provide potential treatment for joint pain. PMID:26521746

  6. Sonoanatomic indices of lumbar facet joints in patients with facetogenic back pain in comparison to healthy subjects.

    PubMed

    Rahimzadeh, Poupak; Faiz, Hamid Reza; Baghaee, Ali Reza; Nader, Nader D

    2017-02-01

    Nowadays, ultrasound is increasingly used with a great accuracy in performing nerve blocks for facet joint disease. To measure sonoanatomic characteristics for the facet joints of lumbar vertebras in patients with facetogenic pain and healthy volunteers. Cross-sectional, observational study. University-affiliated Specialty Clinic for Pain Management. Twenty patients with facet joint disease (FJD) and 40 healthy volunteers (HVGs) were matched for age and sex, height, and weight. Patients with FJD were referred with complaints of pain in the left lumbar facet joints that twice responded favorably to ultrasound guided medial branch blocks. Medial branch blocks. The interfacet joint distance (IFJD) between the third, the fourth, and the fifth lumbar vertebras and their depth from the level of skin (DFS) were measured bilaterally, using a high-resolution ultrasound in both groups. Thirty-one men and 29 women with average age of 41.5±9.5 years were enrolled. The IFJD for L3-L4 was 31.5±4.0 mm on the left side and 31.8±4.0 mm on the right side. The IFJD for L4-L5 was 31.3±4.4 mm on the left side and 31.5±4.0 mm on the right side. The IFJD was uniformly 2.2 mm shorter in the FJD group than those in the HVG group (P=.021). The measurements of DFS increased in lower vertebras (L3facet joints of L4 (P=.016), DFS measurements were similar in FJD and HVG groups. The diagnosis of facet joint disease was merely clinical and the total number of the patients was relatively small. Interfacet distances of the lumbar vertebras are smaller in patients suffering from degenerative FJD compared with HVGs. Degenerative changes of intervertebral discs and partial reduction of space between 2 adjacent vertebras may contribute to this observation. Published by Elsevier Inc.

  7. Explosive growth of facet joint interventions in the medicare population in the United States: a comparative evaluation of 1997, 2002, and 2006 data

    PubMed Central

    2010-01-01

    Background The Office of Inspector General of the Department of Health and Human Services (OIG-DHHS) issued a report which showed explosive growth and also raised questions of lack of medical necessity and/or indications for facet joint injection services in 2006. The purpose of the study was to determine trends of frequency and cost of facet joint interventions in managing spinal pain. Methods This analysis was performed to determine trends of frequency and cost of facet joint Interventions in managing spinal pain, utilizing the annual 5% national sample of the Centers for Medicare and Medicaid Services (CMS) for 1997, 2002, and 2006. Outcome measures included overall characteristics of Medicare beneficiaries receiving facet joint interventions, utilization of facet joint interventions by place of service, by specialty, reimbursement characteristics, and other variables. Results From 1997 to 2006, the number of patients receiving facet joint interventions per 100,000 Medicare population increased 386%, facet joint visits increased 446%, and facet joint interventions increased 543%. The increases were higher in patients aged less than 65 years compared to those 65 or older with patients increasing 504% vs. 355%, visits increasing 587% vs. 404%, and services increasing 683% vs. 498%. Total expenditures for facet joint interventions in the Medicare population increased from over $229 million in 2002 to over $511 million in 2006, with an overall increase of 123%. In 2006, there was a 26.8-fold difference in utilization of facet joint intervention services in Florida compared to the state with the lowest utilization - Hawaii. There was an annual increase of 277.3% in the utilization of facet joint interventions by general physicians, whereas a 99.5% annual increase was seen for nurse practitioners (NPs) and certified registered nurse anesthetists (CRNAs) from 2002 to 2006. Further, in Florida, 47% of facet joint interventions were performed by general physicians

  8. Whiplash-like facet joint loading initiates glutamatergic responses in the DRG and spinal cord associated with behavioral hypersensitivity

    PubMed Central

    Dong, Ling; Quindlen, Julia C.; Lipschutz, Daniel E.; Winkelstein, Beth A.

    2012-01-01

    The cervical facet joint and its capsule are a common source of neck pain from whiplash. Mechanical hyperalgesia elicited by painful facet joint distraction is associated with spinal neuronal hyperexcitability that can be induced by transmitter/receptor systems that potentiate the synaptic activation of neurons. This study investigated the temporal response of a glutamate receptor and transporters in the dorsal root ganglia (DRG) and spinal cord. Bilateral C6/C7 facet joint distractions were imposed in the rat either to produce behavioral sensitivity or without inducing any sensitivity. Neuronal metabotropic glutamate receptor-5 (mGluR5) and protein kinase C-epsilon (PKCε) expression in the DRG and spinal cord were evaluated on days 1 and 7. Spinal expression of a glutamate transporter, excitatory amino acid carrier 1 (EAAC1), was also quantified at both time points. Painful distraction produced immediate behavioral hypersensitivity that was sustained for 7 days. Increased expression of mGluR5 and PKCε in the DRG was not evident until day 7 and only following painful distraction; this increase was observed in small-diameter neurons. Only painful facet joint distraction produced a significant increase (p<0.001) in neuronal mGluR5 over time, and this increase also was significantly elevated (p ≤ 0.05) over responses in the other groups at day 7. However, there were no differences in spinal PKCε expression on either day or between groups. Spinal EAAC1 expression was significantly increased (p<0.03) only in the nonpainful groups on day 7. Results from this study suggest spinal glutamatergic plasticity is selectively modulated in association with facet-mediated pain. PMID:22578356

  9. A review of percutaneous techniques for low back pain and neuralgia: current trends in epidural infiltrations, intervertebral disk and facet joint therapies

    PubMed Central

    Kelekis, Alexis

    2016-01-01

    Low back pain and neuralgia due to spinal pathology are very common symptoms debilitating numerous patients with peak prevalence at ages between 45 and 60 years. Intervertebral discs and facet joints act as pain sources in the vast majority of the cases. Diagnosis is based on the combination of clinical examination and imaging studies. Therapeutic armamentarium for low back pain and neuralgia due to intervertebral discs and/or facet joints includes conservative therapy, injections, percutaneous therapeutic techniques and surgical options. Percutaneous, therapeutic techniques are imaging-guided, minimally invasive treatments which can be performed as outpatient procedures. In cases of facet joint syndrome, they include, apart from injections, neurolysis with radiofrequency/cryoablation, MR-guided high-intensity focused ultrasound and percutaneous fixation techniques. In case of discogenic pain, apart from infiltrations, therapeutic techniques can be classified in to two main categories: decompression (mechanical, thermal, chemical) techniques and biomaterials implantation/disc cell therapies. Strict sterility measures are a prerequisite and should include extensive local sterility and antibiotic prophylaxis. This article will report clinical and imaging findings for each pathology type and the association with treatment decision. In addition, we will describe in detail all possible treatment techniques for low back pain and neuralgia, and we will report recently published results of these techniques summarizing the data concerning safety and effectiveness as well as the level of evidence. Finally, we will try to provide a rational approach for the therapy of low back pain and neuralgia by means of minimally invasive imaging-guided percutaneous techniques. PMID:26463233

  10. A review of percutaneous techniques for low back pain and neuralgia: current trends in epidural infiltrations, intervertebral disk and facet joint therapies.

    PubMed

    Filippiadis, Dimitrios K; Kelekis, Alexis

    2016-01-01

    Low back pain and neuralgia due to spinal pathology are very common symptoms debilitating numerous patients with peak prevalence at ages between 45 and 60 years. Intervertebral discs and facet joints act as pain sources in the vast majority of the cases. Diagnosis is based on the combination of clinical examination and imaging studies. Therapeutic armamentarium for low back pain and neuralgia due to intervertebral discs and/or facet joints includes conservative therapy, injections, percutaneous therapeutic techniques and surgical options. Percutaneous, therapeutic techniques are imaging-guided, minimally invasive treatments which can be performed as outpatient procedures. In cases of facet joint syndrome, they include, apart from injections, neurolysis with radiofrequency/cryoablation, MR-guided high-intensity focused ultrasound and percutaneous fixation techniques. In case of discogenic pain, apart from infiltrations, therapeutic techniques can be classified in to two main categories: decompression (mechanical, thermal, chemical) techniques and biomaterials implantation/disc cell therapies. Strict sterility measures are a prerequisite and should include extensive local sterility and antibiotic prophylaxis. This article will report clinical and imaging findings for each pathology type and the association with treatment decision. In addition, we will describe in detail all possible treatment techniques for low back pain and neuralgia, and we will report recently published results of these techniques summarizing the data concerning safety and effectiveness as well as the level of evidence. Finally, we will try to provide a rational approach for the therapy of low back pain and neuralgia by means of minimally invasive imaging-guided percutaneous techniques.

  11. A prospective morphological study of facet joint integrity following intervertebral disc replacement with the CHARITE Artificial Disc.

    PubMed

    Trouillier, Hans; Kern, P; Refior, H J; Müller-Gerbl, M

    2006-02-01

    In degenerative disc disease (DDD), increased loading in the posterior column increases facet joint subchondral bone density and may lead to facet joint degeneration. While spinal fusion is commonly used to treat patients with symptomatic DDD, increased stress at the levels adjacent to fusion may accelerate facet joint and adjacent segment degeneration. Artificial disc replacements have been developed as an alternative to fusion. In this prospective study, the effects of disc replacement with the CHARITE Artificial Disc on facet joint loading and integrity were evaluated. Thirteen patients aged <50 years with symptomatic DDD were recruited. Computed tomography (CT) osteoabsorptiometry was performed prior to the implantation of the CHARITE Artificial Disc and six months after. With this technique, increases or decreases in facet joint loading and integrity are indicated by corresponding changes in subchondral bone density. Changes in the distribution of load alter the distribution of the areas of maximum bone density. Clinical outcome was also assessed at pre-operative and 6 and 12 month post-operative visits using the Visual Analogue Scale back and leg pain scores, the Oswestry Disability Index and the Short Form-36 (SF-36) questionnaire. The height of the intervertebral space at the operated level was monitored by lateral X-ray. Subchondral bone density was evaluated in the facet joints of all 13 patients at the operated level, 12 patients at the level above the operated segment, and five patients at the level below the operated segment. Quantitative measurements revealed no significant increases (> or =3%) in subchondral bone density of the facet joints at any level in any patient. Significant decreases (> or =3%) in subchondral bone density were measured at the operated level in 10/13 patients, at the level above the operated segment in 6/12 patients, and at the level below the operated segment in 3/5 patients. There were no changes in the distribution of the

  12. Biomechanical evaluation of the impact of various facet joint lesions on the primary stability of anterior plate fixation in cervical dislocation injuries: a cadaver study: Laboratory investigation.

    PubMed

    Oberkircher, Ludwig; Born, Sebastian; Struewer, Johannes; Bliemel, Christopher; Buecking, Benjamin; Wack, Christina; Bergmann, Martin; Ruchholtz, Steffen; Krüger, Antonio

    2014-10-01

    Injuries of the subaxial cervical spine including facet joints and posterior ligaments are common. Potential surgical treatments consist of anterior, posterior, or anterior-posterior fixation. Because each approach has its advantages and disadvantages, the best treatment is debated. This biomechanical cadaver study compared the effect of different facet joint injuries on primary stability following anterior plate fixation. Fractures and plate fixation were performed on 15 fresh-frozen intact cervical spines (C3-T1). To simulate a translation-rotation injury in all groups, complete ligament rupture and facet dislocation were simulated by dissecting the entire posterior and anterior ligament complex between C-4 and C-5. In the first group, the facet joints were left intact. In the second group, one facet joint between C-4 and C-5 was removed and the other side was left intact. In the third group, both facet joints between C-4 and C-5 were removed. The authors next performed single-level anterior discectomy and interbody grafting using bone material from the respective thoracic vertebral bodies. An anterior cervical locking plate was used for fixation. Continuous loading was performed using a servohydraulic test bench at 2 N/sec. The mean load failure was measured when the implant failed. In the group in which both facet joints were intact, the mean load failure was 174.6 ± 46.93 N. The mean load failure in the second group where only one facet joint was removed was 127.8 ± 22.83 N. In the group in which both facet joints were removed, the mean load failure was 73.42 ± 32.51 N. There was a significant difference between the first group (both facet joints intact) and the third group (both facet joints removed) (p < 0.05, Kruskal-Wallis test). In this cadaver study, primary stability of anterior plate fixation for dislocation injuries of the subaxial cervical spine was dependent on the presence of the facet joints. If the bone in one or both facet joints is damaged

  13. Long-Term Function, Pain and Medication Use Outcomes of Radiofrequency Ablation for Lumbar Facet Syndrome

    PubMed Central

    McCormick, Zachary L.; Marshall, Benjamin; Walker, Jeremy; McCarthy, Robert; Walega, David R.

    2015-01-01

    Objective Radiofrequency ablation (RFA) of the medial branch nerves for facet-mediated low back pain demonstrates clinical benefit for 6–12 months and possibly up to 2 years. This study investigated function, pain, and medication use outcomes of RFA for lumbar facet syndrome in a cohort with long-term follow-up. Methods Individuals evaluated in a tertiary academic pain practice between January, 2007–December, 2013, 18–60 years of age, with a clinical and radiologic diagnosis of lumbar facet syndrome, who underwent ≥1set of diagnostic medial branch blocks with resultant >75% pain relief and subsequent RFA were included. Outcomes measured were the proportion of individuals who reported ≥50% improvement in function, ≥50% improvement in pain; change in median NRS pain score, daily morphine equivalent consumption (DME), Medication Quantification Scale III (MSQ III) score and procedure complications. Results Sixty-two consecutive individuals with a median age and 25%–75% interquartile range (IQR) of 34 years (35, 52) met inclusion criteria. Seven individuals were lost to follow-up. Duration of pain was <2 years in 42%, 2–5 years in 40%, >5 years in 18% of individuals. Median duration of follow-up was 39 months (16, 60). Function and pain improved by ≥50% in 58% (CI 45%, 71%) and 53% (CI 40%, 66%) of individuals, respectively. The median reduction in MQS III score was 3.4 points (0, 8.8). No complications occurred in this cohort. Conclusions This study demonstrates a durable treatment effect of RFA for lumbar facet syndrome at long-term follow-up, as measured by improvement in function, pain, and analgesic use. PMID:26005713

  14. Immediate Effects of Paraspinal Dry Needling in Patients with Acute Facet Joint Lock Induced Wry Neck

    PubMed Central

    Mathias, Lawrence

    2017-01-01

    Introduction Acute facet joint lock induced wry neck (AFJL-WN) is common among adult population and it is primarily managed by medications and physiotherapy. However, the immediate recovery from pain and movements restriction caused by AFJL-WN is not documented in favour of existing interventions. Aim To evaluate the immediate effects of paraspinal dry needling (PSDN) on acute neck pain and movement deficit in patients with AFJL-WN. Materials and Methods A total of 21 patients with AFJL-WN were treated with single session of PSDN for 12-15 minutes. The Visual Analog Scale (0-100mm) and Hand Held Goniometer were used to assess the immediate, 24 hours and 1 week follow-up neck pain and cervical spine’s range of motion respectively. The mean and standard deviation was used to make inferences. Results Immediately after PSDN the pain score was reduced and cervical spine range of motion have improved. The 24 hours and 1 week follow-up pain and range of motion scores have shown the sustained improvement without deteriorations. Conclusion PSDN is effective method to achieve pain free neck movements in patients with AFJL-WN. PMID:28764281

  15. The effect of augmented reality training on percutaneous needle placement in spinal facet joint injections.

    PubMed

    Yeo, Caitlin T; Ungi, Tamas; U-Thainual, Paweena; Lasso, Andras; McGraw, Robert C; Fichtinger, Gabor

    2011-07-01

    The purpose of this study was to determine if augmented reality image overlay and laser guidance systems can assist medical trainees in learning the correct placement of a needle for percutaneous facet joint injection. The Perk Station training suite was used to conduct and record the needle insertion procedures. A total of 40 volunteers were randomized into two groups of 20. 1) The Overlay group received a training session that consisted of four insertions with image and laser guidance, followed by two insertions with laser overlay only. 2) The Control group received a training session of six classical freehand insertions. Both groups then conducted two freehand insertions. The movement of the needle was tracked during the series of insertions. The final insertion procedure was assessed to determine if there was a benefit to the overlay method compared to the freehand insertions. The Overlay group had a better success rate (83.3% versus 68.4%, p=0.002), and potential for less tissue damage as measured by the amount of needle movement inside the phantom (3077.6 mm(2) versus 5607.9 mm(2) , p =0.01). These results suggest that an augmented reality overlay guidance system can assist medical trainees in acquiring technical competence in a percutaneous needle insertion procedure. © 2011 IEEE

  16. Analysis of the Relationship between Ligamentum Flavum Thickening and Lumbar Segmental Instability, Disc Degeneration, and Facet Joint Osteoarthritis in Lumbar Spinal Stenosis

    PubMed Central

    Yoshiiwa, Toyomi; Notani, Naoki; Ishihara, Toshinobu; Kawano, Masanori; Tsumura, Hiroshi

    2016-01-01

    Study Design Cross-sectional study. Purpose To investigate the relationship between ligamentum flavum (LF) thickening and lumbar segmental instability and disc degeneration and facet joint osteoarthritis. Overview of Literature Posterior spinal structures, including LF thickness, play a major role in lumbar spinal canal stenosis pathogenesis. The cause of LF thickening is multifactorial and includes activity level, age, and mechanical stress. LF thickening pathogenesis is unknown. Methods We examined 419 patients who underwent computed tomography (CT) myelography and magnetic resonance imaging after complaints of clinical symptoms. To investigate LF hypertrophy, 57 patients whose lumbar vertebra had normal disc heights at L4–5 were selected to exclude LF buckling as a hypertrophy component. LF thickness, disc space widening angulation in flexion, segmental angulation, presence of a vacuum phenomenon, and lumbar lordosis at T12–S1 were investigated. Disc and facet degeneration were also evaluated. Facet joint orientation was measured via an axial CT scan. Results The mean LF thickness in all patients was 4.4±1.0 mm at L4–5. There was a significant correlation between LF thickness and disc degeneration; LF thickness significantly increased with severe disc degeneration and facet joint osteoarthritis. There was a tendency toward increased LF thickness in more sagittalized facet joints than in coronalized facet joints. Logistic regression analysis showed that LF thickening was influenced by segmental angulation and facet joint osteoarthritis. Patient age was associated with LF thickening. Conclusions LF hypertrophy development was associated with segmental instability and severe disc degeneration, severe facet joint osteoarthritis, and a sagittalized facet joint orientation. PMID:27994791

  17. A CT-Based Simulation Study to Compare the Risk of Facet Joint Violation by the Cervical Pedicle Screw Between Degenerative and Nondegenerative Cervical Spines.

    PubMed

    Lee, Dong-Ho; Noh, Hyounmin; Hwang, Chang Ju; Lee, Choon Sung; Abumi, Kuniyoshi; Cho, Jae Hwan

    2017-02-01

    A retrospective case-control study. This study aimed (A) to compare entry points and trajectories of the cervical pedicle screw (CPS) between degenerative and nondegenerative spines, and (B) to evaluate the risk of facet joint violation by the CPS according to the degree of facet degeneration. Entry point, trajectories, and risk of misplacement of the CPS have been widely researched; however, its application to degenerative cervical spine has to be elucidated. Sixty patients who underwent cervical surgeries at our institution were classified into two groups according to cervical facet joint degeneration. A simulation program with 0.7-mm thickness axial computed tomographic images was used to evaluate facet joint violation by the CPS from C3 to C6. Horizontal and vertical offsets of entry points were measured from two different anatomical landmarks on lateral mass, namely the lateral notch and the center of the superior ridge. The transverse and sagittal angles of the screws were also measured. Facet joint violation was evaluated and classified into either "minor" (<50% of screw diameter) or "major" (≥50% of screw diameter). The mean transverse and sagittal angles showed no difference between the two groups. However, a more superior vertical offset from the superior ridge in terms of entry point was observed in the degenerative cervical spine group at all levels (P = 0.001-0.026). In addition, facet joint violation was more frequently found in severely degenerated facet joints than in mild to moderately degenerated facet joints (P = 0.011). The entry point of CPS was moved more superiorly in the degenerative cervical spine in this study, which increased the risk of facet joint violation in our patients. Thus, surgeons need to modify the insertion technique of the CPS or to insert lateral mass screw instead of the CPS when it is considered to insert screws at the uppermost vertebra in the degenerative cervical spine. 4.

  18. Systematic review of patient history and physical examination to diagnose chronic low back pain originating from the facet joints.

    PubMed

    Maas, E T; Juch, J N S; Ostelo, R W J G; Groeneweg, J G; Kallewaard, J W; Koes, B W; Verhagen, A P; Huygen, F J P M; van Tulder, M W

    2017-03-01

    Patient history and physical examination are frequently used procedures to diagnose chronic low back pain (CLBP) originating from the facet joints, although the diagnostic accuracy is controversial. The aim of this systematic review is to determine the diagnostic accuracy of patient history and/or physical examination to identify CLBP originating from the facet joints using diagnostic blocks as reference standard. We searched MEDLINE, EMBASE, CINAHL, Web of Science and the Cochrane Collaboration database from inception until June 2016. Two review authors independently selected studies for inclusion, extracted data and assessed the risk of bias. We calculated sensitivity and specificity values, with 95% confidence intervals (95% CI). Twelve studies were included, in which 129 combinations of index tests and reference standards were presented. Most of these index tests have only been evaluated in single studies with a high risk of bias. Four studies evaluated the diagnostic accuracy of the Revel's criteria combination. Because of the clinical heterogeneity, results were not pooled. The published sensitivities ranged from 0.11 (95% CI 0.02-0.29) to 1.00 (95% CI 0.75-1.00), and the specificities ranged from 0.66 (95% CI 0.46-0.82) to 0.91 (95% CI 0.83-0.96). Due to clinical heterogeneity, the evidence for the diagnostic accuracy of patient history and/or physical examination to identify facet joint pain is inconclusive. Patient history and physical examination cannot be used to limit the need of a diagnostic block. The validity of the diagnostic facet joint block should be studied, and high quality studies are required to confirm the results of single studies.

  19. Effect of changing lumbar stiffness by single facet joint dysfunction on the responsiveness of lumbar muscle spindles to vertebral movement

    PubMed Central

    Reed, William R.; Pickar, Joel G.; Long, Cynthia R.

    2014-01-01

    Objective: Individuals experiencing low back pain often present clinically with intervertebral joint dysfunction. The purpose of this study was to determine whether relative changes in stiffness at a single spinal joint alters neural responsiveness of lumbar muscle spindles to either vertebral movement or position. Methods: Muscle spindle discharge was recorded in response to 1mm L6 ramp and hold movements (0.5mm/s) in the same animal for lumbar laminectomy-only (n=23), laminectomy & L5/6 facet screw (n=19), laminectomy & L5/6 facetectomy (n=5) conditions. Mean instantaneous frequency (MIF) was calculated for the ramp-up, hold, ramp-down and post-ramp phases during each joint condition. Results: Mean MIFs were not significantly different between the laminectomy-only and the other two types of joint dysfunction for the ramp-up, hold, ramp-down, or post-ramp phases. Conclusion: Stiffness changes caused by single facet joint dysfunction failed to alter spindle responses during slow 1mm ramp and hold movements of the L6 vertebra. PMID:24932020

  20. Significance of interfacet distance, facet joint orientation, and lumbar lordosis in spondylolysis.

    PubMed

    Chung, Sang-Bong; Lee, Sungjoon; Kim, Hoon; Lee, Sun-Ho; Kim, Eun Sang; Eoh, Whan

    2012-04-01

    The aim of this study is to reveal the association between lumbar spondylolysis and several radiologic parameters, which had been suggested to be significant. The authors examine interfacet distance (IFD), facet joint orientation (FJO), and lumbar segmental lordosis (LSL) all together on the basis of lumbar computed tomography (CT) scan of 35 patients with L5 spondylolysis and 36 unaffected control groups. Thirty-five Korean military recruits, aged 19-23 (mean 20.9 years), were diagnosed as L5 spondylolysis by lumber CT scans. As a control group, 36 male Korean military recruits, aged 18-25 (mean 21.3 years), were reconfirmed as not affected by lumbar spondylolysis by CT scan when they visited our hospital complaining of back pain. This study compares IFD, FJO, and LSL for each lumbar segment between the spondylolytic and unaffected groups. We also propose the use of normal mean data of IFD, FJO, and LSL of lumbar vertebrae from 36 Korean young military recruits because each measurement has power as an absolute value, like data from an osteologic collection in other studies. Comparison of IFD between spondylolytic and unaffected individuals reveals significant differences at the L3, L4, and L5 level (P = 0.0384, P = 0.0219, and P < 0.0001, respectively). In the group of spondylolysis, the increase of IFD from L4 to S1 was less pronounced (P < 0.0001) and the LSL at L5-S1 was more lordotic (P = 0.0203). Interfacet distance and lumbar lordosis were significantly different between patients with L5 spondylolysis and individuals without pars defect on L5. In the spondylolysis group, and the increase of IFD from L4 to S1 was less pronounced and the LSL at L5-S1 was more lordotic. Copyright © 2011 Wiley Periodicals, Inc.

  1. Ketorolac Reduces Spinal Astrocytic Activation and PAR1 Expression Associated with Attenuation of Pain after Facet Joint Injury

    PubMed Central

    Dong, Ling; Smith, Jenell R.

    2013-01-01

    Abstract Chronic neck pain affects up to 70% of persons, with the facet joint being the most common source. Intra-articular injection of the non-steroidal anti-inflammatory drug ketorolac reduces post-operative joint-mediated pain; however, the mechanism of its attenuation of facet-mediated pain has not been evaluated. Protease-activated receptor-1 (PAR1) has differential roles in pain maintenance depending on the type and location of painful injury. This study investigated if the timing of intra-articular ketorolac injection after painful cervical facet injury affects behavioral hypersensitivity by modulating spinal astrocyte activation and/or PAR1 expression. Rats underwent a painful joint distraction and received an injection of ketorolac either immediately or 1 day later. Separate control groups included injured rats with a vehicle injection at day 1 and sham operated rats. Forepaw mechanical allodynia was measured for 7 days, and spinal cord tissue was immunolabeled for glial fibrillary acidic protein (GFAP) and PAR1 expression in the dorsal horn on day 7. Ketorolac administered on day 1 after injury significantly reduced allodynia (p=0.0006) to sham levels, whereas injection immediately after the injury had no effect compared with vehicle. Spinal astrocytic activation followed behavioral responses and was significantly decreased (p=0.009) only for ketorolac given at day 1. Spinal PAR1 (p=0.0025) and astrocytic PAR1 (p=0.012) were significantly increased after injury. Paralleling behavioral data, astrocytic PAR1 was returned to levels in sham only when ketorolac was administered on day 1. Yet, spinal PAR1 was significantly reduced (p<0.0001) by ketorolac independent of timing. Spinal astrocyte expression of PAR1 appears to be associated with the maintenance of facet-mediated pain. PMID:23126437

  2. Ketorolac reduces spinal astrocytic activation and PAR1 expression associated with attenuation of pain after facet joint injury.

    PubMed

    Dong, Ling; Smith, Jenell R; Winkelstein, Beth A

    2013-05-15

    Chronic neck pain affects up to 70% of persons, with the facet joint being the most common source. Intra-articular injection of the non-steroidal anti-inflammatory drug ketorolac reduces post-operative joint-mediated pain; however, the mechanism of its attenuation of facet-mediated pain has not been evaluated. Protease-activated receptor-1 (PAR1) has differential roles in pain maintenance depending on the type and location of painful injury. This study investigated if the timing of intra-articular ketorolac injection after painful cervical facet injury affects behavioral hypersensitivity by modulating spinal astrocyte activation and/or PAR1 expression. Rats underwent a painful joint distraction and received an injection of ketorolac either immediately or 1 day later. Separate control groups included injured rats with a vehicle injection at day 1 and sham operated rats. Forepaw mechanical allodynia was measured for 7 days, and spinal cord tissue was immunolabeled for glial fibrillary acidic protein (GFAP) and PAR1 expression in the dorsal horn on day 7. Ketorolac administered on day 1 after injury significantly reduced allodynia (p=0.0006) to sham levels, whereas injection immediately after the injury had no effect compared with vehicle. Spinal astrocytic activation followed behavioral responses and was significantly decreased (p=0.009) only for ketorolac given at day 1. Spinal PAR1 (p=0.0025) and astrocytic PAR1 (p=0.012) were significantly increased after injury. Paralleling behavioral data, astrocytic PAR1 was returned to levels in sham only when ketorolac was administered on day 1. Yet, spinal PAR1 was significantly reduced (p<0.0001) by ketorolac independent of timing. Spinal astrocyte expression of PAR1 appears to be associated with the maintenance of facet-mediated pain.

  3. Evaluation of Lumbar Facet Joint Nerve Blocks in Managing Chronic Low Back Pain: A Randomized, Double-Blind, Controlled Trial with a 2-Year Follow-Up

    PubMed Central

    Manchikanti, Laxmaiah; Singh, Vijay; Falco, Frank J.E.; Cash, Kimberly A.; Pampati, Vidyasagar

    2010-01-01

    Study Design: A randomized, double-blind, controlled trial. Objective: To determine the clinical effectiveness of therapeutic lumbar facet joint nerve blocks with or without steroids in managing chronic low back pain of facet joint origin. Summary of Background Data: Lumbar facet joints have been shown as the source of chronic pain in 21% to 41% of low back patients with an average prevalence of 31% utilizing controlled comparative local anesthetic blocks. Intraarticular injections, medial branch blocks, and radiofrequency neurotomy of lumbar facet joint nerves have been described in the alleviation of chronic low back pain of facet joint origin. Methods: The study included 120 patients with 60 patients in each group with local anesthetic alone or local anesthetic and steroids. The inclusion criteria was based upon a positive response to diagnostic controlled, comparative local anesthetic lumbar facet joint blocks. Outcome measures included the numeric rating scale (NRS), Oswestry Disability Index (ODI), opioid intake, and work status, at baseline, 3, 6, 12, 18, and 24 months. Results: Significant improvement with significant pain relief of ≥ 50% and functional improvement of ≥ 40% were observed in 85% in Group 1, and 90% in Group II, at 2-year follow-up. The patients in the study experienced significant pain relief for 82 to 84 weeks of 104 weeks, requiring approximately 5 to 6 treatments with an average relief of 19 weeks per episode of treatment. Conclusions: Therapeutic lumbar facet joint nerve blocks, with or without steroids, may provide a management option for chronic function-limiting low back pain of facet joint origin. PMID:20567613

  4. 18F-Sodium Fluoride PET-CT Hybrid Imaging of the Lumbar Facet Joints: Tracer Uptake and Degree of Correlation to CT-graded Arthropathy

    PubMed Central

    Mabray, Marc C.; Brus-Ramer, Marcel; Behr, Spencer C.; Pampaloni, Miguel H.; Majumdar, Sharmila; Dillon, William P.; Talbott, Jason F.

    2016-01-01

    We aim to evaluate 18F-NaF uptake by facet joints with hybrid PET-CT technique. Specifically, we evaluate NaF uptake in the facet joints of the lower lumbar spine, and correlate with the morphologic grade of facet arthropathy on CT. 30 consecutive patients who underwent standard vertex to toes NaF PET-CT for re-staging of primary neoplastic disease without measurable or documented bony metastases were identified. Maximum (SUVmax) and average (SUVavg) standardized uptake values were calculated for each L3-4, L4-5, and L5-S1 facet joint (n = 180) and normalized to average uptake in the non-diseased femur. A Pathria grade (0-3) was assigned to each facet based upon the CT morphology. Spearman's rank correlation was performed for normalized SUVmax and SUVavg with Pathria grade. ANOVA was performed with Tukey-Kramer pairwise tests to evaluate differences in uptake between Pathria groups. Facet normalized SUVmax (r = 0.31, P < 0.001) and SUVavg (r = 0.28, P < 0.001) demonstrated a mild positive correlation with CT Pathria grade. There was a wide range of uptake values within each Pathria grade subgroup with statistically significant differences in uptake only between Pathria grade 3 as compared to grades 0, 1, and 2. In conclusion, NaF uptake and morphologic changes of the facet joint on CT are weakly correlated. Physiologic information provided by NaF uptake is often discrepant with structural findings on CT suggesting NaF PET may supplement conventional structural imaging for identification of pain generating facet joints. Prospective investigation into the relationship of facet joint NaF uptake with pain and response to pain interventions is warranted. PMID:27134557

  5. Cartilage in facet joints of patients with ankylosing spondylitis (AS) shows signs of cartilage degeneration rather than chondrocyte hypertrophy: implications for joint remodeling in AS.

    PubMed

    Bleil, Janine; Sieper, Joachim; Maier, Rene; Schlichting, Uwe; Hempfing, Axel; Syrbe, Uta; Appel, Heiner

    2015-07-17

    In ankylosing spondylitis (AS), joint remodeling leading to joint ankylosis involves cartilage fusion. Here, we analyzed whether chondrocyte hypertrophy is involved in cartilage fusion and subsequent joint remodeling in AS. We assessed the expression of chondrocyte hypertrophy markers runt-related transcription factor 2 (Runx2), type X collagen (COL10), matrix metalloproteinase 13 (MMP13), osteocalcin and beta-catenin and the expression of positive bone morphogenic proteins (BMPs) and negative regulators (dickkopf-1 (DKK-1)), sclerostin, (wingless inhibitory factor 1 (wif-1)) of chondrocyte hypertrophy in the cartilage of facet joints from patients with AS or osteoarthritis (OA) and from autopsy controls (CO) by immunohistochemistry. Sex determining region Y (SRY)-box 9 (Sox9) and type II collagen (COL2) expression was assessed as indicators of chondrocyte integrity and function. The percentage of hypertrophic chondrocytes expressing Runx2, COL10, MMP13, osteocalcin or beta-catenin was significantly increased in OA but not in AS joints compared to CO joints. Frequencies of sclerostin-positive and DKK-1-positive chondrocytes were similar in AS and CO. In contrast, wif-1- but also BMP-2- and BMP-7-expressing and Sox9-expressing chondrocytes were drastically reduced in AS joints compared to CO as well as OA joints whereas the percentage of COL2-expressing chondrocytes was significantly higher in AS joints compared to CO joints. We found no evidence for chondrocyte hypertrophy within hyaline cartilage of AS joints even in the presence of reduced expression of the wnt inhibitor wif-1 suggesting that chondrocyte hypertrophy is not a predominant pathway involved in joint fusion and remodeling in AS. In contrast, the reduced expression of Sox9, BMP-2 and BMP-7 concomitantly with induced COL2 expression rather point to disturbed cartilage homeostasis promoting cartilage degeneration in AS.

  6. A Modified Posterolateral Approach for Radiofrequency Denervation of the Medial Branch of the Cervical Segmental Nerve in Cervical Facet Joint Pain Based on Anatomical Considerations.

    PubMed

    van Eerd, Maarten; Lataster, Arno; Sommer, Micha; Patijn, Jacob; van Kleef, Maarten

    2016-10-13

    The cervical facet joints, also called the zygapophyseal joints, are a potential source of neck pain (cervical facet joint pain). The cervical facet joints are innervated by the cervical medial branches (CMBs) of the cervical segmental nerves. Cervical facet joint pain has been shown to respond to multisegmental radiofrequency denervation of the cervical medial branches. This procedure is performed under fluoroscopic guidance. Currently, three approaches are described and used. Those three techniques of radiofrequency treatment of the CMBs, classified on the base of the needle trajectory toward the anatomical planes, are as follows: the posterolateral technique, the posterior technique, and the lateral technique. We describe the three techniques with their advantages and disadvantages. Anatomical studies providing a topographic anatomy of the course of the CMBs are reviewed. We developed a novel approach based on the observed strengths and weaknesses of the three currently used approaches and based on recent anatomical findings. With this fluoroscopic-guided approach, there is always bone (the facet column) in front of the needle, which makes it safer, and the insertion point is easier to determine without the risk of positioning the radiofrequency needle too dorsally.

  7. Biomechanical analysis of press-extension technique on degenerative lumbar with disc herniation and staggered facet joint.

    PubMed

    Du, Hong-Gen; Liao, Sheng-Hui; Jiang, Zhong; Huang, Huan-Ming; Ning, Xi-Tao; Jiang, Neng-Yi; Pei, Jian-Wei; Huang, Qin; Wei, Hui

    2016-05-01

    This study investigates the effect of a new Chinese massage technique named "press-extension" on degenerative lumbar with disc herniation and facet joint dislocation, and provides a biomechanical explanation of this massage technique. Self-developed biomechanical software was used to establish a normal L1-S1 lumbar 3D FE model, which integrated the spine CT and MRI data-based anatomical structure. Then graphic technique is utilized to build a degenerative lumbar FE model with disc herniation and facet joint dislocation. According to the actual press-extension experiments, mechanic parameters are collected to set boundary condition for FE analysis. The result demonstrated that press-extension techniques bring the annuli fibrosi obvious induction effect, making the central nucleus pulposus forward close, increasing the pressure in front part. Study concludes that finite element modelling for lumbar spine is suitable for the analysis of press-extension technique impact on lumbar intervertebral disc biomechanics, to provide the basis for the disease mechanism of intervertebral disc herniation using press-extension technique.

  8. Characterization of a New Animal Model for Evaluation and Treatment of Back Pain Due to Lumbar Facet Joint Osteoarthritis

    PubMed Central

    Kim, Jae-Sung; Kroin, Jeffrey S.; Buvanendran, Asokumar; Li, Xin; van Wijnen, Andre J.; Tuman, Kenneth J.; Im, Hee-Jeong

    2011-01-01

    Degeneration of lumbar facet joints (FJs) has been implicated in lower back pain. To verify the biological links between cellular and structural alterations within FJ components and development of symptomatic chronic back pain, we generated an animal model for FJ degeneration by intra-articular injection of monosodium iodoacetate (MIA) in FJs (L3/L4, L4/L5, L5/L6) of Sprague Dawley rats followed by behavioral pain tests. The degree of primary hyperalgesia was assessed by measuring pain sensation due to pressure using an algometer, which mimics a mechanical stimulus for FJ injury. Biochemical assessments and µCT imaging revealed severely damaged FJ cartilage, proteoglycan loss and alterations of subchondral bone structure by MIA injection. The µCT analyses further suggested that the behavioral hyperalgesia from FJ degeneration is not associated with foramina stenosis. These biological and structural changes in FJs are closely related to sustained and robust chronic pain. Therapeutic modulation of chronic pain using pharmaceutical drugs was investigated in the facet joint osteoarthritis animal model. Morphine and pregabalin markedly alleviate pressure hyperalgesia while celecoxib (selective inhibitor of COX-2) and ketorolac (inhibitor of COX-1 and -2) demonstrate moderate to negligible anti-hyperalgesic effects, respectively. PMID:21953085

  9. Fluoroscopic caudal epidural injections in managing chronic axial low back pain without disc herniation, radiculitis, or facet joint pain

    PubMed Central

    Manchikanti, Laxmaiah; Cash, Kimberly A; McManus, Carla D; Pampati, Vidyasagar

    2012-01-01

    Background Chronic low back pain without disc herniation is common. Various modalities of treatments are utilized in managing this condition, including epidural injections. However, there is continued debate on the effectiveness, indications, and medical necessity of any treatment modality utilized for managing axial or discogenic pain, including epidural injections. Methods A randomized, double-blind, actively controlled trial was conducted. The objective was to evaluate the ability to assess the effectiveness of caudal epidural injections of local anesthetic with or without steroids for managing chronic low back pain not caused by disc herniation, radiculitis, facet joints, or sacroiliac joints. A total of 120 patients were randomized to two groups; one group did not receive steroids (group 1) and the other group did (group 2). There were 60 patients in each group. The primary outcome measure was at least 50% improvement in Numeric Rating Scale and Oswestry Disability Index. Secondary outcome measures were employment status and opioid intake. These measures were assessed at 3, 6, 12, 18, and 24 months after treatment. Results Significant pain relief and functional status improvement (primary outcome) defined as a 50% or more reduction in scores from baseline, were observed in 54% of patients in group 1 and 60% of patients in group 2 at 24 months. In contrast, 84% of patients in group 1 and 73% in group 2 saw significant pain relief and functional status improvement in the successful groups at 24 months. Conclusion Caudal epidural injections of local anesthetic with or without steroids are effective in patients with chronic axial low back pain of discogenic origin without facet joint pain, disc herniation, and/or radiculitis. PMID:23091395

  10. Facet-joint injections for people with persistent non-specific low back pain (FIS): study protocol for a randomised controlled feasibility trial.

    PubMed

    Sandhu, Harbinder; Ellard, David R; Achana, Felix; Antrobus, James H L; Balasubramanian, Shyam; Brown, Sally; Cairns, Melinda; Griffiths, Frances; Haywood, Kirstie; Hutchinson, Charles; Lall, Ranjit; Petrou, Stavros; Stallard, Nigel; Tysall, Colin; Walsh, David A; Underwood, Martin

    2015-12-24

    The role of injections of therapeutic substances into the back as treatment for low back pain is unclear. Facet joint injections are widely used despite the absence of evidence of sustained benefit. We hypothesise that facet joint injections might facilitate engagement with physiotherapist-led, best usual care (a combined physical and psychological programme) and is a clinically and cost-effective treatment for people with suspected low back pain of facet joint origin. We present here the protocol for a randomised controlled feasibility trial for a main trial to test the above hypotheses. Patients referred to secondary care with persistent non-specific low back pain will be screened and invited to take part in the study. Those who meet the eligibility criteria will be invited for a physiotherapy assessment to confirm trial eligibility and for baseline data collection. All participants (n = 150) will be offered the best usual care package with physical and psychological components. Those randomised into the intervention arm (n = 75) will, in addition, receive intra-articular facet joint injections with local anaesthetic and steroids. Primary outcome data will be collected using daily and then weekly text messaging service for a pain score on a 0-10 scale. Questionnaire follow-up will be at 3, 6, and 12 months. Evaluation of trial processes and health economic analyses, including a value of information analysis, will be undertaken. The process evaluation will be mixed methods and will include the views of all stakeholders. Whilst this trial is a feasibility study it is currently one of the largest trials in this area. The outcomes will provide some evidence on the use of facet joint injections for patients with clinically diagnosed facet joint pain. EudraCT identifier 2014-000682-50, (registered on 12 February 14). ISRCTN registry number: ISRCTN93184143 DOI 10.1186/ISRCTN93184143 (registered on 27 February 2014).

  11. Subtalar Joint Instability and Calcaneal Spurs Associated with the Configuration of the Articular Facets of Adult Human Calcaneum in Indian Population

    PubMed Central

    Garg, Shilpi; Vasudeva, Neelam

    2016-01-01

    Introduction Morphological variations of articular facets of calcaneum may predispose people to joint instability, ligamentous laxity and development of arthritic changes in the subtalar joint. Knowledge of such variations is essential for treatment and diagnostic procedures in orthopaedic surgeries. Aim The aim of this study was to determine patterns of articular facets of calcanei and to establish its correlation with calcaneal spurs. Materials and Methods The study was conducted on 580 adult calcanei of Indian origin at Maulana Azad Medical College and pattern of articular facets were observed and classified according to five patterns described in literature. A digital vernier calliper was used to measure separation between anterior and middle facet. Degree of intersecting angle between anterior and medial facets was calculated using UTHSCSA Image Tool software. The calcaneal spurs were observed by visual inspection. Results Out of 580 calcanei, 66.55% had fused anterior and middle facets (Pattern I), 27.59% had all three facets separate (Pattern II), 5.52% had absence of anterior facet (Pattern III), 0.17% had all three facets fused (Pattern IV) and 0.17% had fused middle and posterior facets (Pattern V). A significant side variation was present in Pattern III with predominance on left side. Mean angle of intersection was 147.700 in Pattern I and 133.340 in Pattern II calcaneum. Calcaneal spurs were found in 61.38% out of which it was associated with Pattern I in 43.62%, Pattern II in 14.66% and Pattern III in 2.76%. Conclusion Individuals with Pattern I and III calcaneum were found to be at a greater risk of subtalar joint instability than individuals with Pattern II. Angle of intersection was obtuse in Pattern I which resulted in ligament laxity and unstable joint. Pattern I was more common in Indian population and this fact necessitates modifications of the western surgical techniques to suit the Indian scenario. An association between the presence of spur

  12. Percutaneous radiofrequency facet joint denervation with monitoring of compound muscle action potential of the multifidus muscle group for treating chronic low back pain: a preliminary report.

    PubMed

    Kanchiku, Tsukasa; Imajo, Yasuaki; Suzuki, Hidenori; Yoshida, Yuichiro; Nishida, Norihiro; Taguchi, Toshihiko

    2014-10-01

    A retrospective review. The aim of this study was to study the effectiveness of percutaneous radiofrequency neurotomy of facet joints by monitoring compound muscle action potentials (CMAPs) of the multifidus muscle group as an objective index of treatment efficacy. Percutaneous radiofrequency neurotomy of the medial branches of the dorsal rami of the lumbar nerves is a widely accepted treatment for chronic lumbar intervertebral joint pain. However, its success rate has varied in different studies because an objective method for evaluating the facet joint denervation is lacking. Fifty-five patients (age range, 19-76 y; mean age, 55 y) with low back pain persisting for ≥3 months, in whom facet block and/or block of the medial branch of the dorsal ramus were only temporarily effective, were included. The Japanese Orthopaedic Association (JOA) scoring system for back pain was used for clinical assessment. JOA scores were measured before treatment and 1 week, 3 months, 6 months, and 12 months afterward. The improvement rate was calculated with ≥40% improvement rate defined as successful, and the success rate was subsequently evaluated. The patient success rate was 75% (41/55) at 1 week, 71% (39/55) at 3 months, 60% (33/55) at 6 months, and 51% (28/55) at 12 months after treatment. Two cases had minor postoperative complications, which were localized burning pain lasting <1 week at the site of electrode insertion. Our results suggest that percutaneous radiofrequency facet joint denervation with CMAPs monitoring is a safe, long-lasting, and effective treatment for chronic facet joint pain. CMAP monitoring may be useful as an objective index for facet denervation.

  13. [Burning mouth syndrome - a joint biopsychosocial approach].

    PubMed

    Arpone, Francesca; Combremont, Florian; Weber, Kerstin; Scolozzi, Paolo

    2016-02-10

    Burning mouth syndrome (BMS) is a medical condition that is often refractory to conventional diagnostic and therapeutic methods. Patients suffering from BMS can benefit from a biopsychosocial approach in a joint, medical-psychological consultation model. Such a consultation exists at Geneva University Hospitals, involving the collaboration of the maxillo-facial and oral surgery division and the division of liaison psychiatry and crisis intervention, in order to take into account the multiple factors involved in BMS onset and persistence. This article will describe BMS clinical presentation, and present an integrate approach to treat these patients.

  14. A critical evaluation of subtalar joint arthrosis associated with middle facet talocalcaneal coalition in 21 surgically managed patients: a retrospective computed tomography review. Investigations involving middle facet coalitions-part III.

    PubMed

    Kernbach, Klaus J; Barkan, Howard; Blitz, Neal M

    2010-01-01

    Symptomatic middle facet talocalcaneal coalition is frequently associated with rearfoot arthrosis that is often managed surgically with rearfoot fusion. However, no objective method for classifying the extent of subtalar joint arthrosis exists. No study has clearly identified the extent of posterior facet arthrosis present in a large cohort treated surgically for talocalcaneal coalition through preoperative computerized axial tomography. The authors conducted a retrospective review of 21 patients (35 feet) with coalition who were surgically treated over a 12-year period for coalition on at least 1 foot. Using a predefined original staging system, the extent of the arthrosis was categorized into normal or mild (Stage I), moderate (Stage II), and severe (Stage III) arthrosis. The association of stage and age is statistically significant. All of the feet with Stage III arthrosis had fibrous coalitions. No foot with osseous coalition had Stage III arthrosis. The distribution of arthrosis staging differs between fibrous and osseous coalitions. Only fibrous coalitions had the most advanced arthrosis (Stage III), whereas osseous coalitions did not. This suggests that osseous coalitions may have a protective effect in the prevention of severe degeneration of the subtalar joint. Concomitant subtalar joint arthrosis severity progresses with age; surgeons may want to consider earlier surgical intervention to prevent arthrosis progression in patients with symptomatic middle facet talocalcaneal coalition.

  15. Activating transcription factor 4, a mediator of the integrated stress response, is increased in the dorsal root ganglia following painful facet joint distraction

    PubMed Central

    Dong, Ling; Guarino, Benjamin B.; Jordan-Sciutto, Kelly L.; Winkelstein, Beth A.

    2011-01-01

    Chronic neck pain is one of the most common musculoskeletal disorders in the US. Although biomechanical and clinical studies have implicated the facet joint as a primary source of neck pain, specific cellular mechanisms still remain speculative. The purpose of this study was to investigate whether a mediator (ATF4) of the integrated stress response (ISR) is involved in facet-mediated pain. Holtzman rats underwent C6/C7 facet joint loading that produces either painful (n=16) or nonpainful (n=8) responses. A sham group (n=9) was also included as surgical controls. Behavioral sensitivity was measured and the C6 DRGs were harvested on day 7 to evaluate the total and neuronal ATF4 expression. In separate groups, an intra-articular ketorolac injection was administered either immediately (D0 ketorolac) or 1 day (D1 ketorolac) after painful facet joint loading. Allodynia was measured at days 1 and 7 after injury to assess the effects on behavioral responses. ATF4 and BiP (an indicator of ISR activation) were separately quantified at day 7. Facet joint loading sufficient to elicit behavioral hypersensitivity produced a 3-fold increase in total and neuronal ATF4 expression in the DRG. After ketorolac treatment at the time of injury, ATF4 expression was significantly (p<0.01) reduced despite not producing any attenuation of behavioral responses. Interestingly, ketorolac treatment at day 1 significantly (p<0.001) alleviated behavioral sensitivity at day 7, but did not modify ATF4 expression. BiP expression was unchanged after either intervention time. Results suggest that ATF4-dependent activation of the ISR does not directly contribute to persistent pain, but may sensitize neurons responsible for pain initiation. These behavioral and immunohistochemical findings imply that facet-mediated pain may be sustained through other pathways of the ISR. PMID:21821103

  16. Lateral patellar facetectomy and medial reefing in patients with lateral facet syndrome after patellar-retaining total knee arthroplasty.

    PubMed

    Pagenstert, Geert; Seelhoff, Juliane; Henninger, Heath B; Wirtz, Dieter C; Valderrabano, Victor; Barg, Alexej

    2014-11-01

    We analyzed clinical outcomes of partial lateral patellar facetectomy and medial reefing in patients with lateral patellar facet syndrome with painful patellar-retaining total knee arthroplasty. 34 patients were followed for a mean of 40 months. All 34 patients were matched with those having secondary patellar resurfacing without facetectomy. Both groups experienced significant pain relief and range of motion improvement. The facetectomy group had higher Kujala scores than those in patellar resurfacing group. Patients with facetectomy had significantly less pain postoperatively. There were significant differences in postoperative lateral patellar tilt and congruency angle in both groups. The mid-term results for LPF with medial reefing are promising to resolve pain in patients with lateral patellar facet syndrome in patellar-retaining TKA. Therapeutic level III (retrospective comparative study). Copyright © 2014 Elsevier Inc. All rights reserved.

  17. Lumbar Facet Joint Compressive Injury Induces Lasting Changes in Local Structure, Nociceptive Scores, and Inflammatory Mediators in a Novel Rat Model

    PubMed Central

    Henry, James L.; Yashpal, Kiran; Vernon, Howard; Kim, Jaesung; Im, Hee-Jeong

    2012-01-01

    Objective. To develop a novel animal model of persisting lumbar facet joint pain. Methods. Sprague Dawley rats were anaesthetized and the right lumbar (L5/L6) facet joint was exposed and compressed to ~1 mm with modified clamps applied for three minutes; sham-operated and naïve animals were used as control groups. After five days, animals were tested for hind-paw sensitivity using von Frey filaments and axial deep tissue sensitivity by algometer on assigned days up to 28 days. Animals were sacrificed at selected times for histological and biochemical analysis. Results. Histological sections revealed site-specific loss of cartilage in model animals only. Tactile hypersensitivity was observed for the ipsi- and contralateral paws lasting 28 days. The threshold at which deep tissue pressure just elicited vocalization was obtained at three lumbar levels; sensitivity at L1 > L3/4 > L6. Biochemical analyses revealed increases in proinflammatory cytokines, especially TNF-α, IL-1α, and IL-1β. Conclusions. These data suggest that compression of a facet joint induces a novel model of local cartilage loss accompanied by increased sensitivity to mechanical stimuli and by increases in inflammatory mediators. This new model may be useful for studies on mechanisms and treatment of lumbar facet joint pain and osteoarthritis. PMID:22966427

  18. Lumbar disc degeneration was not related to spine and hip bone mineral densities in Chinese: facet joint osteoarthritis may confound the association.

    PubMed

    Pan, Jianjiang; Lu, Xuan; Yang, Ge; Han, Yongmei; Tong, Xiang; Wang, Yue

    2017-12-01

    A sample of 512 Chinese was studied and we observed that greater disc degeneration on MRI was associated with greater spine DXA BMD. Yet, this association may be confounded by facet joint osteoarthritis. BMD may not be a risk factor for lumbar disc degeneration in Chinese.

  19. Evaluation of a Robotic Assistance-System For Percutaneous Computed Tomography-Guided (CT-Guided) Facet Joint Injection: A Phantom Study

    PubMed Central

    Beyer, Lukas Philipp; Michalik, Katharina; Niessen, Christoph; da Silva, Natascha Platz Batista; Wiesinger, Isabell; Stroszczynski, Christian; Wiggermann, Philipp

    2016-01-01

    Background The aim of this study was to compare robotic assisted and freehand facet joint puncture on a phantom model in regards to time requirements and puncture accuracy. Material/Methods Forty facet joints were punctured, 20 using a robotic guidance system and 20 using a freehand procedure. Side and height of the facet joints were randomized and identical for both groups. Procedural accuracy, defined as axial and sagittal deviation, as well as the number of corrections were assessed. Procedure times for each step were documented and time requirements for pre-positioning, reconstruction, planning, and total intervention were calculated. Results Total procedure time for robotic guidance was 259±111 seconds versus 119±77 seconds for freehand procedure (p=1.0). Procedural accuracy for robotic guidance was significantly higher with 0 corrections versus 1.3 corrections for freehand procedure (p=0.02). Needle deviation in the robotics arm was 0.35±1.1 mm in the axial and 2.15±1.2 mm in the sagittal reconstruction. Conclusions Robotic assisted puncture of the facet joint allowed accurate positioning of the needle with a lower number of needle readjustments. Higher procedural accuracy was marginally offset by a slightly longer intervention time. PMID:27648509

  20. Evaluation of a Robotic Assistance-System For Percutaneous Computed Tomography-Guided (CT-Guided) Facet Joint Injection: A Phantom Study.

    PubMed

    Beyer, Lukas Philipp; Michalik, Katharina; Niessen, Christoph; Platz Batista da Silva, Natascha; Wiesinger, Isabell; Stroszczynski, Christian; Wiggermann, Philipp

    2016-09-20

    BACKGROUND The aim of this study was to compare robotic assisted and freehand facet joint puncture on a phantom model in regards to time requirements and puncture accuracy. MATERIAL AND METHODS Forty facet joints were punctured, 20 using a robotic guidance system and 20 using a freehand procedure. Side and height of the facet joints were randomized and identical for both groups. Procedural accuracy, defined as axial and sagittal deviation, as well as the number of corrections were assessed. Procedure times for each step were documented and time requirements for pre-positioning, reconstruction, planning, and total intervention were calculated. RESULTS Total procedure time for robotic guidance was 259±111 seconds versus 119±77 seconds for freehand procedure (p=1.0). Procedural accuracy for robotic guidance was significantly higher with 0 corrections versus 1.3 corrections for freehand procedure (p=0.02). Needle deviation in the robotics arm was 0.35±1.1 mm in the axial and 2.15±1.2 mm in the sagittal reconstruction. CONCLUSIONS Robotic assisted puncture of the facet joint allowed accurate positioning of the needle with a lower number of needle readjustments. Higher procedural accuracy was marginally offset by a slightly longer intervention time.

  1. Indian Hedgehog signaling pathway members are associated with magnetic resonance imaging manifestations and pathological scores in lumbar facet joint osteoarthritis

    NASA Astrophysics Data System (ADS)

    Shuang, Feng; Zhou, Ying; Hou, Shu-Xun; Zhu, Jia-Liang; Liu, Yan; Zhang, Chun-Li; Tang, Jia-Guang

    2015-05-01

    Indian Hedgehog (HH) has been shown to be involved in osteoarthritis (OA) in articular joints, where there is evidence that Indian HH blockade could ameliorate OA. It seems to play a prominent role in development of the intervertebral disc (IVD) and in postnatal maintenance. There is little work on IHH in the IVD. Hence the aim of the current study was to investigate the role of Indian Hedgehog in the pathology of facet joint (FJ) OA. 24 patients diagnosed with lumbar intervertebral disk herniation or degenerative spinal stenosis were included. Preoperative magnetic resonance imaging (MRI) and Osteoarthritis Research Society International (OARSI) histopathology grading system was correlated to the mRNA levels of GLI1, PTCH1, and HHIP in the FJs. The Weishaupt grading and OARSI scores showed high positive correlation (r = 0.894) (P < 0.01). MRI Weishaupt grades showed positive correlation with GLI1 (r = 0.491), PTCH1 (r = 0.444), and HHIP (r = 0.654) mRNA levels (P < 0.05 in each case). OARSI scores were also positively correlated with GLI1 (r = 0. 646), PTCH1 (r = 0. 518), and HHIP (r = 0.762) mRNA levels (P < 0.01 in each case). Cumulatively our findings indicate that Indian HH signaling is increased in OA and is perhaps a key component in OA pathogenesis and progression.

  2. Development Of an Experimental Animal Model For Lower Back Pain By Percutaneous Injury-Induced Lumbar Facet Joint Osteoarthritis

    PubMed Central

    Kim, Jae-Sung; Ahmadinia, Kasra; Li, Xin; Hamilton, John L; Andrews, Steven; Haralampus, Chris A.; Xiao, Guozhi; Sohn, Hong-Moon; You, Jae-Won; Seo, Yo-Seob; Stein, Gary S.; Wijnen, Andre J Van; Kim, Su-Gwan; Im, Hee-Jeong

    2015-01-01

    We report generation and characterization of pain-related behavior in a minimally-invasive facet joint degeneration (FJD) animal model in rats. FJD was produced by a non-open percutaneous puncture-induced injury on the right lumbar FJs at three consecutive levels. Pressure hyperalgesia in the lower back was assessed by measuring the vocalization response to pressure from a force transducer. After hyperalgesia was established, pathological changes in lumbar FJs and alterations of intervertebral foramen size were assessed by histological and imaging analyses. To investigate treatment options for lumber FJ osteoarthritis-induced pain, animals with established hyperalgesia were administered with analgesic drugs, such as morphine, a selective COX-2 inhibitor, a non-steroidal anti-inflammatory drug (NSAID) (ketorolac), or pregabalin. Effects were assessed by behavioral pain responses. One week after percutaneous puncture-induced injury of the lumbar FJs, ipsilateral primary pressure hyperalgesia developed and was maintained for at least 12 weeks without foraminal stenosis. Animals showed decreased spontaneous activity, but no secondary hyperalgesia in the hind paws. Histopathological and microfocus X-ray computed tomography analyses demonstrated that the percutaneous puncture injury resulted in osteoarthritis-like structural changes in the FJs cartilage and subchondral bone. Pressure hyperalgesia was completely reversed by morphine. The administration of celecoxib produced moderate pain reduction with no statistical significance while the administration of ketorolac and pregabalin produced no analgesic effect on FJ osteoarthritis-induced back pain. Our animal model of non-open percutanous puncture-induced injury of the lumbar FJs in rats shows similar characteristics of low back pain produced by human facet arthropathy. PMID:25858171

  3. Cervical Facet Joint Infection and Associated Epidural Abscess with Streptococcus intermedius from a Dental Infection Origin A Case Report and Review.

    PubMed

    Kaye, Ian David; Protopsaltis, Themistocles S

    2016-09-01

    Pyogenic cervical facet joint infections are rare and such infections from a dental origin are even less common. Of these few cases, none have described infection with Streptococcus intermedius as the pathogen. A 65-year-old orthopaedic surgeon complained of fevers, right-sided radiating neck pain, stiffness, swelling, erythema, and right upper extremity weakness one month after he had broken a crown over his right mandibular premolar, a continued source of pain. Imaging of the cervical spine showed a right C4-C5 facet inflammatory arthropathy and a small epidural abscess that was cultured and initially treated with intravenous antibiotics. The oral maxillofacial surgery team performed an extraction of the infected, symptomatic tooth. For continued right upper extremity weakness, the patient underwent C4-C5 laminoforaminotomy and irrigation and debridement of the right C4-C5 facet joint. After 6 weeks of intravenous antibiotics, the patient's infectious and inflammatory markers had normalized. By 4 months, he had regained full strength at his upper extremity and a painless and full range of motion of his cervical spine.Pyogenic cervical facet joint infection is very rare and potentially dangerous. A high clinical suspicion and appropriate imaging, including magnetic resonance imaging, are important for correct diagnosis. Prompt medical and surgical treatment may avert complications, and although the patient presented made a complete recovery, patients may be left with neurological compromise.

  4. Differences Regarding Branded HA in Italy, Part 2: Data from Clinical Studies on Knee, Hip, Shoulder, Ankle, Temporomandibular Joint, Vertebral Facets, and Carpometacarpal Joint

    PubMed Central

    Migliore, A.; Bizzi, E.; De Lucia, O.; Delle Sedie, A.; Tropea, S.; Bentivegna, M.; Mahmoud, A.; Foti, C.

    2016-01-01

    OBJECTIVES The aim of the current study is to collect scientific data on all branded hyaluronic acid (HA) products in Italy that are in use for intra-articular (IA) injection in osteoarthritis (OA) compared with that reported in the leaflet. METHODS An extensive literature research was performed for all articles reporting data on the IA use of HA in OA. Selected studies were taken into consideration only if they are related to products based on HAs that are currently marketed in Italy with the specific joint indication for IA use in patients affected by OA. RESULTS Sixty-two HA products are marketed in Italy: 30 products are indicated for the knee but only 8 were proved with some efficacy; 9 products were effective for the hip but only 6 had hip indication; 7 products proved to be effective for the shoulder but only 3 had the indication; 5 products proved effective for the ankle but only one had the indication; 6 products were effective for the temporomandibular joint but only 2 had the indication; only 2 proved effective for vertebral facet joints but only 1 had the indication; and 5 products proved effective for the carpometacarpal joint but only 2 had the indication. CONCLUSIONS There are only a few products with some evidences, while the majority of products remain without proof. Clinicians and regulators should request postmarketing studies from pharmaceuticals to corroborate with that reported in the leaflet and to gather more data, allowing the clinicians to choose the adequate product for the patient. PMID:27279754

  5. Addressing the confounding role of joint hypermobility syndrome and gastrointestinal involvement in postural orthostatic tachycardia syndrome.

    PubMed

    Farmer, Adam D; Fikree, Asma; Aziz, Qasim

    2014-06-01

    Quantitative and qualitative abnormalities in visceral function have been demonstrated in postural orthostatic tachycardia syndrome. Joint hypermobility is frequently associated with both postural orthostatic tachycardia syndrome and gastrointestinal symptoms. Future studies in this area should appropriately and systematically control for the presence of joint hypermobility syndrome.

  6. Is lumbar facet joint tropism developmental or secondary to degeneration? An international, large-scale multicenter study by the AOSpine Asia Pacific Research Collaboration Consortium.

    PubMed

    Samartzis, Dino; Cheung, Jason Pui Yin; Rajasekaran, Shanmuganathan; Kawaguchi, Yoshiharu; Acharya, Shankar; Kawakami, Mamoru; Satoh, Shigenobu; Chen, Wen-Jer; Park, Chun-Kun; Lee, Chong-Suh; Foocharoen, Thanit; Nagashima, Hideki; Kuh, Sunguk; Zheng, Zhaomin; Condor, Richard; Ito, Manabu; Iwasaki, Motoki; Jeong, Je Hoon; Luk, Keith D K; Prijambodo, Bambang; Rege, Amol; Jahng, Tae-Ahn; Luo, Zhuojing; Tassanawipas, Warat Anant; Acharya, Narayana; Pokharel, Rohit; Shen, Yong; Ito, Takui; Zhang, Zhihai; Aithala P, Janardhana; Kumar, Gomatam Vijay; Jabir, Rahyussalim Ahmad; Basu, Saumyajit; Li, Baojun; Moudgil, Vishal; Goss, Ben; Sham, Phoebe; Williams, Richard

    2016-01-01

    Facet joint tropism is asymmetry in orientation of the bilateral facets. Some studies have shown that tropism may increase the risk of disc degeneration and herniations, as well as degenerative spondylolisthesis (DS). It remains controversial whether tropism is a pre-existing developmental phenomena or secondary to progressive remodeling of the joint structure due to degenerative changes. As such, the following study addressed the occurrence of tropism of the lower lumbar spine (i.e. L3-S1) in a degenerative spondylolisthesis patient model. An international, multi-center cross-sectional study that consisted of 349 patients with single level DS recruited from 33 spine institutes in the Asia Pacific region was performed. Axial MRI/CT from L3-S1 were utilized to assess left and right facet joint sagittal angulation in relation to the coronal plane. The angulation difference between the bilateral facets was obtained. Tropism was noted if there was 8° or greater angulation difference between the facet joints. Tropism was noted at levels of DS and compared to immediate adjacent and distal non-DS levels, if applicable, to the index level. Age, sex-type and body mass index (BMI) were also noted and assessed in relation to tropism. Of the 349 subjects, there were 63.0 % females, the mean age was 61.8 years and the mean BMI was 25.6 kg/m(2). Overall, 9.7, 76.5 and 13.8 % had L3-L4, L4-L5 and L5-S1 DS, respectively. Tropism was present in 47.1, 50.6 and 31.3 % of L3-L4, L4-L5 and L5-S1 of levels with DS, respectively. Tropism involved 33.3 to 50.0 % and 33.3 to 58.8 % of the immediate adjacent and most distal non-DS levels from the DS level, respectively. Patient demographics were not found to be significantly related to tropism at any level (p > 0.05). To the authors' knowledge, this is one of the largest studies conducted, in particular in an Asian population, addressing facet joint tropism. Although levels with DS were noted to have tropism, immediate adjacent

  7. A New CT Method for Assessing 3D Movements in Lumbar Facet Joints and Vertebrae in Patients before and after TDR

    PubMed Central

    Svedmark, Per; Berg, Svante; Noz, Marilyn E.; Zeleznik, Michael P.; Nemeth, Gunnar; Olivecrona, Henrik

    2015-01-01

    This study describes a 3D-CT method for analyzing facet joint motion and vertebral rotation in the lumbar spine after TDR. Ten patients were examined before and then three years after surgery, each time with two CT scans: provoked flexion and provoked extension. After 3D registration, the facet joint 3D translation and segmental vertebral 3D rotation were analyzed at the operated level (L5-S1) and adjacent level (L4-L5). Pain was evaluated using VAS. The median (±SD) 3D movement in the operated level for the left facet joint was 3.2 mm (±1.9 mm) before and 3.5 mm (±1.7 mm) after surgery and for the right facet joint was 3.0 mm (±1.0 mm) before and 3.6 mm (±1.4 mm) after surgery. The median vertebral rotation in the sagittal plane at the operated level was 5.4° (±2.3°) before surgery and 6.8° (±1.7°) after surgery and in the adjacent level was 7.7° (±4.0°) before and 9.2° (±2.7°) after surgery. The median VAS was reduced from 6 (range 5–8) to 3 (range 2–8) in extension and from 4 (range 2–6) to 2 (range 1–3) in flexion. PMID:26587533

  8. Parallel syndromes: two dimensions of narcissism and the facets of psychopathic personality in criminally involved individuals.

    PubMed

    Schoenleber, Michelle; Sadeh, Naomi; Verona, Edelyn

    2011-04-01

    Little research has examined different dimensions of narcissism that may parallel psychopathy facets in criminally involved individuals. In this study, we examined the pattern of relationships between grandiose and vulnerable narcissism, assessed using the Narcissistic Personality Inventory-16 and the Hypersensitive Narcissism Scale, respectively, and the four facets of psychopathy (interpersonal, affective, lifestyle, and antisocial) assessed via the Psychopathy Checklist: Screening Version. As predicted, grandiose and vulnerable narcissism showed differential relationships to psychopathy facets, with grandiose narcissism relating positively to the interpersonal facet of psychopathy and vulnerable narcissism relating positively to the lifestyle facet of psychopathy. Paralleling existing psychopathy research, vulnerable narcissism showed stronger associations than grandiose narcissism to (a) other forms of psychopathology, including internalizing and substance use disorders, and (b) self- and other-directed aggression, measured with the Life History of Aggression and the Forms of Aggression Questionnaire. Grandiose narcissism was nonetheless associated with social dysfunction marked by a manipulative and deceitful interpersonal style and unprovoked aggression. Potentially important implications for uncovering etiological pathways and developing treatment interventions for these disorders in externalizing adults are discussed.

  9. Clinical effects of computed tomography-guided lumbosacral facet joint, transforaminal epidural, and translaminar epidural injections of methylprednisolone acetate in healthy dogs.

    PubMed

    Liotta, Annalisa P; Girod, Maud; Peeters, Dominique; Sandersen, Charlotte; Couvreur, Thierry; Bolen, Géraldine

    2016-10-01

    OBJECTIVE To determine clinical effects of CT-guided lumbosacral facet joint, transforaminal epidural, and translaminar epidural injections of methylprednisolone acetate in healthy dogs. ANIMALS 15 healthy Beagles. PROCEDURES Dogs were randomly assigned to 3 groups (5 dogs/group) and received a single CT-guided lumbosacral facet joint, transforaminal epidural, or translaminar epidural injection of methylprednisolone acetate (0.1 mg/kg). Contrast medium was injected prior to injection of methylprednisolone to verify needle placement. Neurologic examinations were performed 1, 3, 7, and 10 days after the injection. In dogs with neurologic abnormalities, a final neurologic examination was performed 24 days after the procedure. RESULTS Methylprednisolone injections were successfully performed in 14 of the 15 dogs. In 1 dog, vascular puncture occurred, and the methylprednisolone injection was not performed. No major or minor complications were identified during or immediately after the procedure, other than mild transient hyperthermia. During follow-up neurologic examinations, no motor, sensory, or postural deficits were identified, other than mild alterations in the patellar, withdrawal, cranial tibial, and perineal reflexes in some dogs. Overall, altered reflexes were observed in 11 of the 14 dogs, during 27 of 65 neurologic examinations. CONCLUSIONS AND CLINICAL RELEVANCE Results suggested that CT-guided lumbosacral facet joint, transforaminal epidural, and translaminar epidural injections of methylprednisolone acetate were associated with few complications in healthy dogs. However, the number of dogs evaluated was small, and additional studies are needed to assess clinical efficacy and safety of these procedures.

  10. Internal derangements of the temporomandibular joint: description of clinical syndromes.

    PubMed

    Schwartz, H C; Kendrick, R W

    1984-07-01

    Clinical findings and diagnostic criteria for internal derangements of the temporomandibular joint are outlined. Pathophysiology is discussed, including the role of predisposing factors and the relationship with myofascial pain-dysfunction syndrome.

  11. Incorporation of lower neck shear forces to predict facet joint injury risk in low-speed automotive rear impacts.

    PubMed

    Stemper, Brian D; Storvik, Steven G

    2010-06-01

    Lower neck shear force remains a viable candidate for a low-velocity automotive rear-impact injury criterion. Data were previously reported to demonstrate high correlations between the magnitude of lower neck shear force and lower cervical spine facet joint motions. The present study determined the ability of lower neck shear force to predict soft-tissue injury risk in simulated automotive rear impacts. Rear-impact tests were conducted at two velocities and with two seatback orientations using a Hybrid III anthropomorphic test device (ATD) and stock automobile seats from 2007 model year vehicles. Higher velocities and more vertical seatback orientations were associated with higher injury risk based on computational modeling simulations performed in this study. Six cervical spine injury criteria including NIC, Nij, Nkm, LNL, and lower neck shear force and bending moment, increased with impact velocity. NIC, Nij, and shear force were most sensitive to changes in impact velocity. Four metrics, including Nkm, LNL, and lower neck shear force and bending moment, increased for tests with more vertical seatback orientations. Shear force was most sensitive to changes in seatback orientation. Peak values for shear force, NIC, and Nij occurred approximately at the time of head restraint contact for all four test conditions. Therefore, of the six investigated metrics, lower neck shear force was the only metric to demonstrate consistency with regard to injury risk and timing of peak magnitudes. These results demonstrate the ability of lower neck shear force to predict injury risk during low velocity automotive rear impacts and warrant continued investigation into the sensitivity and applicability of this metric for other rear-impact conditions.

  12. The efficacy of conventional radiofrequency denervation in patients with chronic low back pain originating from the facet joints: a meta-analysis of randomized controlled trials.

    PubMed

    Lee, Chang-Hyun; Chung, Chun Kee; Kim, Chi Heon

    2017-05-30

    Radiofrequency denervation is commonly used for the treatment of chronic facet joint pain that has been refractory to more conservative treatments, although the evidence supporting this treatment has been controversial. We aimed to elucidate the precise effects of radiofrequency denervation in patients with low back pain originating from the facet joints relative to those obtained using control treatments, with particular attention to consistency in the denervation protocol. A meta-analysis of randomized controlled trials was carried out. Adult patients undergoing radiofrequency denervation or control treatments (sham or epidural block) for facet joint disease of the lumbar spine comprised the patient sample. Visual analog scale (VAS) pain scores were measured and stratified by response of diagnostic block procedures. We searched PubMed, Embase, Web of Science, and the Cochrane Database for randomized controlled trials regarding radiofrequency denervation and control treatments for back pain. Changes in VAS pain scores of the radiofrequency group were compared with those of the control group as well as the minimal clinically important difference (MCID) for back pain VAS. Meta-regression model was developed to evaluate the effect of radiofrequency treatment according to responses of diagnostic block while controlling for other variables. We then calculated mean differences and 95% confidence intervals (CIs) using random-effects models. We included data from seven trials involving 454 patients who had undergone radiofrequency denervation (231 patients) and control treatments such as sham or epidural block procedures (223 patients). The radiofrequency group exhibited significantly greater improvements in back pain score when compared with the control group for 1-year follow-up. Although the average improvement in VAS scores exceeded the MCID, the lower limit of the 95% CI encompassed the MCID. A subgroup of patients who responded very well to diagnostic block

  13. Radiofrequency treatment has a beneficial role in reducing low back pain due to facet syndrome in octogenarians or older.

    PubMed

    Shabat, Shay; Leitner, Yossi; Bartal, Gabriel; Folman, Yoram

    2013-01-01

    Chronic low back pain is a disabling phenomenon that can cause a severe reduction in quality of life, especially in elderly patients. Surgical treatment is sometimes a big challenge for these elderly patients. Radiofrequency (RF) ablation is an increasingly popular method for treating low back pain caused by facet syndrome. The purpose of this study was to evaluate whether RF neurotomy is effective in terms of pain reduction and functional outcome in elderly patients. Fifty-eight patients aged 80 years and older who had chronic mechanical low back pain were examined after they underwent RF heat lesion of the medial branch. Follow-up occurred 1, 3, 6, and 12 months after treatment. Pain was measured on the visual analog scale and functional outcome was measured using the Oswestry Disability Index. After 1 month, 43 patients (74%) were satisfied with the results. After 3 months, 38 patients (66%) had clinically significant pain relief. After 6 months, 33 patients (57%) had pain relief, and at the 1-year follow-up, 30 patients (52%) showed good results while 28 patients (48%) showed no effect. The Oswestry Disability Index score was substantially improved even after 1 year. Minor complications occurred in eleven patients (19%), who had transient discomfort and burning pain. RF is a safe and partially effective procedure for treating elderly patients with mechanical back pain due to facet syndrome.

  14. Limited joint mobility syndrome in diabetes mellitus: A minireview

    PubMed Central

    Gerrits, Esther G; Landman, Gijs W; Nijenhuis-Rosien, Leonie; Bilo, Henk J

    2015-01-01

    Limited joint mobility syndrome (LJMS) or diabetic cheiroarthropathy is a long term complication of diabetes mellitus. The diagnosis of LJMS is based on clinical features: progression of painless stiffness of hands and fingers, fixed flexion contractures of the small hand and foot joints, impairment of fine motion and impaired grip strength in the hands. As the syndrome progresses, it can also affect other joints. It is important to properly diagnose such a complication as LJMS. Moreover, it is important to diagnose LJMS because it is known that the presence of LJMS is associated with micro- and macrovascular complications of diabetes. Due to the lack of curative treatment options, the suggested method to prevent or decelerate the development of LJMS is improving or maintaining good glycemic control. Daily stretching excercises of joints aim to prevent or delay progression of joint stiffness, may reduce the risk of inadvertent falls and will add to maintain quality of life. PMID:26265997

  15. SAPHO syndrome with ankylosis of the temporomandibular joint.

    PubMed

    Müller-Richter, U D A; Roldán, J C; Mörtl, M; Behr, M; Reichert, T E; Driemel, O

    2009-12-01

    SAPHO syndrome is a rare combination of different symptoms with unknown aetiology. A complete ankylosis of the temporomandibular joint (TMJ) in a patient with SAPHO syndrome has not been described previously. The goal of this case report is to present the disease, give an overview about the frequency of mandibular involvement and describe different therapeutic strategies. The complication of an ankylosis of the TMJ is noted and the literature is reviewed. The authors report a 42-year-old patient with SAPHO syndrome and recurrent swelling of the right mandible and the soft tissue. The persisting involvement of the mandible resulted in a complete osseous ankylosis of the right TMJ and required resection with alloplastic replacement of the right condyle. SAPHO syndrome should be suspected in some cases of 'therapy resistant osteomyelitis' of the mandible. Smaller joints, such as the TMJ may also be affected. Treatment of SAPHO syndrome should include antibiotics and NSAIDs; corticosteroids may be helpful. Surgery is the ultimate treatment.

  16. Critical Values of Facet Joint Angulation and Tropism in the Development of Lumbar Degenerative Spondylolisthesis: An International, Large-Scale Multicenter Study by the AOSpine Asia Pacific Research Collaboration Consortium

    PubMed Central

    Samartzis, Dino; Cheung, Jason Pui Yin; Rajasekaran, Shanmuganathan; Kawaguchi, Yoshiharu; Acharya, Shankar; Kawakami, Mamoru; Satoh, Shigenobu; Chen, Wen-Jer; Park, Chun-Kun; Lee, Chong-Suh; Foocharoen, Thanit; Nagashima, Hideki; Kuh, Sunguk; Zheng, Zhaomin; Condor, Richard; Ito, Manabu; Iwasaki, Motoki; Jeong, Je Hoon; Luk, Keith D. K.; Prijambodo, Bambang; Rege, Amol; Jahng, Tae-Ahn; Luo, Zhuojing; Tassanawipas, Warat; Acharya, Narayana; Pokharel, Rohit; Shen, Yong; Ito, Takui; Zhang, Zhihai; Aithala P, Janardhana; Kumar, Gomatam Vijay; Jabir, Rahyussalim Ahmad; Basu, Saumyajit; Li, Baojun; Moudgil, Vishal; Goss, Ben; Sham, Phoebe; Williams, Richard

    2015-01-01

    Study Design  An international, multicenter cross-sectional image-based study performed in 33 institutions in the Asia Pacific region. Objective  The study addressed the role of facet joint angulation and tropism in relation to L4–L5 degenerative spondylolisthesis (DS). Methods  The study included 349 patients (63% females; mean age: 61.8 years) with single-level DS; 82 had no L4–L5 DS (group A) and 267 had L4–L5 DS (group B). Axial computed tomography and magnetic resonance imaging were utilized to assess facet joint angulations and tropism (i.e., asymmetry between facet joint angulations) between groups. Results  There was a statistically significant difference between group A (left mean: 46.1 degrees; right mean: 48.2 degrees) and group B (left mean: 55.4 degrees; right mean: 57.5 degrees) in relation to bilateral L4–L5 facet joint angulations (p < 0.001). The mean bilateral angulation difference was 7.4 and 9.6 degrees in groups A and B, respectively (p = 0.025). A critical value of 58 degrees or greater significantly increased the likelihood of DS if unilateral (adjusted OR: 2.5; 95% CI: 1.2 to 5.5; p = 0.021) or bilateral facets (adjusted OR: 5.9; 95% CI: 2.7 to 13.2; p < 0.001) were involved. Facet joint tropism was found to be relevant between 16 and 24 degrees angulation difference (adjusted OR: 5.6; 95% CI: 1.2 to 26.1; p = 0.027). Conclusions  In one of the largest studies assessing facet joint orientation in patients with DS, greater sagittal facet joint angulation was associated with L4-L5 DS, with a critical value of 58 degrees or greater increasing the likelihood of the condition for unilateral and bilateral facet joint involvement. Specific facet joint tropism categories were noted to be associated with DS. PMID:27433424

  17. Brain-derived neurotrophic factor is upregulated in the cervical dorsal root ganglia and spinal cord and contributes to the maintenance of pain from facet joint injury in the rat.

    PubMed

    Kras, Jeffrey V; Weisshaar, Christine L; Quindlen, Julia; Winkelstein, Beth A

    2013-10-01

    The facet joint is commonly associated with neck and low back pain and is susceptible to loading-induced injury. Although tensile loading of the cervical facet joint has been associated with inflammation and neuronal hyperexcitability, the mechanisms of joint loading-induced pain remain unknown. Altered brain-derived neurotrophic factor (BDNF) levels are associated with a host of painful conditions, but the role of BDNF in loading-induced joint pain remains undefined. Separate groups of rats underwent a painful cervical facet joint distraction or a sham procedure. Bilateral forepaw mechanical hypersensitivity was assessed and BDNF mRNA and protein levels were quantified in the dorsal root ganglion (DRG) and spinal cord at days 1 and 7. Facet joint distraction induced significant (P < 0.001) mechanical hypersensitivity at both time points. Painful joint distraction did not alter BDNF mRNA in the DRG compared with sham levels but did significantly increase (P < 0.016) BDNF protein expression over sham in the DRG at day 7. Painful distraction also significantly increased BDNF mRNA (P = 0.031) and protein expression (P = 0.047) over sham responses in the spinal cord at day 7. In a separate study, intrathecal administration of the BDNF-sequestering molecule trkB-Fc on day 5 after injury partially attenuated behavioral sensitivity after joint distraction and reduced pERK in the spinal cord at day 7 (P < 0.045). Changes in BDNF after painful facet joint injury and the effect of spinal BDNF sequestration in partially reducing pain suggest that BDNF signaling contributes to the maintenance of loading-induced facet pain but that additional cellular responses are also likely involved. Copyright © 2013 Wiley Periodicals, Inc.

  18. An International Multicenter Study Assessing the Role of Ethnicity on Variation of Lumbar Facet Joint Orientation and the Occurrence of Degenerative Spondylolisthesis in Asia Pacific: A Study from the AOSpine Asia Pacific Research Collaboration Consortium

    PubMed Central

    Williams, Richard; Cheung, Jason Pui Yin; Goss, Ben; Rajasekaran, Shanmuganathan; Kawaguchi, Yoshiharu; Acharya, Shankar; Kawakami, Mamoru; Satoh, Shigenobu; Chen, Wen-Jer; Park, Chun-Kun; Lee, Chong-Suh; Foocharoen, Thanit; Nagashima, Hideki; Kuh, Sunguk; Zheng, Zhaomin; Condor, Richard; Ito, Manabu; Iwasaki, Motoki; Jeong, Je Hoon; Luk, Keith D. K.; Prijambodo, Bambang; Rege, Amol; Jahng, Tae-Ahn; Luo, Zhuojing; Tassanawipas, Warat; Acharya, Narayana; Pokharel, Rohit; Shen, Yong; Ito, Takui; Zhang, Zhihai; Aithala P, Janardhana; Kumar, Gomatam Vijay; Jabir, Rahyussalim Ahmad; Basu, Saumyajit; Li, Baojun; Moudgil, Vishal; Sham, Phoebe; Samartzis, Dino

    2015-01-01

    Study Design A multinational, multiethnic, cross-sectional image-based study was performed in 33 institutions, representing 10 countries, which were part of the AOSpine Asia Pacific Research Collaboration Consortium. Objective Lumbar facet joint orientation has been reported to be associated with the development of degenerative spondylolisthesis (DS). The role of ethnicity regarding facet joint orientation remains uncertain. As such, the following study was performed across a wide-ranging population base to assess the role of ethnicity in facet joint orientation in patients with DS in the Asia Pacific region. Methods Lateral standing X-rays and axial magnetic resonance imaging scans were obtained for patients with lumbar DS. The DS parameters and facet joint angulations were assessed from L3–S1. Sex, age, body mass index (BMI), and ethnicity were also noted. Results The study included 371 patients with known ethnic origin (mean age: 62.0 years; 64% males, 36% females). The mean BMI was 25.6 kg/m2. The level of DS was most prevalent at L4–L5 (74.7%). There were 28.8% Indian, 28.6% Japanese, 18.1% Chinese, 8.6% Korean, 6.5% Thai, 4.9% Caucasian, 2.7% Filipino, and 1.9% Malay patients. Variations in facet joint angulations were noted from L3 to S1 and between patients with and without DS (p < 0.05). No differences were noted with regards to sex and overall BMI to facet joint angulations (p > 0.05); however, increasing age was found to increase the degree of angulation throughout the lumbar spine (p < 0.05). Accounting for age and the presence or absence of DS at each level, no statistically significant differences between ethnicity and degree of facet joint angulations from L3–L5 were noted (p > 0.05). Ethnic variations were noted in non-DS L5–S1 facet joint angulations, predominantly between Caucasian, Chinese, and Indian ethnicities (p < 0.05). Conclusions This study is the first to suggest that ethnicity may not play a role in

  19. An International Multicenter Study Assessing the Role of Ethnicity on Variation of Lumbar Facet Joint Orientation and the Occurrence of Degenerative Spondylolisthesis in Asia Pacific: A Study from the AOSpine Asia Pacific Research Collaboration Consortium.

    PubMed

    Williams, Richard; Cheung, Jason Pui Yin; Goss, Ben; Rajasekaran, Shanmuganathan; Kawaguchi, Yoshiharu; Acharya, Shankar; Kawakami, Mamoru; Satoh, Shigenobu; Chen, Wen-Jer; Park, Chun-Kun; Lee, Chong-Suh; Foocharoen, Thanit; Nagashima, Hideki; Kuh, Sunguk; Zheng, Zhaomin; Condor, Richard; Ito, Manabu; Iwasaki, Motoki; Jeong, Je Hoon; Luk, Keith D K; Prijambodo, Bambang; Rege, Amol; Jahng, Tae-Ahn; Luo, Zhuojing; Tassanawipas, Warat; Acharya, Narayana; Pokharel, Rohit; Shen, Yong; Ito, Takui; Zhang, Zhihai; Aithala P, Janardhana; Kumar, Gomatam Vijay; Jabir, Rahyussalim Ahmad; Basu, Saumyajit; Li, Baojun; Moudgil, Vishal; Sham, Phoebe; Samartzis, Dino

    2016-02-01

    Study Design A multinational, multiethnic, cross-sectional image-based study was performed in 33 institutions, representing 10 countries, which were part of the AOSpine Asia Pacific Research Collaboration Consortium. Objective Lumbar facet joint orientation has been reported to be associated with the development of degenerative spondylolisthesis (DS). The role of ethnicity regarding facet joint orientation remains uncertain. As such, the following study was performed across a wide-ranging population base to assess the role of ethnicity in facet joint orientation in patients with DS in the Asia Pacific region. Methods Lateral standing X-rays and axial magnetic resonance imaging scans were obtained for patients with lumbar DS. The DS parameters and facet joint angulations were assessed from L3-S1. Sex, age, body mass index (BMI), and ethnicity were also noted. Results The study included 371 patients with known ethnic origin (mean age: 62.0 years; 64% males, 36% females). The mean BMI was 25.6 kg/m(2). The level of DS was most prevalent at L4-L5 (74.7%). There were 28.8% Indian, 28.6% Japanese, 18.1% Chinese, 8.6% Korean, 6.5% Thai, 4.9% Caucasian, 2.7% Filipino, and 1.9% Malay patients. Variations in facet joint angulations were noted from L3 to S1 and between patients with and without DS (p < 0.05). No differences were noted with regards to sex and overall BMI to facet joint angulations (p > 0.05); however, increasing age was found to increase the degree of angulation throughout the lumbar spine (p < 0.05). Accounting for age and the presence or absence of DS at each level, no statistically significant differences between ethnicity and degree of facet joint angulations from L3-L5 were noted (p > 0.05). Ethnic variations were noted in non-DS L5-S1 facet joint angulations, predominantly between Caucasian, Chinese, and Indian ethnicities (p < 0.05). Conclusions This study is the first to suggest that ethnicity may not play a role in facet

  20. Fluoroscopic cervical epidural injections in chronic axial or disc-related neck pain without disc herniation, facet joint pain, or radiculitis

    PubMed Central

    Manchikanti, Laxmaiah; Cash, Kimberly A; Pampati, Vidyasagar; Malla, Yogesh

    2012-01-01

    Background While chronic neck pain is a common problem in the adult population, with a typical 12-month prevalence of 30%–50%, there is a lack of consensus regarding its causes and treatment. Despite limited evidence, cervical epidural injections are one of the commonly performed nonsurgical interventions in the management of chronic neck pain. Methods A randomized, double-blind, active, controlled trial was conducted to evaluate the effectiveness of cervical interlaminar epidural injections of local anesthetic with or without steroids for the management of chronic neck pain with or without upper extremity pain in patients without disc herniation, radiculitis, or facet joint pain. Results One hundred and twenty patients without disc herniation or radiculitis and negative for facet joint pain by means of controlled diagnostic medial branch blocks were randomly assigned to one of two treatment groups, ie, injection of local anesthetic only (group 1) or local anesthetic mixed with nonparticulate betamethasone (group 2). The primary outcome of significant pain relief and improvement in functional status (≥50%) was demonstrated in 72% of group 1 and 68% of group 2. The overall average number of procedures per year was 3.6 in both groups with an average total relief per year of 37–39 weeks in the successful group over a period of 52 weeks. Conclusion Cervical interlaminar epidural injections of local anesthetic with or without steroids may be effective in patients with chronic function-limiting discogenic or axial pain. PMID:22826642

  1. [Arthrogryposis multiplex congenita--a rare congenital stiff joints syndrome].

    PubMed

    Velisavljev-Filipović, Gordana

    2006-01-01

    Arthrogryposis multiplex congenita is not a disease but a term describing multiple congenital contractures. Etiological factors include neurological and primary myogenic diseases. This rare syndrome is present at birth and is characterized by reduced mobility of many joints. The contractures involve two or more joints with ankylosis. The accompanying musculature is hypoplastic, but multiple pterygia are also present. Arthrogryposis multiplex congenita is a heterogeneous group of disorders with the incidence rate of 6.2/100000 liveborn infants. The true incidence cannot be established, because many cases result in spontaneous miscarriages or stillbirth. More than 90% of cases are associated with birth defects. The cause of this syndrome is unknown. Many forms are not hereditary, though there are hereditary forms as well. This paper presents a case with arthrogryposis multiplex congenita. The pregnancy was not controlled regularly. During the pregnancy, oligohydramnion was detected. Due to contractures, labor ended is cesarean section. The child was born in the 34th week of gestation. Flexion and extension joint contractures were observed. Active and passive mobility of the afflicted joints was reduced. There was a limited motor function in the shoulder, elbow and wrist joints with a slight internal rotation of the shoulder joint and lower arm joints during pronation. The hips were subluxated; the feet were in equinovarus position and the fingers in ulnar deviation with partial syndactyly of the 4th and 5th fingers on the left hand. The infant had abnormal dermatoglyphics. The neck was short, and the 2nd and 3rd cervical vertebrae were fused. There was also a slight left-sided thoracic scoliosis. Trismus was present due to the existing ankylosis of the temporomandibular joint. The karyotype was normal. The serum creatinine phosphokinase was slightly elevated The electromyographic picture indicate non-specific signs of myopathy. This is a case report of a "stiff joint

  2. Virtual reality imaging with real-time ultrasound guidance for facet joint injection: a proof of concept.

    PubMed

    Clarke, Collin; Moore, John; Wedlake, Christopher; Lee, Donald; Ganapathy, Su; Salbalbal, Maher; Wilson, Timothy; Peters, Terry; Bainbridge, Daniel

    2010-05-01

    Facet interventions continue to be used in pain management. Computed tomographic (CT) images can be registered into a virtual world that includes images generated by an ultrasound (US) probe tracked in real time, permitting guidance of tracked needles. We acquired CT-generated 3-dimensional (3D) images of 2 models and a cadaver. Three-dimensional representations of a US probe and needle were generated. A magnetic system tracked the needle and US probe. Using the US, 3D CT images were registered to the model/cadaver. Images were fused on a single interface. Facet injections were performed in the models and cadaver with radio-opaque markers. A postprocedure CT image determined appropriate placement. The virtual reality system described demonstrates technical innovations that may lead to future advancements in the area of percutaneous interventions in the management of pain.

  3. Human papilloma virus vaccine and primary ovarian failure: another facet of the autoimmune/inflammatory syndrome induced by adjuvants.

    PubMed

    Colafrancesco, Serena; Perricone, Carlo; Tomljenovic, Lucija; Shoenfeld, Yehuda

    2013-10-01

    Post-vaccination autoimmune phenomena are a major facet of the autoimmune/inflammatory syndrome induced by adjuvants (ASIA) and different vaccines, including HPV, have been identified as possible causes. The medical history of three young women who presented with secondary amenorrhea following HPV vaccination was collected. Data regarding type of vaccine, number of vaccination, personal, clinical and serological features, as well as response to treatments were analyzed. All three patients developed secondary amenorrhea following HPV vaccinations, which did not resolve upon treatment with hormone replacement therapies. In all three cases sexual development was normal and genetic screen revealed no pertinent abnormalities (i.e., Turner's syndrome, Fragile X test were all negative). Serological evaluations showed low levels of estradiol and increased FSH and LH and in two cases, specific auto-antibodies were detected (antiovarian and anti thyroid), suggesting that the HPV vaccine triggered an autoimmune response. Pelvic ultrasound did not reveal any abnormalities in any of the three cases. All three patients experienced a range of common non-specific post-vaccine symptoms including nausea, headache, sleep disturbances, arthralgia and a range of cognitive and psychiatric disturbances. According to these clinical features, a diagnosis of primary ovarian failure (POF) was determined which also fulfilled the required criteria for the ASIA syndrome. We documented here the evidence of the potential of the HPV vaccine to trigger a life-disabling autoimmune condition. The increasing number of similar reports of post HPV vaccine-linked autoimmunity and the uncertainty of long-term clinical benefits of HPV vaccination are a matter of public health that warrants further rigorous inquiry. © 2013 John Wiley & Sons Ltd.

  4. Arthrocentesis for temporomandibular joint pain dysfunction syndrome.

    PubMed

    Brennan, Peter A; Ilankovan, Vellupillai

    2006-06-01

    The management of refractory temporomandibular joint (TMJ) pain is both challenging and controversial. A number of simple, noninvasive approaches have been used in the management of this condition with variable success. In patients who fail to respond to conventional conservative measures, in a joint that is not deemed to be grossly mechanically deranged, we advocate the use of TMJ arthrocentesis. In our practice, this is followed by intra-articular morphine infusion in an attempt to give long-term pain relief. Arthrocentesis is a simple technique with minimal morbidity that can be tried instead of more invasive procedures. To date we have used arthrocentesis of the upper joint space, with intra-articular morphine injection in over 500 TMJs. Approximately 90% of patients have found the procedure beneficial, with pain often being reduced 1 year after the procedure. We recommend arthrocentesis as an effective, minimally invasive technique in patients with continuing pain in the TMJ that is unresponsive to conservative management. We additionally advocate the use of intra-articular morphine as a long acting analgesic in these patients. Although arthrocentesis is a well documented technique and there have been many studies published in relation to the use of intra-articular morphine in orthopedic surgery, further research is required, to delineate its use in the TMJ more fully.

  5. SAPHO syndrome of the temporomandibular joint associated with sudden deafness.

    PubMed

    Marsot-Dupuch, K; Doyen, J E; Grauer, W O; de Givry, S C

    1999-05-01

    We report a case of arthritis of the temporomandibular joint (TMJ) associated with sclerosing osteomyelitis of the mandible and temporal bone, causing deafness. The presence of a palmoplantar pustulosis established the diagnosis of SAPHO syndrome. SAPHO (an acronym referring to synovitis, acne, palmoplantar pustulosis, hyperostosis, and osteitis) syndrome is defined by the association of characteristic osteoarticular and dermatologic manifestations, with diffuse sclerosing osteomyelitis of the mandible being a part of this entity. We review the literature of SAPHO syndrome with mandibular manifestations and discuss the mechanisms of inflammatory spread from the TMJ to the cochlea. To our knowledge, this is the first description of skull base involvement in a patient with SAPHO syndrome leading to sudden deafness.

  6. Muscular response to physiologic tensile stretch of the caprine c5/6 facet joint capsule: dynamic recruitment thresholds and latencies.

    PubMed

    Azar, Nadia R; Kallakuri, Srinivasu; Chen, Chaoyang; Cavanaugh, John M

    2011-11-01

    This study examined the cervical muscle response to physiologic, high-rate (100 mm/s) tensile facet joint capsule (FJC) stretch. Six in-vivo caprine C5/6 FJC preparations were subjected to an incremental tensile loading paradigm. EMG activity was recorded from the right trapezius (TR) and multifidus (MF) muscle groups at the C5 and C6 levels; and from the sternomastoid (SM) and longus colli (LC) muscle groups bilaterally at the C5/6 level; during FJC stretch. Capsule load during the displacement applications was recorded via a miniature load cell, and 3D capsule strains (based on stereoimaging of an array of markers on the capsule surface) were reconstructed using finite element methods. EMG traces from each muscle were examined for onset of muscular activity. Capsule strains and loads at the time of EMG onset were recorded for each muscle, as was the time from the onset of FJC stretch to the onset of muscle activity. All muscles were responsive to physiologic high-rate FJC stretch. The deep muscles (MF and LC) were recruited at significantly smaller capsule loads and onset latencies than the superficial muscles (TR and SM). MF activation strain was significantly smaller than LC and TR activation strains. These data were also compared to previously published low-rate data. MF was the first muscle group to be recruited regardless of the activation criterion under consideration (i.e. strain, load, or latency) or the rate of FJC stretch. LC recruitment occurred significantly sooner under high-rate vs. low-rate FJC stretch. The results of this study provide further evidence of extensive ligamento-muscular reflex pathways between the FJC and the cervical musculature, which are responsive to both low-rate and high-rate FJC stretch. These data add to our knowledge of the dynamic response of paraspinal muscles relative to facet joint motion and provide a unique contribution to enhance the precision of computer-simulated impacts.

  7. Relationship between Fatigue and Gait Abnormality in Joint Hypermobility Syndrome/Ehlers-Danlos Syndrome Hypermobility Type

    ERIC Educational Resources Information Center

    Celletti, Claudia; Galli, Manuela; Cimolin, Veronica; Castori, Marco; Albertini, Giorgio; Camerota, Filippo

    2012-01-01

    Ehlers-Danlos syndrome (EDS) is a clinically and genetically heterogeneous group of inherited connective tissue disorders characterised by joint hypermobility, skin hyperextensibility and tissue fragility. It has recently been shown that muscle weakness occurs frequently in EDS, and that fatigue is a common and clinically important symptom. The…

  8. Relationship between Fatigue and Gait Abnormality in Joint Hypermobility Syndrome/Ehlers-Danlos Syndrome Hypermobility Type

    ERIC Educational Resources Information Center

    Celletti, Claudia; Galli, Manuela; Cimolin, Veronica; Castori, Marco; Albertini, Giorgio; Camerota, Filippo

    2012-01-01

    Ehlers-Danlos syndrome (EDS) is a clinically and genetically heterogeneous group of inherited connective tissue disorders characterised by joint hypermobility, skin hyperextensibility and tissue fragility. It has recently been shown that muscle weakness occurs frequently in EDS, and that fatigue is a common and clinically important symptom. The…

  9. [Arthroscopic therapy of ankle joint impingement syndrome after operation of ankle joint fracture dislocation].

    PubMed

    Feng, Zhibin; Mi, Kun; Wei, Renzhi; Liu, Wu; Wang, Bin

    2011-07-01

    To study the operative procedure and the effectiveness of arthroscopic therapy for ankle joint impingement syndrome after operation of ankle joint fracture dislocation. Between March 2008 and April 2010, 38 patients with ankle joint impingement syndrome after operation of ankle joint fracture dislocation were treated. Among them, there were 28 males and 10 females with an average age of 28 years (range, 18 to 42 years). The time from internal fixation to admission was 12-16 months (mean, 13.8 months). There were pressing pain in anterolateral and anterior ankle. The dorsal extension ranged from -20 to -5 degrees (mean, -10.6 degrees), and the palmar flexion was 30-40 degrees (mean, 35.5 degrees). The total score was 48.32 +/- 9.24 and the pain score was 7.26 +/- 1.22 before operation according to American Orthopaedic Foot and Ankle Society (AOFAS) ankle and hindfoot score system. The X-ray films showed osteophyte formation in anterior tibia and talus; MRI showed cartilage injury in 22 cases. Arthroscopic intervention included removing osteophytes, debriding fabric scars and synovial membrane tissues, and removing osteochondral fragments. Arthroscopic microfracture technique was used in 22 patients with cartilage injury. All incisions healed primarily. Thirty-eight cases were followed up 10-26 months (mean, 16 months). At last follow-up, 26 patients had normal range of motion (ROM); the dorsal extension was 15-25 degrees (mean, 19.6 degrees) and the palmar flexion was 35-45 degrees (mean, 40.7 degrees). Eight patients had mild limited ROM; the dorsal extension was 5-15 degrees (mean, 7.2 degrees) and the palmar flexion was 35-45 degrees (mean, 39.5 degrees). Four patients had mild limited ROM and pain in posterior portion of the ankle after a long walking (3-4 hours); the dorsal extension was 0-5 degrees (mean, 2.6 degrees) and the palmar flexion was 35-40 degrees (mean, 37.5 degrees). The total score was 89.45 +/- 9.55 and the pain score was 1.42 +/- 1.26 after

  10. Posterior ankle impingement syndrome caused by malunion of joint depressed type calcaneal fracture.

    PubMed

    Lui, T H

    2008-07-01

    Late complications after calcaneal fracture usually resulted in lateral heel pain. Malunion of joint depressed type calcaneal fracture can result in posterior ankle impingement pain. This is caused by the posterior calcaneal bone spike formed just behind the posterior calcaneal facet. We describe a technique to resect the offending posterior calcaneal bone spike to relieve the posterior ankle impingement pain.

  11. Management of Temporomandibular Joint Reankylosis in Syndromic Patients Corrected with Joint Prostheses: Surgical and Rehabilitation Protocols

    PubMed Central

    Clauser, Luigi C.; Consorti, Giuseppe; Elia, Giovanni; Tieghi, Riccardo; Galiè, Manlio

    2013-01-01

    Temporomandibular joint ankylosis (TMJA) is a severe disorder described as an intracapsular union of the disc-condyle complex to the temporal articular surface with bony fusion. The management of this disability is challenging and rarely based on surgical and rehabilitation protocols. We describe the treatment in two young adults affected by Goldenhar syndrome and Pierre Robin sequence with reankylosis after previous surgical treatments. There are three main surgical procedures for the treatment of TMJA: gap arthroplasty, interpositional arthroplasty, and joint reconstruction. Various authors have described reankylosis as a frequent event after treatment. Treatment failure could be associated with surgical errors and/or inadequate intensive postoperative physiotherapy. Surgical treatment should be individually tailored and adequate postoperative physiotherapy protocol is mandatory for success. PMID:24624260

  12. Parallel Syndromes: Two Dimensions of Narcissism and the Facets of Psychopathic Personality in Criminally-Involved Individuals

    PubMed Central

    2012-01-01

    Little research has examined different dimensions of narcissism that may parallel psychopathy facets in criminally-involved individuals. The present study examined the pattern of relationships between grandiose and vulnerable narcissism, assessed using the Narcissistic Personality Inventory-16 and the Hypersensitive Narcissism Scale, respectively, and the four facets of psychopathy (interpersonal, affective, lifestyle, and antisocial) assessed via the Psychopathy Checklist: Screening Version (PCL:SV). As predicted, grandiose and vulnerable narcissism showed differential relationships to psychopathy facets, with grandiose narcissism relating positively to the interpersonal facet of psychopathy and vulnerable narcissism relating positively to the lifestyle facet of psychopathy. Paralleling existing psychopathy research, vulnerable narcissism showed stronger associations than grandiose narcissism to 1) other forms of psychopathology, including internalizing and substance use disorders, and 2) self- and other-directed aggression, measured using the Life History of Aggression and the Forms of Aggression Questionnaire. Grandiose narcissism was nonetheless associated with social dysfunction marked by a manipulative and deceitful interpersonal style and unprovoked aggression. Potentially important implications for uncovering etiological pathways and developing treatment interventions for these disorders in externalizing adults are discussed. PMID:22448731

  13. Refining patterns of joint hypermobility, habitus, and orthopedic traits in joint hypermobility syndrome and Ehlers-Danlos syndrome, hypermobility type.

    PubMed

    Morlino, Silvia; Dordoni, Chiara; Sperduti, Isabella; Venturini, Marina; Celletti, Claudia; Camerota, Filippo; Colombi, Marina; Castori, Marco

    2017-03-07

    Joint hypermobility syndrome (JHS) and Ehlers-Danlos syndrome, hypermobility type (EDS-HT) are two overlapping heritable disorders (JHS/EDS-HT) recognized by separated sets of diagnostic criteria and still lack a confirmatory test. This descriptive research was aimed at better characterizing the clinical phenotype of JHS/EDS-HT with focus on available diagnostic criteria, and in order to propose novel features and assessment strategies. One hundred and eighty-nine (163 females, 26 males; age: 2-73 years) patients from two Italian reference centers were investigated for Beighton score, range of motion in 21 additional joints, rate and sites of dislocations and sprains, recurrent soft-tissue injuries, tendon and muscle ruptures, body mass index, arm span/height ratio, wrist and thumb signs, and 12 additional orthopedic features. Rough rates were compared by age, sex, and handedness with a series of parametric and non-parametric tools. Multiple correspondence analysis was carried out for possible co-segregations of features. Beighton score and hypermobility at other joints were influenced by age at diagnosis. Rate and sites of joint instability complications did not vary according to age at diagnosis except for soft-tissue injuries. No major difference was registered by sex and dominant versus non-dominant body side. At multiple correspondence analysis, selected features tend to co-segregate in a dichotomous distribution. Dolichostenomelia and arachnodactyly segregated independently. This study pointed out a more protean musculoskeletal phenotype than previously considered according to available diagnostic criteria for JHS/EDS-HT. Our findings corroborated the need for a re-thinking of JHS/EDS-HT on clinical grounds in order to find better therapeutic and research strategies. © 2017 Wiley Periodicals, Inc.

  14. Strain and load thresholds for cervical muscle recruitment in response to quasi-static tensile stretch of the caprine C5-C6 facet joint capsule.

    PubMed

    Azar, Nadia R; Kallakuri, Srinivasu; Chen, Chaoyang; Lu, Ying; Cavanaugh, John M

    2009-12-01

    The aim of this study was to investigate the response of cervical muscles to physiologic tensile stretch of cervical facet joint capsule (FJC) at a quasi-static displacement rate of 0.5mm/s. In vivo caprine left C5-C6 FJC preparations were subjected to an incremental tensile displacement paradigm. EMG activity was recorded during FJC stretch from the right trapezius (TR) and multifidus (MF) muscle groups at the C5 and C6 levels and bilaterally from the sternomastoid (SM) and longus colli (LC) muscle groups at the C5-C6 level. Onset of muscular activity was later analyzed using visual and computer-based methods. Capsule load and strain at the time of onset were recorded and compared between the muscle groups. Results indicated capsule load was a better indicator of the tensile stretch thresholds for muscular recruitment than capsule strain. MF responded at significantly smaller capsule loads than TR and LC, while TR and LC activation loads were not significantly different. SM did not respond to physiologic FJC stretch. Muscle group recruitment order reflected the muscles' fiber type compositions and functional roles in the spine. This study provides the first evidence that the cervical ligamento-muscular reflex pathways are activated via tensile FJC stretch and extend to superficial and deep musculature on the anterior and posterior aspects of the neck, ipsilateral and contralateral to the side of FJC stretch.

  15. Neurodevelopmental attributes of joint hypermobility syndrome/Ehlers-Danlos syndrome, hypermobility type: Update and perspectives.

    PubMed

    Ghibellini, Giulia; Brancati, Francesco; Castori, Marco

    2015-03-01

    In the last decade, increasing attention has been devoted to the extra-articular and extra-cutaneous manifestations of joint hypermobility syndrome, also termed Ehlers-Danlos syndrome, hypermobility type (i.e., JHS/EDS-HT). Despite the fact that the current diagnostic criteria for both disorders remain focused on joint hypermobility, musculoskeletal pain and skin changes, medical practice and research have started investigating a wide spectrum of visceral, neurological and developmental complications, which represent major burdens for affected individuals. In particular, children with generalized joint hypermobility often present with various neurodevelopmental issues and can be referred for neurological consultation. It is common that investigations in these patients yield negative or inconsistent results, eventually leading to the exclusion of any structural neurological or muscle disorder. In the context of specialized clinics for connective tissue disorders, a clear relationship between generalized joint hypermobility and a characteristic neurodevelopmental profile affecting coordination is emerging. The clinical features of these patients tend to overlap with those of developmental coordination disorder and can be associated with learning and other disabilities. Physical and psychological consequences of these additional difficulties add to the chief manifestations of the pre-existing connective tissue disorder, affecting the well-being and development of children and their families. In this review, particular attention is devoted to the nature of the link between joint hypermobility, coordination difficulties and neurodevelopmental issues in children. Presumed pathogenesis and management issues are explored in order to attract more attention on this association and nurture future clinical research.

  16. [Bilateral chronic dislocation of the temporomandibular joints and Meige syndrome].

    PubMed

    Arzul, L; Henoux, M; Marion, F; Corre, P

    2015-04-01

    Chronic dislocation of the temporo-mandibular joint (TMJ) is rare. It occurs when an acute dislocation is left untreated, in certain situations, including severe illness, neurologic or psychiatric diseases or prolonged oral intubation. A 79 years old woman, with Meige syndrome, suffered from bilateral dislocation of the TMJ for over 1 year. Surgical repositioning of the mandibular condyles and temporal bone eminectomy were performed. At the 18 postoperative months control, no recurrence has been noted. Treatment of chronic TMJ dislocations often requires a surgical procedure. Manual reduction, even under general anaesthesia, often fails because of severe muscular spasm and periarticular fibrotic changes. The management of this disorder is still controversial. We review available surgical procedures. Copyright © 2015 Elsevier Masson SAS. All rights reserved.

  17. Torsional syndromes about the knee joint in classical ballet

    PubMed Central

    Burkett, Donald G.; Kinsman, John G.

    1982-01-01

    Dance-related pain of the lower limb is often treated symptomatically, without consideration of the chronic strains placed on the joints due to improper technique and alignment. Three pathomechanical syndromes of the knee which produce knee, ankle and foot pain are described. Clinical therapeutic approaches are proposed which emphasize the biomechanical nature of the etiology. Much information in regards to the basis of dance-related pain need be elicited before the pain-producing phenomena and its treatment can be definitively described. This paper makes no attempt to outline proper ballet technique but rather to make the chiropractor aware that insufficiencies in dance technique can and do lead to problems in the dancer. ImagesFigure 1aFigure 1bFigure 2aFigure 2bFigure 5aFigure 5bFigure 6Figure 7Figures 7c-7d

  18. Facets: Ersatz, Resource and Tag

    ERIC Educational Resources Information Center

    Frické, Martin H.

    2013-01-01

    Introduction: Faceted classification appears to be of utmost importance. Ersatz facets, resource faceting and tag faceting: The distinctions are drawn between facets and ersatz facets, and between faceted resources and faceted tags. Single tag resource faceting and multiple tag information object faceting: The basic features are explored of single…

  19. Joint hypermobility syndrome subclassification in paediatrics: a factor analytic approach.

    PubMed

    Pacey, Verity; Adams, Roger D; Tofts, Louise; Munns, Craig F; Nicholson, Leslie L

    2015-01-01

    To determine if exploratory factor analysis can identify subtypes comprising recognisable clinical patterns of the presenting signs and symptoms of children with joint hypermobility syndrome (JHS). Eighty-nine children with JHS aged 6-16 years. Twelve tests comprising anthropometric, musculoskeletal and functional assessments were conducted. Signs, symptoms and family history were recorded. Exploratory factor analysis was performed, factor scores generated, and correlations calculated to identify associations. Sixty-six percent of the variance in the score set could be accounted for by five JHS subtypes (Eigenvalues >1). Factor 1, 'joint affected' JHS, had loadings on multiple joint pain, recurrent joint instability and postural orthostatic hypotension symptoms, and factor scores were associated with worse pain (r=0.48, p<0.01), fatigue (r=-0.54, p<0.01) and reduced health-related quality of life (HRQOL) (r=-0.5, p<0.01). Factor 2, 'athletic' JHS, loaded on muscle endurance, balance and motor skill proficiency, and scores were associated with less fatigue (r=0.3, p<0.01) and better HRQOL (r=0.44, p<0.01). Factor 3, 'systemic' JHS, loaded on skin involvement, incontinence symptoms, bowel involvement and recurrent joint instability, and was associated with reduced HRQOL (r=-0.24, p=0.03). Factor 4, 'soft tissue affected' JHS, loaded on recurrent soft tissue injuries and reduced muscle length, and was associated with greater fatigue (r=-0.43, p<0.01) and reduced HRQOL (r=-0.44, p<0.0001). Factor 5, 'high BMI' JHS, had high loadings on body mass index (BMI) for age, muscle endurance and no gastrointestinal involvement, and was associated with higher pain (r=0.33, p<0.01). The presenting signs and symptoms of children with JHS can be summarised in five clinically recognisable subtypes. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

  20. Blue rubber bleb nevus syndrome with knee joint disorder.

    PubMed

    Doi, Takehiko; Masumoto, Natsuko; Sonoda, Motoshi; Nakayama, Hideki; Mizuno, Yuji

    2016-08-01

    Blue rubber bleb nevus syndrome (BRBNS) involves cutaneous vascular malformation characterized by multiple venous malformations. This commonly affects the skin and gastrointestinal tract. BRBNS is associated with anemia and occasionally involves orthopedic manifestations. A 6-year-old boy was referred to hospital for evaluation of anemia. He presented with a rubber-like soft-tissue mass in the left knee and the right side of the neck, recurrent pain, and fixed flexion contracture of the knee. Blood examination indicated consumption coagulopathy and anemia caused by not only iron-deficiency anemia but also microangiopathy. Endoscopy of the gastrointestinal tract indicated multiple bluish-black sessile venous malformations. Ultrasonography and magnetic resonance imaging of the knee showed intra-articular and intramuscular involvement. Based on these findings, BRBNS with knee joint disorder was diagnosed. With regard to vascular malformations, like other diseases such as inflammatory arthropathy, ultrasonography of the joint may become a new diagnostic approach for evaluating orthopedic manifestations. © 2016 Japan Pediatric Society.

  1. Urinary CTX‐II levels are associated with radiographic subtypes of osteoarthritis in hip, knee, hand, and facet joints in subject with familial osteoarthritis at multiple sites: the GARP study

    PubMed Central

    Meulenbelt, I; Kloppenburg, M; Kroon, H M; Houwing‐Duistermaat, J J; Garnero, P; Graverand, M‐P Hellio Le; DeGroot, J; Slagboom, P E

    2006-01-01

    Objective To assess the relation between the urinary concentrations of type II collagen C‐telopeptide (UCTX‐II) and radiographic signs of osteoarthritis (ROA) in the GARP (Genetics, Arthrosis and Progression) study. Methods UCTX‐II levels were measured in GARP study participants, who are sibling pairs predominantly with symptomatic osteoarthritis at multiple sites. Kellgren and Lawrence scores were used to assess ROA in the knees, hips, hands, and vertebral facet joints, and spinal disc degeneration. A proportionate score was made for each joint location, based on the number of joints with ROA. The sum total ROA score represents a measure of cartilage abnormalities within each patient. By using linear mixed models the total ROA score and the joint site specific ROA scores were correlated with the UCTX‐II level. Results In 302 subjects the mean (SD) and median (range) for UCTX‐II were 265 (168) and 219 (1346) ng/mmol creatine, respectively. There was a significant association between the total ROA score and UCTX‐II levels. Subsequent multivariate analysis showed that the joint site specific ROA score at all joint sites, except for spinal disc degeneration, contributed independently to this association. Conclusions The total ROA score of GARP patients, representing cartilage abnormalities at the most prevalent ROA joint locations, showed an excellent correlation with UCTX‐II levels. The specific ROA scores at the hip, hand, facet, and knee joints additively and independently explained this association. Even in patients with osteoarthritis at multiple sites, UCTX‐II may be a sensitive quantitative marker of ROA. PMID:16079167

  2. Correlations Between General Joint Hypermobility and Joint Hypermobility Syndrome and Injury in Contemporary Dance Students.

    PubMed

    Ruemper, Alia; Watkins, Katherine

    2012-12-01

    The first objective of this study was to ascertain the prevalence of general joint hypermobility (GJH) and joint hypermobility syndrome (JHS) in BA Dance Theatre 1st and 3rd year students at a contemporary dance conservatory. The second objective was to determine the statistical correlation between GJH, JHS, and injury in this population. A total of 85 (female, N = 78; male, N = 7) contemporary dance students participated in the study. The Beighton score (with a forward flexion test modification) was used to determine GJH, and the Brighton criteria were used to verify JHS. Participants completed a self-reported injury questionnaire that included type of injury (physical complaint, medical diagnosis, or time-loss) and injury frequency. Statistical analysis (Pearson correlation) was used to correlate GJH, JHS, and frequency-of-injury scores. Overall, 69% of the students were found to have GJH, and 33% had JHS. A statistical correlation of r = + 0.331 (p < 0.01) was found between JHS and injury. No significant correlation was found between GJH and injury. This is the first study to look at these correlations in contemporary dance students and suggests that screening programs should include the Brighton criteria to identify JHS in these dancers. Subsequent injury tracking and injury prevention programs would then provide data for further research in this area.

  3. [Ehlers-Danlos syndrome, with special emphasis in the joint hypermobility syndrome].

    PubMed

    Bravo, Jaime F

    2009-11-01

    There is an urgent need to increase the awareness on the Joint Hyper mobility Syndrome QHS). This is a congenital and prevalent emergent condition that is frequently undiagnosed and that causes significant health problems. Besides recurrent muscular-skeletal problems and signs and symptoms derived from tissue fragility, adolescents and young adults may develop osteoporosis, early osteoarthritis or dysautonomia, that are common in the disease, and deteriorate quality of life. Many JHS patients have signs and symptoms suggestive of fibromyalgia and are usually misdiagnosed. Physicians should be able to differentiate the less severe form of JHS from the Vascular Ehlers-Danlos Syndrome, to diagnose it before the appearance of serious complications and even death. The study of these diseases is a promising area for genomic and rheumatologic research.

  4. Radiological characteristics of the knee joint in nail patella syndrome.

    PubMed

    Tigchelaar, S; Rooy, J de; Hannink, G; Koëter, S; van Kampen, A; Bongers, E

    2016-04-01

    Nail patella syndrome (NPS) is a skeletal dysplasia with patellofemoral dysfunction as a key symptom. We present the first in-depth radiological evaluation of the knee in a large series of NPS patients and describe the typical malformations. Conventional radiological examination of 95 skeletally mature patients with NPS was performed. Patellar morphology was classified according to the Wiberg classification as modified by Baumgartl and Ficat criteria, and trochlear shape was classified according to the Dejour classification. Patellar aplasia was present in 4/90 (4%), and patellar hypoplasia in 77/90 (86%) of patients. The prevailing patellar shapes were type III, type IV and Hunter's cap. No patellar shape genotype-phenotype association could be found. The malformations of the distal femur comprised shortening of the lateral femoral condyle in 46 out of 84 patients (55%), with a prominent anterior surface of the lateral femoral condyle in 47 out of 84 patients (56%) and a flat anterior surface of the medial femoral condyle in 78 out of 85 patients (92%). The trochlea was type A1 according to the Dejour classification in 79 out of 85 patients (93%). An easily recognisable characteristic quartet of malformations consisting of patellar aplasiaor hypoplasia and the malformations of the distal femur was found in 22 out of 81 patients (27%), with the majority displaying at least three malformations. The distinct malformations of the knee in nail patella syndrome are easily recognisable on conventional radiographs and lead to the correct interpretation of the aberrant morphology which is essential in the treatment of these patellofemoral disorders. ©2016 The British Editorial Society of Bone & Joint Surgery.

  5. FacetGist: Collective Extraction of Document Facets in Large Technical Corpora

    PubMed Central

    Siddiqui, Tarique; Ren, Xiang; Parameswaran, Aditya; Han, Jiawei

    2017-01-01

    Given the large volume of technical documents available, it is crucial to automatically organize and categorize these documents to be able to understand and extract value from them. Towards this end, we introduce a new research problem called Facet Extraction. Given a collection of technical documents, the goal of Facet Extraction is to automatically label each document with a set of concepts for the key facets (e.g., application, technique, evaluation metrics, and dataset) that people may be interested in. Facet Extraction has numerous applications, including document summarization, literature search, patent search and business intelligence. The major challenge in performing Facet Extraction arises from multiple sources: concept extraction, concept to facet matching, and facet disambiguation. To tackle these challenges, we develop FacetGist, a framework for facet extraction. Facet Extraction involves constructing a graph-based heterogeneous network to capture information available across multiple local sentence-level features, as well as global context features. We then formulate a joint optimization problem, and propose an efficient algorithm for graph-based label propagation to estimate the facet of each concept mention. Experimental results on technical corpora from two domains demonstrate that Facet Extraction can lead to an improvement of over 25% in both precision and recall over competing schemes. PMID:28210517

  6. FacetGist: Collective Extraction of Document Facets in Large Technical Corpora.

    PubMed

    Siddiqui, Tarique; Ren, Xiang; Parameswaran, Aditya; Han, Jiawei

    2016-10-01

    Given the large volume of technical documents available, it is crucial to automatically organize and categorize these documents to be able to understand and extract value from them. Towards this end, we introduce a new research problem called Facet Extraction. Given a collection of technical documents, the goal of Facet Extraction is to automatically label each document with a set of concepts for the key facets (e.g., application, technique, evaluation metrics, and dataset) that people may be interested in. Facet Extraction has numerous applications, including document summarization, literature search, patent search and business intelligence. The major challenge in performing Facet Extraction arises from multiple sources: concept extraction, concept to facet matching, and facet disambiguation. To tackle these challenges, we develop FacetGist, a framework for facet extraction. Facet Extraction involves constructing a graph-based heterogeneous network to capture information available across multiple local sentence-level features, as well as global context features. We then formulate a joint optimization problem, and propose an efficient algorithm for graph-based label propagation to estimate the facet of each concept mention. Experimental results on technical corpora from two domains demonstrate that Facet Extraction can lead to an improvement of over 25% in both precision and recall over competing schemes.

  7. Analysis of IL-17+ cells in facet joints of patients with spondyloarthritis suggests that the innate immune pathway might be of greater relevance than the Th17-mediated adaptive immune response

    PubMed Central

    2011-01-01

    Introduction In this study, we analysed the number of IL-17+ cells in facet joints, in the peripheral blood (PB) and synovial fluid (SF) of spondyloarthritis (SpA) patients and compared these results with those of patients with other rheumatic diseases and controls. Methods Immunohistochemical analysis of IL-17+ cells was performed in facet joints of 33 ankylosing spondylitis (AS) patients and compared with data from 20 osteoarthritis (OA) patients. The frequency of IL-17+CD4+ T cells in PB and SF of SpA patients (PB n = 30, SF n = 11), rheumatoid arthritis (RA) patients (PB n = 14, SF n = 7), OA patients (PB n = 10) and healthy controls (PB n = 12) was analysed after stimulation with Staphylococcus aureus Enterotoxin B and phorbol 12-myristate 13-acetate/ionomycin and quantified by flow cytometry. Results In AS facet joints, the frequency of IL-17-secreting cells was significantly higher than in samples obtained from OA patients (P < 0.001), with a slight predominance of IL-17+ cells among the mononuclear cells (61.5% ± 14.9%) compared to cells with polysegmental nuclei. Immunofluorescence microscopy revealed that the majority of IL-17+ cells were myeloperoxidase-positive (35.84 ± 13.06/high-power field (HPF) and CD15+ neutrophils (24.25 ± 10.36/HPF), while CD3+ T cells (0.51 ± 0.49/HPF) and AA-1+ mast cells (2.28 ± 1.96/HPF) were less often IL-17-positive. The frequency of IL-17+CD4+ T cells in the PB and SF of SpA patients did not differ significantly compared to RA patients, OA patients or healthy controls. Conclusions Our data suggest an important role for IL-17 in the inflammatory processes in AS. However, the innate immune pathway might be of greater relevance than the Th17-mediated adaptive immune response. PMID:21689402

  8. Joint Engagement and the Emergence of Language in Children with Autism and Down Syndrome

    ERIC Educational Resources Information Center

    Adamson, Lauren B.; Bakeman, Roger; Deckner, Deborah F.; Romski, MaryAnn

    2009-01-01

    Systematic longitudinal observations were made as typically developing toddlers and young children with autism and with Down syndrome interacted with their caregivers in order to document how joint engagement developed over a year-long period and how variations in joint engagement experiences predicted language outcome. Children with autism…

  9. Organization of a Simple Two-Joint Synergy in Individuals with Down Syndrome.

    ERIC Educational Resources Information Center

    Aruin, Alexander S.; And Others

    1996-01-01

    Six adults with Down syndrome performed discrete elbow or wrist, flexion or extension movements in a sagittal plane, moving one of the joints as fast as possible. The subjects demonstrated simultaneous bursts of activity in the flexor and extensor muscles controlling both joints. This adaptive feature may reflect a general tendency of these…

  10. Joint Engagement and the Emergence of Language in Children with Autism and Down Syndrome

    ERIC Educational Resources Information Center

    Adamson, Lauren B.; Bakeman, Roger; Deckner, Deborah F.; Romski, MaryAnn

    2009-01-01

    Systematic longitudinal observations were made as typically developing toddlers and young children with autism and with Down syndrome interacted with their caregivers in order to document how joint engagement developed over a year-long period and how variations in joint engagement experiences predicted language outcome. Children with autism…

  11. Gastrointestinal and nutritional issues in joint hypermobility syndrome/Ehlers-Danlos syndrome, hypermobility type.

    PubMed

    Castori, Marco; Morlino, Silvia; Pascolini, Giulia; Blundo, Carlo; Grammatico, Paola

    2015-03-01

    Gastrointestinal involvement is a well known complication of Ehlers-Danlos syndromes (EDSs), mainly in form of abdominal emergencies due to intestinal/abdominal vessels rupture in vascular EDS. In the last decade, a growing number of works investigated the relationship between a wide spectrum of chronic gastrointestinal complaints and various EDS forms, among which the hypermobility type (a.k.a. joint hypermobility syndrome; JHS/EDS-HT) was the most studied. The emerging findings depict a major role for gastrointestinal involvement in the health status and, consequently, management of JHS/EDS-HT patients. Nevertheless, fragmentation of knowledge limits its impact on practice within the boundaries of highly specialized clinics. In this paper, literature review on gastrointestinal manifestations in JHS/EDS-HT was carried out and identified papers categorized as (i) case-control/cohort studies associating (apparently non-syndromic) joint hypermobility and gastrointestinal involvement, (ii) case-control/cohort studies associating JHS/EDS-HT and gastrointestinal involvement, (iii) case reports/series on various gastrointestinal complications in (presumed) JHS/EDS-HT, and (iv) studies reporting gastrointestinal features in heterogeneous EDS patients' cohorts. Gastrointestinal manifestations of JHS/EDS-HT were organized and discussed in two categories, including structural anomalies (i.e., abdominal/diaphragmatic hernias, internal organ/pelvic prolapses, intestinal intussusceptions) and functional features (i.e., dysphagia, gastro-esophageal reflux, dyspepsia, recurrent abdominal pain, constipation/diarrhea), with emphasis on practice and future implications. In the second part of this paper, a summary of possible nutritional interventions in JHS/EDS-HT was presented. Supplementation strategies were borrowed from data available for general population with minor modifications in the light of recent discoveries in the pathogenesis of selected JHS/EDS-HT features.

  12. Interventional radiology in bone and joint

    SciTech Connect

    Bard, M.; Laredo, J.D.

    1988-01-01

    Recent radiologic procedures in bone and joints, some of which eliminate the need for surgery are exposed, including: trephine biopsies of the thoracic and lumbar spine, sacro-iliac joints, peripheral bones synovial membrane and soft tissues, using either fluoroscopic echographic or CT guidance - chemonucleolysis - vascular embolization of skeletal tumors and management of vertebral hemangiomas - selective steroid injection in a broad spectrum of diseases including vertebral facet syndrome, cervicobrachial nerve root pain, rotator cuff calcium deposit, bone cysts.

  13. The effect of different design concepts in lumbar total disc arthroplasty on the range of motion, facet joint forces and instantaneous center of rotation of a L4-5 segment.

    PubMed

    Schmidt, Hendrik; Midderhoff, Stefan; Adkins, Kyle; Wilke, Hans-Joachim

    2009-11-01

    Although both unconstrained and constrained core lumbar artificial disc designs are in clinical use, the effect of their design on the range of motion, center of rotations, and facet joint forces is not well understood. It is assumed that the constrained configuration causes a fixed center of rotation with high facet forces, while the unconstrained configuration leads to a moving center of rotation with lower loaded facets. The authors disagree with both assumptions and hypothesized that the two different designs do not lead to substantial differences in the results. For the different implant designs, a three-dimensional finite element model was created and subsequently inserted into a validated model of a L4-5 lumbar spinal segment. The unconstrained design was represented by two implants, the Charité disc and a newly developed disc prosthesis: Slide-Disc. The constrained design was obtained by a modification of the Slide-Disc whereby the inner core was rigidly connected to the lower metallic endplate. The models were exposed to an axial compression preload of 1,000 N. Pure unconstrained moments of 7.5 Nm were subsequently applied to the three anatomical main planes. Except for extension, the models predicted only small and moderate inter-implant differences. The calculated values were close to those of the intact segment. For extension, a large difference of about 45% was calculated between both Slide-Disc designs and the Charité disc. The models predicted higher facet forces for the implants with an unconstrained core compared to an implant with a constrained core. All implants caused a moving center of rotation. Except for axial rotation, the unconstrained and constrained configurations mimicked the intact situation. In axial rotation, only the Slide- Disc with mobile core reproduced the intact behavior. Results partially support our hypothesis and imply that different implant designs do not lead to strong differences in the range of motion and the location

  14. Quantifying cardiovascular risks in patients with metabolic syndrome undergoing total joint arthroplasty.

    PubMed

    Gandhi, Kishor; Viscusi, Eugene R; Schwenk, Eric S; Pulido, Luis; Parvizi, Javad

    2012-04-01

    The coexistence of diabetes, hypertension, obesity, and dyslipidemia is defined as metabolic syndrome. Studies show substantial cardiovascular risks among these patients. The risk of patients with metabolic syndrome undergoing total joint arthroplasty (TJA) is unknown. Patients with and without metabolic syndrome undergoing TJA during a 3-year period were analyzed for postoperative complications. Metabolic syndrome was defined by having 3 of the following 4 criteria: obesity (body mass index ≥30 kg/m(2)), dyslipidemia, hypertension, and diabetes. Patients with metabolic syndrome had a significantly higher risk of cardiovascular complications compared with controls (P = .017). The risk of an adverse event increased by 29% and 32%, respectively, when there were 3 or 4 syndrome components. Patients with metabolic syndrome undergoing TJA have increased risk for cardiovascular complications. Our results show that metabolic syndrome may have a clustering effect and pose increased risk when individual risks factors are combined. Copyright © 2012 Elsevier Inc. All rights reserved.

  15. Understanding others: a pilot investigation of cognitive and affective facets of social cognition in patients with 22q11.2 deletion syndrome (22q11DS).

    PubMed

    Badoud, D; Schneider, M; Menghetti, S; Glaser, B; Debbané, M; Eliez, S

    2017-09-25

    Although significant impairments in the affective and cognitive facets of social cognition have been highlighted in patients with 22q11.2 deletion syndrome (22q11DS) in previous studies, these domains have never been investigated simultaneously within the same group of participants. Furthermore, despite theoretical evidence, associations between these two processes and schizotypal symptoms or social difficulties in this population have been scarcely examined. Twenty-nine participants with 22q11DS and 27 typically developing controls (N = 5 siblings; N = 22 unrelated controls) aged between 11 and 21 years participated in the study. Both groups were matched for age and gender distribution. Two computerized social cognition tasks evaluating perspective and emotion recognition abilities were administered to all participants. The levels of schizotypal trait expression and social functioning were further investigated in both groups, based on a validated self-report questionnaire (Schizotypal Personality Questionnaire) and parental interview (Vineland Adaptive Behavior Scales). Participants with 22q11DS exhibited lower perspective-taking and emotion recognition capacities than typically developing controls. The two socio-cognitive dimensions investigated here were further correlated in healthy controls. The efficiency of perspective-taking processes (response time) was marginally related to the degree of schizotypal trait expression in patients with 22q11DS. This study first provides support for significant deficits in two core facets of social cognition in 22q11DS. The associations observed between the experimental tasks and measures of social functioning or schizotypal symptoms in 22q11DS open promising research avenue, which should be more deeply investigated in future studies.

  16. Joint engagement and the emergence of language in children with autism and Down syndrome.

    PubMed

    Adamson, Lauren B; Bakeman, Roger; Deckner, Deborah F; Romski, MaryAnn

    2009-01-01

    Systematic longitudinal observations were made as typically developing toddlers and young children with autism and with Down syndrome interacted with their caregivers in order to document how joint engagement developed over a year-long period and how variations in joint engagement experiences predicted language outcome. Children with autism displayed a persistent deficit in coordinated joint attention; children with Down syndrome were significantly less able to infuse symbols into joint engagement. For all groups, variations in amount of symbol-infused supported joint engagement, a state in which the child attended to a shared object and to language but not actively to the partner, contributed to differences in expressive and receptive language outcome, over and above initial language capacity.

  17. Joint Engagement and the Emergence of Language in Children with Autism and Down Syndrome

    PubMed Central

    Adamson, Lauren B.; Bakeman, Roger; Deckner, Deborah F.; Romski, MaryAnn

    2009-01-01

    Systematic longitudinal observations were made as typically-developing toddlers and young children with autism and with Down syndrome interacted with their caregivers in order to document how joint engagement developed over a year-long period and how variations in joint engagement experiences predicted language outcome. Children with autism displayed a persistent deficit in coordinated joint attention; children with Down syndrome were significantly less able to infuse symbols into joint engagement. For all groups, variations in amount of symbol-infused supported joint engagement, a state in which the child attended to a shared object and to language but not actively to the partner, contributed to differences in expressive and receptive language outcome, over and above initial language capacity. PMID:18581223

  18. Benign joint hypermobility syndrome in soldiers; what is the effect of military training courses on associated joint instabilities?

    PubMed Central

    Azma, Kamran; Mottaghi, Peyman; Hosseini, Alireza; Abadi, Hossein Hassan; Nouraei, Mohammad Hadi

    2014-01-01

    Background: Hypermobile joints are joints with beyond normal range of motion and may be associated with joint derangements. This study aimed to evaluate the prevalence of benign joint hypermobility syndrome (BJHS) among soldiers and effect of training courses on related joint instabilities. Materials and Methods: In a prospective cohort study on 721 soldiers of Iran Army in Isfahan in 2013 the prevalence of joint hypermobility was obtained by using Beighton criteria. Soldiers divided in two groups of healthy and suffered based on their scores. The prevalence of ankle sprain, shoulder and temporomandibular joint (TMJ) dislocations identified before beginning service by history-taking and reviewing paraclinical documents. After 3 months of military training, a recent occurrence of mentioned diseases was revaluated in two groups. The collected data were analyzed using SPSS-20 software using Independent-T and Chi-square tests. Results: The frequency of BJHS before military training was 29.4%. After passing military training period, the incidence of ankle sprain was significantly higher in suffered group achieving the minimum Beighton score (BS) of 4 (4.3%, P = 0.03), 5 (5.5%, P = 0.005) and also 6 out of 9 (6.5%, P = 0.01). The incidence of TMJ dislocation was not significantly different based on a minimum score of 4, while it was higher in suffered group when considering the score of 5 (2.1%) and 6 (2.6%) for discrimination of two groups (P = 0.03). There was no significant difference between two groups in case of shoulder dislocation anyway. Conclusion: Military training can increase the incidence of ankle sprains and TMJ dislocations in hypermobility persons with higher BS in comparison with healthy people. Therefore, screening of joint hypermobility may be useful in identifying individuals at increased risk for joint instabilities. PMID:25364364

  19. Chronic temporomandibular joint dislocation by mandibular distraction in a patient with Melnick-needles syndrome.

    PubMed

    Kelley, Patrick; Mata, Carlos; Da Silveira, Adriana

    2010-01-01

    Melnick-Needles syndrome is a congenital syndrome associated with severe architectural disorder of the skeletal system that can cause significant effects on the craniofacial skeleton including the mandible and temporomandibular joint. We report on a case of a young adult patient who experienced chronic dislocation, pain, and dysfunction of her temporomandibular joints related to both a severe bite dysfunction (mandibular hypoplasia) and the underlying bony architectural disorder associated with Melnick-Needles syndrome. The patient underwent bilateral mandibular distraction to correct her skeletal malocclusion and improve the condylar relationship with the temporomandibular joint fossae. The inherent bony abnormalities presented unique challenges to distraction. The patient was successfully distracted using internal mandibular distractors, rhBMP-2, and a prolonged distraction protocol. The patient experienced complete resolution of symptoms and resumed an unrestricted diet 6 months after removal of devices and has been pain-free for more than 24 months.

  20. Do people with benign joint hypermobility syndrome (BJHS) have reduced joint proprioception? A systematic review and meta-analysis.

    PubMed

    Smith, Toby O; Jerman, Emma; Easton, Victoria; Bacon, Holly; Armon, Kate; Poland, Fiona; Macgregor, Alex J

    2013-11-01

    Joint proprioceptive deficit is documented in a variety of musculoskeletal conditions including osteoarthritis, ligament and meniscal injuries, and individuals with increased joint hypermobility, such as those with Ehlers-Danlos. No systematic reviews have assessed joint proprioception in people with benign joint hypermobility syndrome (BJHS). This study addresses this to determine whether people with BJHS exhibit reduced joint proprioception, and, if so, whether this is evident in all age groups. The search strategy was conducted on 31st January 2013. The published literature was assessed using the databases: AMED, CINAHL, MEDLINE, EMBASE, PubMed and the Cochrane Library. Unpublished literature and trial registries were assessed including: OpenGrey, the WHO International Clinical Trials Registry Platform, Current Controlled Trials, the UK National Research Register Archive. All studies comparing the proprioceptive capability of people with and without BJHS were included. Study methodological quality was assessed using the CASP appraisal tool. Meta-analysis techniques were used when study homogeneity permitted. Five studies including 254 people were identified. People with BJHS demonstrated statistically significantly poorer lower limb joint position sense (JPS) (p < 0.001) and threshold detection to movement (p < 0.001) than those without BJHS. The evidence for upper limb proprioceptive difference was less clear, with no statistically significant difference between the cohorts for shoulder JPS (p = 0.10), but a statistically significant difference in finger JPS (p < 0.001). One study which assessed childhood BJHS reported reduced knee proprioceptive capability in those with BJHS (p < 0.001). To conclude, lower limb joint proprioception is reduced in those with BJHS compared to non-BJHS cohorts, whilst unclear in the upper limb.

  1. An observational feasibility study to assess the safety and effectiveness of intranasal fentanyl for radiofrequency ablations of the lumbar facet joints

    PubMed Central

    Bartoszek, Michael W; McCoart, Amy; Hong, Kyung-soo Jason; Haley, Chelsey; Highland, Krista Beth; Plunkett, Anthony R

    2017-01-01

    Purpose The purpose of the present observational, feasibility study is to assess the preliminary safety and effectiveness of intranasal fentanyl for lumbar facet radiofrequency ablation procedures. Patients and methods This cohort observational study included 23 adult patients. Systolic and diastolic blood pressures, heart rate, oxygen saturation percent, Pasero Opioid-Induced Sedation Scale score, and the Defense and Veterans Pain Rating Scale pain score were assessed prior to the procedure and intranasal fentanyl (100 μg) administration and every 15 minutes after administration, up to 60 minutes post administration. Follow-up of patient satisfaction with pain control and treatment was assessed 24 hours after discharge. The primary outcome was safety as evidenced by adverse events. Secondary outcomes included the above-mentioned vital signs and pain ratings. Results No adverse events occurred in the present study and all participants maintained an acceptable level of awareness throughout the assessment period. One-way repeated measures analyses of covariance tests with Bonferroni-adjusted means indicated that oxygen saturation, blood pressure, and heart rate changed from baseline, whereas pain scores were lower at post-administration levels compared with baseline. Finally, the majority of participants reported being satisfied with pain control and treatment. Conclusion Preliminary evidence indicates that intranasal fentanyl is safe and effective for lumbar facet radiofrequency ablation procedures. Future rigorous randomized control trials are needed to confirm the present results and to examine the effects of intranasal fentanyl on intraoperative and postoperative opioid use. PMID:28243139

  2. Joint Engagement and Early Language in Young Children with Fragile X Syndrome

    ERIC Educational Resources Information Center

    Hahn, Laura J.; Brady, Nancy C.; Fleming, Kandace; Warren, Steven F.

    2016-01-01

    Purpose: In this study, we examine joint engagement (JE) in young children with fragile X syndrome (FXS) and its relationship to language abilities and autism spectrum disorder symptomatology at 24 to 36 months (toddler period) and 59 to 68 months (child period). Method: Participants were 28 children with FXS (24 boys, four girls) and their…

  3. Early Interests and Joint Engagement in Typical Development, Autism, and Down Syndrome

    ERIC Educational Resources Information Center

    Adamson, Lauren B.; Deckner, Deborah F.; Bakeman, Roger

    2010-01-01

    This study examines how spontaneous interests in people and in objects relate to joint engagement in typically developing toddlers and young children with autism or Down syndrome. Ratings of interests were made repeatedly during intermissions in a laboratory-based protocol focused on caregiver-child interactions. Interests were moderated by…

  4. Assessing Joint Attention Responding and Initiation in Children with Angelman Syndrome

    ERIC Educational Resources Information Center

    Summers, Jane; Impey, Julie

    2011-01-01

    Background: Angelman syndrome (AS) is a rare neurogenetic disorder that overlaps with autism and is associated with severe cognitive, speech and motor impairments. Communication and social deficits are found among children with AS, both of which may be linked to impairments in joint attention. Methods: The participants in this study were four…

  5. Early Interests and Joint Engagement in Typical Development, Autism, and Down Syndrome

    ERIC Educational Resources Information Center

    Adamson, Lauren B.; Deckner, Deborah F.; Bakeman, Roger

    2010-01-01

    This study examines how spontaneous interests in people and in objects relate to joint engagement in typically developing toddlers and young children with autism or Down syndrome. Ratings of interests were made repeatedly during intermissions in a laboratory-based protocol focused on caregiver-child interactions. Interests were moderated by…

  6. Joint Attention Behaviours and Vocabulary Development in Children with Down Syndrome

    ERIC Educational Resources Information Center

    Zampini, L.; Salvi, A.; D'Odorico, L.

    2015-01-01

    Background: Because of their difficulties in language development, various studies have focussed on the precursors of linguistic skills in children with Down syndrome. However, data on the predictive role of joint attention on language development in this population are inconsistent. The present study aimed to analyse attention behaviours in a…

  7. Joint Attention Behaviours and Vocabulary Development in Children with Down Syndrome

    ERIC Educational Resources Information Center

    Zampini, L.; Salvi, A.; D'Odorico, L.

    2015-01-01

    Background: Because of their difficulties in language development, various studies have focussed on the precursors of linguistic skills in children with Down syndrome. However, data on the predictive role of joint attention on language development in this population are inconsistent. The present study aimed to analyse attention behaviours in a…

  8. Assessing Joint Attention Responding and Initiation in Children with Angelman Syndrome

    ERIC Educational Resources Information Center

    Summers, Jane; Impey, Julie

    2011-01-01

    Background: Angelman syndrome (AS) is a rare neurogenetic disorder that overlaps with autism and is associated with severe cognitive, speech and motor impairments. Communication and social deficits are found among children with AS, both of which may be linked to impairments in joint attention. Methods: The participants in this study were four…

  9. Joint Engagement and Early Language in Young Children with Fragile X Syndrome

    ERIC Educational Resources Information Center

    Hahn, Laura J.; Brady, Nancy C.; Fleming, Kandace; Warren, Steven F.

    2016-01-01

    Purpose: In this study, we examine joint engagement (JE) in young children with fragile X syndrome (FXS) and its relationship to language abilities and autism spectrum disorder symptomatology at 24 to 36 months (toddler period) and 59 to 68 months (child period). Method: Participants were 28 children with FXS (24 boys, four girls) and their…

  10. Inter-Dependent Mechanisms Behind Cognitive Dysfunction, Vascular Biology and Alzheimer's Dementia in Down Syndrome: Multi-Faceted Roles of APP

    PubMed Central

    Nizetic, Dean; Chen, Christopher L.; Hong, Wanjin; Koo, Edward H.

    2015-01-01

    People with Down syndrome (DS) virtually all develop intellectual disability (ID) of varying degree of severity, and also have a high risk of early Alzheimer's disease (AD). ID prior to the onset of dementia, and its relationship to the onset of dementia in DS is a complex phenomenon influenced by many factors, and scarcely understood. Unraveling the causative factors and modulators of these processes remains a challenge, with potential to be informative for both ID and AD, for the development of early biomarkers and/or therapeutic approaches. We review the potential relative and inter-connected roles of the chromosome 21 gene for amyloid precursor protein (APP), in both pathological conditions. Rare non-DS people with duplication of APP (dupAPP) get familial early onset AD (FEOAD) with virtually 100% penetrance and prominent cerebrovascular pathology, but don't suffer from ID before dementia onset. All of these features appear to be radically different in DS. On the other hand, rare individuals with partial trisomy 21 (T21) (with APP, but not DS-critical region in trisomy) have been described having ID. Likewise, partial T21 DS (without APP trisomy) show a range of ID, but no AD pathology. We review the multi-faceted roles of APP that might affect cognitive functioning. Given the fact that both Aβ secretion and synaptic maturation/plasticity are dependent on neuronal activity, we explore how this conflicting inter-dependency might affect cognitive pathogenesis in a dynamic way in DS, throughout the lifespan of an individual. PMID:26648852

  11. Coronal patellar osteotomy of the external facet combined with the release of the lateral retinaculum improves the clinical outcomes of isolated lateral release in lateral knee compartment syndrome.

    PubMed

    Rosales-Varo, A P; Roda-Murillo, O; Prados-Olleta, N; García-Espona, M A

    2016-01-01

    To describe a novel coronal osteotomy of the external facet of the patella, and to evaluate if the outcomes of the treatment of lateral knee compartment syndrome (LKCS) with this osteotomy, combined with the release of the external lateral retinaculum, are better than the isolated lateral retinacular release. A prospective study with a 2 year follow up that included 70 patients diagnosed with LKCS, distributed into 2 groups. The first group included 50 patients on whom the lateral retinacular release combined with osteotomy was performed, and a second group on whom an isolated retinacular release was performed. Measurements were made using the Werner functional scale before the surgery and at 3, 12, and 24 months follow-up. There were significant differences in the overall functional state between the two groups after the surgery (better in the osteotomy group at all the intervals, P<.05). The improvement, which was progressive up to 12 months, was slightly less at 24 months, although the values were still better than the pre-surgical ones in both groups. Pain was the variable that showed most improvement. The patients with LKCS with degenerative signs showed a benefit in all cases. The results demonstrate that the described patellar osteotomy technique, combined with lateral retinacular release, significantly improves the pain and the functional scale score of patients with LKCS after 2 years of follow-up, to a greater extent than isolated lateral retinacular release, including those in which there was evidence of degenerative signs. Copyright © 2016 SECOT. Publicado por Elsevier España, S.L.U. All rights reserved.

  12. Psychopathological manifestations of joint hypermobility and joint hypermobility syndrome/ Ehlers-Danlos syndrome, hypermobility type: The link between connective tissue and psychological distress revised.

    PubMed

    Sinibaldi, Lorenzo; Ursini, Gianluca; Castori, Marco

    2015-03-01

    Psychological distress is a known feature of generalized joint hypermobility (gJHM), as well as of its most common syndromic presentation, namely Ehlers-Danlos syndrome, hypermobility type (a.k.a. joint hypermobility syndrome - JHS/EDS-HT), and significantly contributes to the quality of life of affected individuals. Most published articles dealt with the link between gJHM (or JHS/EDS-HT) and anxiety-related conditions, and a novel generation of studies is emerging aimed at investigating the psychopathologic background of such an association. In this paper, literature review was carried out with a semi-systematic approach spanning the entire spectrum of psychopathological findings in gJHM and JHS/EDS-HT. Interestingly, in addition to the confirmation of a tight link between anxiety and gJHM, preliminary connections with depression, attention deficit (and hyperactivity) disorder, autism spectrum disorders, and obsessive-compulsive personality disorder were also found. Few papers investigated the relationship with schizophrenia with contrasting results. The mind-body connections hypothesized on the basis of available data were discussed with focus on somatotype, presumed psychopathology, and involvement of the extracellular matrix in the central nervous system. The hypothesis of positive Beighton score and alteration of interoceptive/proprioceptive/body awareness as possible endophenotypes in families with symptomatic gJHM or JHS/EDS-HT is also suggested. Concluding remarks addressed the implications of the psychopathological features of gJHM and JHS/EDS-HT in clinical practice.

  13. A point mutation in Fgf9 impedes joint interzone formation leading to multiple synostoses syndrome.

    PubMed

    Tang, Lingyun; Wu, Xiaolin; Zhang, Hongxin; Lu, Shunyuan; Wu, Min; Shen, Chunling; Chen, Xuejiao; Wang, Yicheng; Wang, Weigang; Shen, Yan; Gu, Mingmin; Ding, Xiaoyi; Jin, Xiaolong; Fei, Jian; Wang, Zhugang

    2017-04-01

    Human multiple synostoses syndrome (SYNS) is an autosomal dominant disorder characterized by multiple joint fusions. We previously identified a point mutation (S99N) in FGF9 that causes human SYNS3. However, the physiological function of FGF9 during joint development and comprehensive molecular portraits of SYNS3 remain elusive. Here, we report that mice harboring the S99N mutation in Fgf9 develop the curly tail phenotype and partially or fully fused caudal vertebrae and limb joints, which mimic the major phenotypes of SYNS3 patients. Further study reveals that the S99N mutation in Fgf9 disrupts joint interzone formation by affecting the chondrogenic differentiation of mesenchymal cells at the early stage of joint development. Consistently, the limb bud micromass culture (LBMMC) assay shows that Fgf9 inhibits mesenchymal cell differentiation into chondrocytes by downregulating the expression of Sox6 and Sox9. However, the mutant protein does not exhibit the same inhibitory effect. We also show that Fgf9 is required for normal expression of Gdf5 in the prospective elbow and knee joints through its activation of Gdf5 promoter activity. Signal transduction assays indicate that the S99N mutation diminishes FGF signaling in developmental limb joints. Finally, we demonstrate that the conformational change in FGF9 resulting from the S99N mutation disrupts FGF9/FGFR/heparin interaction, which impedes FGF signaling in developmental joints. Taken together, we conclude that the S99N mutation in Fgf9 causes SYNS3 via the disturbance of joint interzone formation. These results further implicate the crucial role of Fgf9 during embryonic joint development. © The Author 2017. Published by Oxford University Press. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

  14. Functional assessments of the knee joint biomechanics by using pendulum test in adults with Down syndrome.

    PubMed

    Casabona, Antonino; Valle, Maria Stella; Pisasale, Mariangela; Pantò, Maria Rosita; Cioni, Matteo

    2012-12-01

    In this study, we assessed kinematics and viscoelastic features of knee joint in adults with Down syndrome (DS) by means of the Wartenberg pendulum test. This test allows the measuring of the kinematics of the knee joint during passive pendular motion of leg under the influence of gravity. In addition, by a combination of kinematic and anthropometric data, pendulum test provides estimates of joint viscoelastic properties by computing damping and stiffness coefficients. To monitor the occurrences of muscle activation, the surface electromyogram (EMG) of muscle rectus femoris was recorded. The experimental protocol was performed in a group of 10 adults with DS compared with 10 control adults without DS. Joint motion amplitude, velocity, and acceleration of the leg during the first knee flexion significantly decreased in persons with DS with respect to those without DS. This behavior was associated with the activation of rectus femoris in subjects with DS that resulted in increasing of joint resistance shortly after the onset of the first leg flexion. The EMG bursts mostly occurred between 50 and 150 ms from the leg flexion onset. During the remaining cycles of pendular motion, persons with DS exhibited passive leg oscillations with low tonic EMG activity and reduced damping coefficient compared with control subjects. These results suggest that adults with DS might perform preprogrammed contractions to increase joint resistance and compensate for inherent joint instability occurring for quick and unpredictable perturbations. The reduction of damping coefficients observed during passive oscillations could be a predictor of muscle hypotonia.

  15. Functional assessments of the knee joint biomechanics by using pendulum test in adults with Down syndrome

    PubMed Central

    Casabona, Antonino; Valle, Maria Stella; Pisasale, Mariangela; Pantò, Maria Rosita

    2012-01-01

    In this study, we assessed kinematics and viscoelastic features of knee joint in adults with Down syndrome (DS) by means of the Wartenberg pendulum test. This test allows the measuring of the kinematics of the knee joint during passive pendular motion of leg under the influence of gravity. In addition, by a combination of kinematic and anthropometric data, pendulum test provides estimates of joint viscoelastic properties by computing damping and stiffness coefficients. To monitor the occurrences of muscle activation, the surface electromyogram (EMG) of muscle rectus femoris was recorded. The experimental protocol was performed in a group of 10 adults with DS compared with 10 control adults without DS. Joint motion amplitude, velocity, and acceleration of the leg during the first knee flexion significantly decreased in persons with DS with respect to those without DS. This behavior was associated with the activation of rectus femoris in subjects with DS that resulted in increasing of joint resistance shortly after the onset of the first leg flexion. The EMG bursts mostly occurred between 50 and 150 ms from the leg flexion onset. During the remaining cycles of pendular motion, persons with DS exhibited passive leg oscillations with low tonic EMG activity and reduced damping coefficient compared with control subjects. These results suggest that adults with DS might perform preprogrammed contractions to increase joint resistance and compensate for inherent joint instability occurring for quick and unpredictable perturbations. The reduction of damping coefficients observed during passive oscillations could be a predictor of muscle hypotonia. PMID:22995394

  16. Impact of metabolic syndrome on perioperative complication rates after total joint arthroplasty surgery.

    PubMed

    Gage, Mark J; Schwarzkopf, Ran; Abrouk, Michael; Slover, James D

    2014-09-01

    This study investigated the impact of metabolic syndrome (MetS) on perioperative and postoperative complication rates: the results of a cohort of 168 total hip and knee arthroplasties, 63 of normal weight, 105 with obesity without risk factors for metabolic syndrome and 39 with obesity and other factors that classify them with metabolic syndrome. Patients with metabolic syndrome were more likely to have complications than those without metabolic syndrome (P=0.0156). Perioperative and postoperative complication rates for the MetS and control groups were 35.9% and 16.3%, respectively. Elevated BMI was the element of MetS that had the largest impact on post-surgical complication rates, and this was statistically significant (P=0.0028). The presence of MetS in patients undergoing total joint arthroplasty has a significant impact on surgical complication rates. This cannot be attributed to the BMI component alone, and may help guide efforts of patient optimization prior to total joint arthroplasty. Copyright © 2014 Elsevier Inc. All rights reserved.

  17. Distraction Arthrodesis of the C1-C2 Facet Joint with Preservation of the C2 Root for the Management of Intractable Occipital Neuralgia Caused by C2 Root Compression.

    PubMed

    Yeom, Jin S; Riew, K Daniel; Kang, Sung Shik; Yi, Jemin; Lee, Gun Woo; Yeom, Arim; Chang, Bong-Soon; Lee, Choon-Ki; Kim, Ho-Joong

    2015-10-15

    Prospective observational cohort study. To compare the outcomes of our new technique, distraction arthrodesis of C1-C2 facet joint with C2 root preservation (Study group), to those of conventional C1-C2 fusion with C2 root transection (Control group) for the management of intractable occipital neuralgia caused by C2 root compression. We are not aware of any report concerning C2 root decompression during C1-C2 fusion. Inclusion criteria were visual analogue scale (VAS) score for occipital neuralgia 7 or more; C2 root compression at the collapsed C1-C2 neural foramen; and follow-up 12 months or more. The Study group underwent surgery with our new technique including (1) C1-C2 facet joint distraction and bone block insertion while preserving the C2 root; and (2) use of C1 posterior arch screws instead of conventional lateral mass screws during C1-C2 segmental screw fixation. The Control group underwent C2 root transection with C1-C2 segmental screw fixation and fusion. We compared the prospectively collected outcomes data. There were 15 patients in the Study group and 8 in the Control group. Although there was no significant difference in the VAS score for the occipital neuralgia between the 2 groups preoperatively (8.2 ± 0.9 vs. 7.9 ± 0.6, P = 0.39), it was significantly lower in the Study group at 1, 3, and 6 months postoperatively (P < 0.01, respectively). At 12 months, it was 0.4 ± 0.6 versus 2.5 ± 2.6 (P = 0.01). There was no significant difference in improvement in the VAS score for neck pain and neck disability index and Japanese Orthopedic Association recovery rate, which are minimally influenced by occipital neuralgia. Our novel technique of distraction arthrodesis with C2 root preservation can be an effective option for the management of intractable occipital neuralgia caused by C2 root compression.

  18. Early interests and joint engagement in typical development, autism, and Down syndrome.

    PubMed

    Adamson, Lauren B; Deckner, Deborah F; Bakeman, Roger

    2010-06-01

    This study examines how spontaneous interests in people and in objects relate to joint engagement in typically developing toddlers and young children with autism or Down syndrome. Ratings of interests were made repeatedly during intermissions in a laboratory-based protocol focused on caregiver-child interactions. Interests were moderated by diagnosis and relatively stable across intermissions. In autism, interest in people tended to be low and to decline rapidly, and the balance of interests favored familiar objects over people. Lower interest in people and in unfamiliar objects was associated with less coordinated joint engagement and with less steep developmental trajectories for symbol-infused joint engagement. These findings suggest that variations in interests may contribute to differences in the child's engagement during social interactions that facilitate the acquisition of language.

  19. Early Interests and Joint Engagement in Typical Development, Autism, and Down Syndrome

    PubMed Central

    Deckner, Deborah F.; Bakeman, Roger

    2010-01-01

    This study examines how spontaneous interests in people and in objects relate to joint engagement in typically developing toddlers and young children with autism or Down syndrome. Ratings of interests were made repeatedly during intermissions in a laboratory-based protocol focused on caregiver-child interactions. Interests were moderated by diagnosis and relatively stable across intermissions. In autism, interest in people tended to be low and to decline rapidly, and the balance of interests favored familiar objects over people. Lower interest in people and in unfamiliar objects was associated with less coordinated joint engagement and with less steep developmental trajectories for symbol-infused joint engagement. These findings suggest that variations in interests may contribute to differences in the child’s engagement during social interactions that facilitate the acquisition of language. PMID:20012678

  20. Syndromic Surveillance System for Korea-US Joint Biosurveillance Portal: Design and Lessons Learned.

    PubMed

    Rhee, Chulwoo; Burkom, Howard; Yoon, Chang-Gyo; Stewart, Miles; Elbert, Yevgeniy; Katz, Aaron; Tak, Sangwoo

    2016-01-01

    Driven by the growing importance of situational awareness of bioterrorism threats, the Republic of Korea (ROK) and the United States have constructed a joint military capability, called the Biosurveillance Portal (BSP), to enhance biosecurity. As one component of the BSP, we developed the Military Active Real-time Syndromic Surveillance (MARSS) system to detect and track natural and deliberate disease outbreaks. This article describes the ROK military health data infrastructure and explains how syndromic data are derived and made available to epidemiologists. Queries corresponding to 8 syndromes, based on published clinical effects of weaponized pathogens, were used to classify military hospital patient records to form aggregated daily syndromic counts. A set of ICD-10 codes for each syndrome was defined through literature review and expert panel discussion. A study set of time series of national daily counts for each syndrome was extracted from the Defense Medical Statistical Information System between January 1, 2011, and May 31, 2014. A stratified, adjusted cumulative summation algorithm was implemented for each syndrome group to signal alerts prompting investigation. The algorithm was developed by calculating sensitivity to sets of 1,000 artificial outbreak signals randomly injected in the dataset, with each signal injected in a separate trial. Queries and visualizations were adapted from the Suite for Automated Global bioSurveillance. Findings indicated that early warning of outbreaks affecting fewer than 50 patients will require analysis at subnational levels, especially for common syndrome groups. Developing MARSS to improve sensitivity will require modification of underlying syndromic diagnosis codes, engineering to coordinate alerts among subdivisions, and enhanced algorithms. The bioterrorist threat in the Korean peninsula mandates these efforts.

  1. Effects of Neoprene Wrist/Hand Splints on Handwriting for Students with Joint Hypermobility Syndrome: A Single System Design Study

    ERIC Educational Resources Information Center

    Frohlich, Lauren; Wesley, Alison; Wallen, Margaret; Bundy, Anita

    2012-01-01

    Purpose: Pain associated with hypermobility of wrist and hand joints can contribute to decreased handwriting output. This study examined the effectiveness of a neoprene wrist/hand splint in reducing pain and increasing handwriting speed and endurance for students with joint hypermobility syndrome. Methods: Multiple baseline, single system design…

  2. Effects of Neoprene Wrist/Hand Splints on Handwriting for Students with Joint Hypermobility Syndrome: A Single System Design Study

    ERIC Educational Resources Information Center

    Frohlich, Lauren; Wesley, Alison; Wallen, Margaret; Bundy, Anita

    2012-01-01

    Purpose: Pain associated with hypermobility of wrist and hand joints can contribute to decreased handwriting output. This study examined the effectiveness of a neoprene wrist/hand splint in reducing pain and increasing handwriting speed and endurance for students with joint hypermobility syndrome. Methods: Multiple baseline, single system design…

  3. A rare case of Ramsay Hunt syndrome following temporomandibular joint surgery.

    PubMed

    Lehman, H; Rushinek, H

    2015-08-01

    Surgical approaches to the temporomandibular joint (TMJ) have been designed specifically to minimize injury to the temporal branch of the facial nerve. In spite of this, facial nerve dysfunction occurs in 1-32% of patients undergoing TMJ surgery. Ramsay Hunt syndrome is characterized by peripheral facial paralysis that often involves other cranial nerves, mostly cranial nerve VIII. The pathology is attributed to the reactivation of latent varicella zoster virus in the geniculate ganglion. The diagnosis is based mostly on history and physical findings. Surgical procedures have been known to reactivate varicella zoster virus, but Ramsay Hunt syndrome subsequent to TMJ surgery has not been described yet. This report describes a case of Ramsay Hunt syndrome associated with TMJ surgery. Because of the relatively high incidence of facial nerve dysfunction associated with TMJ surgery, patients with varicella zoster virus reactivation may initially be misdiagnosed with iatrogenic facial palsy, or vice versa.

  4. Comparison of the efficacy of saline, local anesthetics, and steroids in epidural and facet joint injections for the management of spinal pain: A systematic review of randomized controlled trials

    PubMed Central

    Manchikanti, Laxmaiah; Nampiaparampil, Devi E.; Manchikanti, Kavita N.; Falco, Frank J.E.; Singh, Vijay; Benyamin, Ramsin M.; Kaye, Alan D.; Sehgal, Nalini; Soin, Amol; Simopoulos, Thomas T.; Bakshi, Sanjay; Gharibo, Christopher G.; Gilligan, Christopher J.; Hirsch, Joshua A.

    2015-01-01

    Background: The efficacy of epidural and facet joint injections has been assessed utilizing multiple solutions including saline, local anesthetic, steroids, and others. The responses to these various solutions have been variable and have not been systematically assessed with long-term follow-ups. Methods: Randomized trials utilizing a true active control design were included. The primary outcome measure was pain relief and the secondary outcome measure was functional improvement. The quality of each individual article was assessed by Cochrane review criteria, as well as the criteria developed by the American Society of Interventional Pain Physicians (ASIPP) for assessing interventional techniques. An evidence analysis was conducted based on the qualitative level of evidence (Level I to IV). Results: A total of 31 trials met the inclusion criteria. There was Level I evidence that local anesthetic with steroids was effective in managing chronic spinal pain based on multiple high-quality randomized controlled trials. The evidence also showed that local anesthetic with steroids and local anesthetic alone were equally effective except in disc herniation, where the superiority of local anesthetic with steroids was demonstrated over local anesthetic alone. Conclusion: This systematic review showed equal efficacy for local anesthetic with steroids and local anesthetic alone in multiple spinal conditions except for disc herniation where the superiority of local anesthetic with steroids was seen over local anesthetic alone. PMID:26005584

  5. Multiwalled nanotube faceting unravelled.

    PubMed

    Leven, Itai; Guerra, Roberto; Vanossi, Andrea; Tosatti, Erio; Hod, Oded

    2016-12-01

    Nanotubes show great promise for miniaturizing advanced technologies. Their exceptional physical properties are intimately related to their morphological and crystal structure. Circumferential faceting of multiwalled nanotubes reinforces their mechanical strength and alters their tribological and electronic properties. Here, the nature of this important phenomenon is fully rationalized in terms of interlayer registry patterns. Regardless of the nanotube identity (that is, diameter, chirality, chemical composition), faceting requires the matching of the chiral angles of adjacent layers. Above a critical diameter that corresponds well with experimental results, achiral multiwalled nanotubes display evenly spaced extended axial facets whose number equals the interlayer difference in circumferential unit cells. Elongated helical facets, commonly observed in experiment, appear in nanotubes that exhibit small interlayer chiral angle mismatch. When the wall chiralities are uncorrelated, faceting is suppressed and outer layer corrugation, which is induced by the Moiré superlattice, is obtained in agreement with experiments. Finally, we offer an explanation for the higher incidence of faceting in multiwalled boron nitride nanotubes with respect to their carbon-based counterparts.

  6. Multiwalled nanotube faceting unravelled

    NASA Astrophysics Data System (ADS)

    Leven, Itai; Guerra, Roberto; Vanossi, Andrea; Tosatti, Erio; Hod, Oded

    2016-12-01

    Nanotubes show great promise for miniaturizing advanced technologies. Their exceptional physical properties are intimately related to their morphological and crystal structure. Circumferential faceting of multiwalled nanotubes reinforces their mechanical strength and alters their tribological and electronic properties. Here, the nature of this important phenomenon is fully rationalized in terms of interlayer registry patterns. Regardless of the nanotube identity (that is, diameter, chirality, chemical composition), faceting requires the matching of the chiral angles of adjacent layers. Above a critical diameter that corresponds well with experimental results, achiral multiwalled nanotubes display evenly spaced extended axial facets whose number equals the interlayer difference in circumferential unit cells. Elongated helical facets, commonly observed in experiment, appear in nanotubes that exhibit small interlayer chiral angle mismatch. When the wall chiralities are uncorrelated, faceting is suppressed and outer layer corrugation, which is induced by the Moiré superlattice, is obtained in agreement with experiments. Finally, we offer an explanation for the higher incidence of faceting in multiwalled boron nitride nanotubes with respect to their carbon-based counterparts.

  7. Lack of consensus on tests and criteria for generalized joint hypermobility, Ehlers-Danlos syndrome: hypermobile type and joint hypermobility syndrome.

    PubMed

    Remvig, Lars; Flycht, Lise; Christensen, Karl B; Juul-Kristensen, Birgit

    2014-03-01

    The objectives of this study were to register clinicians performance and opinion of importance of clinical tests for generalized joint hypermobility (GJH), Ehlers-Danlos syndrome, hypermobility type (EDS-HT) and joint hypermobility syndrome (JHS), and to reach a consensus among clinicians on criteria for diagnosing GJH, EDS-HT and JHS. A panel of clinicians answered questions about how to perform and interpret clinical tests and rated test importance on an 11-box scale. The questionnaire was developed on the basis of information from focus groups and the literature. Cronbach's α was used as a measure of internal consistency/consensus among the panelists. The results showed Cronbach's α on importance score of items for diagnosing GJH, EDS-HT and JHS was 0.61, 0.79, and 0.44, respectively. Panelist-group correlation for the three conditions varied substantially (-0.46 to 0.89, 0.03 to 0.68, and -0.07 to 0.68) indicating heterogeneity among the panelists. There was agreement on which tests to use, but performance of the tests (i.e., the specific maneuvers) varied considerably inclusive use of tests with unknown reliability. Furthermore, agreement on the diagnostic criteria varied. We conclude that the level of consensus for the importance of various items for diagnosing GJH, EDS-HT and JHS, was below the required limit (Cronbach's α >0.90) for clinical decision-making and diagnosing. Consensus on tests and criteria through a Delphi process could not be reached. Better descriptions of, and reliability studies on, test maneuvers and criteria sets for these conditions are needed. Subsequent intensive training and implementation of these tests and criteria, nationally as well as internationally should be established.

  8. Rating Parent-Child Interactions: Joint Engagement, Communication Dynamics, and Shared Topics in Autism, Down Syndrome, and Typical Development

    PubMed Central

    Adamson, Lauren B.; Bakeman, Roger; Deckner, Deborah F.; Nelson, P. Brooke

    2012-01-01

    A battery of 17 rating items were applied to video records of typically-developing toddlers and young children with autism and Down syndrome interacting with their parents during the Communication Play Protocol. This battery provided a reliable and broad view of the joint engagement triad of child, partner, and shared topic. Ratings of the child’s joint engagement correlated very strongly with state coding of joint engagement and replicated the findings that coordinated joint engagement was less likely in children with autism and symbol-infused joint engagement was less likely in children with Down syndrome. Ratings of other child actions, of parent contributions, and of shared topics and communicative dynamics also documented pervasive variations related to diagnosis, language facility, and communicative context. PMID:22466689

  9. Transcriptome-Wide Expression Profiling in Skin Fibroblasts of Patients with Joint Hypermobility Syndrome/Ehlers-Danlos Syndrome Hypermobility Type

    PubMed Central

    Chiarelli, Nicola; Carini, Giulia; Zoppi, Nicoletta; Dordoni, Chiara; Ritelli, Marco; Venturini, Marina; Castori, Marco; Colombi, Marina

    2016-01-01

    Joint hypermobility syndrome/Ehlers–Danlos syndrome hypermobility type (JHS/EDS-HT), is likely the most common systemic heritable connective tissue disorder, and is mostly recognized by generalized joint hypermobility, joint instability complications, minor skin changes and a wide range of satellite features. JHS/EDS-HT is considered an autosomal dominant trait but is still without a defined molecular basis. The absence of (a) causative gene(s) for JHS/EDS-HT is likely attributable to marked genetic heterogeneity and/or interaction of multiple loci. In order to help in deciphering such a complex molecular background, we carried out a comprehensive immunofluorescence analysis and gene expression profiling in cultured skin fibroblasts from five women affected with JHS/EDS-HT. Protein study revealed disarray of several matrix structural components such as fibrillins, tenascins, elastin, collagens, fibronectin, and their integrin receptors. Transcriptome analysis indicated perturbation of different signaling cascades that are required for homeostatic regulation either during development or in adult tissues as well as altered expression of several genes involved in maintenance of extracellular matrix architecture and homeostasis (e.g., SPON2, TGM2, MMP16, GPC4, SULF1), cell-cell adhesion (e.g., CDH2, CHD10, PCDH9, CLDN11, FLG, DSP), immune/inflammatory/pain responses (e.g., CFD, AQP9, COLEC12, KCNQ5, PRLR), and essential for redox balance (e.g., ADH1C, AKR1C2, AKR1C3, MAOB, GSTM5). Our findings provide a picture of the gene expression profile and dysregulated pathways in JHS/EDS-HT skin fibroblasts that correlate well with the systemic phenotype of the patients. PMID:27518164

  10. Rating parent-child interactions: joint engagement, communication dynamics, and shared topics in autism, Down syndrome, and typical development.

    PubMed

    Adamson, Lauren B; Bakeman, Roger; Deckner, Deborah F; Nelson, P Brooke

    2012-12-01

    A battery of 17 rating items were applied to video records of typically-developing toddlers and young children with autism and Down syndrome interacting with their parents during the Communication Play Protocol. This battery provided a reliable and broad view of the joint engagement triad of child, partner, and shared topic. Ratings of the child's joint engagement correlated very strongly with state coding of joint engagement and replicated the finding that coordinated joint engagement was less likely in children with autism. Ratings of other child actions, of parent contributions, and of shared topics and communicative dynamics also documented pervasive variations related to diagnosis, language facility, and communicative context.

  11. Knowledge, assessment, and management of adults with joint hypermobility syndrome/Ehlers-Danlos syndrome hypermobility type among Flemish physiotherapists.

    PubMed

    Rombaut, Lies; Deane, Janet; Simmonds, Jane; De Wandele, Inge; De Paepe, Anne; Malfait, Fransiska; Calders, Patrick

    2015-03-01

    Physiotherapy plays a fundamental role in managing adults with the joint hypermobility syndrome/Ehlers-Danlos syndrome hypermobility type (JHS/EDS-HT). However, it is a challenge for both the patient and the physiotherapist as the condition is poorly understood and treatment for JHS/EDS-HT is currently undefined. Insight into current practice is, therefore, necessary in order to establish baseline knowledge in this area and in the long term to improve the standard of patient care. Therefore, the purpose of this study was to evaluate current physiotherapists' knowledge of JHS/EDS-HT and to gain insight into current physiotherapy practice with emphasis on assessment, management, and treatment efficacy. Three hundred twenty-five Flemish physiotherapists participated in the study by filling out electronically a modified version of the "Hypermobility and Hypermobility Syndrome Questionnaire" (HHQ), which covered theoretical constructs such as general knowledge, assessment, management, and learning in relation to generalized joint hypermobility and JHS/EDS-HT. The results show that physiotherapists report a low level of confidence with regard to assessment and management of JHS/EDS-HT. Knowledge of hypermobility and JHS/EDS-HT is weak, especially regarding the features associated with JHS/EDS-HT. Many treatment approaches are used by physiotherapists with the majority showing preference for education, reassurance, muscle strengthening, proprioceptive and core stability training. Almost all approaches were perceived as being clinically effective by the physiotherapists, highlighting a lack of consensus. In conclusion, this study in Flemish physiotherapists confirms that JHS/EDS-HT is under-recognized, not well known and deemed difficult to treat. Further education is required and sought by the physiotherapists surveyed, and future research is needed.

  12. FDG uptake in cervical facet subchondral cysts demonstrated by PET/CT.

    PubMed

    Lin, Eugene; Sicuro, Paul

    2008-04-01

    F-18 fluorodeoxyglucose (FDG) uptake in facet joints related to degenerative disease has been previously described. However, FDG uptake in subchondral cysts is the subject of this report. We describe 2 cases of intense focal FDG uptake in subchondral cysts in the cervical facets seen on positron emission tomography/computed tomography (PET/CT) exams. The location of these cysts immediately adjacent to the facet joints and the presence of associated facet joint degenerative changes are helpful in distinguishing this uptake from metastatic disease or other bone lesions.

  13. Lower extremity thrust and non-thrust joint mobilization for patellofemoral pain syndrome: a case report.

    PubMed

    Simpson, Brad G; Simon, Corey B

    2014-05-01

    A 40-year old female presented to physical therapy with a one-year history of insidious right anteromedial and anterolateral knee pain. Additionally, the patient had a history of multiple lateral ankle sprains bilaterally, the last sprain occurring on the right ankle 1 year prior to the onset of knee pain. The patient was evaluated and given a physical therapy diagnosis of patellofemoral pain syndrome (PFPS), with associated talocrural and tibiofemoral joint hypomobility limiting ankle dorsiflexion and knee extension, respectively. Treatment included a high-velocity low amplitude thrust manipulation to the talocrural joint, which helped restore normal ankle dorsiflexion range of motion. The patient also received tibiofemoral joint non-thrust manual therapy to regain normal knee extension mobility prior to implementing further functional progression exercises to her home program (HEP). This case report highlights the importance of a detailed evaluation of knee and ankle joint mobility in patients presenting with anterior knee pain. Further, manual physical therapy to the lower extremity was found to be successful in restoring normal movement patterns and pain-free function in a patient with chronic anterior knee pain.

  14. Alpha 1 antitrypsin deficiency alleles are associated with joint dislocation and scoliosis in Williams syndrome.

    PubMed

    Morris, Colleen A; Pani, Ariel M; Mervis, Carolyn B; Rios, Cecilia M; Kistler, Doris J; Gregg, Ronald G

    2010-05-15

    Elastin haploinsufficiency is responsible for a significant portion of the Williams syndrome (WS) phenotype including hoarse voice, supravalvar aortic stenosis (SVAS), hernias, diverticuli of bowel and bladder, soft skin, and joint abnormalities. All of the connective tissue signs and symptoms are variable in the WS population, but few factors other than age and gender are known to influence the phenotype. We examined a cohort of 205 individuals with WS for mutations in SERPINA1, the gene that encodes alpha-1-antitrypsin (AAT), the inhibitor of elastase. Individuals with classic WS deletions and SERPINA1 genotypes PiMS or PiMZ were more likely than those with a SERPINA1 PiMM genotype to have joint dislocation or scoliosis. However, carrier status for AAT deficiency was not correlated with presence of inguinal hernia or with presence or severity of SVAS. These findings suggest that genes important in elastin metabolism are candidates for variability in the connective tissue abnormalities in WS.

  15. Evaluation of knee proprioception and effects of proprioception exercise in patients with benign joint hypermobility syndrome.

    PubMed

    Sahin, Nilay; Baskent, Akin; Cakmak, Aysegul; Salli, Ali; Ugurlu, Hatice; Berker, Ender

    2008-08-01

    The first aim is to show if there is a disorder in proprioception in cases with benign joint hypermobility syndrome (BJHS) when compared to healthy subjects. The second aim is to evaluate the effect of proprioception exercise in BJHS cases. To evaluate the proprioceptive sensibility of the knee joint with 40 BJHS and 30 healthy subjects enrolled in the study. Then, cases with BJHS were randomized into two groups; proprioceptive exercises were applied to 15 patients for 8 weeks in clinic and 25 patients were taken as controls. Outcome measures included proprioceptive sensation, AIMS2 and VAS. Proprioception is significantly impaired in cases with BJHS. In BJHS group, significant decreases in VAS levels were detected in cases who did exercise compared with cases who did not, and statistically significant improvements were detected in occupational activity. For this reason proprioception exercises cause decrease in pain and improvement of functional status in BJHS group.

  16. Low tendon stiffness and abnormal ultrastructure distinguish classic Ehlers-Danlos syndrome from benign joint hypermobility syndrome in patients.

    PubMed

    Nielsen, Rie Harboe; Couppé, Christian; Jensen, Jacob Kildevang; Olsen, Morten Raun; Heinemeier, Katja Maria; Malfait, Fransiska; Symoens, Sofie; De Paepe, Anne; Schjerling, Peter; Magnusson, Stig Peter; Remvig, Lars; Kjaer, Michael

    2014-11-01

    There is a clinical overlap between classic Ehlers-Danlos syndrome (cEDS) and benign joint hypermobility syndrome (BJHS), with hypermobility as the main symptom. The purpose of this study was to investigate the role of type V collagen mutations and tendon pathology in these 2 syndromes. In patients (cEDS, n=7; BJHS, n=8) and controls (Ctrl, n=8), we measured patellar tendon ultrastructure (transmission electron microscopy), dimensions (magnetic resonance imaging), and biomechanical properties (force and ultrasonographic measurements during a ramped isometric knee extension). Mutation analyses (COL5A1 and COL5A2) were performed in the patients. COL5A1 mutations were found in 3 of 4 of the patients with cEDS. Patellar tendon dimensions were similar between the groups, but large, irregular collagen fibrils were in 4 of 5 patients with cEDS. In the cEDS group, tendon stiffness and Young's modulus were reduced to ∼50% of that in BJHS and Ctrl groups (P<0.05). The nonhypermobile, healthy controls were matched with the patients in age, sex, body weight, and physical activity, to compare outcomes. COL5A1 mutations led to structural tendon pathology and low tendon stiffness in cEDS, explaining the patients' hypermobility, whereas no tendon pathology was found that explained the hypermobility in BJHS.

  17. Intra-Articular Fibroma of Tendon Sheath in a Knee Joint Associated with Iliotibial Band Friction Syndrome

    PubMed Central

    Choi, Sunseob; Kim, Soo-Jin; Lih, Wang

    2015-01-01

    Iliotibial band (ITB) friction syndrome is a common overuse injury typically seen in the active athlete population. A nodular lesion on the inner side of the ITB as an etiology or an accompanying lesion from friction syndrome has been rarely reported. A 45-year-old male presented with recurrent pain and a movable nodule at the lateral joint area, diagnosed as ITB friction syndrome. The nodule was confirmed as a rare intra-articular fibroma of the tendon sheath (FTS) on the basis of histopathologic findings. We describe the MRI findings, arthroscopic and pathologic features, in this case of intra-articular FTS presenting with ITB friction syndrome. PMID:25598686

  18. Intra-articular fibroma of tendon sheath in a knee joint associated with iliotibial band friction syndrome.

    PubMed

    Ha, Dong-Ho; Choi, Sunseob; Kim, Soo-Jin; Lih, Wang

    2015-01-01

    Iliotibial band (ITB) friction syndrome is a common overuse injury typically seen in the active athlete population. A nodular lesion on the inner side of the ITB as an etiology or an accompanying lesion from friction syndrome has been rarely reported. A 45-year-old male presented with recurrent pain and a movable nodule at the lateral joint area, diagnosed as ITB friction syndrome. The nodule was confirmed as a rare intra-articular fibroma of the tendon sheath (FTS) on the basis of histopathologic findings. We describe the MRI findings, arthroscopic and pathologic features, in this case of intra-articular FTS presenting with ITB friction syndrome.

  19. A case report of severely damaged hip joint caused by SAPHO syndrome treated with 2-stage total hip arthroplasty

    PubMed Central

    Yeo, Ingwon; Cha, Hoon-Suk; Yoon, Young Cheol; Park, Youn-Soo; Lim, Seung-Jae

    2016-01-01

    Abstract Introduction: Synovitis, acne, pustulosis, hyperostosis, and osteitis (SAPHO) syndrome is an increasingly recognized entity. The hip joint is known as a less frequently affected site in SAPHO syndrome, and there has been limited reports about hip joint diseases caused by SAPHO syndrome, and as such adequate treatment for this disease spectrum is still not fully elucidated. Case: We describe the case of a 52-year-old man admitted for SAPHO syndrome who went on to be diagnosed with advanced secondary hip arthritis associated with disabling right hip pain. The diagnosis of SAPHO syndrome was delayed; the patient was given a clinical diagnosis of osteomyelitis and treated with prolonged courses of antibiotics and open surgical debridement at previous tertiary health facility. The patient underwent 2-stage joint replacement surgery in our hospital. At 1 year after the surgery, he is well, with minimal right hip pain and the prosthesis is functioning well. Conclusion: This case shows the safety and effectiveness of the 2-stage joint replacement in treating destructive hip disease caused by SAPHO syndrome mimicking infectious arthritis. PMID:27399138

  20. SLAC All Access: FACET

    ScienceCinema

    Hogan, Mark

    2016-07-12

    SLAC's Facility for Advanced Accelerator Experimental Tests, or FACET, is a test-bed where researchers are developing the technologies required for particle accelerators of the future. Scientists from all over the world come to explore ways of improving the power and efficiency of the particle accelerators used in basic research, medicine, industry and other areas important to society. In this video, Mark Hogan, head of SLAC's Advanced Accelerator Research Department, offers a glimpse into FACET, which uses part of SLAC's historic two-mile-long linear accelerator.

  1. Faceted solar energy collectors

    NASA Technical Reports Server (NTRS)

    Segna, D. R.

    1976-01-01

    Two concepts enhance efficiency and flexibility of solar collectors: faceting collector surface and adding coloring agent to working fluid. Collector can be placed on existing structures and oriented to take advantage of position of sun. By adding coloring agent to working fluid, total absorbance can be increased and altered if required.

  2. Facets of Subjectification

    ERIC Educational Resources Information Center

    Visconti, Jacqueline

    2013-01-01

    Subjectification, as the diachronic facet of subjectivity, has raised in the last two decades a number of interesting questions in grammaticalization and semantic change theory. In this paper I shall reflect on the nature and construal of subjectification, focusing on the question, formulated by Traugott (2010a, p. 58), "whether it is possible to…

  3. Facets of Subjectification

    ERIC Educational Resources Information Center

    Visconti, Jacqueline

    2013-01-01

    Subjectification, as the diachronic facet of subjectivity, has raised in the last two decades a number of interesting questions in grammaticalization and semantic change theory. In this paper I shall reflect on the nature and construal of subjectification, focusing on the question, formulated by Traugott (2010a, p. 58), "whether it is possible to…

  4. Beam Diagnostics for FACET

    SciTech Connect

    Li, S.Z.; Hogan, M.J.; /SLAC

    2011-08-19

    FACET, the Facility for Advanced Accelerator and Experimental Tests, is a new facility being constructed in sector 20 of the SLAC linac primarily to study beam driven plasma wakefield acceleration beginning in summer 2011. The nominal FACET parameters are 23GeV, 3nC electron bunches compressed to about 20 {micro}m long and focussed to about 10 {micro}m wide. Characterization of the beam-plasma interaction requires complete knowledge of the incoming beam parameters on a pulse-to-pulse basis. FACET diagnostics include Beam Position Monitors, Toroidal current monitors, X-ray and Cerenkov based energy spectrometers, optical transition radiation (OTR) profile monitors and coherent transition radiation (CTR) bunch length measurement systems. The compliment of beam diagnostics and their expected performance are reviewed. Beam diagnostic measurements not only provide valuable insights to the running and tuning of the accelerator but also are crucial for the PWFA experiments in particular. Beam diagnostic devices are being set up at FACET and will be ready for beam commissioning in summer 2011.

  5. Unexpected association between joint hypermobility syndrome/Ehlers-Danlos syndrome hypermobility type and obsessive-compulsive personality disorder.

    PubMed

    Pasquini, Massimo; Celletti, Claudia; Berardelli, Isabella; Roselli, Valentina; Mastroeni, Simona; Castori, Marco; Biondi, Massimo; Camerota, Filippo

    2014-05-01

    Joint hypermobility syndrome/Ehlers-Danlos syndrome hypermobility type (JHS/EDS-HT) is a largely unrecognized, heritable connective tissue disorder, mainly characterized by joint instability complications, widespread musculoskeletal pain, and minor skin features. In a case-control study, 47 consecutive JHS/EDS-HT patients were investigated for the prevalence of psychiatric disorders and compared to 45 healthy controls in a single center. The psychiatric evaluation consisted of structured clinical interview for DSM-IV criteria by using the SCID-I and the SCID-II. Symptom severity was assessed using the Hamilton Anxiety Rating Scale (HAM-A), the Hamilton Depression Rating Scale (HAM-D), and the Brief Psychiatric Rating Scale (BPRS). The Global Assessment of Functioning Scale (GAF) was used to assess the overall severity of psychological, social, and occupational functions. JHS/EDS-HT patients had significantly higher mean scores for all questionnaires: HAM-A (6.7 vs. 3.8), HAM-D (6.4 vs. 2.7), GAF (75.0 vs. 86.1), and BPRS (27.5 vs. 25.6). The JHS/EDS-HT group had a 4.3 higher risk of being affected by any psychiatric disorder, and in particular, a 5.8 higher risk of having a personality disorder. In particular, 5 JHS/EDS-HT suffered from obsessive-compulsive personality disorder with an observed prevalence rate of 10.6 % (3.6-23.1). Psychiatric assessment of JHS/EDS-HT patients showed an extremely high prevalence of personality disorders (21 %), and of Axis-I disorders (38 %), mostly depressive. This study did not confirm the previously reported increased rate of panic disorders in JHS/EDS-HT.

  6. [Association between joint of heat and noise and metabolic syndrome in steel workers].

    PubMed

    Li, Xue; Wang, Chaoyang; Fan, Hongmin; Wang, Xiaokai; Zhang, Meihang; Jia, Chongyan; Chai, Feng; Chen, Yinping; Hu, Bo; Yuan, Juxiang; Dong, Ya'nan; Wang, Jianbo

    2015-01-01

    To analyze the relationship between joint of heat and noise, and metabolic syndrome in a steel rolling factory workers. A total of 590 steel workers were selected as subjects by cluster sampling method from workers of a steel factory. They were investigated by face to face way with the unified questionnaire which contents included personal information, occupational history, personal history, habits and other factors. Furthermore, height, weight, waist circumference and blood pressure were measured. Referring to the 2005 International Diabetes Federation (IDF) issued by the metabolic syndrome (MS) worldwide uniform definition combines waist diagnosis MS. A database was built by Epidata 3.0 software, and data was analyzed by SPSS 17.0. 571 steel workers were from 22 to 60 years, mean age (41.2 -7.9) years old. The prevalence of metabolic syndrome in steel workers was 17.9%. The prevalence of metabolic syndrome of those who exposed to high temperature was 18.8%, higher than that of those who did not expose to high temperature (5.3%), there was a statistically significant difference (P < 0.05). The prevalence of metabolic syndrome of those who exposed to noise was 20.6%, higher than that of those who did not exposed to noise (14.0%) (P < 0.05). After adjusting for the effects of confounding factors, the prevalence of MS those who exposed to high temperatures and noise is 1.118 times as high as that of those who did not exposed to high temperatures and noise. The combined effects of heat and noise is related to the increasing prevalence of MS of steel workers.

  7. TIBIOFEMORAL JOINT MOBILIZATION IN THE SUCCESSFUL MANAGEMENT OF PATELLOFEMORAL PAIN SYNDROME: A CASE REPORT

    PubMed Central

    Emerson-Kavchak, Alicia J.; Mischke, John J.; Courtney, Carol A.

    2016-01-01

    ABSTRACT Background and Purpose Patellofemoral pain syndrome (PFPS) is a common source of anterior knee pain. Controversy exists over the exact clinical findings which define PFPS, thus, diagnosis and management can be challenging for clinicians. There is paucity in the literature concerning joint mobilization as treatment for PFPS, particularly at the tibiofemoral joint, as standard management is currently focused on therapeutic exercise, orthotics, bracing and taping. Therefore, the purpose of this case report is to describe the effects of tibiofemoral joint mobilization in the successful treatment of an individual with chronic PFPS as it relates to pain, function and central processing of pain. Study Design Case Report Case Description The subject was a 28-year-old female with a two year history of left anterior, inferior patellar knee pain consistent with chronic PFPS. She demonstrated diminished pressure pain threshold (PPT) and allodynia at the anterior knee, suggesting a component of central sensitization to her pain. She met several common diagnostic criteria for PFPS, however, only tibiofemoral anterior-posterior joint mobilization increased her pain. Subsequent treatment sessions (Visits 1-6) consisted of solely joint mobilization supplemented by instruction in a home exercise program (therapeutic exercise and balance training). As outcomes improved, treatment sessions (Visits 7-8) consisted of solely therapeutic exercise and balance training with focus on return to independent pain free functional activity. Outcomes Improvements consistent with the minimally clinically important difference were noted on the Kujala Anterior Knee Pain Scale, Numeric Pain Rating Scale, Global Rating of Change (GROC). Scores on the Fear Avoidance-Belief Questionnaire (6/24 to 2/24 PA, 31/42 to 5/42 W), PPT (119 to 386 kPa) and Step Down Test (11 to 40 steps) also demonstrated improvement. At a two month follow up, the subject reported continued improvement in functional

  8. The role of narrative medicine in the management of joint hypermobility syndrome/Ehlers-Danlos syndrome, hypermobility type.

    PubMed

    Knight, Isobel

    2015-03-01

    Joint hypermobility syndrome/Ehlers-Danlos syndrome hypermobility type (JHS/EDS-HT) is a hereditary connective tissue disorder affecting every bodily system. It is largely underdiagnosed by many practitioners, with the result of a considerable delay in diagnosis and, consequently, in the onset of adequate management schedule and treatment. Patients may also experience to be misbelieved, erroneously considered affected by a psychiatric or psychosomatic disorders, and rejected by the medical profession, which can lead to feelings of anger and resentment. Patient journeys are often long and complicated, but if doctors allowed the patient time to tell the full story, and were more prepared to think holistically, there may be a far more positive outcome. Here, the patients' perspective is presented with a narrative medicine approach, illustrating the tri-dimensional experience of a JHS/EDS-HT patient, who is also a Bowen Practitioner and a medical writer/educator. Narrative medicine would be invaluable in working with JHS/EDS-HT so that the patient can tell the story, and offer the practitioner a whole picture of her/his suffering and, often, the key for understanding the cause(s). Once this has been achieved, it might be possible to build upon a more positive and therapeutic dialogue which would result in better treatment and more effective management. It is also important for doctors to communicate with JHS/EDS-HT experts who will ultimately improve the patient journey and treatment outcomes of such a complex connective tissue disorder.

  9. Craniovertebral Junction Instability: A Review of Facts about Facets

    PubMed Central

    2015-01-01

    Craniovertebral junction surgery involves an appropriate philosophical, biomechanical and anatomical understanding apart from high degree of technical skill and ability of controlling venous and arterial bleeding. The author presents his 30-year experience with treating complex craniovertebral junction instability related surgical issues. The facets of atlas and axis form the primary site of movements at the craniovertebral junction. All craniovertebral junction instability is essentially localized to the atlantoaxial facet joint. Direct manipulation and fixation of the facets forms the basis of treatment for instability. PMID:26240728

  10. Short stature, severe aortic root dilation, skin hyperextensibility, extreme joint laxity and craniofacial dysmorphic features: a probable new syndrome.

    PubMed

    Verstraeten, Elke; Symoens, Sofie; Renard, Marjolijn; Callewaert, Bert; Vandekerckhove, Kristof; De Backer, Julie; Malfait, Fransiska; Marks, Luc; Coucke, Paul; De Paepe, Anne; Loeys, Bart

    2010-07-01

    We report a 10-year-old male proband, born from consanguineous marriage, presenting with short stature, severe aortic root dilation, skin hyperextensibility, extreme joint laxity and craniofacial dysmorphism. Clinical, biochemical and molecular findings did not match any of the well-described connective tissue syndromes in the differential diagnosis for this specific combination of features. We presume that the phenotype presented in this patient may constitute a newly recognized syndrome of likely autosomal recessive inheritance.

  11. Joint Involvement in Primary Sjögren's Syndrome: An Ultrasound “Target Area Approach to Arthritis”

    PubMed Central

    Amezcua-Guerra, Luis M.; Vargas, Angelica; Rodriguez-Henriquez, Pedro; Solano, Carla; Hernández-Díaz, Cristina; Castillo-Martinez, Diana; Ventura-Ríos, Lucio; Gutiérrez, Marwin; Pineda, Carlos

    2013-01-01

    Objective. To characterize the ultrasound (US) pattern of joint involvement in primary Sjögren's syndrome (pSS). Methods. Seventeen patients with pSS, 18 with secondary Sjögren's syndrome (sSS), and 17 healthy controls underwent US examinations of various articular regions. Synovitis (synovial hypertrophy/joint effusion), power Doppler (PD) signals, and erosions were assessed. Results. In patients with pSS, synovitis was found in the metacarpophalangeal joints (MCP, 76%), wrists (76%), and knees (76%), while the proximal interphalangeal joints, elbows, and ankles were mostly unscathed. Intra-articular PD signals were occasionally detected in wrists (12%), elbows (6%), and knees (6%). Erosions were evident in the wrists of three (18%) patients with pSS, one of these also having anti-cyclic citrullinated peptide (anti-CCP) antibodies. While US synovitis does not discriminate between sSS and pSS, demonstration of bone erosions in the 2nd MCP joints showed 28.8% sensitivity and 100% specificity for diagnosing sSS; in comparison, these figures were 72.2 and 94.1% for circulating anti-CCP antibodies. Conclusions. In pSS, the pattern of joint involvement by US is polyarticular, bilateral, and symmetrical. Synovitis is the US sign most commonly found in patients with pSS, especially in MCP joints, wrists, and knees, and bone erosions also may occur. PMID:23936829

  12. Orthostatic Intolerance and Postural Orthostatic Tachycardia Syndrome in Joint Hypermobility Syndrome/Ehlers-Danlos Syndrome, Hypermobility Type: Neurovegetative Dysregulation or Autonomic Failure?

    PubMed

    Celletti, Claudia; Camerota, Filippo; Castori, Marco; Censi, Federica; Gioffrè, Laura; Calcagnini, Giovanni; Strano, Stefano

    2017-01-01

    Background. Joint hypermobility syndrome/Ehlers-Danlos syndrome, hypermobility type (JHS/EDS-HT), is a hereditary connective tissue disorder mainly characterized by generalized joint hypermobility, skin texture abnormalities, and visceral and vascular dysfunctions, also comprising symptoms of autonomic dysfunction. This study aims to further evaluate cardiovascular autonomic involvement in JHS/EDS-HT by a battery of functional tests. Methods. The response to cardiovascular reflex tests comprising deep breathing, Valsalva maneuver, 30/15 ratio, handgrip test, and head-up tilt test was studied in 35 JHS/EDS-HT adults. Heart rate and blood pressure variability was also investigated by spectral analysis in comparison to age and sex healthy matched group. Results. Valsalva ratio was normal in all patients, but 37.2% of them were not able to finish the test. At tilt, 48.6% patients showed postural orthostatic tachycardia, 31.4% orthostatic intolerance, 20% normal results. Only one patient had orthostatic hypotension. Spectral analysis showed significant higher baroreflex sensitivity values at rest compared to controls. Conclusions. This study confirms the abnormal cardiovascular autonomic profile in adults with JHS/EDS-HT and found the higher baroreflex sensitivity as a potential disease marker and clue for future research.

  13. Orthostatic Intolerance and Postural Orthostatic Tachycardia Syndrome in Joint Hypermobility Syndrome/Ehlers-Danlos Syndrome, Hypermobility Type: Neurovegetative Dysregulation or Autonomic Failure?

    PubMed Central

    Castori, Marco; Censi, Federica; Gioffrè, Laura; Calcagnini, Giovanni; Strano, Stefano

    2017-01-01

    Background. Joint hypermobility syndrome/Ehlers-Danlos syndrome, hypermobility type (JHS/EDS-HT), is a hereditary connective tissue disorder mainly characterized by generalized joint hypermobility, skin texture abnormalities, and visceral and vascular dysfunctions, also comprising symptoms of autonomic dysfunction. This study aims to further evaluate cardiovascular autonomic involvement in JHS/EDS-HT by a battery of functional tests. Methods. The response to cardiovascular reflex tests comprising deep breathing, Valsalva maneuver, 30/15 ratio, handgrip test, and head-up tilt test was studied in 35 JHS/EDS-HT adults. Heart rate and blood pressure variability was also investigated by spectral analysis in comparison to age and sex healthy matched group. Results. Valsalva ratio was normal in all patients, but 37.2% of them were not able to finish the test. At tilt, 48.6% patients showed postural orthostatic tachycardia, 31.4% orthostatic intolerance, 20% normal results. Only one patient had orthostatic hypotension. Spectral analysis showed significant higher baroreflex sensitivity values at rest compared to controls. Conclusions. This study confirms the abnormal cardiovascular autonomic profile in adults with JHS/EDS-HT and found the higher baroreflex sensitivity as a potential disease marker and clue for future research. PMID:28286774

  14. Comparison of computed tomography and magnetic resonance imaging in the evaluation of facet tropism and facet arthrosis in degenerative cervical spondylolisthesis.

    PubMed

    Xu, C; Ding, Z H; Xu, Y K

    2014-05-30

    The aim of this study was to determine the reliability of magnetic resonance imaging (MRI) in the assessment of facet tropism and facet arthrosis of spondylolisthesis levels in degenerative cervical spondylolisthesis as compared to computed tomography (CT). The discrepancies in the interpretation of CT and MRI data in the evaluation of facet tropism and arthrosis have given rise to questions regarding the reliability of comparisons of the two techniques. Using a 4-point scale, 3 blinded readers independently graded the severity of facet tropism and facet arthrosis of 79 cervical facet joints on axial T2-weighted and sagittal T1 and T2-weighted turbo spin echo images as well as the corresponding axial CT scans. All results were subjected to the kappa coefficient statistic for strength of agreement. In the assessment of the severity of facet arthrosis, intermethod agreement (weighted κ) between CT scanning with a moderate inter-rater reliability (range κ = 0.43-0.57) and MRI with fair inter-rater reliability (range κ = 0.23-0.38) was 0.76 and 0.43 for the severity of facet tropism and facet arthrosis, respectively. Intra-rater reliability for the severity of facet arthrosis was moderate to substantial for CT and was moderate for MRI scans. Intra-rater reliability for the severity of facet tropism was substantial to very good for CT and substantial for MRI scans. MRI can reliably determine the presence or degree of facet tropism but not facet arthrosis. Therefore, for a comprehensive assessment of cervical facet joint degeneration, both a CT and an MRI scan should be performed.

  15. Rating Parent-Child Interactions: Joint Engagement, Communication Dynamics, and Shared Topics in Autism, Down Syndrome, and Typical Development

    ERIC Educational Resources Information Center

    Adamson, Lauren B.; Bakeman, Roger; Deckner, Deborah F.; Nelson, P. Brooke

    2012-01-01

    A battery of 17 rating items were applied to video records of typically-developing toddlers and young children with autism and Down syndrome interacting with their parents during the Communication Play Protocol. This battery provided a reliable and broad view of the joint engagement triad of child, partner, and shared topic. Ratings of the child's…

  16. Rating Parent-Child Interactions: Joint Engagement, Communication Dynamics, and Shared Topics in Autism, Down Syndrome, and Typical Development

    ERIC Educational Resources Information Center

    Adamson, Lauren B.; Bakeman, Roger; Deckner, Deborah F.; Nelson, P. Brooke

    2012-01-01

    A battery of 17 rating items were applied to video records of typically-developing toddlers and young children with autism and Down syndrome interacting with their parents during the Communication Play Protocol. This battery provided a reliable and broad view of the joint engagement triad of child, partner, and shared topic. Ratings of the child's…

  17. Manipulative management of the temporomandibular joint pain-dysfunction syndrome: a report of two cases

    PubMed Central

    Nykoliation, J. W.; Cassidy, J. D.

    1984-01-01

    The temporomandibular pain-dysfunction syndrome (TMJ-PDS) is a frequent but often unappreciated cause of head, neck, and facial pain. Information regarding its etiology, pathophysiology, diagnosis, and treatment is fragmentary, and often reflects an approach influenced by the background specialty of the involved practitioner. Current treatment is often multidisciplinary, involving the use of various dental splints in conjunction with physiotherapy, psychotherapy, and analgesic medication. This paper suggests that chiropractic manipulation to the temporomandibular joints (TMJ) may be an effective approach to treatment of TJM-PDS. Illustrative cases are presented. ImagesFigure 1Figure 2Figure 3Figure 4Figure 5Figure 6Figure 6Figure 7Figure 8Figure 9

  18. [Current research of the excessive lateral pressure syndrome of patellofemoral joint].

    PubMed

    Liu, Jin-song; Zhang, Dao-ping

    2011-05-01

    As modern medicine getting deeply to understand ever-detailed anatomy,structure and animal mechanics of the patellofemoral joint, excessive lateral pressure syndrome, a very common patellofemoral disorder, has been reacquainted by the clinicians. On account to the complexity and variety of the etiology and the mechanism of the pain, still, there are many difficulties and arguments on the exact description of the clinical symptoms and the establishment of a universally accepted diagnostic criteria. Accurately grasping different causes, pathomechanisms and developmental stages of the disease would be especially important. As a result, rational choice of the pertinent procedures become the clinical lynchpin. This paper reviews domestic and international pertinent literatures in the past 10 years, and provide an overview of the latest study of anatomy, biomechanic, pathomechanism and clinical experience, anticipating to offer help on standardizing the diagnosis and treatment of ELPS.

  19. Recurrent temporomandibular joint subluxation and facial ecchymosis leading to diagnosis of Ehlers-Danlos syndrome: report of surgical management and review of the literature.

    PubMed

    Sacks, H; Zelig, D; Schabes, G

    1990-06-01

    This article reports a patient with Ehlers-Danlos syndrome for whom the syndrome was diagnosed as a result of her TMJ complaints. The surgical management of the patient's joint laxity is discussed, and a review of the syndrome's biochemical basis, clinical features, and importance to the surgeon is presented.

  20. The relationship between malocclusion, benign joint hypermobility syndrome, condylar position and TMD symptoms.

    PubMed

    Barrera-Mora, José Ma; Espinar Escalona, Eduardo; Abalos Labruzzi, Camilo; Llamas Carrera, José Ma; Ballesteros, Emilio Jiménez-Castellanos; Solano Reina, Enrique; Rocabado, Mariano

    2012-04-01

    The current study investigated the association between temporomandibular disorders, malocclusion patterns, benign joint hypermobility syndrome and the initial condylar position. One hundred sixty-two subjects were analyzed using the Rocabado Temporomandibular Pain Analysis; Helkimo Index parameters; the Carter-Wilkinson modified test; and a mounting cast with condylar position indicator registration (MPI). The study revealed a significant association between: 1. Delta H, skeletal pattern (p = 0.034); 2. Delta Y, transversal malocclusion (p = 0.04); 3. right and left, Delta Z, right and left posteroinferior synovial pain (p < 0.05); 4. hypermobility scale, gender (p < 0.001), malocclusion pattern (p = 0.021); 5. TMJ function impairment, gender (p = 0.043); 6. sagittal malocclusion pattern, right temporomandibular pain analysis joint (TPAJ) (p = 0.0034); 7. TMJ function impairment, left and right TPAJ (p = 0.007); and 8. mandibular motion, left and right TPAJ (p = 0.035, p = 0.015). The conclusion was that anterior crossbite and condylar displacements in the vertical plane are risk factors in developing TMJ symptoms.

  1. Alpha 1 antitrypsin deficiency alleles are associated with joint dislocation and scoliosis in Williams syndrome

    PubMed Central

    Morris, Colleen A.; Pani, Ariel M.; Mervis, Carolyn B.; Rios, Cecilia M.; Kistler, Doris J.; Gregg, Ronald G.

    2010-01-01

    Elastin haploinsufficiency is responsible for a significant portion of the Williams syndrome (WS) phenotype including hoarse voice, supravalvar aortic stenosis (SVAS), hernias, diverticuli of bowel and bladder, soft skin, and joint abnormalities. All of the connective tissue signs and symptoms are variable in the WS population, but few factors other than age and gender are known to influence the phenotype. We examined a cohort of 205 individuals with WS for mutations in SERPINA1, the gene that encodes alpha-1-antitrypsin (AAT), the inhibitor of elastase. Individuals with classic WS deletions and SERPINA1 genotypes PiMS or PiMZ were more likely than those with a SERPINA1 PiMM genotype to have joint dislocation or scoliosis. However, carrier status for AAT deficiency was not correlated with presence of inguinal hernia or with presence or severity of SVAS. These findings suggest that genes important in elastin metabolism are candidates for variability in the connective tissue abnormalities in WS. PMID:20425789

  2. United States Physical Therapists' Knowledge About Joint Hypermobility Syndrome Compared with Fibromyalgia and Rheumatoid Arthritis.

    PubMed

    Russek, Leslie N; LaShomb, Emily A; Ware, Amy M; Wesner, Sarah M; Westcott, Vanessa

    2016-03-01

    Joint hypermobility syndrome (JHS) is one of the most common inherited connective tissue disorders. It causes significant pain and disability for all age groups, ranging from developmental delay among children to widespread chronic pain in adults. Experts in JHS assert that the condition is under-recognized and poorly managed. The aim of this study was to assess US physical therapists' knowledge about JHS compared with other causes of widespread pain and activity limitations: fibromyalgia, juvenile rheumatoid arthritis and adult rheumatoid arthritis. Cross-sectional, Internet-based survey of randomly selected members of the American Physical Therapy Association and descriptive statistics were used to explore physical therapists' knowledge about JHS, fibromyalgia, juvenile rheumatoid arthritis and adult rheumatoid arthritis, and chi square was used to compare knowledge about the different conditions. The response rate was 15.5% (496). Although 36% recognized the Beighton Scale for assessing joint hypermobility, only 26.8% of respondents were familiar with the Brighton Criteria for diagnosing JHS. Few respondents (11-19%) realized that JHS has extra-articular features such as anxiety disorder, fatigue, headache, delayed motor development, easy bruising and sleep disturbance. Physical therapists working in environments most likely to see patients with JHS underestimated the likely prevalence in their patient population. The results suggest that many physical therapists in the United States are not familiar with the diagnostic criteria, prevalence or common clinical presentation of JHS. Copyright © 2014 John Wiley & Sons, Ltd.

  3. Spectrum of mucocutaneous manifestations in 277 patients with joint hypermobility syndrome/Ehlers-Danlos syndrome, hypermobility type.

    PubMed

    Castori, Marco; Dordoni, Chiara; Morlino, Silvia; Sperduti, Isabella; Ritelli, Marco; Valiante, Michele; Chiarelli, Nicola; Zanca, Arianna; Celletti, Claudia; Venturini, Marina; Camerota, Filippo; Calzavara-Pinton, Piergiacomo; Grammatico, Paola; Colombi, Marina

    2015-03-01

    Cutaneous manifestations are a diagnostic criterion of Ehlers-Danlos syndrome, hypermobility type (EDS-HT) and joint hypermobility syndrome (JHS). These two conditions, originally considered different disorders, are now accepted as clinically indistinguishable and often segregate as a single-familial trait. EDS-HT and JHS are still exclusion diagnoses not supported by any specific laboratory test. Accuracy of clinical diagnosis is, therefore, crucial for appropriate patients' classification and management, but it is actually hampered by the low consistency of many applied criteria including the cutaneous one. We report on mucocutaneous findings in 277 patients with JHS/EDS-HT with both sexes and various ages. Sixteen objective and five anamnestic items were selected and ascertained in two specialized outpatient clinics. Feature rates were compared by sex and age by a series of statistical tools. Data were also used for a multivariate correspondence analysis with the attempt to identify non-causal associations of features depicting recognizable phenotypic clusters. Our findings identified a few differences between sexes and thus indicated an attenuated sexual dimorphism for mucocutaneous features in JHS/EDS-HT. Ten features showed significantly distinct rates at different ages and this evidence corroborated the concept of an evolving phenotype in JHS/EDS-HT also affecting the skin. Multivariate correspondence analysis identified three relatively discrete phenotypic profiles, which may represent the cutaneous counterparts of the three disease phases previously proposed for JHS/EDS-HT. These findings could be used for revising the cutaneous criterion in a future consensus for the clinical diagnosis of JHS/EDS-HT.

  4. Differential diagnosis and diagnostic flow chart of joint hypermobility syndrome/ehlers-danlos syndrome hypermobility type compared to other heritable connective tissue disorders.

    PubMed

    Colombi, Marina; Dordoni, Chiara; Chiarelli, Nicola; Ritelli, Marco

    2015-03-01

    Joint hypermobility syndrome/Ehlers-Danlos syndrome hypermobility type (JHS/EDS-HT) is an evolving and protean disorder mostly recognized by generalized joint hypermobility and without a defined molecular basis. JHS/EDS-HT also presents with other connective tissue features affecting a variety of structures and organs, such as skin, eye, bone, and internal organs. However, most of these signs are present in variable combinations and severity in many other heritable connective tissue disorders. Accordingly, JHS/EDS-HT is an "exclusion" diagnosis which needs the absence of any consistent feature indicative of other partially overlapping connective tissue disorders. While both Villefranche and Brighton criteria include such an exclusion as a mandatory item, a systematic approach for reaching a stringent clinical diagnosis of JHS/EDS-HT is still lacking. The absence of a consensus on the diagnostic approach to JHS/EDS-HT concerning its clinical boundaries with similar conditions contribute to limit our actual understanding of the pathologic and molecular bases of this disorder. In this review, we revise the differential diagnosis of JHS/EDS-HT with those heritable connective tissue disorders which show a significant overlap with the former and mostly include EDS classic, vascular and kyphoscoliotic types, osteogenesis imperfecta, Marfan syndrome, Loeys-Dietz syndrome, arterial tortuosity syndrome, and lateral meningocele syndrome. A diagnostic flow chart is also offered with the attempt to support the less experienced clinician in stringently recognizing JHS/EDS-HT and stimulate the debate in the scientific community for both management and research purposes.

  5. [Association between limited joint mobility syndrome and risk of accidental falls in diabetic patients].

    PubMed

    López-Martín, I; Benito Ortiz, L; Rodríguez-Borlado, B; Cano Langreo, M; García-Martínez, F J; Martín Rodríguez, M F

    2015-03-01

    Limited joint mobility syndrome (LJMS) appears exclusively in both type 1 and type 2 diabetic patients. It is characterized by a limited range of digital motion, with involvement of small joints of the hands. It initially affects the proximal interphalangeal joints, followed by wrists, elbows, shoulders, knees, and axial skeleton. The diagnosis can be made by the simple "prayer sign" test. The objective was to study the prevalence of diabetic patients with LJMS, and to evaluate the association between LJMS and metabolic control, and the risk of accidental falls. A cross-sectional study was conducted in the San Fernando II Health Centre, Madrid (suburbs). The sample consisted of 184 patients with a diagnosis of diabetes of over 5 years from November to March, 2013. The prayer sign was used to define which patients had LJMS. Fall risk was determined using the Timed Up & Go test. A total of 99 patients (53.8%) (95% CI 46.6 to 61) had a positive prayer sign. No statistically significant relationship was found with HbA1c, but there was an association with the Timed Up & Go test (P<.001) (95% CI 1.173 to 1.611). The patients with LJMS had a moderate risk of falls compared with those without LJMS, which was of low risk. The prevalence of LJMS is high. This is the first study that shows a relationship between LJMS and the risk of falls in diabetic patients. Copyright © 2013 Sociedad Española de Médicos de Atención Primaria (SEMERGEN). Publicado por Elsevier España. All rights reserved.

  6. IINCIDENCE OF ANKLE SPRAINS IN SOCCER PLAYERS WITH JOINT HYPERMOBILITY SYNDROME

    PubMed Central

    Vieira, Rodrigo Barreiros; Bertolini, Fabricio Melo; Vieira, Tallys Campos; Aguiar, Rodrigo Manso; Pinheiro, Guilherme Baldez; Lasmar, Rodrigo Campos Pace

    2015-01-01

    Objective: Eighty-three soccer players aged between 14 and 19 years, in the basic category of a professional soccer club in the city of Belo Horizonte, were followed up during the 2009 season. Methods: A prospective observational cohort study was conducted, in which these soccer players were divided randomly into two groups. The first consisted of individuals with joint hypermobility syndrome (JHS), totaling 22 players, and the second was a control group with 61 players without this syndrome, determined through a physical examinati. Results: Both groups were studied with regard to incidence of ankle sprains. At the end of this period, the data were compiled and statistical analysis was performed. A total of 43 cases of ankle injury due to sprains were recorded, of which nine episodes were in players with JHS, thus making p = 0.106. The significance level was 5%. Conclusion: We were able to conclude that in our study there was insufficient evidence to assert that there is an association with increased incidence of ankle sprains among patients with JHS. PMID:27047888

  7. Targeted deletion of collagen V in tendons and ligaments results in a classic Ehlers-Danlos syndrome joint phenotype.

    PubMed

    Sun, Mei; Connizzo, Brianne K; Adams, Sheila M; Freedman, Benjamin R; Wenstrup, Richard J; Soslowsky, Louis J; Birk, David E

    2015-05-01

    Collagen V mutations underlie classic Ehlers-Danlos syndrome, and joint hypermobility is an important clinical manifestation. We define the function of collagen V in tendons and ligaments, as well as the role of alterations in collagen V expression in the pathobiology in classic Ehlers-Danlos syndrome. A conditional Col5a1(flox/flox) mouse model was bred with Scleraxis-Cre mice to create a targeted tendon and ligament Col5a1-null mouse model, Col5a1(Δten/Δten). Targeting was specific, resulting in collagen V-null tendons and ligaments. Col5a1(Δten/Δten) mice demonstrated decreased body size, grip weakness, abnormal gait, joint laxity, and early-onset osteoarthritis. These gross changes were associated with abnormal fiber organization, as well as altered collagen fibril structure with increased fibril diameters and decreased fibril number that was more severe in a major joint stabilizing ligament, the anterior cruciate ligament (ACL), than in the flexor digitorum longus tendon. The ACL also had a higher collagen V content than did the flexor digitorum longus tendon. The collagen V-null ACL and flexor digitorum longus tendon both had significant alterations in mechanical properties, with ACL exhibiting more severe changes. The data demonstrate critical differential regulatory roles for collagen V in tendon and ligament structure and function and suggest that collagen V regulatory dysfunction is associated with an abnormal joint phenotype, similar to the hypermobility phenotype in classic Ehlers-Danlos syndrome.

  8. Exploring third metacarpal capitate facet shape in early hominins.

    PubMed

    Rein, Thomas R; Harvati, Katerina

    2013-02-01

    The joint between the capitate and third metacarpal plays an important role in stabilizing the manus during hand use in great apes and humans. Researchers have examined the morphology of this region in humans, our fossil relatives, and other extant primates to try to understand the importance of this joint in human evolution. The first goal of our research was to explore shape variation of the third metacarpal capitate facet across extant anthropoids, including hominoids, cercopithecoids, and platyrrhines. This analysis allowed us to examine the range of variation in the capitate facet and the degree to which locomotor behavior, phylogeny, and size explained shape variation. We also examined capitate facet shape in the early hominin fossil record in order to explore how the shape of this articular surface has changed during early hominin evolution. We captured six landmark coordinates on the edge of the capitate facet in extant anthropoids and fossil specimens to quantify and visualize shape variation in this region. We used principal components analysis, Procrustes distances, and multivariate regression analysis to investigate different possible influences on shape variation. We found that shape variation corresponded to function, phylogeny, and size. With the exception of brachiation, shape variation did not clearly correspond with any specific locomotor behavior. However, we identified a shift in the relative mediolateral breadth of the capitate facet during early hominin evolution, which is most likely one of several adaptations for a more stable joint surface. Copyright © 2012 Wiley Periodicals, Inc.

  9. Ankylosis of temporomandibular joints after mandibular distraction osteogenesis in patients with Nager syndrome: Report of two cases and literature review.

    PubMed

    Wu, Cheng Chun; Sakahara, Daisuke; Imai, Keisuke

    2017-10-01

    Nager syndrome, also known as Nager acrofacial dysostosis, was first described by Nager and de Reynier in 1948. The patients commonly present with micrognathia, and a preventive tracheostomy is necessary when there are symptoms of upper airway obstruction. Mandibular distraction osteogenesis is considered as an effective procedure, which not only improves micrognathia but also minimizes the chances of tracheostomy. However, mandibular distraction osteogenesis has some complications such as relapse, teeth injury, infection, and injury of the temporomandibular joints (TMJs). In this study, the author reported two patients with Nager syndrome who suffered from ankylosis of TMJs after mandibular distraction osteogenesis. In addition, a comprehensive literature review of post-distraction ankylosis of TMJs in patients with Nager syndrome was performed. Few studies demonstrated the condition of TMJs after mandibular distraction osteogenesis, and three studies were identified from the review. One study reported ankylosis of bilateral coronoid processes, in which coronoidectomies were necessary. Another study reported the use of prostheses to replace the ankylosed joints in a patient who had undergone many surgeries of the joints, such as gap arthroplasties, reconstructions with costochondral grafts, etc. One other study raised the concept of unloading the condyles during the mandibular distraction to prevent subsequent ankylosis. It seems that multiple factors are related to the ankylosis of TMJs after mandibular distraction osteogenesis in patients with Nager syndrome. Prevention of post-distraction ankylosis of the joints is important because the treatment is difficult and not always effective. We should conduct more studies about protection of the joints during mandibular distraction in the future. Copyright © 2017 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved.

  10. Facet control of gold nanorods

    SciTech Connect

    Zhang, Qingfeng; Han, Lili; Jing, Hao; Blom, Douglas A.; Lin, Ye; Xin, Huolin L.; Wang, Hui

    2016-01-21

    While great success has been achieved in fine-tuning the aspect ratios and thereby the plasmon resonances of cylindrical Au nanorods, facet control with atomic level precision on the highly curved nanorod surfaces has long been a significantly more challenging task. The intrinsic structural complexity and lack of precise facet control of the nanorod surfaces remain the major obstacles for the atomic-level elucidation of the structure–property relationships that underpin the intriguing catalytic performance of Au nanorods. Here we demonstrate that the facets of single-crystalline Au nanorods can be precisely tailored using cuprous ions and cetyltrimethylammonium bromide as a unique pair of surface capping competitors to guide the particle geometry evolution during nanorod overgrowth. By deliberately maneuvering the competition between cuprous ions and cetyltrimethylammonium bromide, we have been able to create, in a highly controllable and selective manner, an entire family of nanorod-derived anisotropic multifaceted geometries whose surfaces are enclosed by specific types of well-defined high-index and low-index facets. This facet-controlled nanorod overgrowth approach also allows us to fine-tune the particle aspect ratios while well-preserving all the characteristic facets and geometric features of the faceted Au nanorods. Furthermore, taking full advantage of the combined structural and plasmonic tunability, we have further studied the facet-dependent heterogeneous catalysis on well-faceted Au nanorods using surface-enhanced Raman spectroscopy as an ultrasensitive spectroscopic tool with unique time-resolving and molecular finger-printing capabilities.

  11. FACETS: multi-faceted functional decomposition of protein interaction networks

    PubMed Central

    Seah, Boon-Siew; Bhowmick, Sourav S.; Forbes Dewey, C.

    2012-01-01

    Motivation: The availability of large-scale curated protein interaction datasets has given rise to the opportunity to investigate higher level organization and modularity within the protein–protein interaction (PPI) network using graph theoretic analysis. Despite the recent progress, systems level analysis of high-throughput PPIs remains a daunting task because of the amount of data they present. In this article, we propose a novel PPI network decomposition algorithm called FACETS in order to make sense of the deluge of interaction data using Gene Ontology (GO) annotations. FACETS finds not just a single functional decomposition of the PPI network, but a multi-faceted atlas of functional decompositions that portray alternative perspectives of the functional landscape of the underlying PPI network. Each facet in the atlas represents a distinct interpretation of how the network can be functionally decomposed and organized. Our algorithm maximizes interpretative value of the atlas by optimizing inter-facet orthogonality and intra-facet cluster modularity. Results: We tested our algorithm on the global networks from IntAct, and compared it with gold standard datasets from MIPS and KEGG. We demonstrated the performance of FACETS. We also performed a case study that illustrates the utility of our approach. Contact: seah0097@ntu.edu.sg or assourav@ntu.edu.sg Supplementary information: Supplementary data are available at the Bioinformatics online. Availability: Our software is available freely for non-commercial purposes from: http://www.cais.ntu.edu.sg/∼assourav/Facets/ PMID:22908217

  12. FACETS: multi-faceted functional decomposition of protein interaction networks.

    PubMed

    Seah, Boon-Siew; Bhowmick, Sourav S; Dewey, C Forbes

    2012-10-15

    The availability of large-scale curated protein interaction datasets has given rise to the opportunity to investigate higher level organization and modularity within the protein-protein interaction (PPI) network using graph theoretic analysis. Despite the recent progress, systems level analysis of high-throughput PPIs remains a daunting task because of the amount of data they present. In this article, we propose a novel PPI network decomposition algorithm called FACETS in order to make sense of the deluge of interaction data using Gene Ontology (GO) annotations. FACETS finds not just a single functional decomposition of the PPI network, but a multi-faceted atlas of functional decompositions that portray alternative perspectives of the functional landscape of the underlying PPI network. Each facet in the atlas represents a distinct interpretation of how the network can be functionally decomposed and organized. Our algorithm maximizes interpretative value of the atlas by optimizing inter-facet orthogonality and intra-facet cluster modularity. We tested our algorithm on the global networks from IntAct, and compared it with gold standard datasets from MIPS and KEGG. We demonstrated the performance of FACETS. We also performed a case study that illustrates the utility of our approach. Supplementary data are available at the Bioinformatics online. Our software is available freely for non-commercial purposes from: http://www.cais.ntu.edu.sg/~assourav/Facets/

  13. Hypermobility and joint hypermobility syndrome in Brazilian students and teachers of ballet dance.

    PubMed

    Sanches, S B; Oliveira, G M; Osório, F L; Crippa, J A S; Martín-Santos, R

    2015-04-01

    The current literature has been discussing the risks and benefits of joint hypermobility (JHM) for careers in ballet This study aimed to evaluate the prevalence of JHM and joint hypermobility syndrome (JHS) in a group of ballet teachers and students, looking both at aspects related to the flexibility required to dance, as at the risk of injuries when hypermobility is associated with other symptoms, in the case of JHS. We evaluated ballet teachers and ballet students, with age ranging from 18 to 40 years. All participants completed identification and sociodemographic questionnaires and underwent a physical examination. JHM was assessed using the Beighton score with goniometry. Symptoms of JHS were evaluated according to the Brighton criteria. Final sample consisted of 77 participants, being 44 ballet students and 33 ballet teachers. The prevalence of JHM in the sample as a whole was 58 %. Teachers and students had no significant differences regarding the prevalence of JHM (p = 0.74) (OR 1.21; 95 % CI 0.48-3.07). However, the prevalence of JHS was significantly different (p = 0.04) between students (16 %) and teachers (36 %). Teachers were three times more likely than student to have JHS (OR 3.02; 95 % CI 1.03-8.85). Teachers and students also presented differences in the frequency of specific items of Beighton score and Brighton criteria. These data provide elements to discuss the relationship between hypermobility, ballet technique and selection for dance, suggesting that dancers with JHS could find in ballet teaching an alternative to maintain professional activity with dance, while remaining protected from the higher risk of injury that professional dancers may be exposed to.

  14. Hip-spine syndrome: A cadaveric analysis between osteoarthritis of the lumbar spine and hip joints.

    PubMed

    Weinberg, D S; Gebhart, J J; Liu, R W

    2017-09-01

    Authors have recently proposed the concept of "hip-spine syndrome", however there exists limited evidence available to differentiate whether these concomitant arthritides are due to anatomic/structural causes, or systemic/metabolic effects. Exploring this relationship has important implications during the evaluation and treatment of both spine and hip disorders-a common clinical presentation of many patients. The purpose of this experiment was to investigate the individual contribution of hip arthritis towards the development of spine arthritis, with knee arthritis also being analyzed as a negative (systemic) control. Hip and spine arthritis are caused by both metabolic and anatomic causes. A large, well-organized osteological database was queried, and osteoarthritis of the spine, hip, and knee joints was quantified using a validated scoring criteria. Six hundred and twenty-five specimens were chosen for analysis. Multivariate linear regression models were created to quantify the independent contributions of age, gender, race, height, and arthritis of the spine and hip joints. Age was the strongest predictor of arthritis at each site (standardized betas>0.281, P<0.001 for all). Hip arthritis was a stronger predictor of spine arthritis than was knee arthritis (standardized betas 0.215 and 0.155, respectively, P<0.001 for both). Spine arthritis was also a stronger predictor of hip arthritis than was knee arthritis (standardized betas 0.232 and 0.173, P<0.001 for both). Anatomic/structural influences about the lumbosacral-pelvic junction contribute towards the development of arthritis that is separate from any systemic/metabolic effects. Surgeons performing total hip arthroplasty should remain aware of these relationships, although future research is necessary regarding optimal surgical treatment of these patients. N/A (cadaveric study). Copyright © 2017 Elsevier Masson SAS. All rights reserved.

  15. Living with joint hypermobility syndrome: patient experiences of diagnosis, referral and self-care

    PubMed Central

    Terry, Rohini H; Rimes, Katharine A; Clark, Carol J; Simmonds, Jane V; Horwood, Jeremy P

    2015-01-01

    Background. Musculoskeletal problems are common reasons for seeking primary health care. It has been suggested that many people with ‘everyday’ non-inflammatory musculoskeletal problems may have undiagnosed joint hypermobility syndrome (JHS), a complex multi-systemic condition. JHS is characterized by joint laxity, pain, fatigue and a wide range of other symptoms. Physiotherapy is usually the preferred treatment option for JHS, although diagnosis can be difficult. The lived experience of those with JHS requires investigation. Objective. The aim of the study was to examine patients’ lived experience of JHS, their views and experiences of JHS diagnosis and management. Methods. Focus groups in four locations in the UK were convened, involving 25 participants with a prior diagnosis of JHS. The focus groups were audio recorded, fully transcribed and analysed using the constant comparative method to inductively derive a thematic account of the data. Results. Pain, fatigue, proprioception difficulties and repeated cycles of injury were among the most challenging features of living with JHS. Participants perceived a lack of awareness of JHS from health professionals and more widely in society and described how diagnosis and access to appropriate health-care services was often slow and convoluted. Education for patients and health professionals was considered to be essential. Conclusions. Timely diagnosis, raising awareness and access to health professionals who understand JHS may be particularly instrumental in helping to ameliorate symptoms and help patients to self-manage their condition. Physiotherapists and other health professionals should receive training to provide biopsychosocial support for people with this condition. PMID:25911504

  16. A 7-year-old with indurated skin and unilateral progressive joint immobility: A case of stiff skin syndrome.

    PubMed

    Ogunmakin, Kehinde; Vangipuram, Ramya; Sturgeon, Ashley; Shimizu, Ikue

    2015-09-17

    Stiff skin syndrome is a rare sclerotic condition that presents during infancy or early childhood. It has an insidious chronic course and may lead to significant co-morbidity and reduced quality of life. Often, affected individuals experience impaired ambulation and immobilization related to joint involvement. Clinically, it may resemble other sclerotic diseases, so histopathological evaluation is necessary to establish a diagnosis. As it is a condition with limited treatment options, prompt diagnosis and early initiation of physical therapy is crucial to prevent joint restriction and maintain quality of life. We describe a case of a 7-year-old with stiff skin syndrome, and review the literature to discuss the clinical presentation, histological findings, and management of this condition.

  17. The effect of open and closed chain exercise and knee joint position on patellar tracking in lateral patellar compression syndrome.

    PubMed

    Doucette, S A; Child, D D

    1996-02-01

    There are numerous rehabilitation protocols for patellofemoral problems, but there is little objective data to determine the most effective exercise program to conservatively treat this disorder. The purpose of this study was to determine the effect of open and closed chain exercise and knee joint position on patellar tracking in lateral patellar compression syndrome. Computed tomography scans of the patellofemoral joint were performed with the leg in three muscle conditions and at five knee angles in 16 subjects with lateral patellar compression syndrome. Patellar tracking was evaluated by measuring congruence angle. Relaxed and closed chain conditions demonstrated improved congruence as compared with the open chain condition at 0, 10, and 20 degrees of knee flexion (p < .0001). Open chain strengthening techniques appear to be most appropriate after 30 degrees of knee flexion. The three muscle conditions demonstrated progressively improved patellar congruence from 0 to 40 degrees of knee flexion.

  18. The Many Facets of PISA

    ERIC Educational Resources Information Center

    Berliner, David C.

    2015-01-01

    Trying to understand PISA is analogous to the parable of the blind men and the elephant. There are many facets of the PISA program, and thus many ways to both applaud and critique this ambitious international program of assessment that has gained enormous importance in the crafting of contemporary educational policy. One of the facets discussed in…

  19. The Many Facets of PISA

    ERIC Educational Resources Information Center

    Berliner, David C.

    2015-01-01

    Trying to understand PISA is analogous to the parable of the blind men and the elephant. There are many facets of the PISA program, and thus many ways to both applaud and critique this ambitious international program of assessment that has gained enormous importance in the crafting of contemporary educational policy. One of the facets discussed in…

  20. Depression, anhedonia and anxiety in temporomandibular joint and other facial pain syndromes.

    PubMed

    Marbach, J J; Lund, P

    1981-08-01

    Depression, anhedonia, state anxiety (A-state), trait anxiety (A-trait), and self-reported pain estimate were measured in almost 500 facial pain patients. These patients were divided into 3 diagnostic categories: myofacial pain dysfunction syndrome (MPD) [18], arthritis of the temporomandibular joints (TMJ arthritis), and trigeminal neuralgia. Three control groups were measured for comparison. They consisted of an normal, or non-patient group, a group of arthritis patients, and a group of movement disorder patients attending a neurology clinic. Among the facial pain patients and the normal controls few differences were found with regard to anhedonia and depression, The arthritis and neurology patients produced significantly higher depression and anhedonia scores than did several of the facial pain groups. Pain estimate ranged from 0 for control, to a mean of 67.6 +/- 31.3 for the trigeminal neuralgia patients with the MPD (means = 56.2 +/- 32.5) and the TMJ arthritis patients (means = 46.7 +/- 30.8) somewhat lower. Clinical variables such as duration of pain, help seeking behavior and total number of symptoms were correlated with depression but not with anhedonia scores, It is hypothesized that anhedonia is a measure separate from depression and may be more closely linked to suffering behavior that to pain behavior. Psychological variables did not discriminate among facial pain patients and in particular did not distinguish between so-called functional and organic illness.

  1. Joint Engagement and Early Language in Young Children With Fragile X Syndrome.

    PubMed

    Hahn, Laura J; Brady, Nancy C; Fleming, Kandace K; Warren, Steven F

    2016-10-01

    In this study, we examine joint engagement (JE) in young children with fragile X syndrome (FXS) and its relationship to language abilities and autism spectrum disorder symptomatology at 24 to 36 months (toddler period) and 59 to 68 months (child period). Participants were 28 children with FXS (24 boys, four girls) and their mothers. Videotaped home observations were conducted during the toddler period and coded for JE. Language abilities were measured at both ages from a developmental assessment, a functional measure, and from a language sample. The Childhood Autism Rating Scale (Schopler, Reichler, & Renner, 1988) was completed at both ages. Children with FXS spent more time in supported JE than in coordinated JE. Using a weighted JE variable, we found that children with FXS who had higher weighted JE scores also had more advanced expressive language skills at both the toddler and child periods. Weighted JE was negatively related to autism symptomatology in the toddler period. This study provides evidence that children with FXS who use more JE also have more advanced expressive language skills in early development. Therefore, existing early interventions that target JE behaviors may be effective for promoting language, social communication, and social interaction in this population.

  2. Re-writing the natural history of pain and related symptoms in the joint hypermobility syndrome/Ehlers-Danlos syndrome, hypermobility type.

    PubMed

    Castori, Marco; Morlino, Silvia; Celletti, Claudia; Ghibellini, Giulia; Bruschini, Michela; Grammatico, Paola; Blundo, Carlo; Camerota, Filippo

    2013-12-01

    Joint hypermobility syndrome (JHS) and Ehlers-Danlos syndrome, hypermobility type (EDS-HT) are two clinically overlapping connective tissue disorders characterized by chronic/recurrent pain, joint instability complications, and minor skin changes. Fatigue and headache are also common, although are not yet considered diagnostic criteria. JHS/EDS-HT is a unexpectedly common condition that remains underdiagnosed by most clinicians and pain specialists. This results in interventions limited to symptomatic and non-satisfactory treatments, lacking reasonable pathophysiologic rationale. In this manuscript the fragmented knowledge on pain, fatigue, and headache in JHS/EDS is presented with review of the available published information and a description of the clinical course by symptoms, on the basis of authors' experience. Pathogenic mechanisms are suggested through comparisons with other functional somatic syndromes (e.g., chronic fatigue syndrome, fibromyalgia, and functional gastrointestinal disorders). The re-writing of the natural history of JHS/EDS-HT is aimed to raise awareness among clinical geneticists and specialists treating chronic pain conditions about pain and other complications of JHS/EDS-HT. Symptoms' clustering by disease stage is proposed to investigate both the molecular causes and the symptoms management of JHS/EDS-HT in future studies.

  3. Short-term effects of kinesio tape on joint position sense, isokinetic measurements, and clinical parameters in patellofemoral pain syndrome.

    PubMed

    Kurt, Emine Eda; Büyükturan, Öznur; Erdem, Hatice Rana; Tuncay, Figen; Sezgin, Hicabi

    2016-07-01

    [Purpose] To evaluate the short-term effects of kinesio tape on joint position sense, isokinetic measurements, kinesiophobia, symptoms, and functional limitations in patients with patellofemoral pain syndrome. [Subjects and Methods] A total of 90 patients (112 knees) with patellofemoral pain syndrome were randomized into a kinesio tape group (n=45) or placebo kinesio tape group (n=45). Baseline isokinetic quadriceps muscle tests and measurements of joint position sense were performed in both groups. Pain was measured with a Visual Analog Scale, kinesiophobia with the Tampa kinesiophobia scale, and symptoms and functional limitations with the Kujala pain scale. Measurements were repeated 2 days after kinesio tape application. [Results] No differences were found between baseline isokinetic muscle measurements and those taken 2 days after application. However, significant improvements were observed in the kinesio tape group, with regard to joint position sense, pain, kinesiophobia, symptoms, and functional limitations after treatment. Examination of the differences between pre- and post-treatment values in both groups revealed that the kinesio tape group demonstrated greater improvements compared to the placebo kinesio tape group. [Conclusion] Although short-term kinesio tape application did not increase hamstring muscle strength, it may have improved joint position sense, pain, kinesiophobia, symptoms, and daily limitations.

  4. Short-term effects of kinesio tape on joint position sense, isokinetic measurements, and clinical parameters in patellofemoral pain syndrome

    PubMed Central

    Kurt, Emine Eda; Büyükturan, Öznur; Erdem, Hatice Rana; Tuncay, Figen; Sezgin, Hicabi

    2016-01-01

    [Purpose] To evaluate the short-term effects of kinesio tape on joint position sense, isokinetic measurements, kinesiophobia, symptoms, and functional limitations in patients with patellofemoral pain syndrome. [Subjects and Methods] A total of 90 patients (112 knees) with patellofemoral pain syndrome were randomized into a kinesio tape group (n=45) or placebo kinesio tape group (n=45). Baseline isokinetic quadriceps muscle tests and measurements of joint position sense were performed in both groups. Pain was measured with a Visual Analog Scale, kinesiophobia with the Tampa kinesiophobia scale, and symptoms and functional limitations with the Kujala pain scale. Measurements were repeated 2 days after kinesio tape application. [Results] No differences were found between baseline isokinetic muscle measurements and those taken 2 days after application. However, significant improvements were observed in the kinesio tape group, with regard to joint position sense, pain, kinesiophobia, symptoms, and functional limitations after treatment. Examination of the differences between pre- and post-treatment values in both groups revealed that the kinesio tape group demonstrated greater improvements compared to the placebo kinesio tape group. [Conclusion] Although short-term kinesio tape application did not increase hamstring muscle strength, it may have improved joint position sense, pain, kinesiophobia, symptoms, and daily limitations. PMID:27512259

  5. Low-level laser therapy of myofascial pain syndromes of patients with osteoarthritis of knee and hip joints

    NASA Astrophysics Data System (ADS)

    Gasparyan, Levon V.

    2001-04-01

    The purpose of the given research is the comparison of efficiency of conventional treatment of myofascial pain syndromes of patients with osteoarthritis (OA) of hip and knee joints and therapy with additional application of low level laser therapy (LLLT) under dynamic control of clinical picture, rheovasographic, electromyographic examinations, and parameters of peroxide lipid oxidation. The investigation was made on 143 patients with OA of hip and knee joints. Patients were randomized in 2 groups: basic group included 91 patients, receiving conventional therapy with a course of LLLT, control group included 52 patients, receiving conventional treatment only. Transcutaneous ((lambda) equals 890 nm, output peak power 5 W, frequency 80 - 3000 Hz) and intravenous ((lambda) equals 633 nm, output 2 mW in the vein) laser irradiation were used for LLLT. Studied showed, that clinical efficiency of LLLT in the complex with conventional treatment of myofascial pain syndromes at the patients with OA is connected with attenuation of pain syndrome, normalization of parameters of myofascial syndrome, normalization of the vascular tension and parameters of rheographic curves, as well as with activation of antioxidant protection system.

  6. The Facet Orientation of the Subaxial Cervical Spine and the Implications for Cervical Movements and Clinical Conditions.

    PubMed

    Rong, Xin; Liu, Ziyang; Wang, Beiyu; Chen, Hua; Liu, Hao

    2017-03-15

    Computed tomography study. To obtain detailed information on the facet orientation in the subaxial cervical spine and explore the correlation to the cervical movements and relevant clinical conditions. Although facet orientation was well studied in the lumbar spine, the literatures on the cervical facet orientation were limited and the descriptions were nonspecific. The computed tomography scans of 100 individuals were reconstructed. For each level from C2/C3 to C6/C7, the horizontal plane, the mid-sagittal plane, the coronal plane, and the two facet planes were established. The normal vectors of the five planes were used for the calculation of the facet orientation and the facet tropism. The angle of the facet plane with respect to the horizontal plane at the C6/7 level was the largest (left side: 64.34° ± 6.60°, right side: 63.37° ± 6.81°, P >0.05). The angle of the facet plane with respect to the coronal plane decreased from C2/C3 level to C6/C7 level. Regarding the angle of the facet plane with respect to the sagittal plane, for the paired facet joints, three types were found: posteromedially oriented, posterolaterally oriented, and ipsilaterally oriented. All (100%) of the facet joints at the C2/C3 level and 65% at the C3/C4 level were posteromedially oriented. In the lower levels of the cervical spine, the posteromedially oriented facet joints were less common. The facet tropism was common phenomenon in the subaxial cervical spine. This study provided detailed information on the facet orientation in the subaxial cervical spine. The cervical facet orientation correlated well with the spinal movements and related clinical conditions. 3.

  7. Facet control of gold nanorods

    DOE PAGES

    Zhang, Qingfeng; Han, Lili; Jing, Hao; ...

    2016-01-21

    While great success has been achieved in fine-tuning the aspect ratios and thereby the plasmon resonances of cylindrical Au nanorods, facet control with atomic level precision on the highly curved nanorod surfaces has long been a significantly more challenging task. The intrinsic structural complexity and lack of precise facet control of the nanorod surfaces remain the major obstacles for the atomic-level elucidation of the structure–property relationships that underpin the intriguing catalytic performance of Au nanorods. Here we demonstrate that the facets of single-crystalline Au nanorods can be precisely tailored using cuprous ions and cetyltrimethylammonium bromide as a unique pair ofmore » surface capping competitors to guide the particle geometry evolution during nanorod overgrowth. By deliberately maneuvering the competition between cuprous ions and cetyltrimethylammonium bromide, we have been able to create, in a highly controllable and selective manner, an entire family of nanorod-derived anisotropic multifaceted geometries whose surfaces are enclosed by specific types of well-defined high-index and low-index facets. This facet-controlled nanorod overgrowth approach also allows us to fine-tune the particle aspect ratios while well-preserving all the characteristic facets and geometric features of the faceted Au nanorods. Furthermore, taking full advantage of the combined structural and plasmonic tunability, we have further studied the facet-dependent heterogeneous catalysis on well-faceted Au nanorods using surface-enhanced Raman spectroscopy as an ultrasensitive spectroscopic tool with unique time-resolving and molecular finger-printing capabilities.« less

  8. Endurance of the ankle joint plantar flexor muscles in athletes with medial tibial stress syndrome: a case-control study.

    PubMed

    Madeley, Luke T; Munteanu, Shannon E; Bonanno, Daniel R

    2007-12-01

    Medial tibial stress syndrome (MTSS) is a common overuse leg injury seen in athletes and can be recalcitrant to management. This cross-sectional study aimed to determine if there are differences in the isotonic endurance of the ankle joint plantar flexor muscles in athletes with MTSS compared to athletes without MTSS. The isotonic endurance of the ankle joint plantar flexors was measured in 30 participants diagnosed with MTSS, and 30 reference participants that were matched to MTSS participants on the basis of age (+/-5 years), gender, BMI (+/-5%) and type of sporting activity. The number of heel-rise repetitions of the participants in each group was compared for differences. There were no significant differences between participants with and without MTSS for age (p=0.34), height (p=0.40) or BMI (p=0.27). The mean number of heel-rise repetitions performed by participants in the MTSS group was significantly less than the reference group (mean 23, S.D. 5.6, versus mean 33, S.D. 8.6; p<0.001). These results suggest that athletes with MTSS have endurance deficits of the ankle joint plantar flexor muscles. Rehabilitation of athletes with MTSS should comprise training designed to enhance endurance of the lower limb musculature, including the ankle joint plantar flexors. It is not known whether a lack of endurance of the ankle joint plantar flexor muscles is the cause or effect of MTSS.

  9. Two cases with HSS/DRESS syndrome developing after prosthetic joint surgery: does vancomycin-laden bone cement play a role in this syndrome?

    PubMed

    Güner, Müberra Devrim; Tuncbilek, Semra; Akan, Burak; Caliskan-Kartal, Aysun

    2015-05-28

    We report two cases of hypersensitivity syndrome/drug reaction with eosinophilia and systemic symptoms (HSS/DRESS) syndrome following systemic and local (via antibiotic laden bone cement (ALBC)) exposures to vancomycin. Both cases developed symptoms 2-4 weeks after the initiation of treatment. They responded to systemic corticosteroid treatment and were cured completely. Various drug groups may cause HSS/DRESS syndrome, and vancomycin-related cases do not exceed 2-5% of the reported cases. Almost all of these cases developed the syndrome following systemic exposure to vancomycin. ALBC seems to be the safer antibiotic administration method, as systemic antibiotic levels did not reach a toxic threshold level. However, local administration may not always be sufficient for bone-related/joint-related infections; these infections may require systemic antibiotics as well. As HSS/DRESS syndrome can mimic infectious diseases, it must be considered during differential diagnosis before suspecting failure of treatment and initiation of a different antibiotic course. 2015 BMJ Publishing Group Ltd.

  10. The effects of fatigue on lower extremity kinematics, kinetics and joint coupling in symptomatic female runners with iliotibial band syndrome.

    PubMed

    Brown, Allison M; Zifchock, Rebecca A; Hillstrom, Howard J; Song, Jinsup; Tucker, Carole A

    2016-11-01

    Altered hip and knee kinematics and joint coupling have been documented in runners with iliotibial band syndrome. Symptoms often present themselves after several minutes of running, yet the effect of fatigue warrants further exploration. The purpose of this study was to determine the effect of a run to fatigue in runners with iliotibial band syndrome, as compared to healthy controls. Twenty uninjured and 12 female runners with iliotibial band syndrome performed a treadmill run to fatigue. Prior-to and following a run to fatigue, overground running data were collected. Variables of interest included stance phase: peak hip adduction and internal rotation, peak hip abductor and external rotator joint moments and frontal-sagittal plane hip and knee joint coupling. Fatigue resulted in decreased peak hip adduction angles in injured runners. Fatigue did not affect injured runners differently than controls with respect to the remaining variables. Coupling differences did not exist between healthy and injured runners with respect to the loading or propulsive phases of stance. While clinicians often strengthen hip abductor muscles and provide gait re-training to decrease stance phase hip adduction, our results suggest that, when exerted, female runners with iliotibial band syndrome independently modify their running gait to decrease hip adduction, potentially as a result of pain. Fatigue did not have an effect on the remaining study variables. It is possible that reducing the length of the iliotibial band through minimizing hip adduction reduces pain, but the other variables examined are not sensitive to this phenomenon. Copyright © 2016 Elsevier Ltd. All rights reserved.

  11. Efficacy of an out-patient pain management programme for people with joint hypermobility syndrome.

    PubMed

    Rahman, Anisur; Daniel, Clare; Grahame, Rodney

    2014-11-01

    Joint hypermobility syndrome (JHS) is common in patients presenting to rheumatologists and can cause a range of symptoms leading to physical and psychological distress. Chronic musculoskeletal pain in patients with JHS often responds poorly to analgesics, and a pain management approach may be helpful. Since patients with JHS often have beliefs and experiences different to those of other chronic pain patients, they could fare better in JHS-specific programmes. Here, we report on the outcomes of patients in a JHS cognitive behavioural pain management programme. Patients fulfilling the Brighton criteria for JHS, who had suffered pain for at least 3 months, were assessed by a psychologist and physiotherapist for suitability for this programme. Those accepted took part in a programme of 8 days spread over 6 weeks, delivered by a multidisciplinary team and incorporating a cognitive behavioural approach. Outcomes were assessed at baseline, 1- and 5-month post-programme using validated outcome measures. Outcome measures at baseline and 1-month were available for 87 patients (96 % female, mean age 35 years). There were significant improvements in self-efficacy, pain catastrophising, depression, anxiety, frustration, impact of pain and average pain intensity (all P < 0.001). Although by 5 months all these outcomes had regressed towards pre-programme levels there remained significant improvements compared to baseline in all except average pain intensity. This open study shows that patients with JHS experienced significant benefits after attending a JHS-specific pain management programme, which were still evident 5 months later. Longer-term controlled studies are required.

  12. Management of Marfan Syndrome during pregnancy: A real world experience from a Joint Cardiac Obstetric Service.

    PubMed

    Lim, Joanna C E-S; Cauldwell, Matthew; Patel, Roshni R; Uebing, Anselm; Curry, Ruth A; Johnson, Mark R; Gatzoulis, Michael A; Swan, Lorna

    2017-09-15

    Pregnancy in Marfan Syndrome (MFS) is associated with increased maternal risk of cardiovascular events. Given the maternal and genetic risks, pre-conception counselling is essential to facilitate informed choices. Multidisciplinary antenatal care with regular imaging is mandatory and best delivered through a Joint Cardiac Obstetric Service (JCOS). The aim of this study was to compare the care delivered in a JCOS against recognised international standards (European Society of Cardiology (ESC)). Pregnancies in women with MFS from 2005 to 2015 were identified from our institutional database. Patient records were reviewed and practice assessed against pre-determined standards based on ESC guidelines. There were 23 pregnancies in 15 women with MFS. 13/23 (57%) occurred in women with aortic dilatation at baseline. There were 3 important maternal cardiac events (type A dissection; deterioration in left ventricular function; significant left ventricular and progressive aortic dilatation). Four women did not have access to expert pre-conception counselling. These women were all referred to the JCOS late in established pregnancy. Imaging was often delayed and only 7/23 cases (30%) met the standard for minimum frequency of echocardiographic surveillance. Only 12/23 (52%) had pre-conception imaging of the whole aorta with CT/MRI. Distal aortic dilatation was identified in 7/23 cases but none of these underwent further MRI evaluation during pregnancy. Despite having a dedicated JCOS, our data show that facilitating complete obstetric and cardiac care for this group remains challenging. Education of local care providers and timely referral for expert pre-conception counselling in a JCOS are key. Copyright © 2017 Elsevier B.V. All rights reserved.

  13. Targeted Radiofrequency Ablation as an Adjunct in Treatment of Lumbar Facet Cysts

    PubMed Central

    Granville, Michelle; Berti, Aldo; Jacobson, Robert E

    2017-01-01

    Lumbar facet cysts are frequently found in patients with facet degeneration and segmental instability. When the facet cyst is localized in the neural foramina and lateral recess or becomes large, it can cause radiculopathy or neurogenic claudication. These symptomatic cysts are typically treated interventionally with drainage and a corticosteroid injection or attempts via overinflation to rupture the cyst; however, these procedures have a significant recurrence rate (up to 50%) and often need to be repeated or lead to lumbar surgery if unsuccessful.   This is the first report of using targeted radiofrequency (RF) current as an adjunct to cyst drainage. Although RF has been used for years to treat facet pain indirectly by targeting the medial facet nerve branches, with this technique, under image guidance, the actual cyst is percutaneously drained and then cauterized along with the associated facet capsule, where the original cyst developed. This has improved overall results with less cyst recurrence than previous percutaneous methods and was documented with both intermediate and long-term followup clinically and with magnetic resonance imaging (MRI) scans. This report reviews the underlying anatomy and pathology of the facet joint relating to the development of facet cysts and how current percutaneous treatments for lumbar facet cysts can be supplemented and improved by adding targeted RF ablation to the percutaneous options available to treat a lumbar facet cyst. PMID:28690952

  14. SLAC Linac Preparations for FACET

    SciTech Connect

    Erickson, R.; Bentson, L.; Kharakh, D.; Owens, A.; Schuh, P.; Seeman, J.; Sheppard, J.C.; Stanek, M.; Wittmer, W.; Yocky, G.; Wienands, U.; /SLAC

    2011-02-07

    The SLAC 3km linear electron accelerator has been cut at the two-thirds point to provide beams to two independent programs. The last third provides the electron beam for the Linac Coherent Light Source (LCLS), leaving the first two-thirds available for FACET, the new experimental facility for accelerator science and test beams. In this paper, we describe this separation and projects to prepare the linac for the FACET experimental program.

  15. Continuum Modeling of Facet Evolution

    NASA Astrophysics Data System (ADS)

    Kandel, Daniel

    2000-03-01

    Standard continuum models of surface dynamics are very useful for studying thin film evolution on the micron length scale. Unfortunately, they are inadequate below the roughening transition, since they do not appropriately describe faceting. Our goal is to propose a continuum approach which deals with facet dynamics in a physically accurate way. We studied in detail the dynamics of faceting in simple submicron surface structures [1], and proposed two approaches for the development of continuum models. First, we rigorously derived continuum kinetic models of the systems of interest, starting from step flow models. These models break down at singular points, which we identify as facet edges. The models are not applicable on facets, and the surface profile is obtained as a solution of the continuum model with boundary conditions at the singular points. Secondly, we showed [2] that if the existence of both steps and anti-steps in regions of small surface slope is taken into account, it is possible to construct continuum models that are valid even on facets. The solutions of both types of continuum models are in excellent agreement with step flow models. The resulting surface profiles are of relevance to experiments on decay of one dimensional periodic gratings. Our work points to a possible general continuum model for an accurate description of kinetics of crystalline surfaces below the roughening transition. [1] N. Israeli and D. Kandel, Phys. Rev. Lett. 80, 3300 (1998); N. Israeli and D. Kandel, Phys. Rev. B 60, 5946 (1999). [2] N. Israeli and D. Kandel, preprint.

  16. 3D Morphometric Analysis of Normal Sacroiliac Joints: A New Classification of Surface Shape Variation and the Potential Implications in Pain Syndromes.

    PubMed

    Jesse, Mary Kristen; Kleck, Christopher; Williams, Adam; Petersen, Brian; Glueck, Deborah; Lind, Kimberly; Patel, Vikas

    2017-07-01

    Normal sacroiliac (SI) joints vary widely in shape, and it is unclear whether SI joint morphology plays a role in the development of pain. To answer this question, we used 3D-CT surface rendering to image healthy study participants and used the resulting images to develop a classification system for SI joint morphology. In a case-control study comparing health research participants to patients with SI pain, we assessed whether the classification of SI joint morphology was associated with pain. We aimed to define normal variation in area and shape of the synovialized SI joint. We also aimed to determine interactions between joint area and shape and SI pain in men and women. A retrospective cohort study. University hospital tertiary care center. We conducted a retrospective case-control study. We acquired 3D-CT surface rendered images of the SI joint in 223 normal controls and 34 patients with SI pain syndrome. We measured the sacral and iliac surface areas and performed morphologic 3D assessment of both articular surfaces. We classified SI joints into 3 types based on morphology (types one, 2, and 3). We used descriptive statistics to provide a reference standard for normal SI joints. We used multivariate models to assess whether articular surface area differed between study participants with and without SI pain. We also assessed the association between morphology type and the presence of pain. Sacral and iliac surface areas differ by participant gender. Sacral and iliac surface area was associated with SI joint pain in both men (P = 0.0007) and in women (P = 0.02). In women (P = 0.04), but not in men (P = 0.11), joint shape was associated with pain. A retrospective study may create potential for misclassification bias if SI joint symptoms/histories were present but not well-documented in the electronic medical record. A lack of clinical standardization in the pre-procedural assessment of SI joint pain via provocative maneuvers (FABER, etc.) is also a limitation

  17. Management of pain and fatigue in the joint hypermobility syndrome (a.k.a. Ehlers-Danlos syndrome, hypermobility type): principles and proposal for a multidisciplinary approach.

    PubMed

    Castori, Marco; Morlino, Silvia; Celletti, Claudia; Celli, Mauro; Morrone, Aldo; Colombi, Marina; Camerota, Filippo; Grammatico, Paola

    2012-08-01

    Joint hypermobility syndrome (JHS), or Ehlers-Danlos syndrome (EDS) hypermobility type (EDS-HT), is a underdiagnosed heritable connective tissue disorder characterized by generalized joint hypermobility and a wide range of visceral, pelvic, neurologic, and cognitive dysfunctions. Deterioration of quality of life is mainly associated with pain and fatigue. Except for the recognized effectiveness of physiotherapy for some musculoskeletal features, there are no standardized guidelines for the assessment and treatment of pain and fatigue. In this work, a practical classification of pain presentations and factors contributing in generating painful sensations in JHS/EDS-HT is proposed. Pain can be topographically classified in articular limb (acute/subacute and chronic), muscular limb (myofascial and fibromyalgia), neuropathic limb, back/neck, abdominal and pelvic pain, and headache. For selected forms of pain, specific predisposing characteristics are outlined. Fatigue appears as the result of multiple factors, including muscle weakness, respiratory insufficiency, unrefreshing sleep, dysautonomia, intestinal malabsorption, reactive depression/anxiety, and excessive use of analgesics. A set of lifestyle recommendations to instruct patients as well as specific investigations aimed at characterizing pain and fatigue are identified. Available treatment options are discussed in the set of a structured multidisciplinary approach based on reliable outcome tools.

  18. The effects of neuromuscular taping on gait walking strategy in a patient with joint hypermobility syndrome/Ehlers–Danlos syndrome hypermobility type

    PubMed Central

    Camerota, Filippo; Galli, Manuela; Celletti, Claudia; Ancillao, Andrea; Blow, David; Albertini, Giorgio

    2015-01-01

    Objective: In this case study, biomechanical alterations induced by neuromuscular taping (NMT) were quantified, during walking, in a patient with joint hypermobility syndrome/Ehlers–Danlos syndrome hypermobility type (JHS/EDS-HT). Methods: A female JHS/EDS-HT patient underwent NMT applications over the low back spine and bilaterally to the knee. Quantitative gait analyses were collected before the NMT application and at the end of the treatment (2 weeks after the first application of NMT). Results: At the end of treatment following the NMT application, left step length showed improvements in cadence and velocity, the left knee showed a reduction in its flexed position at initial contact, and the right ankle joint improved its position at initial contact and in the swing phase. Improvements were also found in kinetics, in terms of the ankle moment and power. Conclusions: Results show that NMT seems to be a promising low-cost intervention for improving gait strategy in patients with JHS/EDS-HT. Further investigations are needed to assess the effects of this treatment intervention on pathological symptoms. PMID:25649985

  19. L5 – S1 Segmental Kinematics After Facet Arthroplasty

    PubMed Central

    Voronov, Leonard I.; Havey, Robert M.; Rosler, David M.; Sjovold, Simon G.; Rogers, Susan L.; Carandang, Gerard; Ochoa, Jorge A.; Yuan, Hansen; Webb, Scott

    2009-01-01

    Background Facet arthroplasty is a motion restoring procedure. It is normally suggested as an alternative to rigid fixation after destabilizing decompression procedures in the posterior lumbar spine. While previous studies have reported successful results in reproducing normal spine kinematics after facet replacement at L4-5 and L3-4, there are no data on the viability of facet replacement at the lumbosacral joint. The anatomy of posterior elements and the resulting kinematics at L5-S1 are distinctly different from those at superior levels, making the task of facet replacement at the lumbosacral level challenging. This study evaluated the kinematics of facet replacement at L5-S1. Methods Six human cadaveric lumbar spines (L1-S1, 46.7 ± 13.0 years) were tested in the following sequence: (1) intact (L1-S1), (2) complete laminectomy and bilateral facetectomy at L5-S1, and (3) implantation of TFAS-LS (Lumbosacral Total Facet Arthroplasty System, Archus Orthopedics, Redmond, Washington) at L5-S1 using pedicle screws. Specimens were tested in flexion (8Nm), extension (6Nm), lateral bending (LB, ± 6Nm), and axial rotation (AR, ± 5Nm). The level of significance was α = .017 after Bonferroni correction for three comparisons: (1) intact vs. destabilized, (2) destabilized vs. reconstructed, and (3) intact vs. reconstructed. Results Laminectomy-facetectomy at L5-S1 increased the L5-S1 angular range of motion (ROM) in all directions. Flexion-extension (F-E) ROM increased from 15.3 ± 2.9 to 18.7 ± 3.5 degrees (P < .017), LB from 8.2 ± 1.8 to 9.3 ± 1.6 degrees (P < .017), and AR from 3.7 ± 2.0 to 5.9 ± 1.8 degrees (P < .017). The facet arthroplasty system decreased ROM compared to the laminectomy-facetectomy condition in all tested directions (P < .017). The facet arthroplasty system restored the L5-S1 ROM to its intact levels in LB and AR (P > .017). F-E ROM after the facet arthroplasty system implantation was smaller than the intact value (10.1 ± 2.2 vs. 15.3 ± 2

  20. Joint position sense and vibratory perception sense in patients with Ehlers-Danlos syndrome type III (hypermobility type).

    PubMed

    Rombaut, Lies; De Paepe, Anne; Malfait, Fransiska; Cools, Ann; Calders, Patrick

    2010-03-01

    Neurophysiological deficits could make patients with Ehlers-Danlos syndrome (EDS) type III (hypermobility type) more vulnerable to musculoskeletal problems, particularly to joint instability. The purpose of this study was to investigate whether joint position sense (JPS) and vibratory perception sense (VPS) in EDS type III patients in the knee and shoulder joints are impaired. Thirty-two female EDS type III patients as defined by the Villefranche criteria and 32 individually gender- and age-matched healthy control subjects were included in the study. Range of motion was determined using a goniometer, passive and active JPS were assessed with an isokinetic dynamometer system, and the VPS was measured by a biothesiometer. Daily physical activity was evaluated by the Baecke questionnaire. The EDS type III group showed significantly larger ranges of movement (P < 0.05) and lower levels of sport physical activity (SPA) compared to the control group (P = 0.023). Considering SPA as covariate, the EDS type III group demonstrated a significant impairment in knee joint reposition compared to the control group (P = 0.018). No significant differences were found for shoulder JPS. The VPS was not significantly different in the EDS type III group compared to the control group. In addition, no significant correlation was found between JPS and VPS, neither at the knee nor at the shoulder joint. This is the first study examining proprioception deficits in EDS type III patients as defined by the Villefranche criteria. Further research on the neurophysiological dysfunctions and mechanisms in this pathologic entity is needed.

  1. Minimally invasive facet restoration implant for chronic lumbar zygapophysial pain: 1-year outcomes

    PubMed Central

    2014-01-01

    Background The zygapophysial (facet) joint is the primary pain generator in one third of chronic low back pain cases. Current treatment options include temporarily palliative nonsurgical approaches, facet injections, radiofrequency denervation, and, rarely, lumbar arthrodesis. The purpose of this study was to assess the safety and effectiveness of a minimally invasive implant intended to restore facet joint function in patients with chronic lumbar facetogenic pain. Methods This prospective, multi-center feasibility study enrolled patients with confirmed lumbar facetogenic joint pain at 1 or 2 levels who underwent at least 6 months of unsuccessful nonoperative care. Patients received a minimally invasive implant (Glyder® Facet Restoration Device, Zyga Technology, Inc., Minnetonka, MN) intended to restore facet joint function while preserving the native anatomy. Main outcomes included back pain severity using a visual analogue scale, back-specific disability using the Oswestry Disability Index (ODI), and adverse events adjudicated by an independent Clinical Events Committee. Results Of 40 enrolled patients, 37 patients received the facet restoration implant and 34 patients had complete 1-year follow-up data available. Over the 1-year follow-up period, back pain severity decreased 41% and ODI decreased 34%, on average. Freedom from a device- or procedure-related serious adverse event through 1 year was 84%. Implant migration was observed in 3 patients and implant expulsion from the facet joint occurred in 3 patients. In total, 2 (5.4%) patients underwent implant removal through 1 year post-treatment. Conclusions A minimally invasive facet restoration implant is a promising treatment option in select patients with chronic lumbar zygapophysial pain who have exhausted nonsurgical treatments, with therapeutic benefit persisting at 1 year follow-up. PMID:26628910

  2. Pre- and post-operative comorbidities in idiopathic carpal tunnel syndrome: cervical arthritis, basal joint arthritis of the thumb, and trigger digit.

    PubMed

    Kim, J H; Gong, H S; Lee, H J; Lee, Y H; Rhee, S H; Baek, G H

    2013-01-01

    We retrospectively reviewed 633 hands in 362 patients who had idiopathic carpal tunnel syndrome and underwent carpal tunnel release between 1999 and 2009. Electrophysiological studies and simple radiographs of the wrist, cervical spine, and basal joint of the thumb were routinely checked, and patients were also assessed for the presence of trigger digit or de Quervain's disease before and after surgery. Among 362 patients, cervical arthritis was found in 253 patients (70%), and C5-C6 arthritis was the most common site. Basal joint arthritis of the thumb was observed in 216 (34%) of the 633 hands. Trigger digit or de Quervain's disease was observed in 85 of the 633 hands (13%) before surgery, and developed in 67 hands (11%) after surgery. Cervical arthritis, basal joint arthritis, and trigger digit commonly coexist with idiopathic carpal tunnel syndrome. Patient education about these disorders is very important when they coexist with idiopathic carpal tunnel syndrome.

  3. [The role of therapeutic exercises in the combined treatment and rehabilitation of patients with pain syndrome associated with the dysfunction of temporomandibular joint].

    PubMed

    Silant'eva, E N

    2010-01-01

    In a group of patients with pain syndrome associated with the dysfunction of temporomandibular joint positive results of combined therapy and rehabilitative treatment including remedial gymnastics persisted significantly longer than in controls (p < 0.01). Results of long-term follow-up confirmed the desirability of rehabilitation based on therapeutic exercises. This approach permits to enhance the effectiveness of therapy and rehabilitation of patients with pain syndrome associated with the dysfunction of temporomandibular joint, reduce the number of the patients' visits for repeated treatment and its total duration during a year.

  4. A geometric approach to study the contact mechanisms in the patellofemoral joint of normal versus patellofemoral pain syndrome subjects.

    PubMed

    Islam, Kamrul; Duke, Kajsa; Mustafy, Tanvir; Adeeb, Samer M; Ronsky, Janet L; El-Rich, Marwan

    2015-01-01

    The biomechanics of the patellofemoral (PF) joint is complex in nature, and the aetiology of such manifestations of PF instability as patellofemoral pain syndrome (PFPS) is still unclear. At this point, the particular factors affecting PFPS have not yet been determined. This study has two objectives: (1) The first is to develop an alternative geometric method using a three-dimensional (3D) registration technique and linear mapping to investigate the PF joint contact stress using an indirect measure: the depth of virtual penetration (PD) of the patellar cartilage surface into the femoral cartilage surface. (2) The second is to develop 3D PF joint models using the finite element analysis (FEA) to quantify in vivo cartilage contact stress and to compare the peak contact stress location obtained from the FE models with the location of the maximum PD. Magnetic resonance images of healthy and PFPS subjects at knee flexion angles of 15°, 30° and 45° during isometric loading have been used to develop the geometric models. The results obtained from both approaches demonstrated that the subjects with PFPS show higher PD and contact stresses than the normal subjects. Maximum stress and PD increase with flexion angle, and occur on the lateral side in healthy and on the medial side in PFPS subjects. It has been concluded that the alternative geometric method is reliable in addition to being computationally efficient compared with FEA, and has the potential to assess the mechanics of PFPS with an accuracy similar to the FEA.

  5. Median nerve T2 assessment in the wrist joints: preliminary study in patients with carpal tunnel syndrome and healthy volunteers.

    PubMed

    Cha, Jang Gyu; Han, Jong Kyu; Im, Soo Bin; Kang, Sung Jin

    2014-10-01

    To perform a prospective quantitative analysis of median nerve T2 values and cross-sectional area (CSA) in patients with carpal tunnel syndrome (CTS) as compared to asymptomatic volunteers. Twelve CTS patients with positive nerve conduction results and 12 healthy volunteers (controls) were enrolled and underwent axial T2 mapping of the wrist joints. Median nerve T2 values and CSAs at the distal radioulnar joint, pisiform, and hook of hamate levels were compared between the groups. The T2 values at the proximal and distal carpal tunnel were higher in the CTS patients than in the controls (P < 0.05). The T2 values at the distal radioulnar joint did not differ between the groups (P = 0.99). The CSAs of the median nerve at all levels of the carpal tunnel were significantly larger in the CTS patients than in the controls (P < 0.05). In conclusion, our study demonstrated that median nerve T2 assessment is feasible and that T2 assessment may offer functional information about the median nerve in the carpal tunnel and has the potential to be a promising complementary method for evaluation of CTS patients. A future study with larger sample sizes is necessary to investigate the potential effect of median nerve T2 assessment to a reliable tool in the diagnosis of CTS. © 2013 Wiley Periodicals, Inc.

  6. A new autosomal recessive syndrome of characteristic facies, joint contractures, skeletal abnormalities, and normal development: second report with further clinical delineation

    PubMed Central

    Gupta, Ajay; Hall, Christine M; Ransley, Yvonne F; Murday, Victoria A

    1995-01-01

    We describe a girl of Pakistani origin, born to consanguineous parents, with a multiple congenital anomaly (MCA) syndrome. This is the second report confirming an apparently new autosomal recessive syndrome reported earlier by van den Ende et al in 1992. The hallmarks of this MCA syndrome include characteristic facies with blepharophimosis, narrow, beaked nose, hypoplastic maxilla with or without cleft palate and everted lower lip, arachnodactyly, self-limiting congenital joint contractures, peculiar skeletal abnormalities, and normal growth and development. Further clinical and radiological delineation of the syndrome in this report suggests that the term “Marden-Walker-like syndrome without psychomotor retardation”, used in the first report to describe this condition, does not accurately reflect its clinical picture. The overall prognosis in this syndrome seems good. Images PMID:8558561

  7. Plasma Wakefield Experiments at FACET

    SciTech Connect

    Hogan, M.J.; England, R.J.; Frederico, J.; Hast, C.; Li, S.Z.; Litos, M.; Walz, D.; An, W.; Clayton, C.E.; Joshi, C.; Lu, W.; Marsh, K.A.; Mori, W.; Tochitsky, S.; Muggli, P.; Pinkerton, S.; Shi, Y.; /Southern California U.

    2011-08-19

    FACET, the Facility for Advanced Accelerator and Experimental Tests, is a new facility being constructed in sector 20 of the SLAC linac primarily to study beam driven plasma wakefield acceleration beginning in summer 2011. The nominal FACET parameters are 23GeV, 3nC electron bunches compressed to {approx}20{micro}m long and focused to {approx}10{micro}m wide. The intense fields of the FACET bunches will be used to field ionize neutral lithium or cesium vapor produced in a heat pipe oven. Previous experiments at the SLAC FFTB facility demonstrated 50GeV/m gradients in an 85cm field ionized lithium plasma where the interaction distance was limited by head erosion. Simulations indicate the lower ionization potential of cesium will decrease the rate of head erosion and increase single stage performance. The initial experimental program will compare the performance of lithium and cesium plasma sources with single and double bunches. Later experiments will investigate improved performance with a pre-ionized cesium plasma. The status of the experiments and expected performance are reviewed. The FACET Facility is being constructed in sector 20 of the SLAC linac primarily to study beam driven plasma wakefield acceleration. The facility will begin commissioning in summer 2011 and conduct an experimental program over the coming five years to study electron and positron beam driven plasma acceleration with strong wake loading in the non-linear regime. The FACET experiments aim to demonstrate high-gradient acceleration of electron and positron beams with high efficiency and negligible emittance growth.

  8. Shoulder function, pain and health related quality of life in adults with joint hypermobility syndrome/Ehlers-Danlos syndrome-hypermobility type.

    PubMed

    Johannessen, Elise Christine; Reiten, Helle Sundnes; Løvaas, Helene; Maeland, Silje; Juul-Kristensen, Birgit

    2016-07-01

    Purpose To investigate shoulder function, pain and Health-Related Quality of life (HRQoL) among adults with joint hypermobility syndrome/Ehlers-Danlos syndrome-hypermobility type (JHS/EDS-HT), compared with the general population (controls). Method In a cross-sectional study using postal survey, 110 patients diagnosed with JHS/EDS-HT and 140 gender- and age-matched healthy controls from Statistics Norway participated. Shoulder function, pain and HRQol were registered by Western Ontario Shoulder Instability Index (WOSI), Numerical Rating Scale (NRS), pain drawings, 36-item Short Form (SF-36). Results Eighty-one individuals responded, with response rate 34% (JHS/EDS-HT: 53%, controls: 21%). JHS/EDS-HT had lower shoulder function (WOSI total: 49.9 versus 83.3; p < 0.001), lower HRQol on SF-36 Physical Component Scale (PCS: 28.1 versus 49.9; p < 0.001), and higher pain intensity (NRS: 6.4 versus 2.7; p < 0.001) than controls. Neck and shoulder joints were rated as primary painful areas in both groups, with significantly higher frequency in JHS/EDS-HT (neck: 90% versus 27%; shoulder: 80% versus 37%). Further, JHS/EDS-HT most often reported generalized pain (96%). Conclusions Adults with JHS/EDS-HT have impaired shoulder function, increased pain intensity, as well as reduced physical HRQoL compared with controls. Although neck and shoulder were most frequently rated as painful, significantly more JHS/EDS-HT also reported generalized pain compared to controls. Implications for Rehabilitation Adults with JHS/EDS-HT have impaired shoulder function, and most often painful areas in the neck and shoulder joints, which need to be targeted in the treatment strategy. Compared with the general population adults with JHS/EDS-HT have reduced physical HRQoL, supporting a physical approach for this group. Adults with JHS/EDS-HT may present with both specific painful joints and generalized pain.

  9. Facet orientation and tropism: Associations with asymmetric lumbar paraspinal and psoas muscle parameters in patients with chronic low back pain.

    PubMed

    Xu, W B; Chen, S; Fan, S W; Zhao, F D; Yu, X J; Hu, Z J

    2016-08-10

    Many studies have explored the relationship between facet tropism and facet joint osteoarthritis, disc degeneration and degenerative spondylolisthesis. However, the associations between facet orientation and tropism, and paraspinal muscles have not been studied. To analyze the associations between facet orientation and tropism, and parameters of paraspinal muscles in patients with chronic low back pain. Ninety-five patients with chronic low back pain were consecutively enrolled. Their facet joint angles were measured on computed tomography (CT) while gross cross-sectional area (GCSA), functional cross-sectional area (FCSA) and T2 signal intensity of lumbar paraspinal and psoas muscle were evaluated on magnetic resonance imaging (MRI). The GCSA and FCSA were significantly smaller for multifidus muscle (P< 0.001), but significantly larger for erector spinae and psoas muscles (P< 0.001), in coronally-orientated group than those in sagittally-orientated group. The differences of bilateral GCSA and FCSA of multifidus muscle were significantly larger in facet tropism group than those in no facet tropism group (P= 0.009 and P= 0.019). Muscular asymmetries may develop in the lumbar region of the spine, which are associated with facet asymmetry in patients with chronic low back pain. Longitudinal studies are needed to understand the causal relationship between facet orientation and tropism and muscular asymmetry in future.

  10. Multiorgan dysfunction syndrome secondary to joint supplement overdosage in a dog

    PubMed Central

    Nobles, Irma J.; Khan, Safdar

    2015-01-01

    A 5-year-old spayed female Bernese mountain dog, with a chief complaint of vomiting and melena ingested approximately 200 nutritional joint supplement tablets. Despite aggressive therapy, the patient developed a coagulopathy, pancreatitis, peritonitis, acute kidney injury, and was euthanized. Postmortem examination revealed myocardial necrosis, pneumonia, centrilobular hemorrhage and necrosis of the liver, vasculitis, and acute tubular necrosis. PMID:25829554

  11. Long QT, syndactyly, joint contractures, stroke and novel CACNA1C mutation: expanding the spectrum of Timothy syndrome.

    PubMed

    Gillis, Jane; Burashnikov, Elena; Antzelevitch, Charles; Blaser, Susan; Gross, Gil; Turner, Lesley; Babul-Hirji, Riyana; Chitayat, David

    2012-01-01

    Timothy syndrome (TS) is an autosomal dominant condition with the constellation of features including prolonged QT interval, hand and foot abnormalities, and mental retardation or autism. Splawski et al. [2004] previously described two phenotypes associated with TS distinguished by two unique and different mutations within the CACNA1C gene. We report on a newborn who presented with prolonged QT interval and associated polymorphic ventricular tachycardia, dysmorphic facial features, syndactyly of the hands and feet, and joint contractures, suggestive of TS. He developed a stroke, subsequent intractable seizures, and was found to have cortical blindness and later profound developmental delay. Initial targeted mutation analysis did not identify either of the previously described TS associated mutations; however, full gene sequencing detected a novel CACNA1C gene mutation (p.Ala1473Gly). The clinical and genetic findings in our case expand both the clinical and molecular knowledge of TS.

  12. Gynecologic and obstetric implications of the joint hypermobility syndrome (a.k.a. Ehlers-Danlos syndrome hypermobility type) in 82 Italian patients.

    PubMed

    Castori, Marco; Morlino, Silvia; Dordoni, Chiara; Celletti, Claudia; Camerota, Filippo; Ritelli, Marco; Morrone, Aldo; Venturini, Marina; Grammatico, Paola; Colombi, Marina

    2012-09-01

    Joint hypermobility syndrome (JHS) emerges as likely the most common clinical form of Ehlers-Danlos syndrome. Given the striking predominance of affected women, practitioners often face gynecologic and obstetric issues. However, their decisions are still based on personal experience rather than literature due to the lack of a consistent body of evidence. We collected a set of gynecologic and obstetric features in 82 post-puberal women with JHS attending two Italian centers. Common gynecologic findings were dysmenorrhea (82.9%), meno/metrorrhagias (53.7%), irregular menses (46.3%), and dispareunia/vulvodinia (31.7%). Forty women were nulliparous and 42 had one or more pregnancy for a total of 93 diagnosed conceptions. Of them, 16.1% were spontaneous abortions, 6.5% voluntary interruptions, 10.7% preterm deliveries, and 66.7% deliveries at term. Overall outcome of proceeding pregnancies was good with no stillbirth and fetal/neonatal hypoxic/ischemic event. Non-operative vaginal delivery was registered in 72.2%, forceps/vacuum use in 5.5% and cesarean in 22.3%. Local/total anesthesia was successfully performed in 17 pregnancies without any problem. Major post-partum complications included abnormal scar formation after cesarean or episiotomy (46.1%), hemorrhage (19.4%), pelvic prolapses (15.3%), deep venous thrombosis (4.2%), and coccyx dislocation (1.4%). Prolapses were the most clinically relevant complication and associated with episiotomy. Gathered data were discussed for practically oriented considerations.

  13. Morphological Stability of Faceted Interfaces

    NASA Technical Reports Server (NTRS)

    Abbaschian, Reza; Golyshev, V. D.; Gonik, M.; Tsvetivsky, V.; deVahlDavis, G.; Leonardi, E.

    2001-01-01

    The major focus of this investigation is to study the fundamentals of layer spreading mechanisms during growth of doped Ge (a facet forming material), and to determine the conditions for morphological instability of vicinal solid-liquid interfaces. The investigation will also lead to the determination of the effect of dopants on the layer growth kinetics, step free energy, and dopant capture by the advancing ledges. The theoretical treatment of growth of faceted interfaces indicates that the kinetics of a step on a growing vicinal interface considerably depends on its angle of inclination, the melt concentration, and characteristics of flow currents in the melt. The morphological stability of the interface also depends on these parameters, as well as on the density and spreading velocity of the steps. However, the treatment of the instability of the interface by the layer growth mechanism is rather difficult because it requires exact knowledge of the thermal and solutal fields, hydrodynamics of the melt, and supercooling at the interface. The results of recent space experiments of the principal investigator involving directional solidification of faceted Bi-Sn alloys have shown that the morphological stability of various crystallographic orientations is significantly affected by the anistropy in interfacial properties of the faceted alloy in general, and the interface kinetics in particular. These findings have also raised many important and fundamental questions, particularly with respect to the behavior of interfacial steps, which need to be addressed via additional groundbased and microgravity experiments. For the present investigation we will use a novel crystal growth technique which provides axial heat flux close to the solid-liquid boundary. The Axial Heat Processing (AHP) technique allows for precise control and determination of the heat and mass transfer close to the crystallization front, and the establishment of a planar interface over the entire cross

  14. Morphological Stability of Faceted Interfaces

    NASA Technical Reports Server (NTRS)

    Abbaschian, Reza; Golyshev, V. D.; Gonik, M.; Tsvetivsky, V.; deVahlDavis, G.; Leonardi, E.

    2001-01-01

    The major focus of this investigation is to study the fundamentals of layer spreading mechanisms during growth of doped Ge (a facet forming material), and to determine the conditions for morphological instability of vicinal solid-liquid interfaces. The investigation will also lead to the determination of the effect of dopants on the layer growth kinetics, step free energy, and dopant capture by the advancing ledges. The theoretical treatment of growth of faceted interfaces indicates that the kinetics of a step on a growing vicinal interface considerably depends on its angle of inclination, the melt concentration, and characteristics of flow currents in the melt. The morphological stability of the interface also depends on these parameters, as well as on the density and spreading velocity of the steps. However, the treatment of the instability of the interface by the layer growth mechanism is rather difficult because it requires exact knowledge of the thermal and solutal fields, hydrodynamics of the melt, and supercooling at the interface. The results of recent space experiments of the principal investigator involving directional solidification of faceted Bi-Sn alloys have shown that the morphological stability of various crystallographic orientations is significantly affected by the anistropy in interfacial properties of the faceted alloy in general, and the interface kinetics in particular. These findings have also raised many important and fundamental questions, particularly with respect to the behavior of interfacial steps, which need to be addressed via additional groundbased and microgravity experiments. For the present investigation we will use a novel crystal growth technique which provides axial heat flux close to the solid-liquid boundary. The Axial Heat Processing (AHP) technique allows for precise control and determination of the heat and mass transfer close to the crystallization front, and the establishment of a planar interface over the entire cross

  15. Design of a lattice-based faceted classification system

    NASA Technical Reports Server (NTRS)

    Eichmann, David A.; Atkins, John

    1992-01-01

    We describe a software reuse architecture supporting component retrieval by facet classes. The facets are organized into a lattice of facet sets and facet n-tuples. The query mechanism supports precise retrieval and flexible browsing.

  16. The effect of patellar taping on joint reaction forces during squatting in subjects with Patellofemoral Pain Syndrome (PFPS).

    PubMed

    Mostamand, Javid; Bader, Dan L; Hudson, Zoë

    2010-10-01

    The mechanisms of pain reduction have not completely been established following patellar taping in subjects with patellofemoral pain syndrome (PFPS); although it might be related to alteration in the kinetics of the patellofemoral joint. Patellofemoral Joint Reaction Force (PFJRF) of eighteen subjects with PFPS and eighteen healthy subjects as controls were assessed by a motion-analysis system and one force plate. This procedure was performed on the affected knee of subjects with PFPS, before, during and finally after patellar taping during unilateral squatting. A similar procedure was also performed on the unaffected knees of both groups. The mean values of PFJRF prior to taping (2025N, SD 347N) were decreased significantly following a period of taping (1720N, SD 303N) (P<0.05). There were no significant differences between the mean values of PFJRF among controls (1922N, SD 398N) and subjects with PFPS prior to taping (P>0.05) which might be due to small sample size in both groups and large variability observed in the study. Decreased values of PFJRF may explain the mechanism of pain reduction following patellar taping in subjects with PFPS. Copyright © 2009 Elsevier Ltd. All rights reserved.

  17. A novel FGD1 mutation in a family with Aarskog–Scott syndrome and predominant features of congenital joint contractures

    PubMed Central

    Griffin, Laurie Beth; Farley, Frances A.; Antonellis, Anthony; Keegan, Catherine E.

    2016-01-01

    Mutations in FGD1 cause Aarskog–Scott syndrome (AAS), an X-linked condition characterized by abnormal facial, skeletal, and genital development due to abnormal embryonic morphogenesis and skeletal formation. Here we report a novel FGD1 mutation in a family with atypical features of AAS, specifically bilateral upper and lower limb congenital joint contractures and cardiac abnormalities. The male proband and his affected maternal uncle are hemizygous for the novel FGD1 mutation p.Arg921X. This variant is the most carboxy-terminal FGD1 mutation identified in a family with AAS and is predicted to truncate the FGD1 protein at the second to last amino acid of the carboxy-terminal pleckstrin homology (PH) domain. Our study emphasizes the importance of the 3′ peptide sequence in the structure and/or function of the FGD1 protein and further demonstrates the need to screen patients with X-linked congenital joint contractures for FGD1 mutations. PMID:27551683

  18. Physiotherapy management of joint hypermobility syndrome--a focus group study of patient and health professional perspectives.

    PubMed

    Palmer, S; Terry, R; Rimes, K A; Clark, C; Simmonds, J; Horwood, J

    2016-03-01

    To develop an understanding of patient and health professional views and experiences of physiotherapy to manage joint hypermobility syndrome (JHS). An explorative qualitative design. Seven focus groups were convened, audio recorded, fully transcribed and analysed using a constant comparative method to inductively derive a thematic account of the data. Four geographical areas of the U.K. 25 people with JHS and 16 health professionals (14 physiotherapists and two podiatrists). Both patients and health professionals recognised the chronic heterogeneous nature of JHS and reported a lack of awareness of the condition amongst health professionals, patients and wider society. Diagnosis and subsequent referral to physiotherapy services for JHS was often difficult and convoluted. Referral was often for acute single joint injury, failing to recognise the long-term multi-joint nature of the condition. Health professionals and patients felt that if left undiagnosed, JHS was more difficult to treat because of its chronic nature. When JHS was treated by health professionals with knowledge of the condition patients reported satisfactory outcomes. There was considerable agreement between health professionals and patients regarding an 'ideal' physiotherapy service. Education was reported as an overarching requirement for patients and health care professionals. Physiotherapy should be applied holistically to manage JHS as a long-term condition and should address injury prevention and symptom amelioration rather than cure. Education for health professionals and patients is needed to optimise physiotherapy provision. Further research is required to explore the specific therapeutic actions of physiotherapy for managing JHS. Copyright © 2015 Chartered Society of Physiotherapy. Published by Elsevier Ltd. All rights reserved.

  19. Compartment Syndrome Following Arthroscopic Removal of a Bullet in the Knee Joint after a Low-Velocity Gunshot Injury.

    PubMed

    Keskinbora, Mert; Yalçin, Sercan; Oltulu, İsmail; Erdil, Mehmet Emin; Örmeci, Tuğrul

    2016-03-01

    Gunshot injuries are getting more frequently reported while the civilian (nongovernmental) armament increases in the world. A 42-year-old male patient presented to emergency room of Istanbul Medipol University Hospital due to a low-velocity gunshot injury. We detected one entry point on the posterior aspect of the thigh, just superior to the popliteal groove. No exit wound was detected on his physical examination. There was swelling around the knee and range of motion was limited due to pain and swelling. Neurological and vascular examinations were intact. Following the initial assessment, the vascular examination was confirmed by doppler ultrasonography of the related extremity. There were no signs of compartment syndrome in the preoperative physical examination. A bullet was detected in the knee joint on the initial X-rays. Immediately after releasing the tourniquet, swelling of the anterolateral compartment of the leg and pulse deficiency was detected on foot in the dorsalis pedis artery. Although the arthroscopic removal of intra-articular bullets following gunshot injuries seems to have low morbidity rates, it should always be considered that the articular capsule may have been ruptured and the fluids used during the operation may leak into surrounding tissues and result in compartment syndrome.

  20. Compartment Syndrome Following Arthroscopic Removal of a Bullet in the Knee Joint after a Low-Velocity Gunshot Injury

    PubMed Central

    Yalçin, Sercan; Oltulu, İsmail; Erdil, Mehmet Emin; Örmeci, Tuğrul

    2016-01-01

    Gunshot injuries are getting more frequently reported while the civilian (nongovernmental) armament increases in the world. A 42-year-old male patient presented to emergency room of Istanbul Medipol University Hospital due to a low-velocity gunshot injury. We detected one entry point on the posterior aspect of the thigh, just superior to the popliteal groove. No exit wound was detected on his physical examination. There was swelling around the knee and range of motion was limited due to pain and swelling. Neurological and vascular examinations were intact. Following the initial assessment, the vascular examination was confirmed by doppler ultrasonography of the related extremity. There were no signs of compartment syndrome in the preoperative physical examination. A bullet was detected in the knee joint on the initial X-rays. Immediately after releasing the tourniquet, swelling of the anterolateral compartment of the leg and pulse deficiency was detected on foot in the dorsalis pedis artery. Although the arthroscopic removal of intra-articular bullets following gunshot injuries seems to have low morbidity rates, it should always be considered that the articular capsule may have been ruptured and the fluids used during the operation may leak into surrounding tissues and result in compartment syndrome. PMID:26929809

  1. Can extra-articular strains be used to measure facet contact forces in the lumbar spine? An in-vitro biomechanical study.

    PubMed

    Zhu, Q A; Park, Y B; Sjovold, S G; Niosi, C A; Wilson, D C; Cripton, P A; Oxland, T R

    2008-02-01

    Experimental measurement of the load-bearing patterns of the facet joints in the lumbar spine remains a challenge, thereby limiting the assessment of facet joint function under various surgical conditions and the validation of computational models. The extra-articular strain (EAS) technique, a non-invasive measurement of the contact load, has been used for unilateral facet joints but does not incorporate strain coupling, i.e. ipsilateral EASs due to forces on the contralateral facet joint. The objectives of the present study were to establish a bilateral model for facet contact force measurement using the EAS technique and to determine its effectiveness in measuring these facet joint contact forces during three-dimensional flexibility tests in the lumbar spine. Specific goals were to assess the accuracy and repeatability of the technique and to assess the effect of soft-tissue artefacts. In the accuracy and repeatability tests, ten uniaxial strain gauges were bonded to the external surface of the inferior facets of L3 of ten fresh lumbar spine specimens. Two pressure-sensitive sensors (Tekscan) were inserted into the joints after the capsules were cut. Facet contact forces were measured with the EAS and Tekscan techniques for each specimen in flexion, extension, axial rotation, and lateral bending under a +/- 7.5 N m pure moment. Four of the ten specimens were tested five times in axial rotation and extension for repeatability. These same specimens were disarticulated and known forces were applied across the facet joint using a manual probe (direct accuracy) and a materials-testing system (disarticulated accuracy). In soft-tissue artefact tests, a separate set of six lumbar spine specimens was used to document the virtual facet joint contact forces during a flexibility test following removal of the superior facet processes. Linear strain coupling was observed in all specimens. The average peak facet joint contact forces during flexibility testing was greatest in

  2. [The role of computed tomography and magnetic resonance in assessing degenerative arthropathy of the lumbar articular facets].

    PubMed

    Leone, A; Aulisa, L; Tamburrelli, F; Lupparelli, S; Tartaglione, T

    1994-11-01

    Degenerative arthropathy of the lumbar facet joints remains a debated issue relative to both its etiopathogenesis and its clinical significance. The authors studied 9 autoptic specimens by means of CT and MRI: the diagnostic value of the two methods was assessed taking the histopathologic findings of the relative specimens as the gold standard. The following signs of degenerative arthropathy were investigated in each specimen: cartilaginous wears, hypertrophy of the articular processes, osteophytosis, subchondral sclerosis and geodes and capsular and ligamentous calcifications. CT clearly demonstrated the characteristic signs of arthropathy, although failing to assess the cartilaginous wears in the early degeneration phases. Cartilaginous surface tears were directly depicted by MRI in the specimens showing medium and advanced degeneration. In our opinion, CT represents the examination of choice in the diagnosis of degenerative arthropathy of the lumbar apophyseal joints. Nevertheless, human trials are needed to assess MR capabilities in better detailing subchondral bone structure and in depicting the joint capsule and the synovial membrane and fluid as a major MR potential to diagnose back pain syndromes arising from the posterior arch.

  3. Intra-articular Fibroma of Tendon Sheath in Knee Joint Associated with Iliotibial Band Friction Syndrome: Rare Occurrence in a Teenage Girl

    PubMed Central

    Rathore, Sameer; Quadri, Vasil; Tapadia, Sanjay; Krishnaiah, K; Krishna, V P Nithin

    2017-01-01

    Introduction: Iliotibial band (ITB) friction syndrome is a common overuse injury typically seen in active athlete population. A nodular lesion on the inner side of the ITB as an etiology or an accompanying lesion with friction syndrome has rarely been reported. Among such nodular lesions around knee, fibroma of tendon sheath (FTS) is a rare occurrence. All the more intra-articular occurrence is extremely rare. Case Report: A 16-year-old female presented with recurrent pain and movable nodule at the lateral joint area, diagnosed as ITB friction syndrome. The nodule was confirmed as rare intra-articular FTS on the basis of histopathology findings. Conclusion: When nodular lesions around knee are detected on magnetic resonance imaging, a FTS could be included in the differential diagnosis. Etiology and pathogenesis of ITB friction syndrome should be revised in view of such rare presentations. PMID:28630835

  4. Intra-articular Fibroma of Tendon Sheath in Knee Joint Associated with Iliotibial Band Friction Syndrome: Rare Occurrence in a Teenage Girl.

    PubMed

    Rathore, Sameer; Quadri, Vasil; Tapadia, Sanjay; Krishnaiah, K; Krishna, V P Nithin

    2017-01-01

    Iliotibial band (ITB) friction syndrome is a common overuse injury typically seen in active athlete population. A nodular lesion on the inner side of the ITB as an etiology or an accompanying lesion with friction syndrome has rarely been reported. Among such nodular lesions around knee, fibroma of tendon sheath (FTS) is a rare occurrence. All the more intra-articular occurrence is extremely rare. A 16-year-old female presented with recurrent pain and movable nodule at the lateral joint area, diagnosed as ITB friction syndrome. The nodule was confirmed as rare intra-articular FTS on the basis of histopathology findings. When nodular lesions around knee are detected on magnetic resonance imaging, a FTS could be included in the differential diagnosis. Etiology and pathogenesis of ITB friction syndrome should be revised in view of such rare presentations.

  5. Nosology and inheritance pattern(s) of joint hypermobility syndrome and Ehlers-Danlos syndrome, hypermobility type: a study of intrafamilial and interfamilial variability in 23 Italian pedigrees.

    PubMed

    Castori, Marco; Dordoni, Chiara; Valiante, Michele; Sperduti, Isabella; Ritelli, Marco; Morlino, Silvia; Chiarelli, Nicola; Celletti, Claudia; Venturini, Marina; Camerota, Filippo; Calzavara-Pinton, Piergiacomo; Grammatico, Paola; Colombi, Marina

    2014-12-01

    Joint hypermobility syndrome (JHS) and Ehlers-Danlos syndrome, hypermobility type (EDS-HT) are two markedly overlapping heritable connective tissue disorders. The cumulative frequency of JHS and EDS-HT seems high, but their recognition remains an exclusion diagnosis based on different sets of diagnostic criteria. Although proposed by a panel of experts, clinical identity between JHS and EDS-HT is still a matter of debate due to unknown molecular basis. We present 23 families with three or more individuals with a diagnosis of JHS and/or EDS-HT. Rough data from the 82 individuals were used to assess the frequency of major and minor criteria, as well as selected additional features. A series of statistical tools were applied to assess intrafamilial and interfamilial variability, emphasizing intergenerational, and intersex differences. This study demonstrates marked heterogeneity within and between families in terms of agreement of available diagnostic criteria. In 21 pedigrees affected individuals belong to two or three phenotypic sub-categories among JHS, EDS-HT, and JHS + EDS-HT overlap. Intergenerational analysis depicts a progressive shifting, also within the same pedigree, from EDS-HT in childhood, to JHS + EDS-HT in early adulthood and JHS later in life. Female-male ratio is 2.1:1, which results lower than previously observed in unselected patients' cohorts. In these pedigrees, JHS, EDS-HT, and JHS + EDS-HT segregate as a single dominant trait with complete penetrance, variable expressivity, and a markedly evolving phenotype. This study represents a formal demonstration that EDS-HT and JHS contitute the same clinical entity, and likely share the same genetic background, at least, in familial cases.

  6. Gabapentin alleviates facet-mediated pain in the rat through reduced neuronal hyperexcitability and astrocytic activation in the spinal cord

    PubMed Central

    Dong, Ling; Crosby, Nathan D.; Winkelstein, Beth A.

    2013-01-01

    Although joint pain is common, its mechanism(s) remain undefined, with little known about the spinal neuronal responses that contribute to this type of pain. Afferent activity and sustained spinal neuronal hyperexcitability correlate to facet joint loading and the extent of behavioral sensitivity induced after painful facet injury, suggesting spinal neuronal plasticity is induced in association with facet-mediated pain. This study used a rat model of painful C6/C7 facet joint stretch, together with intrathecal administration of gabapentin, to investigate the effects of one aspect of spinal neuronal function on joint pain. Gabapentin or saline vehicle was given via lumbar puncture prior to and at 1 day after painful joint distraction. Mechanical hyperalgesia was measured in the forepaw for 7 days. Extracellular recordings of neuronal activity and astrocytic and microglial activation in the cervical spinal cord were evaluated at day 7. Gabapentin significantly (p=0.0001) attenuated mechanical hyperalgesia and the frequency of evoked neuronal firing also significantly decreased (p<0.047) with gabapentin treatment. Gabapentin also decreased (p<0.04) spinal GFAP expression. Although spinal Iba1 expression was doubled over sham, gabapentin did not reduce it. Facet joint-mediated pain appears to be sustained through spinal neuronal modifications that are also associated with astrocytic activation. PMID:24094695

  7. [Chronic knee joint discomfort].

    PubMed

    Wittke, R

    2005-06-23

    Chronic pain in the knee joint is frequently a sign of arthrosis in adults. This must be clearly differentiated from other knee problems. Patellofemoral stress syndrome (occurs mostly in young people) and arthritis with effusion in the knee joint after long and mostly unusual stress also allow only a reduced function of the knee joint. However, even when the knee joint is still fully functional, chronic problems could already exist: For example, for joggers, iliotibial band friction syndrome (runner's knee) or after high unphysiological stress, patellar tendinopathy (jumper's knee). These must be differentiated from pes anserinus syndrome and a plica mediopatellaris.

  8. The Physiological Basis of Cervical Facet-Mediated Persistent Pain: Basic Science and Clinical Challenges.

    PubMed

    Ita, Meagan E; Zhang, Sijia; Holsgrove, Timothy P; Kartha, Sonia; Winkelstein, Beth A

    2017-07-01

    Synopsis Chronic neck pain is a common condition and a primary clinical symptom of whiplash and other spinal injuries. Loading-induced neck injuries produce abnormal kinematics between the vertebrae, with the potential to injure facet joints and the afferent fibers that innervate the specific joint tissues, including the capsular ligament. Mechanoreceptive and nociceptive afferents that innervate the facet have their peripheral terminals in the capsule, cell bodies in the dorsal root ganglia, and terminal processes in the spinal cord. As such, biomechanical loading of these afferents can initiate nociceptive signaling in the peripheral and central nervous systems. Their activation depends on the local mechanical environment of the joint and encodes the neural processes that initiate pain and lead to its persistence. This commentary reviews the complex anatomical, biomechanical, and physiological consequences of facet-mediated whiplash injury and pain. The clinical presentation of facet-mediated pain is complex in its sensory and emotional components. Yet, human studies are limited in their ability to elucidate the physiological mechanisms by which abnormal facet loading leads to pain. Over the past decade, however, in vivo models of cervical facet injury that reproduce clinical pain symptoms have been developed and used to define the complicated and multifaceted electrophysiological, inflammatory, and nociceptive signaling cascades that are involved in the pathophysiology of whiplash facet pain. Integrating the whiplash-like mechanics in vivo and in vitro allows transmission of pathophysiological mechanisms across scales, with the hope of informing clinical management. Yet, despite these advances, many challenges remain. This commentary further describes and highlights such challenges. J Orthop Sports Phys Ther 2017;47(7):450-461. Epub 16 Jun 2017. doi:10.2519/jospt.2017.7255.

  9. New facets of antifungal therapy.

    PubMed

    Chang, Ya-Lin; Yu, Shang-Jie; Heitman, Joseph; Wellington, Melanie; Chen, Ying-Lien

    2017-02-17

    Invasive fungal infections remain a major cause of morbidity and mortality in immunocompromised patients, and such infections are a substantial burden to healthcare systems around the world. However, the clinically available armamentarium for invasive fungal diseases is limited to 3 main classes (i.e., polyenes, triazoles, and echinocandins), and each has defined limitations related to spectrum of activity, development of resistance, and toxicity. Further, current antifungal therapies are hampered by limited clinical efficacy, high rates of toxicity, and significant variability in pharmacokinetic properties. New antifungal agents, new formulations, and novel combination regimens may improve the care of patients in the future by providing improved strategies to combat challenges associated with currently available antifungal agents. Likewise, therapeutic drug monitoring may be helpful, but its present use remains controversial due to the lack of available data. This article discusses new facets of antifungal therapy with a focus on new antifungal formulations and the synergistic effects between drugs used in combination therapy.

  10. Facets of the balanced minimal evolution polytope.

    PubMed

    Forcey, Stefan; Keefe, Logan; Sands, William

    2016-08-01

    The balanced minimal evolution (BME) method of creating phylogenetic trees can be formulated as a linear programming problem, minimizing an inner product over the vertices of the BME polytope. In this paper we undertake the project of describing the facets of this polytope. We classify and identify the combinatorial structure and geometry (facet inequalities) of all the facets in dimensions up to five, and classify even more facets in all dimensions. A full set of facet inequalities would allow a full implementation of the simplex method for finding the BME tree-although there are reasons to think this an unreachable goal. However, our results provide the crucial first steps for a more likely-to-be-successful program: finding efficient relaxations of the BME polytope.

  11. Waterhouse-Friderichsen syndrome

    MedlinePlus

    ... Friderichsen syndrome; Fulminant meningococcal sepsis - Waterhouse-Friderichsen syndrome; Hemorrhagic adrenalitis ... bacteria growing (multiplying) inside the body. Symptoms include: Fever and chills Joint and muscle pain Headache Vomiting ...

  12. Traumatic unilateral lumbosacral jumped facet without fracture in a child - presentation of a safe treatment strategy for a rare injury.

    PubMed

    Szentirmai, Oszkar; Seinfeld, Joshua; Beauchamp, Kathryn; Patel, Vikas

    2008-11-10

    The vast majority of pediatric lumbosacral spondylolisthesis have developmental etiology. Of the very rare type of pediatric lumbosacral facet dislocations, there are only three reported cases of a pediatric unilateral jumped facet injury. All of these cases are associated with fracture dislocation of L5-S1. Hyperflexion with rotation is thought to provoke this uncommon type of spine injury.The authors report the first pediatric patient reported in literature to date with a traumatic unilateral jumped facet at the lumbosacral joint without fracture. The presentation, surgical treatment, hospital course, outcome and management options with the review of the literature is summarized.

  13. The relationship between benign joint hypermobility syndrome and psychological distress: a systematic review and meta-analysis.

    PubMed

    Smith, Toby O; Easton, Victoria; Bacon, Holly; Jerman, Emma; Armon, Kate; Poland, Fiona; Macgregor, Alex J

    2014-01-01

    This study examines the reported evidence of an association between benign joint hypermobility syndrome (BJHS) and psychological symptoms. A systematic review of published (AMED, CINAHL, MEDLINE, EMBASE, PubMed, Cochrane Library) and unpublished research databases (OpenGrey, the World Health Organization (WHO) International Clinical Trials Registry Platform, Current Controlled Trials, the UK National Research Register Archive) was performed from their inception to January 2013. Studies assessing the prevalence and incidence of psychological conditions for people diagnosed with BJHS were included. Meta-analysis assessing the odds ratio (OR) and standardized mean difference in severity of psychological conditions was performed. Methodological quality was assessed using the Critical Appraisal Skills Programme (CASP) appraisal tools. Fourteen papers including 3957 participants, 1006 people with and 2951 controls without BJHS were eligible. The overall methodological quality was moderate. The results indicated that people with BJHS experience significantly greater perceptions of fear and more intense fear (P < 0.05) and have a higher probability of demonstrating agoraphobia (P < 0.05), anxiety (OR 4.39, 95% CI 1.92, 10.40), depression (OR 4.10, 95% CI 1.79, 9.41) and panic disorders (OR 6.72, 95% CI 2.22, 20.35) than those without BJHS (P ≤ 0.005). Neither anxiety nor depression have been assessed in childhood populations. People with BJHS commonly exhibit a range of symptoms related to anxiety and depression. Considerable emotional symptoms accompany BJHS. Further study is warranted to explore how these results relate to non-Mediterranean populations and children. However, the data suggest that targeting psychological symptoms could be an important approach to managing the range of symptoms reported in these patients.

  14. Emerging facets of prokaryotic glycosylation

    PubMed Central

    Schäffer, Christina; Messner, Paul

    2017-01-01

    Glycosylation of proteins is one of the most prevalent post-translational modifications occurring in nature, with a wide repertoire of biological implications. Pathways for the main types of this modification, the N- and O-glycosylation, can be found in all three domains of life—the Eukarya, Bacteria and Archaea—thereby following common principles, which are valid also for lipopolysaccharides, lipooligosaccharides and glycopolymers. Thus, studies on any glycoconjugate can unravel novel facets of the still incompletely understood fundamentals of protein N- and O-glycosylation. While it is estimated that more than two-thirds of all eukaryotic proteins would be glycosylated, no such estimate is available for prokaryotic glycoproteins, whose understanding is lagging behind, mainly due to the enormous variability of their glycan structures and variations in the underlying glycosylation processes. Combining glycan structural information with bioinformatic, genetic, biochemical and enzymatic data has opened up an avenue for in-depth analyses of glycosylation processes as a basis for glycoengineering endeavours. Here, the common themes of glycosylation are conceptualised for the major classes of prokaryotic (i.e. bacterial and archaeal) glycoconjugates, with a special focus on glycosylated cell-surface proteins. We describe the current knowledge of biosynthesis and importance of these glycoconjugates in selected pathogenic and beneficial microbes. PMID:27566466

  15. Accuracy and repeatability of a new method for measuring facet loads in the lumbar spine.

    PubMed

    Wilson, Derek C; Niosi, Christina A; Zhu, Qingan A; Oxland, Thomas R; Wilson, David R

    2006-01-01

    We assessed the repeatability and accuracy of a relatively new, resistance-based sensor (Tekscan 6900) for measuring lumbar spine facet loads, pressures, and contact areas in cadaver specimens. Repeatability of measurements in the natural facet joint was determined for five trials of four specimens loaded in pure moment (+/- 7.5 N m) flexibility tests in axial rotation and flexion-extension. Accuracy of load measurements in four joints was assessed by applying known compressive loads of 25, 50, and 100 N to the natural facet joint in a materials testing machine and comparing the known applied load to the measured load. Measurements of load were obtained using two different calibration approaches: linear and two-point calibrations. Repeatability for force, pressure, and area (average of standard deviation as a percentage of the mean for all trials over all specimens) was 4-6% for axial rotation and 7-10% for extension. Peak resultant force in axial rotation was 30% smaller when calculated using the linear calibration method. The Tekscan sensor overestimated the applied force by 18 +/- 9% (mean+/-standard deviation), 35 +/- 7% and 50 +/- 9% for compressive loads of 100, 50, and 25 N, respectively. The two-point method overestimated the loads by 35 +/- 16%, 45 +/- 7%, and 56 +/- 10% for the same three loads. Our results show that the Tekscan sensor is repeatable. However, the sensor measurement range is not optimal for the small loads transmitted by the facets and measurement accuracy is highly dependent on calibration protocol.

  16. The Natural History and Clinical Syndromes of Degenerative Cervical Spondylosis

    PubMed Central

    Kelly, John C.; Groarke, Patrick J.; Butler, Joseph S.; Poynton, Ashley R.; O'Byrne, John M.

    2012-01-01

    Cervical spondylosis is a broad term which describes the age related chronic disc degeneration, which can also affect the cervical vertebrae, the facet and other joints and their associated soft tissue supports. Evidence of spondylitic change is frequently found in many asymptomatic adults. Radiculopathy is a result of intervertebral foramina narrowing. Narrowing of the spinal canal can result in spinal cord compression, ultimately resulting in cervical spondylosis myelopathy. This review article examines the current literature in relation to the cervical spondylosis and describes the three clinical syndromes of axial neck pain, cervical radiculopathy and cervical myelopathy PMID:22162812

  17. Facet injection trends in the Medicare population and the impact of bundling codes.

    PubMed

    Beckworth, William Jeremy; Jiang, Miao; Hemingway, Jennifer; Hughes, Danny; Staggs, Donald

    2016-09-01

    Interventional spine procedures have seen a steady increase in utilization over the last 10 to 20 years. In 2010, the Current Procedural Terminology (CPT) codes for facet injections were bundled with image guidance (fluoroscopic or computed tomography) and limited billing to a maximum of three levels. This was done in part because of increased utilization and to ensure that procedures were done appropriately with image guidance. The study aimed to evaluate if the CPT code changes correlated with a decreased utilization of facet injections. This is a retrospective time series study. The sample was composed of 100% Medicare Part B claims submitted for facet joint injections from 2000 to 2012, as documented in the Centers for Medicare & Medicaid Services (CMS) Physician Supplier Procedure Summary (PSPS) master files. Procedure numbers and trends were the outcome measures. The trends of facet injections were analyzed from 2000 to 2012 using the CMS PSPS master files. The total number of lumbosacral and cervical-thoracic facet injections was noted. Changes over those years were calculated with specific attention to 2010, when CPT were bundled with image guidance and injections were limited to no more than three levels. Also, to account for the growth in the Medicare population, a calculation was done of injections per 100,000 Medicare enrollees. No funding was used for this study. Facet injection utilization increased from 2000 to 2012, with an average growth rate of 11% per year for lumbosacral facet injections and 15% for cervical-thoracic facet injections (per 100,000 Medicare enrollees). The largest growth occurred from 2000 to 2006 (25% growth per year for lumbosacral and 32% for cervical-thoracic injections per 100,000 Medicare enrollees) and this leveled off from 2007 to 2012 (-3% growth per year for lumbosacral and -2% for cervical-thoracic injections per 100,000 Medicare enrollees). The biggest drop in these procedures was in 2010, when there was a drop of 14

  18. Patient-reported quality of life in highest-functioning Apert and Crouzon syndromes: a comparative study.

    PubMed

    Raposo-Amaral, Cassio Eduardo; Neto, José Garcia Junqueira; Denadai, Rafael; Raposo-Amaral, Cassio Menezes; Raposo-Amaral, Cesar Augusto

    2014-02-01

    Crouzon and Apert syndromes are the most common syndromic forms of craniofacial dysostosis. Apert syndrome has a broad clinical spectrum, including complex craniofacial involvement, as well as limiting deformities of the hands, feet, and other joints that require multiple surgical procedures when compared with Crouzon syndrome, which is generally less severe. The authors hypothesized that the quality of life of Apert syndrome patients is inferior to that of Crouzon syndrome patients. The quality of life of Apert (n = 8) and Crouzon (n = 12) syndrome patients was assessed using the World Health Organization Quality of Life-100 questionnaire. The Mann-Whitney test was used to compare the quality-of-life scores between Apert and Crouzon patients. Values were considered significant for a confidence interval of 95 percent (p < 0.05). Apert patients showed an overall higher (score > 60 percent) quality of life in most World Health Organization Quality of Life-100 facets (68 percent) and domains (83.33 percent), with significance (p < 0.05) in three facets (energy and fatigue, mobility, and environment in the home), compared with Crouzon patients. Contrary to the authors' initial hypothesis, both the highest-functioning Apert patients and the Crouzon patients presented a satisfactory quality of life, demonstrating that these syndromic patients had acquired the necessary repertoire to manage the adverse daily situations of their lives.

  19. Increased Pelvic Incidence is Associated With a More Coronal Facet Orientation in the Lower Lumbar Spine: A Cadaveric Study of 599 Lumbar Spines.

    PubMed

    Weinberg, Douglas S; Xie, Katherine K; Liu, Raymond W; Gebhart, Jeremy J; Gordon, Zachary L

    2016-10-01

    An anatomic study of facet angle orientation and morphology of the lumbar spine was performed. The aim of this study was to determine how age, gender, race, and pelvic incidence (PI) correlate with facet orientation in the lumbar spine. Lumbar facet orientation has important implications in the development of numerous pathologies of the spine, including arthritis, spondylolisthesis, and adult spinal deformity. Preliminary reports have suggested that sagittal balance of the spine may contribute to facet joint orientation. We therefore designed an anatomic study to investigate the relationship between PI and facet orientation, within the context of age, gender, and race. Five hundred ninety-nine cadaveric lumbar spines were obtained from the Hamann-Todd osteological collection. It was determined that facet angle was most reliably assessed by measuring the angle between the superior articular facet and the spinous process. Facet angles were measured bilaterally at each level from T12-L1 through L5-S1 in every specimen. Multivariate regression analysis was used to determine independent predictors of facet angle at each level. Facet angle increased rostrally to caudally, from 22.6 ± 8.3° at T12-L1 to 49.1 ± 12.4° at L5-S1. Cadaver age was an independent predictor of a more sagittal facet angle at lower spinal levels. Caucasian race was an independent predictor of increasing facet angle. Increased PI had no effect on facet angle at T12-L1, L1-L2, L2-L3, or L3-L4, although was a significant predictor of more coronally oriented facet joints at L4-L5 (standardized beta 0.096, P = 0.009) and L5-S1 (standardized beta 0.079, P = 0.032). The results of this study provide important data regarding differences in facet angle that exists between individuals. Moreover, the results of this study suggest that facet joints do possess the ability to remodel over time, perhaps in response to perturbations of sagittal balance, osteophyte formation, or other yet to be

  20. FACET: SLAC___s New User Facility

    SciTech Connect

    Clarke, C.I.; Decker, F.-J.; England, R.J.; Erickson, R.A.; Hast, C.; Hogan, M.J.; Li, S.Z.; Litos, M.D.; Nosochkov, Y.; Seeman, J.T.; Sheppard, J.; Wienands, U.; Woodley, M.; Yocky, G.; /SLAC

    2012-05-16

    FACET (Facility for Advanced Accelerator Experimental Tests) is a new User Facility at SLAC National Accelerator Laboratory. The first User Run started in spring 2012 with 20 GeV, 3 nC electron beams. The facility is designed to provide short (20 {micro}m) bunches and small (20 {micro}m wide) spot sizes, producing uniquely high power beams. FACET supports studies from many fields but in particular those of Plasma Wakefield Acceleration and Dielectric Wakefield Acceleration. The creation of drive and witness bunches and shaped bunch profiles is possible with 'Notch' Collimation. FACET is also a source of THz radiation for material studies. Positrons will be available at FACET in future user runs. We present the User Facility and the available tools and opportunities for future experiments.

  1. FACET: Future ATM Concepts Evaluation Tool

    NASA Technical Reports Server (NTRS)

    Bilmoria, Karl D.; Banavar, Sridhar; Chatterji, Gano B.; Sheth, Kapil S.; Grabbe, Shon

    2000-01-01

    FACET (Future ATM Concepts Evaluation Tool) is an Air Traffic Management research tool being developed at the NASA Ames Research Center. This paper describes the design, architecture and functionalities of FACET. The purpose of FACET is to provide E simulation environment for exploration, development and evaluation of advanced ATM concepts. Examples of these concepts include new ATM paradigms such as Distributed Air-Ground Traffic Management, airspace redesign and new Decision Support Tools (DSTs) for controllers working within the operational procedures of the existing air traffic control system. FACET is currently capable of modeling system-wide en route airspace operations over the contiguous United States. Airspace models (e.g., Center/sector boundaries, airways, locations of navigation aids and airports) are available from databases. A core capability of FACET is the modeling of aircraft trajectories. Using round-earth kinematic equations, aircraft can be flown along flight plan routes or great circle routes as they climb, cruise and descend according to their individual aircraft-type performance models. Performance parameters (e.g., climb/descent rates and speeds, cruise speeds) are obtained from data table lookups. Heading, airspeed and altitude-rate dynamics are also modeled. Additional functionalities will be added as necessary for specific applications. FACET software is written in Java and C programming languages. It is platform-independent, and can be run on a variety of computers. FACET has been designed with a modular software architecture to enable rapid integration of research prototype implementations of new ATM concepts. There are several advanced ATM concepts that are currently being implemented in FACET airborne separation assurance, dynamic density predictions, airspace redesign (re-sectorization), benefits of a controller DST for direct-routing, and the integration of commercial space transportation system operations into the U.S. National

  2. FACET: Future ATM Concepts Evaluation Tool

    NASA Technical Reports Server (NTRS)

    Bilmoria, Karl D.; Banavar, Sridhar; Chatterji, Gano B.; Sheth, Kapil S.; Grabbe, Shon

    2000-01-01

    FACET (Future ATM Concepts Evaluation Tool) is an Air Traffic Management research tool being developed at the NASA Ames Research Center. This paper describes the design, architecture and functionalities of FACET. The purpose of FACET is to provide E simulation environment for exploration, development and evaluation of advanced ATM concepts. Examples of these concepts include new ATM paradigms such as Distributed Air-Ground Traffic Management, airspace redesign and new Decision Support Tools (DSTs) for controllers working within the operational procedures of the existing air traffic control system. FACET is currently capable of modeling system-wide en route airspace operations over the contiguous United States. Airspace models (e.g., Center/sector boundaries, airways, locations of navigation aids and airports) are available from databases. A core capability of FACET is the modeling of aircraft trajectories. Using round-earth kinematic equations, aircraft can be flown along flight plan routes or great circle routes as they climb, cruise and descend according to their individual aircraft-type performance models. Performance parameters (e.g., climb/descent rates and speeds, cruise speeds) are obtained from data table lookups. Heading, airspeed and altitude-rate dynamics are also modeled. Additional functionalities will be added as necessary for specific applications. FACET software is written in Java and C programming languages. It is platform-independent, and can be run on a variety of computers. FACET has been designed with a modular software architecture to enable rapid integration of research prototype implementations of new ATM concepts. There are several advanced ATM concepts that are currently being implemented in FACET airborne separation assurance, dynamic density predictions, airspace redesign (re-sectorization), benefits of a controller DST for direct-routing, and the integration of commercial space transportation system operations into the U.S. National

  3. Surface Activation of Faceted Photocatalyst: When Metal Cocatalyst Determines the Nature of the Facets.

    PubMed

    Wang, Bin; Liu, Maochang; Zhou, Zhaohui; Guo, Liejin

    2015-11-01

    Pt nanoparticles with tunable size are prepared on the entire surface of facet-engineered Cu2WS4 decahedral photocatalyst via a kinetic-controlled chemical reduction process. The {101} facets of the photocatalyst which featured photo-oxidation, are successfully activated for photoreduction by Pt. The resulting photocatalyst shows an activity nine times higher compared to that of the only {001}-facets activated catalyst obtained by a conventional in situ photodeposition route.

  4. The posterior ligamentous complex inflammatory syndrome: spread of fluid and inflammation in the retrodural space of Okada.

    PubMed

    Lehman, V T; Murthy, N S; Diehn, F E; Verdoorn, J T; Maus, T P

    2015-05-01

    The retrodural space of Okada is situated dorsal to the ligamentum flavum in the interlaminar space, and provides communication between contralateral facet joints. MRI will often demonstrate heterogeneous signal abnormality with contrast enhancement in this space and several communicating compartments of the posterior ligamentous complex: bilateral facet joints, adventitial interspinous bursae, or retrodural cysts penetrating the ligamentum flavum. Pars interarticularis defects are frequently present. This imaging pattern may be associated with axial low back pain and/or radicular pain. Recognition of this pattern at MRI has distinct implications for image interpretation, unifying prior reports of involvement of individual components of the posterior ligamentous complex. Its recognition will also affect planning for therapeutic interventional pain procedures. We refer to this constellation of imaging and clinical findings as posterior ligamentous complex inflammatory syndrome (PLCIS). Copyright © 2014 The Royal College of Radiologists. Published by Elsevier Ltd. All rights reserved.

  5. MultiFacet: A Faceted Interface for Browsing Large Multimedia Collections

    SciTech Connect

    Henry, Michael J.; Hampton, Shawn D.; Endert, Alexander; Roberts, Ian E.; Payne, Deborah A.

    2013-10-31

    Faceted browsing is a common technique for exploring collections where the data can be grouped into a number of pre-defined categories, most often generated from textual metadata. Historically, faceted browsing has been applied to a single data type such as text or image data. However, typical collections contain multiple data types, such as information from web pages that contain text, images, and video. Additionally, when browsing a collection of images and video, facets are often created based on the metadata which may be incomplete, inaccurate, or missing altogether instead of the actual visual content contained within those images and video. In this work we address these limitations by presenting MultiFacet, a faceted browsing interface that supports multiple data types. MultiFacet constructs facets for images and video in a collection from the visual content using computer vision techniques. These visual facets can then be browsed in conjunction with text facets within a single interface to reveal relationships and phenomena within multimedia collections. Additionally, we present a use case based on real-world data, demonstrating the utility of this approach towards browsing a large multimedia data collection.

  6. Late diagnosis of lateral meningocele syndrome in a 55-year-old woman with symptoms of joint instability and chronic musculoskeletal pain.

    PubMed

    Castori, Marco; Morlino, Silvia; Ritelli, Marco; Brancati, Francesco; De Bernardo, Carmelilia; Colombi, Marina; Grammatico, Paola

    2014-02-01

    Lateral meningocele syndrome (LMS) is a rare hereditary connective tissue disorder characterized by pan-spinal meningoceles, specific facial dysmorphism, skeletal and soft tissue abnormalities, and hypotonia and/or muscle weakness. LMS has been observed in eleven patients with two instances of vertical transmission, and seven sporadic cases with an age at diagnosis ranging from 25 months to 33 years. We report on a further observation of LMS in a 55-year-old woman presenting with a long history of joint instability, chronic musculoskeletal pain, and iatrogenic bladder and anorectal dysfunction due to irreversible nerve damage after surgical excision of a meningeal cyst. Her clinical characteristics are compared with those of previously reported patients, as well as two further cases originally diagnosed with Hajdu-Cheney and Ehlers-Danlos syndromes, but displaying typical features of LMS.

  7. Severe destruction of the temporomandibular joint with complete resorption of the condyle associated with synovitis, acne, pustulosis, hyperostosis, and osteitis syndrome.

    PubMed

    Kodama, Yasumitsu; Tanaka, Ray; Kurokawa, Akira; Ohnuki, Hisashi; Sultana, Sara; Hayashi, Takafumi; Iizuka, Tateyuki; Takagi, Ritsuo

    2013-08-01

    The synovitis, acne, pustulosis, hyperostosis, and osteitis (SAPHO) syndrome consists of a combination of inflammatory bone disorders and dermatologic pathology. Bone lesions as a form of diffuse sclerosing osteomyelitis in the mandible occur in the posterior body and ramus. Bone lesions rarely spread to the temporomandibular joint (TMJ) where ankylosis may result. Herein we present an unusual case of SAPHO syndrome with TMJ involvement in which severe destruction of the TMJ occurred. We observed an extension of the invasive soft tissue lesion into the infratemporal fossa from the TMJ with complete resorption of the condyle. In contrast to other previously reported cases, in our case the condyle was strongly suspected as the primary site of the bone lesion with subsequent extension to the ramus and infratemporal fossa. The destructive nature and related symptoms resembled a malignant tumor.

  8. Surface Processes of Faceted Growth

    NASA Technical Reports Server (NTRS)

    Chernov, A.; Curreri, Peter A. (Technical Monitor)

    2002-01-01

    Atomic force microscopy and high precision optical interferometry allow to analyze the processes that are in the core of our present understanding of faceted crystal growth. Some of these processes will be reviewed. Recent experiments suggest that the Gibbs-Thomson Law (GTL) may not be applicable to the weakly fluctuating strongly polygonized steps, with low kink density. Propagation rate of a straight short step segment changes with the segment length much steeper than predicted by GTL. If the step fluctuations are still well developed, the typical transition length may be determined just by the radius of rounded comers of the polygonized step. If fluctuations do not have enough time to develop, the kinetic effects may be essential. Indeed, 'communications' between comers of a short straight step segment may occur and, thus, the GTL may be implemented only via kink exchange. E.g., dissolutions of this short segment at macroscopic equilibrium occurs as follows: The kinks are split from one comer as a result of fluctuations, and annihilate with kinks of the opposite sign generated by another comer. Similarly, an exchange via chain of kinks on a rough step is the mechanism to implement the GT Law. If there is a supersaturation with respect to a large crystal, the kinks not only diffuse along the step, but move back the generating comers. This 'wind' prevents communication between the comers and places upper limit supersaturation only below which GTL is applicable. Steps replace kinks in the 3D case, though, of course, another dimensionality brings about another physics. Another specific problem to think about is if fluctuations are always fast enough to provide enough kinks for linear dependence of step rate on supersaturation. Increasing azimuthal polygonization of growth hillocks is a sign of insufficient fluctuation rate. Morphological stability of vicinal faces is usually considered on the basis of mutually parallel steps. Azimuthal anisotropy and interlacing of

  9. Surface Processes of Faceted Growth

    NASA Technical Reports Server (NTRS)

    Chernov, A.; Curreri, Peter A. (Technical Monitor)

    2002-01-01

    Atomic force microscopy and high precision optical interferometry allow to analyze the processes that are in the core of our present understanding of faceted crystal growth. Some of these processes will be reviewed. Recent experiments suggest that the Gibbs-Thomson Law (GTL) may not be applicable to the weakly fluctuating strongly polygonized steps, with low kink density. Propagation rate of a straight short step segment changes with the segment length much steeper than predicted by GTL. If the step fluctuations are still well developed, the typical transition length may be determined just by the radius of rounded comers of the polygonized step. If fluctuations do not have enough time to develop, the kinetic effects may be essential. Indeed, 'communications' between comers of a short straight step segment may occur and, thus, the GTL may be implemented only via kink exchange. E.g., dissolutions of this short segment at macroscopic equilibrium occurs as follows: The kinks are split from one comer as a result of fluctuations, and annihilate with kinks of the opposite sign generated by another comer. Similarly, an exchange via chain of kinks on a rough step is the mechanism to implement the GT Law. If there is a supersaturation with respect to a large crystal, the kinks not only diffuse along the step, but move back the generating comers. This 'wind' prevents communication between the comers and places upper limit supersaturation only below which GTL is applicable. Steps replace kinks in the 3D case, though, of course, another dimensionality brings about another physics. Another specific problem to think about is if fluctuations are always fast enough to provide enough kinks for linear dependence of step rate on supersaturation. Increasing azimuthal polygonization of growth hillocks is a sign of insufficient fluctuation rate. Morphological stability of vicinal faces is usually considered on the basis of mutually parallel steps. Azimuthal anisotropy and interlacing of

  10. A distinct X-linked syndrome involving joint contractures, keloids, large optic cup-to-disc ratio, and renal stones results from a filamin A (FLNA) mutation.

    PubMed

    Lah, Melissa; Niranjan, Tejasvi; Srikanth, Sujata; Holloway, Lynda; Schwartz, Charles E; Wang, Tao; Weaver, David D

    2016-04-01

    We further evaluated a previously reported family with an apparently undescribed X-linked syndrome involving joint contractures, keloids, an increased optic cup-to-disc ratio, and renal stones to elucidate the genetic cause. To do this, we obtained medical histories and performed physical examination on 14 individuals in the family, five of whom are affected males and three are obligate carrier females. Linkage analysis was performed on all but one individual and chromosome X-exome sequencing was done on two affected males. The analysis localized the putative gene to Xq27-qter and chromosome X-exome sequencing revealed a mutation in exon 28 (c.4726G>A) of the filamin A (FLNA) gene, predicting that a conserved glycine had been replaced by arginine at amino acid 1576 (p.G1576R). Segregation analysis demonstrated that all known carrier females tested were heterozygous (G/A), all affected males were hemizygous for the mutation (A allele) and all normal males were hemizygous for the normal G allele. The data and the bioinformatic analysis indicate that the G1576R mutation in the FLNA gene is very likely pathogenic in this family. The syndrome affecting the family shares phenotypic overlap with other syndromes caused by FLNA mutations, but appears to be a distinct phenotype, likely representing a unique genetic syndrome. © 2016 Wiley Periodicals, Inc.

  11. Dynesys dynamic stabilization-related facet arthrodesis.

    PubMed

    Fay, Li-Yu; Chang, Peng-Yuan; Wu, Jau-Ching; Huang, Wen-Cheng; Wang, Chun-Hao; Tsai, Tzu-Yun; Tu, Tsung-Hsi; Chang, Hsuan-Kan; Wu, Ching-Lan; Cheng, Henrich

    2016-01-01

    OBJECTIVE Dynamic stabilization devices are designed to stabilize the spine while preserving some motion. However, there have been reports demonstrating limited motion at the instrumented level of the lumbar spine after Dynesys dynamic stabilization (DDS). The causes of this limited motion and its actual effects on outcomes after DDS remain elusive. In this study, the authors investigate the incidence of unintended facet arthrodesis after DDS and clinical outcomes. METHODS This retrospective study included 80 consecutive patients with 1- or 2-level lumbar spinal stenosis who underwent laminectomy and DDS. All medical records, radiological data, and clinical evaluations were analyzed. Imaging studies included pre- and postoperative radiographs, MR images, and CT scans. Clinical outcomes were measured by a visual analog scale (VAS) for back and leg pain, the Oswestry Disability Index (ODI), and Japanese Orthopaedic Association (JOA) scores. Furthermore, all patients had undergone postoperative CT for the detection of unintended arthrodesis of the facets at the indexed level, and range of motion was measured on standing dynamic radiographs. RESULTS A total of 70 patients (87.5%) with a mean age of 64.0 years completed the minimum 24-month postoperative follow-up (mean duration 29.9 months). Unintended facet arthrodesis at the DDS instrumented level was demonstrated by CT in 38 (54.3%) of the 70 patients. The mean age of patients who had facet arthrodesis was 9.8 years greater than that of the patients who did not (68.3 vs 58.5 years, p = 0.009). There were no significant differences in clinical outcomes, including VAS back and leg pain, ODI, and JOA scores between patients with and without the unintended facet arthrodesis. Furthermore, those patients older than 60 years were more likely to have unintended facet arthrodesis (OR 12.42) and immobile spinal segments (OR 2.96) after DDS. Regardless of whether unintended facet arthrodesis was present or not, clinical

  12. Accessory Anterolateral Talar Facet as an Etiology of Painful Talocalcaneal Impingement in the Rigid Flatfoot: A New Diagnosis

    PubMed Central

    Martus, Jeffrey E.; Femino, John E.; Caird, Michelle S.; Kuhns, Lawrence R.; Craig, Clifford L.; Farley, Frances A.

    2008-01-01

    A retrospective review identified six patients with seven painful rigid flatfeet. In each case, pain was localized laterally to an accessory facet of the anterolateral talus. cross-sectional imaging demonstrated no evidence of tarsal coalition. In five of the six, preoperative magnetic resonance imaging (MRI) was obtained and in each case demonstrated focal abutting bone marrow edema consistent with impingement between the accessory facet and the anterior calcaneus. Seven feet in six patients underwent resection of the accessory facet with additional subtalar joint-sparing reconstructive procedures. At an average follow-up of 11 months, clinical results were graded as four good and two fair. An association between this accessory facet and pain in the rigid flatfoot has not been previously reported. Obesity was universal and may represent a risk factor for facet impingement. At early follow-up, facet resection with subtalar joint-sparing flatfoot reconstruction provided good results with symptomatic and functional improvement in the majority of patients. PMID:19223941

  13. Pain from intra-articular NGF or joint injury in the rat requires contributions from peptidergic joint afferents.

    PubMed

    Kras, Jeffrey V; Weisshaar, Christine L; Pall, Parul S; Winkelstein, Beth A

    2015-09-14

    Non-physiological stretch of the cervical facet joint's capsular ligament induces persistent behavioral hypersensitivity and spinal neuronal hyperexcitability via an intra-articular NGF-dependent mechanism. Although that ligament is innervated by nociceptors, it is unknown if a subpopulation is exclusively responsible for the behavioral and spinal neuronal responses to intra-articular NGF and/or facet joint injury. This study ablated joint afferents using the neurotoxin saporin targeted to neurons involved in either peptidergic ([Sar(9),Met (O2)(11)]-substance P-saporin (SSP-Sap)) or non-peptidergic (isolectin B4-saporin (IB4-Sap)) signaling to investigate the contributions of those neuronal populations to facet-mediated pain. SSP-Sap, but not IB4-Sap, injected into the bilateral C6/C7 facet joints 14 days prior to an intra- articular NGF injection prevents NGF-induced mechanical and thermal hypersensitivity in the forepaws. Similarly, only SSP- Sap prevents the increase in mechanical forepaw stimulation- induced firing of spinal neurons after intra-articular NGF. In addition, intra-articular SSP-Sap prevents both behavioral hypersensitivity and upregulation of NGF in the dorsal root ganglion after a facet joint distraction that normally induces pain. These findings collectively suggest that disruption of peptidergic signaling within the joint may be a potential treatment for facet pain, as well as other painful joint conditions associated with elevated NGF, such as osteoarthritis. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

  14. Identification of microRNA-181a-5p and microRNA-4454 as mediators of facet cartilage degeneration

    PubMed Central

    Nakamura, Akihiro; Sharma, Anirudh; Lewis, Stephen J.; Wu, Brian; Datta, Poulami; Sundararajan, Kala; Endisha, Helal; Rossomacha, Evgeny; Rockel, Jason S.; Jurisica, Igor

    2016-01-01

    Osteoarthritis (OA) of spine (facet joints [FJs]) is one of the major causes of severe low back pain and disability worldwide. The degeneration of facet cartilage is a hallmark of FJ OA. However, endogenous mechanisms that initiate degeneration of facet cartilage are unknown, and there are no disease-modifying therapies to stop FJ OA. In this study, we have identified microRNAs (small noncoding RNAs) as mediators of FJ cartilage degeneration. We first established a cohort of patients with varying degrees of facet cartilage degeneration (control group: normal or mild facet cartilage degeneration; FJ OA group: moderate to severe facet cartilage degeneration) and then screened 2,100 miRNAs and identified 2 miRNAs (miR-181a-5p and miR-4454) that were significantly elevated in FJ OA cartilage compared with control facet cartilage. We further explored their role, function, and signaling mechanisms using computational, in vitro functional, and in vivo studies. We specifically indicate that miR-181a-5p and miR-4454 are involved in promoting inflammatory, catabolic, and cell death activity in FJ chondrocytes. This is the first report to our knowledge that identifies miR-181a-5p and miR-4454 as mediators of cartilage degeneration in FJs and potential therapeutic targets for stopping cartilage degeneration. PMID:27699225

  15. FACET ORIENTATION AND TROPISM: ASSOCIATION WITH ACCELERATED DEGENERATION OF STABILIZING STRUCTURES IN LOWER LUMBAR SPINE.

    PubMed

    Jelec, Vjekoslav; Turner, Rajka; Franić, Miljenko; Korušić, Anđelko; Rotim, Krešimir

    2016-03-01

    The influence of facet orientation and tropism on the process of spinal degeneration has been extensively studied during the last few decades, but there are still many controversies and conflicting results in this field of research. The biomechanical cause of accelerated degeneration of stabilizing structures in lower lumbar spine lies within the combination of several factors, but two most important ones are compressive load and more coronal facet orientation that offers less resistance against torsional loading. Axial rotation of lower lumbar spine is undoubtedly associated with higher strain in disc annulus, and enhanced range of secondary rotational movements may be even more significant for the progression of annular degeneration. Accordingly, more pronounced facet tropism could be having part in faster progression of disc degeneration in lower lumbar spine, as indicated by a number of recent studies. More sagittal facet orientation in patients with a higher facet osteoarthritis score at lower lumbar segments is very likely related to arthritic remodeling commonly seen in other synovial joints. There is also a possibility that it could be associated with the adaptation to partial loss of lumbar lordosis, as both coincide with advanced age.

  16. Social Attention, Joint Attention and Sustained Attention in Autism Spectrum Disorder and Williams Syndrome: Convergences and Divergences

    ERIC Educational Resources Information Center

    Vivanti, Giacomo; Fanning, Peter A. J.; Hocking, Darren R.; Sievers, Stephanie; Dissanayake, Cheryl

    2017-01-01

    There is limited knowledge on shared and syndrome-specific attentional profiles in autism spectrum disorder (ASD) and Williams syndrome (WS). Using eye-tracking, we examined attentional profiles of 35 preschoolers with ASD, 22 preschoolers with WS and 20 typically developing children across social and non-social dimensions of attention. Children…

  17. Dutch Multidisciplinary Guideline for Invasive Treatment of Pain Syndromes of the Lumbosacral Spine.

    PubMed

    Itz, Coen J; Willems, Paul C; Zeilstra, Dick J; Huygen, Frank J

    2016-01-01

    When conservative therapies such as pain medication or exercise therapy fail, invasive treatment may be indicated for patients with lumbosacral spinal pain. The Dutch Society of Anesthesiologists, in collaboration with the Dutch Orthopedic Association and the Dutch Neurosurgical Society, has taken the initiative to develop the guideline "Spinal low back pain," which describes the evidence regarding diagnostics and invasive treatment of the most common spinal low back pain syndromes, that is, facet joint pain, sacroiliac joint pain, coccygodynia, pain originating from the intervertebral disk, and failed back surgery syndrome. The aim of the guideline is to determine which invasive treatment intervention is preferred for each included pain syndrome when conservative treatment has failed. Diagnostic studies were evaluated using the EBRO criteria, and studies on therapies were evaluated with the Grading of Recommendations Assessment, Development and Evaluation system. For the evaluation of invasive treatment options, the guideline committee decided that the outcome measures of pain, function, and quality of life were most important. The definition, epidemiology, pathophysiological mechanism, diagnostics, and recommendations for invasive therapy for each of the spinal back pain syndromes are reported. The guideline committee concluded that the categorization of low back pain into merely specific or nonspecific gives insufficient insight into the low back pain problem and does not adequately reflect which therapy is effective for the underlying disorder of a pain syndrome. Based on the guideline "Spinal low back pain," facet joint pain, pain of the sacroiliac joint, and disk pain will be part of a planned nationwide cost-effectiveness study. © 2015 World Institute of Pain.

  18. Facet development for a faceted stretched-membrane dish by Solar Kinetics, Inc.

    NASA Astrophysics Data System (ADS)

    Schertz, P. T.; Brown, D. C.; Konnerth, A., III

    1991-07-01

    A 3.6-meter diameter stretched-membrane optical facet for a parabolic dish has been successfully designed and demonstrated under contract with Sandia National Laboratories. Twelve facets identical to them will be used to make the lightweight reflector of the dish. The project goal of 2.5-mrad surface accuracy was met with each of the two full-sized prototypes, and accuracies of as low as 1.1 mrad were achieved. The facet weight is 11.7 kg/sq m (2.4 lbs/sq ft). The facet is similar in construction to the successful stretched-membrane heliostat; it has two thin metal membranes attached to a ring. However, the front membrane for this facet is plastically formed at the factor in order to achieve a shorter facet f/D (approximately 3.0). A passive tether restrains the front membrane when not in operation, that is, when the stabilizing vacuum is off. The optical surface is achieved with a silvered-acrylic film laminated to the metal membrane. The facet is expected to cost $55.40/sq m at a production rate of 10,000 facets per year and $115,000/sq m at a production rate of 500 facets a year. Several key issues have been resolved. Stress concentrations due to seams in the reflective laminate did not cause membrane rupture during forming as they have for dishes with lower focal length-to-diameter ratios. The laminate survived the forming process and simulated operation without deterioration. The optical effect of the tether on the membrane was tested and found to be very small. Most important, highly accurate shapes were obtained using a simple forming procedure. Additional tests are needed to demonstrate process repeatability and facet performance in typical operating conditions.

  19. Facet development for a faceted stretched-membrane dish by Solar Kinetics, Inc

    SciTech Connect

    Schertz, P.T.; Brown, D.C.; Konnerth, A. III )

    1991-07-01

    A 3.6-meter diameter stretched-membrane optical facet for a parabolic dish has been successfully designed and demonstrated under contract with Sandia National Laboratories. Twelve facets identical to them will be used to make the lightweight reflector of the dish. The project goal of 2.5-mrad surface accuracy was met with each of the two full-sized prototypes, and accuracies of as low as 1.1 mrad were achieved. The facet weight is 11.7 kg/m{sup 2} (2.4lbs/ft{sup 2}). The facet is similar in construction to the successful stretched-membrane heliostat; it has two thin metal membranes attached to a ring. However, the front membrane for this facet is plastically formed at the factor in order to achieve a shorter facet f/D (approximately 3.0). A passive tether restrains the from membrane when not in operation, that is, when the stabilizing vacuum is off. The optical surface is achieved with a silvered-acrylic film laminated to the metal membrane. The facet is expected to cost $55.40/m{sup 2} at a production rate of 10,000 facets per year and $115, 000/m{sup 2}-at a production rate of 500 facets a year. Several key issues have been resolved. Stress concentrations due to seams in the reflective laminate did not cause membrane rupture during forming as they have for dishes with lower focal length-to-diameter ratios. The laminate survived the forming process and simulated operation without deterioration. The optical effect of the tether on the membrane was tested and found to be very small. Most important, highly accurate shapes were obtained using a simple forming procedure. Additional tests are needed to demonstrate process repeatablility and facet performance in typical operating conditions. 18 refs., 36 figs., 11 tabs.

  20. Effects of medially wedged foot orthoses on knee and hip joint running mechanics in females with and without patellofemoral pain syndrome.

    PubMed

    Boldt, Andrew R; Willson, John D; Barrios, Joaquin A; Kernozek, Thomas W

    2013-02-01

    We examined the effects of medially wedged foot orthoses on knee and hip joint mechanics during running in females with and without patellofemoral pain syndrome (PFPS). We also tested if these effects depend on standing calcaneal eversion angle. Twenty female runners with and without PFPS participated. Knee and hip joint transverse and frontal plane peak angle, excursion, and peak internal knee and hip abduction moment were calculated while running with and without a 6° full-length medially wedged foot orthoses. Separate 3-factor mixed ANOVAs (group [PFPS, control] x condition [medial wedge, no medial wedge] x standing calcaneal angle [everted, neutral, inverted]) were used to test the effect of medially wedged orthoses on each dependent variable. Knee abduction moment increased 3% (P = .03) and hip adduction excursion decreased 0.6° (P < .01) using medially wedged foot orthoses. No significant group x condition or calcaneal angle x condition effects were observed. The addition of medially wedged foot orthoses to standardized running shoes had minimal effect on knee and hip joint mechanics during running thought to be associated with the etiology or exacerbation of PFPS symptoms. These effects did not appear to depend on injury status or standing calcaneal posture.

  1. The facets of relativistic quantum field theory

    NASA Astrophysics Data System (ADS)

    Dosch, H. G.; Müller, V. F.

    2011-04-01

    Relativistic quantum field theory is generally recognized to form the adequate theoretical frame for subatomic physics, with the Standard Model of Particle Physics as a major achievement. We point out that quantum field theory in its present form is not a monolithic theory, but rather consists of distinct facets, which aim at a common ideal goal. We give a short overview of the strengths and limitations of these facets. We emphasize the theory-dependent relation between the quantum fields, and the basic objects in the empirical domain, the particles. Given the marked conceptual differences between the facets, we argue to view these, and therefore also the Standard Model, as symbolic constructions. We finally note that this view of physical theories originated in the 19th century and is related to the emergence of the classical field as an autonomous concept.

  2. Tumor necrosis factor receptor-associated periodic syndrome (TRAPS): definition, semiology, prognosis, pathogenesis, treatment, and place relative to other periodic joint diseases.

    PubMed

    Masson, Charles; Simon, Virginie; Hoppé, Emmanuel; Insalaco, Paolo; Cissé, Idrissa; Audran, Maurice

    2004-07-01

    Tumor necrosis factor receptor-associated periodic syndrome (TRAPS) is an autosomal dominant inherited condition of periodic fever and pain. Most patients are of northern European descent. The attacks manifest as fever and pain in the joints, abdomen, muscles, skin, or eyes, with variations across patients. An acute-phase response occurs during the attacks. Patients with TRAPS are at risk for AA amyloidosis, the most common targets being the kidneys and liver. Soluble TNFRSF1A is usually low between the attacks and may be normal during the attacks, when TNF levels are high. TNFRSF1A is found in abnormally high numbers on leukocyte cell membranes. TRAPS is the first condition for which naturally occurring mutations in a TNF receptor were found; the mutations affect the soluble TNFRSF1A gene in the 12p13 region. In some patients, the pathogenesis involves defective TNFRSF1A shedding from cell membranes in response to a given stimulus. Thus, TRAPS is a model for a novel pathogenic concept characterized by failure to shed a cytokine receptor. This review compares TRAPS to other inherited periodic febrile conditions, namely, familial Mediterranean fever, Muckle-Wells syndrome, cold urticaria, and hyper-IgD syndrome. The place of TRAPS relative to other intermittent systemic joint diseases is discussed. Colchicine neither relieves nor prevents the attacks, whereas oral glucocorticoid therapy is effective when used in dosages greater than 20 mg/day. The pathogenic hypothesis involving defective TNFRSF1A shedding suggests that medications targeting TNF may be effective in TRAPS.

  3. Facet engineering of high power single emitters

    NASA Astrophysics Data System (ADS)

    Yanson, Dan; Levi, Moshe; Shamay, Moshe; Tesler, Renana; Rappaport, Noam; Don, Yaroslav; Karni, Yoram; Schnitzer, Itzhak; Sicron, Noam; Shusterman, Sergey

    2011-03-01

    The ever increasing demand for high-power, high-reliability operation of single emitters at 9xx nm wavelengths requires the development of laser diodes with improved facet regions immune to both catastrophic and wear-out failure modes. In our study, we have evaluated several laser facet definition technologies in application to 90 micron aperture single emitters in asymmetric design (In)GaAs/AlGaAs based material emitting at 915, 925 and 980nm. A common epitaxy and emitter design makes for a straightforward comparison of the facet technologies investigated. Our study corroborates a clear trend of increasing difficulty in obtaining reliable laser operation from 980nm down to 915nm. At 980nm, one can employ dielectric facet passivation with a pre-clean cycle delivering a device lifetime in excess of 3,000 hours at increasing current steps. At 925nm, quantum-well intermixing can be used to define non-absorbing mirrors giving good device reliability, albeit with a large efficiency penalty. Vacuum cleaved emitters have delivered excellent reliability at 915nm, and can be expected to perform just as well at 925 and 980nm. Epitaxial regrowth of laser facets is under development and has yet to demonstrate an appreciable reliability improvement. Only a weak correlation between start-of-life catastrophic optical mirror damage (COMD) levels and reliability was established. The optimized facet design has delivered maximum powers in excess of 19 MW/sq.cm (rollover limited) and product-grade 980nm single emitters with a slope efficiency of >1 W/A and a peak efficiency of >60%. The devices have accumulated over 1,500 hours of CW operation at 11W. A fiber-coupled device emits 10W ex-fiber with 47% efficiency.

  4. [Analysis and discussion on the facet of the spinal column, spiral CT lock multiplanar reconstruction and 
3D reconstruction].

    PubMed

    Zheng, Zhifeng; Wang, Shuhang; Si, Donglei

    2015-10-01

    To investigate the imaging appearances and diagnostic value of axial CT scanning, spiral CT multiplanar reconstruction (MPR) and three-dimensional (3D) reconstruction in vertebral facet joints locking.
 A total of 31 cases of vertebral facet joints locking, with injuries in different parts, were recruited to explore their CT features, and to evaluate their advantages in diagnosis against each other.
 Among the CT images of 31 cases with "Hamburger" sign in axial view, there were 21 cases of cervical spine and 10 cases of thoracolumbar segment; in vertical plane of MPR, "top to top" form was formed below the inferior and the superior articular process, accompanied by I° spondylolisthesis and inferior articular process tip fracture; 5 cases were unilateral locked cervical spine; none case for thoracolumbar segment. The inferior articular process was crossed with the superior articular process below and moved forward, formed "back to back" form, accompanied by II°-III° spondylolisthesis. 9 or 6 cases were bilateral or unilateral locking cervical spine, 10 cases were thoracolumbar segment, accompanied by teardrop fracture in the vertebral body below cervical spine. In coronal plane of MPR, inferior articular process showed ingression in different extent, and relied on the superior articular process below or locked in the articular fossa (21 cases for cervical spine); inferior articular process displayed upward displacement or appeared with the superior articular process at the same time, which meant joint structure disappearing thoracolumbar segment (10 cases). In 3D reconstruction, 31 cases displayed clearly in the spatial form of vertebral facet joints locking and the degree of spondylolisthesis of vertebral body.
 MPR and 3D image were more clear and intuitive in vertebral facet joints locking comparing to axial CT scan image. Spiral CT MPR and 3D reconstruction contributed to the diagnosis of vertebral facet joints locking and the reduction of misdiagnoses

  5. Kinematics of total facet replacement (TFAS-TL) with total disc replacement

    PubMed Central

    Voronov, Leonard I.; Havey, Robert M.; Sjovold, Simon G.; Funk, Michael; Carandang, Gerard; Zindrick, Daniel; Rosler, David M.; Patwardhan, Avinash G.

    2009-01-01

    Background Total disc replacement (TDR) and total facet replacement (TFR) have been the focus of recent kinematics evaluations. Yet their concurrent function as a total joint replacement of the lumbar spine's 3-joint complex has not been comprehensively reported. This study evaluated the effect of a TFR specifically designed to replace the natural facets and supplement the function with the natural disc and with TDR. The ability to replace degenerated facets to complement a pre-existing or simultaneously implanted TDR may allow surgeons to completely address degenerative pathologies of the 3-joint complex of the lumbar spine. We hypothesized that TFR would reproduce the biomechanical function of the natural facets when implanted in conjunction with TDR. Methods Lumbar spines (L1-5, 51.3 ± 14.2 years, N = 6) were tested sequentially as follows: (1) intact, (2) after TDR implantation, and (3) after TFR implantation in conjunction with TDR, all at L3-4. Specimens were tested in flexion-extension (+ 8 Nm to − 6 Nm), lateral bending (± 6 Nm), and axial rotation (± 5 Nm). A 400 N compressive follower preload was applied during flexion-extension tests. Three-dimensional segmental motion was recorded and analyzed using analysis of variance in Systat (Systat Software Inc., Chicago, Illinois) and multiple comparisons with Bonferroni correction. Results The TDR implantation (TDR + natural facets) allowed similar lateral bending (P = .66), but it generally increased flexion-extension (P = .06) and axial rotation (P < .05) range of motion (ROM) at the implanted level compared to intact. The TFR + TDR (following replacement of the natural facets with TFR) decreased ROM to levels similar to intact in lateral bending (P = .70) and axial rotation (P = .23). The TFR + TDR flexion-extension ROM was reduced in comparison to intact and TDR + natural facets (P < .05). Conclusions The TFR with TDR was able to restore stability to the lumbar segment after bilateral facetectomy, while

  6. History, prevalence and assessment of limited joint mobility: from stiff hand syndrome to diabetic foot ulcer prevention.

    PubMed

    Francia, Piergiorgio; Anichini, Roberto; Seghieri, Giuseppe; De Bellis, Alessandra; Gulisano, Massimo

    2017-08-16

    Diabetes mellitus (DM) is one of the most important global public health problems. Patients with DM may develop different dreaded complications during their lifetime, one of which is limited joint mobility (LJM). Joint abnormalities and LJM are problems that can arise at disease onset, and progressively worsen together with the disease. Because LJM shares causal factors with other chronic diabetes-induced complications, its study has been considered useful for monitoring the risk of developing other chronic complications due to DM such as vascular disease or diabetic foot. Joint deficits have been investigated using several methods in populations of different ages and types of DM. As a result, its exact prevalence is still difficult to define which can hinder the definition of prevention strategies. The several studies carried out recently have underlined the relationship between joint mobility, glycemic control, and disease duration in addition to considering LJM as a major risk factor for the development of diabetic foot. More recently, it has been demonstrated that joint mobility can significantly improve after short-term exercise therapy protocols. Identifying the threshold values of joint mobility for the risk of developing foot ulcers has been an additional important result. Analyzing the history of the relationship between diabetes and LJM is essential for better understanding of its own complexity in order to define appropriate prevention and treatment. The main aim of this review is to describe and define the history of the relationship between DM and joint mobility in addition to explaining its prevalence, assessment and role in the development of diabetic foot ulcers for the aim of designing preventive treatments. Copyright© Bentham Science Publishers; For any queries, please email at epub@benthamscience.org.

  7. Social Attention, Joint Attention and Sustained Attention in Autism Spectrum Disorder and Williams Syndrome: Convergences and Divergences.

    PubMed

    Vivanti, Giacomo; Fanning, Peter A J; Hocking, Darren R; Sievers, Stephanie; Dissanayake, Cheryl

    2017-03-27

    There is limited knowledge on shared and syndrome-specific attentional profiles in autism spectrum disorder (ASD) and Williams syndrome (WS). Using eye-tracking, we examined attentional profiles of 35 preschoolers with ASD, 22 preschoolers with WS and 20 typically developing children across social and non-social dimensions of attention. Children with ASD and those with WS presented with overlapping deficits in spontaneous visual engagement with the target of others' attention and in sustained attention. Children with ASD showed syndrome-specific abnormalities in monitoring and following a person's referential gaze, as well as a lack of preferential attention to social stimuli. Children with ASD and WS present with shared as well as syndrome-specific abnormalities across social and non-social dimensions of attention.

  8. Alignment and focus of mirrored facets of a heliosat

    DOEpatents

    Yellowhair, Julius E; Ho, Clifford Kuofei; Diver, Richard B; Moss, Timothy A

    2013-11-12

    Various technologies pertaining to aligning and focusing mirrored facets of a heliostat are described herein. Updating alignment and/or focus of mirrored facets is undertaken through generation of a theoretical image, wherein the theoretical image is indicative of a reflection of the target via the mirrored facets when the mirrored facets are properly aligned. This theoretical image includes reference points that are overlaid on an image of the target as reflected by the mirrored facets of the heliostat. A technician adjusts alignment/focus of a mirrored facet by causing reflected reference markings to become aligned with the reference points in the theoretical image.

  9. Grounded Classification: Grounded Theory and Faceted Classification.

    ERIC Educational Resources Information Center

    Star, Susan Leigh

    1998-01-01

    Compares the qualitative method of grounded theory (GT) with Ranganathan's construction of faceted classifications (FC) in library and information science. Both struggle with a core problem--the representation of vernacular words and processes, empirically discovered, which will, although ethnographically faithful, be powerful beyond the single…

  10. Problem of time: facets and Machian strategy.

    PubMed

    Anderson, Edward

    2014-10-01

    The problem of time is that "time" in each of ordinary quantum theory and general relativity are mutually incompatible notions. This causes difficulties in trying to put these two theories together to form a theory of quantum gravity. The problem of time has eight facets in canonical approaches. I clarify that all but one of these facets already occur at the classical level, and reconceptualize and re-name some of these facets as follows. The frozen formalism problem becomes temporal relationalism, the thin sandwich problem becomes configurational relationalism, via the notion of best matching. The problem of observables becomes the problem of beables, and the functional evolution problem becomes the constraint closure problem. I also outline how each of the global and multiple-choice problems of time have their own plurality of facets. This article additionally contains a local resolution to the problem of time at the conceptual level and which is actually realizable for the relational triangle and minisuperspace models. This resolution is, moreover, Machian, and has three levels: classical, semiclassical, and a combined semiclassical-histories-timeless records scheme. I end by delineating the current frontiers of this program toward resolution of the problem of time in the cases of full general relativity and of slightly inhomogeneous cosmology. © 2014 New York Academy of Sciences.

  11. Joint swelling

    MedlinePlus

    Swelling of a joint ... Joint swelling may occur along with joint pain . The swelling may cause the joint to appear larger or abnormally shaped. Joint swelling can cause pain or stiffness. After an ...

  12. Escobar syndrome mimicing congenital patellar syndrome.

    PubMed

    Ezirmik, Naci; Yildiz, Kadri; Can, Cahit Emre

    2012-08-01

    Multiple pterygium syndrome (MPS) is a syndrome that is characterized abnormal face, short length and skin pterygiums on some body legions (servical, antecubital, popliteal, interdigital and on neck). It is also called as Pterygium Colli syndrome, Escobar syndrome or Pterygium syndrome. Escobar (multyple pterygium) syndrome is a rare syndrome. Intrauterin growth reterdation, abnormal face, wide-spead pterygiums that resulted in joint contractures, ptosis, chryptoorchidism, patellar dysplasia and foot deformities are seen on this syndrome. Primarly autosomal resesive crossing are observed; also autosomal dominant and X-linked crossing. This case were presented as it has components of Escobar syndrome and Isolated Patellar Aplasia syndrome in same time.

  13. Vertical Reduction Using Atlantoaxial Facet Spacer in Basilar Invagination with Atlantoaxial Instability

    PubMed Central

    Kim, Il Sup; Sung, Jae Hoon; Byun, Jae Hoon

    2011-01-01

    Although posterior segmental fixation technique is becoming increasingly popular, surgical treatment of craniovertebral junctional disorders is still challenging because of its complex anatomy and surrounding critical neurovascular structures. Basilar invagination is major pathology of craniovertebral junction that has been a subject of clinical interest because of its various clinical presentations and difficulty of treatment. Most authors recommend a posterior occipitocervical fixation following transoral decompression or posterior decompression and occipitocervical fixation. However, both surgical modalities inadvertently sacrifice C0-1 and C1-2 joint motion. We report two cases of basilar invagination reduced by the vertical distraction between C1-2 facet joint. We reduced the C1-2 joint in an anatomical position and fused the joint with iliac bone graft and C1-2 segmental fixation using the polyaxial screws and rods C-1 lateral mass and the C-2 pedicle. PMID:22323942

  14. Facets for Discovery and Exploration in Text Collections

    SciTech Connect

    Rose, Stuart J.; Roberts, Ian E.; Cramer, Nicholas O.

    2011-10-24

    Faceted classifications of text collections provide a useful means of partitioning documents into related groups, however traditional approaches of faceting text collections rely on comprehensive analysis of the subject area or annotated general attributes. In this paper we show the application of basic principles for facet analysis to the development of computational methods for facet classification of text collections. Integration with a visual analytics system is described with summaries of user experiences.

  15. Results from Plasma Wakefield Experiments at FACET

    SciTech Connect

    Li, S.Z.; Clarke, C.I.; England, R.J.; Frederico, J.; Gessner, S.J.; Hogan, M.J.; Jobe, R.K.; Litos, M.D.; Walz, D.R.; Muggli, P.; An, W.; Clayton, C.E.; Joshi, C.; Lu, W.; Marsh, K.A.; Mori, W.; Tochitsky, S.; Adli, E.; /U. Oslo

    2011-12-13

    We report initial results of the Plasma Wakefield Acceleration (PWFA) Experiments performed at FACET - Facility for Advanced aCcelertor Experimental Tests at SLAC National Accelerator Laboratory. At FACET a 23 GeV electron beam with 1.8 x 10{sup 10} electrons is compressed to 20 {mu}m longitudinally and focused down to 10 {mu}m x 10 {mu}m transverse spot size for user driven experiments. Construction of the FACET facility completed in May 2011 with a first run of user assisted commissioning throughout the summer. The first PWFA experiments will use single electron bunches combined with a high density lithium plasma to produce accelerating gradients > 10 GeV/m benchmarking the FACET beam and the newly installed experimental hardware. Future plans for further study of plasma wakefield acceleration will be reviewed. The experimental hardware and operation of the plasma heat-pipe oven have been successfully commissioned. Plasma wakefield acceleration was not observed because the electron bunch density was insufficient to ionize the lithium vapor. The remaining commissioning time in summer 2011 will be dedicated to delivering the FACET design parameters for the experimental programs which will begin in early 2012. PWFA experiments require the shorter bunches and smaller transverse sizes to create the plasma and drive large amplitude wakefields. Low emittance and high energy will minimize head erosion which was found to be a limiting factor in acceleration distance and energy gain. We will run the PWFA experiments with the design single bunch conditions in early 2012. Future PWFA experiments at FACET are discussed in [5][6] and include drive and witness bunch production for high energy beam manipulation, ramped bunch to optimize tranformer ratio, field-ionized cesium plasma, preionized plasmas, positron acceleration, etc.. We will install a notch collimator for two-bunch operation as well as new beam diagnostics such as the X-band TCAV [7] to resolve the two bunches

  16. Comprehensive drilling of the C1-2 facets to achieve direct posterior reduction in irreducible atlantoaxial dislocation.

    PubMed

    Salunke, Pravin; Sahoo, Sushanta K; Deepak, Arsikere N; Ghuman, Mandeep S; Khandelwal, Niranjan K

    2015-09-01

    The cause of irreducibility in irreducible atlantoaxial dislocation (AAD) appears to be the orientation of the C1-2 facets. The current management strategies for irreducible AAD are directed at removing the cause of irreducibility followed by fusion, rather than transoral decompression and posterior fusion. The technique described in this paper addresses C1-2 facet mobilization by facetectomies to aid intraoperative manipulation. Using this technique, reduction was achieved in 19 patients with congenital irreducible AAD treated between January 2011 and December 2013. The C1-2 joints were studied preoperatively, and particular attention was paid to the facet orientation. Intraoperatively, oblique C1-2 joints were opened widely, and extensive drilling of the facets was performed to make them close to flat and parallel to each other, converting an irreducible AAD to a reducible one. Anomalous vertebral arteries (VAs) were addressed appropriately. Further reduction was then achieved after vertical distraction and joint manipulation. Adequate facet drilling was achieved in all but 2 patients, due to VA injury in 1 patient and an acute sagittal angle operated on 2 years previously in the other patient. Complete reduction could be achieved in 17 patients and partial in the remaining 2. All patients showed clinical improvement. Two patients showed partial redislocation due to graft subsidence. The fusion rates were excellent. Comprehensive drilling of the C1-2 facets appears to be a logical and effective technique for achieving direct posterior reduction in irreducible AAD. The extensive drilling makes large surfaces raw, increasing fusion rates.

  17. Identifying Facets of Problem Solving in Mathematics Instruction.

    ERIC Educational Resources Information Center

    Klieme, Eckhard; Clausen, Marten

    Facets of problem solving instruction (PSI) were studied in German mathematics classrooms. Nine different facets of PSI were identified from the research literature, and a video rating form was developed to assess these facets and teacher effectiveness. Videotaped mathematics lessons (n=147) for German eighth graders from the sample for the Third…

  18. Zeroing In on Mindfulness Facets: Similarities, Validity, and Dimensionality across Three Independent Measures

    PubMed Central

    Siegling, Alex B.; Petrides, K. V.

    2016-01-01

    The field of mindfulness has seen a proliferation of psychometric measures, characterised by differences in operationalisation and conceptualisation. To illuminate the scope of, and offer insights into, the diversity apparent in the burgeoning literature, two distinct samples were used to examine the similarities, validity, and dimensionality of mindfulness facets and subscales across three independent measures: the Five Facet Mindfulness Questionnaire (FFMQ), Philadelphia Mindfulness Scale (PHLMS), and Toronto Mindfulness Scale (TMS). Results revealed problematic associations of FFMQ Observe with the other FFMQ facets and supported a four-factor structure (omitting this facet), while disputing the originally envisaged five-factor model; thus, solidifying a pattern in the literature. Results also confirmed the bidimensional nature of the PHLMS and TMS subscales, respectively. A joint Confirmatory Factor Analysis showed that PHLMS Acceptance could be assimilated within the FFMQ’s four-factor model (as a distinct factor). The study offers a way of understanding interrelationships between the available mindfulness scales, so as to help practitioners and researchers make a more informed choice when conceptualising and operationalising mindfulness. PMID:27055017

  19. Zeroing In on Mindfulness Facets: Similarities, Validity, and Dimensionality across Three Independent Measures.

    PubMed

    Siegling, Alex B; Petrides, K V

    2016-01-01

    The field of mindfulness has seen a proliferation of psychometric measures, characterised by differences in operationalisation and conceptualisation. To illuminate the scope of, and offer insights into, the diversity apparent in the burgeoning literature, two distinct samples were used to examine the similarities, validity, and dimensionality of mindfulness facets and subscales across three independent measures: the Five Facet Mindfulness Questionnaire (FFMQ), Philadelphia Mindfulness Scale (PHLMS), and Toronto Mindfulness Scale (TMS). Results revealed problematic associations of FFMQ Observe with the other FFMQ facets and supported a four-factor structure (omitting this facet), while disputing the originally envisaged five-factor model; thus, solidifying a pattern in the literature. Results also confirmed the bidimensional nature of the PHLMS and TMS subscales, respectively. A joint Confirmatory Factor Analysis showed that PHLMS Acceptance could be assimilated within the FFMQ's four-factor model (as a distinct factor). The study offers a way of understanding interrelationships between the available mindfulness scales, so as to help practitioners and researchers make a more informed choice when conceptualising and operationalising mindfulness.

  20. PSMB8 Encoding the β5i Proteasome Subunit Is Mutated in Joint Contractures, Muscle Atrophy, Microcytic Anemia, and Panniculitis-Induced Lipodystrophy Syndrome

    PubMed Central

    Agarwal, Anil K.; Xing, Chao; DeMartino, George N.; Mizrachi, Dario; Hernandez, Maria Dolores; Sousa, Ana Berta; Martínez de Villarreal, Laura; dos Santos, Heloísa G.; Garg, Abhimanyu

    2010-01-01

    We performed homozygosity mapping in two recently reported pedigrees from Portugal and Mexico with an autosomal-recessive autoinflammatory syndrome characterized by joint contractures, muscle atrophy, microcytic anemia, and panniculitis-induced lipodystrophy (JMP). This revealed only one homozygous region spanning 2.4 Mb (5818 SNPs) on chromosome 6p21 shared by all three affected individuals from both families. We directly sequenced genes involved in immune response located in this critical region, excluding the HLA complex genes. We found a homozygous missense mutation c.224C>T (p.Thr75Met) in the proteasome subunit, beta-type, 8 (PSMB8) gene in affected patients from both pedigrees. The mutation segregated in an autosomal-recessive fashion and was not detected in 275 unrelated ethnically matched healthy subjects. PSMB8 encodes a catalytic subunit of the 20S immunoproteasomes called β5i. Immunoproteasome-mediated proteolysis generates immunogenic epitopes presented by major histocompatibility complex (MHC) class I molecules. Threonine at position 75 is highly conserved and its substitution with methionine disrupts the tertiary structure of PSMB8. As compared to normal lymphoblasts, those from an affected patient showed significantly reduced chymotrypsin-like proteolytic activity mediated by immunoproteasomes. We conclude that mutations in PSMB8 cause JMP syndrome, most probably by affecting MHC class I antigen processing. PMID:21129723

  1. Syndrome of short stature, widow's peak, ptosis, posteriorly angulated ears, and joint problems: exclusion of the Aarskog (FGD1) gene as a candidate gene.

    PubMed

    LaDine, B J; Simmons, J A; Shrimpton, A E; Hoo, J J

    2001-03-15

    A syndrome encompassing postnatal onset of short stature, widow's peak, ptosis, posteriorly angulated ears, and limitation of forearm supination is reported in a boy and his mother. The boy has not yet experienced dislocation of patella or other joint anomaly except for limitation of supination of the forearms. On the other hand, the mother has a milder limitation of supination only on the left arm and is devoid of ptosis. Their condition is reminiscent of that described in the family reported by Kapur et al. [1989: Am. J. Med. Genet. 33: 357-363.], which showed an X-linked dominant mode of inheritance. DNA study on our family using an intragenic polymorphism of the Aarskog syndrome (FGD1) gene and four other adjacent markers convincingly excludes the possibility that their condition could be caused by a mutation of the FGD1 gene. Our family and the family reported by Kapur et al. may suggest segregation of a novel X-linked dominant condition.

  2. Nonradiative Step Facets in Semiconductor Nanowires.

    PubMed

    Sanchez, Ana M; Zhang, Yunyan; Tait, Edward W; Hine, Nicholas D M; Liu, Huiyun; Beanland, Richard

    2017-04-12

    One of the main advantages of nanowires for functional applications is their high perfection, which results from surface image forces that act on line defects such as dislocations, rendering them unstable and driving them out of the crystal. Here we show that there is a class of step facets that are stable in nanowires, with no long-range strain field or dislocation character. In zinc-blende semiconductors, they take the form of Σ3 (112) facets with heights constrained to be a multiple of three {111} monolayers. Density functional theory calculations show that they act as nonradiative recombination centers and have deleterious effects on nanowire properties. We present experimental observations of these defects on twin boundaries and twins that terminate inside GaAsP nanowires and find that they are indeed always multiples of three monolayers in height. Strategies to use the three-monolayer rule during growth to prevent their formation are discussed.

  3. Rough surface scattering based on facet model

    NASA Technical Reports Server (NTRS)

    Khamsi, H. R.; Fung, A. K.; Ulaby, F. T.

    1974-01-01

    A model for the radar return from bare ground was developed to calculate the radar cross section of bare ground and the effect of the frequency averaging on the reduction of the variance of the return. It is shown that, by assuming that the distribution of the slope to be Gaussian and that the distribution of the length of the facet to be in the form of the positive side of a Gaussian distribution, the results are in good agreement with experimental data collected by an 8- to 18-GHz radar spectrometer system. It is also shown that information on the exact correlation length of the small structure on the ground is not necessary; an effective correlation length may be calculated based on the facet model and the wavelength of the incident wave.

  4. Facets of Emotional Clarity and Suspiciousness

    PubMed Central

    Boden, Matthew Tyler; Berenbaum, Howard

    2012-01-01

    In a college student sample, we explored the relations between individual differences in facets of emotional clarity and suspiciousness. Previous theory and research has treated emotional clarity as a one-dimensional construct. Boden and Berenbaum (2011) proposed that a second facet of emotional clarity, source awareness (a general understanding of the cause of their emotions), could be distinguished from type awareness (a general understanding of the type of emotions [anger, fear] experienced). We found that source and type awareness were incrementally, inversely associated with suspiciousness when statistically accounting for the extent to which emotions are attended to, and gender. Additionally, source awareness significantly predicted suspiciousness after accounting for anger, anxious arousal, and social anxiety, whereas type awareness did not. Findings are consistent with the hypothesis that, among individuals with low source and type awareness, suspicious beliefs are formed to make sense of and explain emotional arousal. PMID:22736879

  5. How faceted liquid droplets grow tails

    PubMed Central

    Guttman, Shani; Sapir, Zvi; Schultz, Moty; Butenko, Alexander V.; Ocko, Benjamin M.; Deutsch, Moshe; Sloutskin, Eli

    2016-01-01

    Liquid droplets, widely encountered in everyday life, have no flat facets. Here we show that water-dispersed oil droplets can be reversibly temperature-tuned to icosahedral and other faceted shapes, hitherto unreported for liquid droplets. These shape changes are shown to originate in the interplay between interfacial tension and the elasticity of the droplet’s 2-nm-thick interfacial monolayer, which crystallizes at some T = Ts above the oil’s melting point, with the droplet’s bulk remaining liquid. Strikingly, at still-lower temperatures, this interfacial freezing (IF) effect also causes droplets to deform, split, and grow tails. Our findings provide deep insights into molecular-scale elasticity and allow formation of emulsions of tunable stability for directed self-assembly of complex-shaped particles and other future technologies. PMID:26733673

  6. Facets of Emotional Clarity and Suspiciousness.

    PubMed

    Boden, Matthew Tyler; Berenbaum, Howard

    2012-09-01

    In a college student sample, we explored the relations between individual differences in facets of emotional clarity and suspiciousness. Previous theory and research has treated emotional clarity as a one-dimensional construct. Boden and Berenbaum (2011) proposed that a second facet of emotional clarity, source awareness (a general understanding of the cause of their emotions), could be distinguished from type awareness (a general understanding of the type of emotions [anger, fear] experienced). We found that source and type awareness were incrementally, inversely associated with suspiciousness when statistically accounting for the extent to which emotions are attended to, and gender. Additionally, source awareness significantly predicted suspiciousness after accounting for anger, anxious arousal, and social anxiety, whereas type awareness did not. Findings are consistent with the hypothesis that, among individuals with low source and type awareness, suspicious beliefs are formed to make sense of and explain emotional arousal.

  7. Effect of Retrograde Reaming for Tibiotalocalcaneal Arthrodesis on Subtalar Joint Destruction: A Cadaveric Study.

    PubMed

    Lowe, Jason A; Routh, Lucas K; Leary, Jeffrey T; Buzhardt, Paul C

    2016-01-01

    Recent published data have suggested successful union of subtalar and tibiotalar joints without formal debridement during tibiotalocalcaneal (TTC) fusion procedures. Although previous studies have reported on the importance of the proper guidewire starting point and trajectory to obtain appropriate hindfoot alignment for successful fusion, to our knowledge, no studies have quantified the amount of articular damage to the subtalar joint with retrograde reaming. We hypothesized that reaming would destroy >50% of the posterior facet of the subtalar joint. The bilateral lower extremities of 5 cadavers were obtained and the subtalar joints exposed. Retrograde TTC nail guidewires were inserted, and a 12-mm reamer was passed through the subtalar and ankle joints. Pre- and postreaming images of the subtalar joint were obtained to compare the amount of joint destruction after reaming. We found an average of 5.89% articular destruction of the talar posterior facet and an average of 4.01% articular destruction of the posterior facet of the calcaneus. No damage to the middle facets of the subtalar joint was observed. TTC nailing is a successful procedure for ankle and subtalar joint fusion. Published studies have reported successful subtalar union using TTC nailing without formal open debridement of the subtalar joint, preserving the soft tissue envelope. TTC nail insertion using a 12-mm reamer will destroy 5.89% and 4.01% of the respective talar and calcaneal posterior facets of the subtalar joint.

  8. FACET: The New User Facility at SLAC

    SciTech Connect

    Clarke, C.I.; Decker, F.J.; Erikson, R.; Hast, C.; Hogan, M.J.; Iverson, R.; Li, S.Z.; Nosochkov, Y.; Phinney, N.; Sheppard, J.; Wienands, U.; Woodley, M.; Yocky, G.; Seryi, A.; Wittmer, W.; /Michigan State U.

    2011-12-13

    FACET (Facility for Advanced Accelerator and Experimental Tests) is a new User Facility at SLAC National Accelerator Laboratory. Its high power electron and positron beams make it a unique facility, ideal for beam-driven Plasma Wakefield Acceleration studies. The first 2 km of the SLAC linac produce 23 GeV, 3.2 nC electron and positron beams with short bunch lengths of 20 {mu}m. A final focusing system can produce beam spots 10 {mu}m wide. User-aided Commissioning took place in summer 2011 and FACET will formally come online in early 2012. We present the User Facility, the current features, planned upgrades and the opportunities for further experiments. Accelerators are our primary tool for discovering the fundamental laws to the universe. Each new frontier we probe requires a new, more powerful method. Accelerators are therefore increasing in size and cost. The future of this field requires new accelerating techniques that can reach the high energies required over shorter distances. New concepts for high gradient acceleration include utilizing the wakes in plasma and dielectric and metallic structures. FACET was built to provide a test bed for novel accelerating concepts with its high charge and highly compressed beams. As a test facility unlike any other, it has also attracted groups interested in beam diagnostic techniques and terahertz studies. The first phase of the construction was completed in May 2011. Beam commissioning began in June and was interleaved with the installation of five experiments. Users were invited to aid with the commissioning for the month of August during which time experimental hardware and software were checked out and some first measurements were taken. FACET is currently in the process of becoming a Department of Energy User Facility for High Energy Physics.

  9. JPL tests of a LaJet concentrator facet

    NASA Technical Reports Server (NTRS)

    Dennison, E. W.; Argoud, M. J.

    1983-01-01

    A LaJet Energy Company (LEC) concentrator facet, 60 in. in diameter, was tested for imaging quality. The following two methods were used: (1) autofocus tests with a point source of light at the facet's radius of curvature; and (2) tests with the Sun close to the horizon as a distant source. The tests of the LaJet facet indicate that all of the solar image reflected by an LEC 460 solar concentrator made of like facets should fall within a 9-in. aperture if the outer facets are carefully adjusted. Such a concentrator would have acceptable performance, but complete evaluation must be made with an assembled concentrator.

  10. Kinetics of faceting of crystals in growth, etching, and equilibrium

    NASA Astrophysics Data System (ADS)

    Vlachos, D. G.; Schmidt, L. D.; Aris, R.

    1993-03-01

    The faceting of crystals in equilibrium with the gas phase and also during crystal growth and etching conditions is studied using the Monte Carlo method. The dynamics of the transformation of unstable crystallographic orientations into hill and valley structures and the spatial patterns that develop are examined as functions of surface temperature, crystallographic orientation, and strength of interatomic potential for two transport processes: adsorption-desorption and surface diffusion. The results are compared with the continuum theory for facet formation. Thermodynamically unstable orientations break into hill and valley structures, and faceting exhibits three time regimes: disordering, facet nucleation, and coarsening of small facets to large facets. Faceting is accelerated as temperature increases, but thermal roughening can occur at high temperatures. Surface diffusion is the dominant mechanism at short times and small facets but adsorption-desorption becomes important at long times and large facets. Growth and etching promote faceting for conditions close to equilibrium but induce kinetic roughening for conditions far from equilibrium. Simultaneous irreversible growth and etching conditions with fast surface diffusion result in enhanced faceting.

  11. CT of facet distraction in flexion injuries of the thoracolumbar spine: the "naked" facet.

    PubMed

    O'Callaghan, J P; Ullrich, C G; Yuan, H A; Kieffer, S A

    1980-03-01

    Vertical distraction of the articular processes is an important sign of ligamentous disruption due to flexion injuries of the thoracolumbar spine. In addition to illustrating this finding in cross section (the "naked" facet), computed tomography in the transaxial plane allows assessment of the presence and position of fracture fragments that may encroach on the spinal canal. Image reconstruction in sagittal and coronal planes provides a clear demonstration of the degree of bony compression, facet distraction, and kyphosis associated with flexion injuries without additional patient manipulation or radiation exposure.

  12. The joint effect of cigarette smoking and polymorphisms on LRP5, LEPR, near MC4R and SH2B1 genes on metabolic syndrome susceptibility in Taiwan.

    PubMed

    Yang, Chuan-Wei; Li, Chia-Ing; Liu, Chiu-Shong; Bau, Da-Tian; Lin, Chih-Hsueh; Lin, Wen-Yuan; Li, Tsai-Chung; Lin, Cheng-Chieh

    2013-01-01

    Metabolic syndrome (MetS) is a combination of medical disorders, consisting of multiple, interrelated risk factors of metabolic origin. To investigate the associations of MetS with appetite-related genes (LEPR, near MC4R and SH2B1) and cholesterol metabolism-related gene (LRP5) polymorphism variants and the joint effect of cigarette smoking and these polymorphism variants on MetS in a community-based case-control study. Metabolic syndrome was defined according to the American Heart Association and National Heart Lung Blood Institute (AHA/NHLBI) criteria. A total of 237 MetS cases and 202 subjects without MetS aged 40 or over in Taiwan were analyzed. The genotypes of LRP5-rs3736228, LEPR-rs1137100, near MC4R-rs17782313 and SH2B1-rs4788102 were analyzed by the PCR-restriction fragment length polymorphism method. A strong association of the SNP rs17782313 near MC4R gene with MetS susceptibility was found. The data indicated that the C allele of near MC4R-rs17782313 is an obvious risk factor for MetS susceptibility. The joint effects of cigarette smoking and susceptible genotypes of LRP5, LEPR, near MC4R or SH2B1 genes led to a relatively higher risk of having MetS. Using subjects with the wild-type of LRP5, LEPR, near MC4R or SH2B1 genes and without a smoking habit as a reference group, those with cigarette smoking (current and former) and more than one variant type had a 4.1-fold (95 % CI = 1.6-10.2) risk of having MetS. The genotypes of the appetite-related genes (LEPR, near MC4R and SH2B1) and cholesterol metabolism-related gene (LRP5), together with a cigarette smoking habit, are important risk factors for MetS.

  13. FIRO-B: factors and facets.

    PubMed

    Macrosson, W D

    2000-02-01

    10 FIRO-B intercorrelation matrices were factor analysed; one matrix was derived from new FIRO-B data, all the other matrices were found in the literature. The correlation matrices were also subjected to meta-analysis. The findings suggested that the four FIRO-B scales associated with Inclusion and Affection are facets of the ubiquitous interpersonal superfactor, Nurturance, but the two FIRO-B Control scales each express an orthogonal construct both of which relate to the super-factor, Dominance.

  14. Fabrication of faceted nanopores in magnesium

    SciTech Connect

    Wu, Shujing; Cao, Fan; Zheng, He; Sheng, Huaping; Liu, Chun; Liu, Yu; Zhao, Dongshan; Wang, Jianbo

    2013-12-09

    In this paper, using high resolution transmission electron microscopy, we showed the fabrication of faceted nanopores with various shapes in magnesium by focused electron beam (e-beam). The characteristics of nanopore shapes and the crystallographic planes corresponding to the edges of the nanopores were discussed in detail. Interestingly, by manipulating the e-beam (e.g., irradiation direction and duration), the nanopore shape and size could be effectively controlled along different directions. Our results provide important insight into the nanopore patterning in metallic materials and are of fundamental importance concerning the relevant applications, such as nanopore-based sensor, etc.

  15. FACETS -- Infrastructure for Integrated Fusion Modeling

    NASA Astrophysics Data System (ADS)

    Shasharina, Svetlana; Cary, John; Carlsson, Johan; Hakim, Ammar; Kruger, Scott; Miah, Mahmood; Pletzer, Alexander; Vadlamani, Srinath; Wade-Stein, David; Balay, Satish; McInnes, Lois; Zhang, Hong; Candy, Jeff; Fahey, Mark; Cohen, Ron; Epperly, Tom; Rognlien, Tom; Estep, Don; Pankin, Alexei; Malony, Allen; Morris, Alan; Shende, Sameer; Indireshkumar, Keshavamurthy; McCune, Douglas; Pigarov, Alexander

    2009-11-01

    It is desirable that an infrastructure for integrated fusion modeling has support for: legacy and new components used interchangeably; consistent management of components lifecycle; allocating parallel resources consistent with the nature of participating components and the problem scope; components written in multiple programming languages; composition of sequentially and concurrently executing components respecting dependencies; tight and loose coupling of components; testing and validation of separate and integrated components; and use of multiple platforms from desktops to LCFs. In this poster we will describe the status of the FACETS with respect to these features.

  16. Comparison of muscle and joint pressure-pain thresholds in patients with complex regional pain syndrome and upper limb pain of other origin.

    PubMed

    Mainka, Tina; Bischoff, Florian S; Baron, Ralf; Krumova, Elena K; Nicolas, Volkmar; Pennekamp, Werner; Treede, Rolf-Detlef; Vollert, Jan; Westermann, Andrea; Maier, Christoph

    2014-03-01

    Pain localized in the deep tissues occurs frequently in complex regional pain syndrome (CRPS). In addition, hyperalgesia to blunt pressure over muscles is common in CRPS, but it often appears in limb pain of other origin as well. Considering that 3-phase bone scintigraphy (TPBS) reveals periarticular enhanced bone metabolism in CRPS, joint-associated hyperalgesia to blunt pressure might be a more specific finding than hyperalgesia over muscles. In 34 patients with upper limb pain (18 CRPS, 16 non-CRPS; diagnosed in accordance to the Budapest criteria) and in 18 healthy controls, pressure-pain thresholds (PPT) were assessed bilaterally over the thenar (PPTThenar), the metacarpophalangeal (PPTMCP), and the proximal interphalangeal (PPTPIP) joints using a pressure algometer (Somedic, Sweden). Beforehand, all patients had received TPBS for diagnostic purposes independently of the study. Region-of-interest (ROI) ratios (mineralization phase) for the MCP and PIP, excluding fracture sites, were correlated with the PPT. In CRPS, all ROI ratios were significantly increased and all PPT of the affected hand were decreased compared to non-CRPS (PPTThenar: 243±150kPa vs 358±197kPa, PPTMCP: 80±67kPa vs 159±93kPa, PPTPIP: 80±56kPa vs 184±110kPa; P<.01) and controls (PPTThenar: 478±106kPa, PPTMCP: 254±50kPa, PPTPIP: 275±76kPa; P<.01). A PPTThenar below 293kPa revealed 77% sensitivity but only 63% specificity, whereas a PPTPIP below 102kPa had 82% sensitivity and 94% specificity to identify CRPS. Only in CRPS were PPTMCP and PPTPIP correlated significantly inversely with the ROI ratio (MCP: r=-0.439, PIP: r=-0.447). PPTPIP shows higher specificity for CRPS type I than PPTThenar without loss of sensitivity. Therefore, measurement of joint PPT could be a noninvasive diagnostic tool reflecting increased bone metabolism assessed by TPBS as a sign of bone pathophysiology. Copyright © 2013 International Association for the Study of Pain. Published by Elsevier B.V. All rights

  17. Independent and joint associations of TV viewing time and snack food consumption with the metabolic syndrome and its components; a cross-sectional study in Australian adults.

    PubMed

    Thorp, Alicia A; McNaughton, Sarah A; Owen, Neville; Dunstan, David W

    2013-08-09

    Television (TV) viewing time is positively associated with the metabolic syndrome (MetS) in adults. However, the mechanisms through which TV viewing time is associated with MetS risk remain unclear. There is evidence that the consumption of energy-dense, nutrient poor snack foods increases during TV viewing time among adults, suggesting that these behaviors may jointly contribute towards MetS risk. While the association between TV viewing time and the MetS has previously been shown to be independent of adult's overall dietary intake, the specific influence of snack food consumption on the relationship is yet to be investigated. The purpose of this study was to examine the independent and joint associations of daily TV viewing time and snack food consumption with the MetS and its components in a sample of Australian adults. Population-based, cross-sectional study of 3,110 women and 2,572 men (>35 years) without diabetes or cardiovascular disease. Participants were recruited between May 1999 and Dec 2000 in the six states and the Northern Territory of Australia. Participants were categorised according to self-reported TV viewing time (low: 0-2 hr/d; high: >2 hr/d) and/or consumption of snack foods (low: 0-3 serves/d; high: >3 serves/d). Multivariate odds ratios [95% CI] for the MetS and its components were estimated using gender-specific, forced entry logistic regression. OR [95% CI] for the MetS was 3.59 [2.25, 5.74] (p≤0.001) in women and 1.45 [1.02, 3.45] (p = 0.04) in men who jointly reported high TV viewing time and high snack food consumption. Obesity, insulin resistance and hypertension (women only) were also jointly associated with high TV viewing time and high snack food consumption. Further adjustment for diet quality and central adiposity maintained the associations in women. High snack food consumption was also shown to be independently associated with MetS risk [OR: 1.94 (95% CI: 1.45, 2.60), p < 0.001] and hypertension [OR: 1.43 (95% CI: 1

  18. Independent and joint associations of TV viewing time and snack food consumption with the metabolic syndrome and its components; a cross-sectional study in Australian adults

    PubMed Central

    2013-01-01

    Background Television (TV) viewing time is positively associated with the metabolic syndrome (MetS) in adults. However, the mechanisms through which TV viewing time is associated with MetS risk remain unclear. There is evidence that the consumption of energy-dense, nutrient poor snack foods increases during TV viewing time among adults, suggesting that these behaviors may jointly contribute towards MetS risk. While the association between TV viewing time and the MetS has previously been shown to be independent of adult’s overall dietary intake, the specific influence of snack food consumption on the relationship is yet to be investigated. The purpose of this study was to examine the independent and joint associations of daily TV viewing time and snack food consumption with the MetS and its components in a sample of Australian adults. Methods Population-based, cross-sectional study of 3,110 women and 2,572 men (>35 years) without diabetes or cardiovascular disease. Participants were recruited between May 1999 and Dec 2000 in the six states and the Northern Territory of Australia. Participants were categorised according to self-reported TV viewing time (low: 0-2 hr/d; high: >2 hr/d) and/or consumption of snack foods (low: 0-3 serves/d; high: >3 serves/d). Multivariate odds ratios [95% CI] for the MetS and its components were estimated using gender-specific, forced entry logistic regression. Results OR [95% CI] for the MetS was 3.59 [2.25, 5.74] (p≤0.001) in women and 1.45 [1.02, 3.45] (p = 0.04) in men who jointly reported high TV viewing time and high snack food consumption. Obesity, insulin resistance and hypertension (women only) were also jointly associated with high TV viewing time and high snack food consumption. Further adjustment for diet quality and central adiposity maintained the associations in women. High snack food consumption was also shown to be independently associated with MetS risk [OR: 1.94 (95% CI: 1.45, 2.60), p < 0.001] and

  19. Foundations of reusable and interoperable facet models using category theory.

    PubMed

    Harris, Daniel R

    2016-10-01

    Faceted browsing has become ubiquitous with modern digital libraries and online search engines, yet the process is still difficult to abstractly model in a manner that supports the development of interoperable and reusable interfaces. We propose category theory as a theoretical foundation for faceted browsing and demonstrate how the interactive process can be mathematically abstracted. Existing efforts in facet modeling are based upon set theory, formal concept analysis, and light-weight ontologies, but in many regards, they are implementations of faceted browsing rather than a specification of the basic, underlying structures and interactions. We will demonstrate that category theory allows us to specify faceted objects and study the relationships and interactions within a faceted browsing system. Resulting implementations can then be constructed through a category-theoretic lens using these models, allowing abstract comparison and communication that naturally support interoperability and reuse.

  20. An Integrated Facet-Based Library for Arbitrary Software Components

    NASA Astrophysics Data System (ADS)

    Schmidt, Matthias; Polowinski, Jan; Johannes, Jendrik; Fernández, Miguel A.

    Reuse is an important means of reducing costs and effort during the development of complex software systems. A major challenge is to find suitable components in a large library with reasonable effort. This becomes even harder in today's development practice where a variety of artefacts such as models and documents play an equally important role as source code. Thus, different types of heterogeneous components exist and require consideration in a component search process. One flexible approach to structure (software component) libraries is faceted classification. Faceted classifications and in particular faceted browsing are nowadays widely used in online systems. This paper takes a fresh approach towards using faceted classification in heterogeneous software component libraries by transferring faceted browsing concepts from the web to software component libraries. It presents an architecture and implementation of such a library. This implementation is used to evaluate the applicability of facets in the context of an industry-driven case study.

  1. Facets of Dispositional Mindfulness and Health Among College Students.

    PubMed

    Bodenlos, Jamie S; Wells, Stephanie Y; Noonan, Marleah; Mayrsohn, Aubreyanne

    2015-10-01

    The purpose of the current study was to examine the relationship between the facets of trait mindfulness with psychological and physical health while controlling for health behaviors in college students. 310 students from a small, private college in the Northeastern United States. Students completed self-report measures, including the Perceived Stress Scale (PSS-14), the Five Facet Mindfulness Questionnaire (FFMQ), Medical Outcomes Short-Form Health Survey (SF-36), and the Rutgers Alcohol Problems Index (RAPI). After controlling for other health behaviors, the observation facet of mindfulness was negatively associated with physical health. Both acting with awareness and nonjudging facets were positively associated with emotional well-being. For social functioning, nonjudging was a significant positive facet for this domain of health. Tailoring mindfulness-based interventions to enhance these facets may be beneficial to young adults.

  2. Facet-Engineered Surface and Interface Design of Photocatalytic Materials.

    PubMed

    Bai, Song; Wang, Lili; Li, Zhengquan; Xiong, Yujie

    2017-01-01

    The facet-engineered surface and interface design for photocatalytic materials has been proven as a versatile approach to enhance their photocatalytic performance. This review article encompasses some recent advances in the facet engineering that has been performed to control the surface of mono-component semiconductor systems and to design the surface and interface structures of multi-component heterostructures toward photocatalytic applications. The review begins with some key points which should receive attention in the facet engineering on photocatalytic materials. We then discuss the synthetic approaches to achieve the facet control associated with the surface and interface design. In the following section, the facet-engineered surface design on mono-component photocatalytic materials is introduced, which forms a basis for the discussion on more complex systems. Subsequently, we elucidate the facet-engineered surface and interface design of multi-component photocatalytic materials. Finally, the existing challenges and future prospects are discussed.

  3. Faceted ceramic fibers, tapes or ribbons and epitaxial devices therefrom

    SciTech Connect

    Goyal, Amit

    2013-07-09

    A crystalline article includes a single-crystal ceramic fiber, tape or ribbon. The fiber, tape or ribbon has at least one crystallographic facet along its length, which is generally at least one meter long. In the case of sapphire, the facets are R-plane, M-plane, C-plane or A-plane facets. Epitaxial articles, including superconducting articles, can be formed on the fiber, tape or ribbon.

  4. Faceted ceramic fibers, tapes or ribbons and epitaxial devices therefrom

    DOEpatents

    Goyal, Amit [Knoxville, TN

    2012-07-24

    A crystalline article includes a single-crystal ceramic fiber, tape or ribbon. The fiber, tape or ribbon has at least one crystallographic facet along its length, which is generally at least one meter long. In the case of sapphire, the facets are R-plane, M-plane, C-plane or A-plane facets. Epitaxial articles, including superconducting articles, can be formed on the fiber, tape or ribbon.

  5. Accommodation of angular incompatibilities between interfacial facets during precipitate growth

    NASA Astrophysics Data System (ADS)

    Pond, R. C.; Jiao, H.; Zhang, L. C.; Aindow, M.

    2006-03-01

    Precipitate growth in a duplex stainless steel and a titanium aluminide alloy has been studied using transmission electron microscopy. Particles with similar crystallography and acicular form arise in both cases, and are bounded by two principal facets. One facet, designated C, is based on a commensurate singular interface structure, and the coherency strains are accommodated by interfacial defects. The other facet, designated I, is based on a singular configuration that is incommensurate in one dimension. The orientation relationship (OR) between the particle and the matrix for the singular C structure is Kurdjumov-Sachs (K-S), whereas that for the I facet is Pitsch. The angular incompatibility between these two types of facets must be accommodated to minimize the displacement field as particles grow. The present observations suggest that this is accomplished through the generation of crystal dislocations at facet junctions and their subsequent climb along the facets. The total density of defects needed to accommodate the angular discrepancy is fixed, but the partitioning of these dislocations between C and I facets is not. The actual partitioning determines the observed OR for a particle, and is determined by the kinetics of climb, which is likely to be different in the two facets. In the stainless steel, the observations are consistent with climb occurring in both the C and I facets, but faster in the I facet, leading to a distribution of observed ORs that is skewed away from Pitsch toward K-S. In the titanium aluminide alloy, no climb into the C facets was found, so a unique OR close to K-S arises.

  6. Ultrasound-guided facet block to low back pain: a case report.

    PubMed

    Santiago, Ana Ellen Q; Leal, Plinio C; Bezerra, Elmiro Helio M; Giraldes, Ana Laura A; Ferraro, Leonardo C; Rezende, Andre H; Sakata, Rioko Kimiko

    2014-01-01

    osteoarthrosis is a common cause of low back pain. The diagnosis is clinical and can be confirmed by imaging studies. Pain treatment and confirmation of diagnosis are made by intra-articular injection of corticosteroid and by local anesthetic use, due to clinical improvement. A direct monitoring of the procedure can be done under fluoroscopy, a classic technique, or else by an ultrasound-guided procedure. female patient, 88 years old, 1.68 m and 72 kg, with facet osteoarthrosis at L2-L3, L3-L4 and L4-L5 for two years. On physical examination, she exhibited pain on lateralization and spinal extension. We opted in favor of an ultrasound-guided facet joint block. A midline spinal longitudinal scan was obtained, with identification of the desired joint space at L3-L4. A 25G needle was inserted into the skin by the echographic off-plane ultrasound technique. 1 mL of contrast was administered, with confirmation by fluoroscopy. After aspiration of the contrast, 1 mL of solution containing 0.25% bupivacaine hydrochloride and 10mg of methylprednisolone acetate was injected. Injections into L3-L4, L2-L3 and L1-L2 to the right were applied. the visualization of the facet joint by ultrasound involves minimal risk, besides reduction of radiation. This option is suitable for a large part of the population. However, fluoroscopy and computed tomography remain as monitoring techniques indicated for patients with specific characteristics, such as obesity, severe degenerative diseases and anatomical malformations, in which the ultrasound technique is still in need of further study. Copyright © 2013 Sociedade Brasileira de Anestesiologia. Published by Elsevier Editora Ltda. All rights reserved.

  7. [Ultrasound-guided facet block to low back pain: a case report].

    PubMed

    Santiago, Ana Ellen Q; Leal, Plinio C; Bezerra, Elmiro Helio M; Giraldes, Ana Laura A; Ferraro, Leonardo C; Rezende, Andre H; Sakata, Rioko Kimiko

    2014-01-01

    Osteoarthrosis is a common cause of low back pain. The diagnosis is clinical and can be confirmed by imaging studies. Pain treatment and confirmation of diagnosis are made by intra-articular injection of corticosteroid and by local anesthetic use, due to clinical improvement. A direct monitoring of the procedure can be done under fluoroscopy, a classic technique, or else by an ultrasound-guided procedure. Female patient, 88 years old, 1.68m and 72kg, with facet osteoarthrosis at L2-L3, L3-L4 and L4-L5 for two years. On physical examination, she exhibited pain on lateralization and spinal extension. We opted in favor of an ultrasound-guided facet joint block. A midline spinal longitudinal scan was obtained, with identification of the desired joint space at L3-L4. A 25 G needle was inserted into the skin by the echographic off-plane ultrasound technique. 1 mL of contrast was administered, with confirmation by fluoroscopy. After aspiration of the contrast, 1 mL of solution containing 0.25% bupivacaine hydrochloride and 10 mg of methylprednisolone acetate was injected. Injections into L3-L4, L2-L3 and L1-L2 to the right were applied. The visualization of the facet joint by ultrasound involves minimal risk, besides reduction of radiation. This option is suitable for a large part of the population. However, fluoroscopy and computed tomography remain as monitoring techniques indicated for patients with specific characteristics, such as obesity, severe degenerative diseases and anatomical malformations, in which the ultrasound technique is still in need of further study. Copyright © 2013 Sociedade Brasileira de Anestesiologia. Publicado por Elsevier Editora Ltda. All rights reserved.

  8. Question mark ears, temporo-mandibular joint malformation and hypotonia: auriculo-condylar syndrome or a distinct entity?

    PubMed

    Priolo, M; Lerone, M; Rosaia, L; Calcagno, E P; Sadeghi, A K; Ghezzi, F; Ravazzolo, R; Silengo, M

    2000-10-01

    We report a boy with prominent, peculiarly malformed ears, abnormality of the ramus of the mandible and hypotonia. An isolated peculiar bilateral ear deformity named 'question mark ear' has been delineated in plastic reconstruction surgery reviews [Cosman et al., 1970 Plast Reconstr Surg 46:454-457; Cosman (1984) Plast Reconstr Surg 73:572-576; Takato et al. (1989) Ann Plast Surg 22:69-73; Brodovsky (1997) Plast Reconstr Surg 100:1254-1257; Park (1998) Plast Reconstr Surg 101:1620-1623; Al-Quattan (1998) Plast Reconstr Surg 102:439-441] and a similar deformity of the ear and changes in the temporo-mandibular joint and condyle has been described by Jampol et al. [(1998) Am J Med Genet 75:449-452] and by Guion-Almeida et al. [(1999) Am J Med Genet 86:130-133]. The present case may be the third description of this malformation complex with additional clinical features characterized by hypotonia and mild developmental delay, or possibly a new distinct entity.

  9. [Performance assessment using the Many-Facet Rasch Measurement].

    PubMed

    Prieto Adánez, Gerardo

    2011-04-01

    This paper describes how the Many-Facet Rasch Measurement (MFRM) can be applied to constructed-response items and rater analysis. The article provides an introduction to MFRM, a description of facet analysis procedures, and an illustrative example to examine the effects of various sources of variability on students' performance on a DELE (Diplomas in Spanish as a Foreign Language) test by means of the FACETS program. Results highlight the usefulness of the MFRM to detect raters that have extreme values on the continuum of severity. MFRM facilitates comprehension of the assessment process as well as providing objective measurement of facet elements.

  10. Global faceting behavior of strained Ge islands on Si.

    PubMed

    Robinson, Jeremy T; Rastelli, Armando; Schmidt, Oliver; Dubon, Oscar D

    2009-02-25

    The evolution of crystallographic facets of strained heteroepitaxial Ge islands on Si is investigated. Islands growing on Si(001), (111), (110) and (113) are bound by an equilibrium set of facets that includes only shared stable surfaces between bulk Si and Ge--{105}, {113}, {15 3 23} and {111}. The formation of a stereographic map from these indices facilitates the prediction of Ge faceted-island shapes on any Si substrate at different stages of growth. The analysis presented here can be applied to other heteroepitaxial islanding systems where a finite set of shared equilibrium facets exists for the bulk starting materials.

  11. The functional anatomy of the cricothyroid joint.

    PubMed

    Windisch, Gunther; Hammer, Georg Philipp; Prodinger, Peter Michael; Friedrich, Gerhard; Anderhuber, Friedrich

    2010-02-01

    Postoperative long-term treatment problems of male-to-female transsexuals can be caused by the underestimated mobility of the cricothyroid joint. One hundred cadaveric larynges were analysed to reveal the morphological and functional anatomy of the CTJ focusing on possible horizontal and vertical gliding movements. Furthermore, the distance of the cricothyroid space for rotational movements was measured. The articular surface of the cricothyroid joint showed three different possibilities: a well-defined facet (Type 1 61%), no definable facet (Type 2 22%) or a flat surface with or without a tiny protuberance (Type 3 17%). Side different statements and intraindividual differences between male and female specimens were included. These different types affect horizontal and vertical gliding movements, besides rotational movements. The mobility between Type 1 and the others was highly significant (P < 0.001). Regarding different motions in the cricothyroid joint, rotational movements caused significant elongation of the vocal folds, which should be taken into consideration for phonosurgical methods.

  12. Type II collagen defect in two sibs with the Goldblatt syndrome, a chondrodysplasia with dentinogenesis imperfecta, and joint laxity.

    PubMed

    Bonaventure, J; Stanescu, R; Stanescu, V; Allain, J C; Muriel, M P; Ginisty, D; Maroteaux, P

    1992-12-01

    We report on a syndrome of spondylo-epimetaphyseal dysplasia, dentinogenesis imperfecta, and ligamentous hyperextensibility in two sibs born to nonconsanguineous parents. This chondrodysplasia was characterized by severe shortness of stature and an osteoporosis without fractures. Electron microscopic examination of the cartilage documented large vacuoles of dilated rough endoplasmic reticulum within the cytoplasm of chondrocytes. Gel electrophoresis of pepsin-soluble collagen extracted from cartilage demonstrated the presence of type II collagen chains with an abnormal mobility. Prolyl and lysyl hydroxylations were slightly increased. The abnormal molecules melted at a higher temperature than the normal ones. CNBr peptide mapping of type II collagen showed an altered electrophoretic migration of peptides CB 11, CB 8, and CB 10,5 whereas CB 9,7 looked normal. In addition, two small non-collagenous proteins isolated from cartilage were not found in an age-matched control individual but were detected in a normal newborn infant. The quantitation of proline-labelled collagen synthesized by dermal fibroblasts demonstrated a 50% reduction of total collagen. This decrease essentially affected the amount of extracellular type I collagen, which was secreted less efficiently than in control cells. Nevertheless, type I collagen chains behaved normally on 5% polyacrylamide gels. The reduced mRNA levels of alpha 1I and alpha 2I chains might reflect either a transcriptional defect or a decreased stability of mRNA transcripts. We suggest that the association of both pathological chondrocytes producing altered collagen type II and decreased synthesis of type I could be responsible for this peculiar phenotype. The overmodification of alpha 1II CNBr peptides is consistent with the presence of a single-base substitution in the COL2A1 gene. Whether there is a direct causal relationship between the type II collagen defect and the underexpression of type I collagen will require

  13. Cervical Radiculopathy Due to Disc Herniation with Adjacent Facet Hypertrophy: Case Report

    PubMed Central

    YAMAHATA, Hitoshi; YASUDA, Muneyoshi; AOYAMA, Tatsuro; OSUKA, Koji; ARITA, Kazunori; TAKAYASU, Masakazu

    2014-01-01

    We report a rare case of cervical radiculopathy associated with facet hypertrophy and disc herniation. The patient was a 38-year-old woman with sudden-onset left arm pain. As conservative therapy failed to alleviate her symptoms she was referred to us. On physical examination she manifested no neurological deficits except pain and dysesthesia in the left C7 territory. Computed tomography revealed hypertrophic ossified changes in the left T1 facet joint with encroachment on the spinal canal. Magnetic resonance imaging showed compression of the spinal cord at C6/7 by disc herniation at C6/7. Anterior cervical decompression and fusion by corpectomy (C7 corpectomy and C6/T1 fixation with a titanium cage) ameliorated her pain. Facet hypertrophy in a morphologically normal cervicothoracic spine is extremely rare and its etiology is unknown. We speculate the possibility that our patient harbored a congenital anomaly and that the morphologic changes were the consequence of an injury she sustained in a traffic accident. PMID:24477059

  14. Joint Problems

    MedlinePlus

    ... Information Causes & Symptoms Diagnosis & Tests Care & Treatment Lifestyle & ... Facts & Information What are Joint Problems? Your musculoskeletal system is constructed of bones, muscles, and joints. The ...

  15. Explorations in statistics: statistical facets of reproducibility.

    PubMed

    Curran-Everett, Douglas

    2016-06-01

    Learning about statistics is a lot like learning about science: the learning is more meaningful if you can actively explore. This eleventh installment of Explorations in Statistics explores statistical facets of reproducibility. If we obtain an experimental result that is scientifically meaningful and statistically unusual, we would like to know that our result reflects a general biological phenomenon that another researcher could reproduce if (s)he repeated our experiment. But more often than not, we may learn this researcher cannot replicate our result. The National Institutes of Health and the Federation of American Societies for Experimental Biology have created training modules and outlined strategies to help improve the reproducibility of research. These particular approaches are necessary, but they are not sufficient. The principles of hypothesis testing and estimation are inherent to the notion of reproducibility in science. If we want to improve the reproducibility of our research, then we need to rethink how we apply fundamental concepts of statistics to our science.

  16. Diagnostics Challenges for FACET-II

    SciTech Connect

    Clarke, Christine

    2015-10-07

    FACET-II is a prospective user facility at SLAC National Accelerator Laboratory. The facility will focus on high-energy, high-brightness beams and their interaction with plasma and lasers. The accelerator is designed for high-energy-density electron beams with peak currents of approximately 50 kA (potentially 100 kA) that are focused down to below 10x10 micron transverse spot size at an energy of 10 GeV. Subsequent phases of the facility will provide positron beams above 10 kA peak current to the experiment station. Experiments will require well characterised beams; however, the high peak current of the electron beam can lead to material failure in wirescanners, optical transition radiation screens and other instruments critical for measurement or delivery. The radiation environment and space constraints also put additional pressure on diagnostic design.

  17. FACET Tolerances for Static and Dynamic Misalignments

    SciTech Connect

    Federico, Joel

    2012-07-13

    The Facility for AdvancedAccelerator and Experimental Tests (FACET) at the SLAC National Accelerator Laboratory is designed to deliver a beam with a transverse spot size on the order of 10 {micro}m x 10 {micro}m in a new beamline constructed at the two kilometer point of the SLAC linac. Commissioning the beamline requires mitigating alignment errors and their effects, which can be significant and result in spot sizes orders of magnitude larger. Sextupole and quadrupole alignment errors in particular can introduce errors in focusing, steering, and dispersion which can result in spot size growth, beta mismatch, and waist movement. Alignment errors due to static misalignments, mechanical jitter, energy jitter, and other physical processes can be analyzed to determine the level of accuracy and precision that the beamline requires. It is important to recognize these effects and their tolerances in order to deliver a beam as designed.

  18. Possible burst-like facet growth mode at high temperatures

    NASA Astrophysics Data System (ADS)

    Lovrić, Davorin; Vučić, Zlatko; Gladić, Jadranko

    2008-07-01

    A decade ago, a burst-like growth mode of c-facets of 4He crystals growing at mK temperatures, characterized by the alternation of time intervals during which the facet does not advance with the intervals of its fast advancement, was found [J.P. Ruutu, P.J. Hakonen, A.V. Babkin, A.Y. Parshin, J.S. Penttilä, J.P. Saramäki, G. Tvalashvili, Phys. Rev. Lett. 76 (1996) 4187]. We investigate the possibility that a similar facet growth mode exists for facets at high growth temperatures. We have applied the digital laser interferometry for monitoring facet kinetics of spherical copper selenide single crystals during their growth at constant volume growth rate around 800 K. Our analysis of directly measured (1 1 1) facet advancement curves has revealed that they consist of time intervals during which the facet does not advance vertically alternating with the time intervals of enhanced growth, resembling the burst-like facet growth mode. The results are discussed in terms of the enhancement of the local supersaturation induced by the existence of nucleation barrier.

  19. Search Interface Design Using Faceted Indexing for Web Resources.

    ERIC Educational Resources Information Center

    Devadason, Francis; Intaraksa, Neelawat; Patamawongjariya, Pornprapa; Desai, Kavita

    2001-01-01

    Describes an experimental system designed to organize and provide access to Web documents using a faceted pre-coordinate indexing system based on the Deep Structure Indexing System (DSIS) derived from POPSI (Postulate based Permuted Subject Indexing) of Bhattacharyya, and the facet analysis and chain indexing system of Ranganathan. (AEF)

  20. Search Interface Design Using Faceted Indexing for Web Resources.

    ERIC Educational Resources Information Center

    Devadason, Francis; Intaraksa, Neelawat; Patamawongjariya, Pornprapa; Desai, Kavita

    2001-01-01

    Describes an experimental system designed to organize and provide access to Web documents using a faceted pre-coordinate indexing system based on the Deep Structure Indexing System (DSIS) derived from POPSI (Postulate based Permuted Subject Indexing) of Bhattacharyya, and the facet analysis and chain indexing system of Ranganathan. (AEF)

  1. Oxygen induced facet formation on Rh(2 1 0) surface

    NASA Astrophysics Data System (ADS)

    Govind; Chen, Wenhua; Wang, Hao; Madey, T. E.

    2009-10-01

    Oxygen induced nanometer-scale faceting of the atomically rough Rh(2 1 0) surface has been studied using Auger electron spectroscopy (AES), low energy electron diffraction (LEED), and scanning tunneling microscopy (STM). The Rh(2 1 0) surface completely covered with nanometer-scale facets when annealed at ≥550 K in the presence of oxygen. LEED studies reveal that the pyramidal faceted surface is characterized by three-sided nanoscale pyramids exposing (7 3 1), (7 3 -1) and (1 1 0) faces. A clean faceted surface was prepared through the use of low temperature surface cleaning method using the reaction with H 2 while preserving ("freezing") the pyramidal facet structure. The resulting clean faceted surface remains stable for T ˜ 600 K and for higher temperatures; the faceted surface irreversibly relaxes to the planar surface. STM measurements confirms the formation of nanopyramids with average pyramid size ranging from 12 to 21 nm depending upon the annealing temperature. The nanopyramidal faceted Rh surface may be used as a potential template for the growth of metallic nanoclusters and for structure sensitive reactions.

  2. Domains and Facets: A Hierarchical Approach to Personality Assessment.

    ERIC Educational Resources Information Center

    McCrae, Robert R.

    The domain and facet approach to personality assessment is discussed. The strategy used to identify and measure aspects of the five factors of personality structure is described. Evidence concerning the factorial invariance of the resulting set of 30 facet scales and some recent evidence concerning their discriminant validity are reviewed. Some…

  3. New facets of the STS polytope generated from known facets of the ATS polytope.

    SciTech Connect

    Simonetti, Neil; Fischetti, Matteo; Balas, Egon; Carr, Robert D.

    2005-05-01

    While it had been known for a long time how to transform an asymmetric traveling salesman (ATS) problem on the complete graph with n vertices into a symmetric traveling salesman (STS) problem on an incomplete graph with 2n vertices, no method was available for using this correspondence to derive facets of the symmetric polytope from facets of the asymmetric polytope until the work of E. Balas and M. Fischetti in [Lifted cycle inequalities for the asymmetric traveling salesman problem, Mathematics of Operations Research 24 (2) (1999) 273-292] suggested an approach. The original Balas-Fischetti method uses a standard sequential lifting procedure for the computation of the coefficient of the edges that are missing in the incomplete STS graph, which is a difficult task when addressing classes of (as opposed to single) inequalities. In this paper we introduce a systematic procedure for accomplishing the lifting task. The procedure exploits the structure of the tight STS tours and organizes them into a suitable tree structure. The potential of the method is illustrated by deriving large new classes of facet-defining STS inequalities.

  4. Role of chemical potential in relaxation of faceted crystal structure

    NASA Astrophysics Data System (ADS)

    Schneider, Joshua P.; Nakamura, Kanna; Margetis, Dionisios

    2014-06-01

    Below the roughening transition, crystal surfaces have macroscopic plateaus, facets, whose evolution is driven by the microscale dynamics of steps. A long-standing puzzle was how to reconcile discrete effects in facet motion with fully continuum approaches. We propose a resolution of this issue via connecting, through a jump condition, the continuum-scale surface chemical potential away from the facet, characterized by variations of the continuum surface free energy, with a chemical potential originating from the decay of atomic steps on top of the facet. The proposed condition accounts for step flow inside a discrete boundary layer near the facet. To validate this approach, we implement in a radial geometry a hybrid discrete-continuum scheme in which the continuum theory is coupled with only a few, minimally three, steps in diffusion-limited kinetics with conical initial data.

  5. Concurrent, parallel, multiphysics coupling in the FACETS project

    NASA Astrophysics Data System (ADS)

    Cary, J. R.; Candy, J.; Cobb, J.; Cohen, R. H.; Epperly, T.; Estep, D. J.; Krasheninnikov, S.; Malony, A. D.; McCune, D. C.; McInnes, L.; Pankin, A.; Balay, S.; Carlsson, J. A.; Fahey, M. R.; Groebner, R. J.; Hakim, A. H.; Kruger, S. E.; Miah, M.; Pletzer, A.; Shasharina, S.; Vadlamani, S.; Wade-Stein, D.; Rognlien, T. D.; Morris, A.; Shende, S.; Hammett, G. W.; Indireshkumar, K.; Pigarov, A. Yu; Zhang, H.

    2009-07-01

    FACETS (Framework Application for Core-Edge Transport Simulations), is now in its third year. The FACETS team has developed a framework for concurrent coupling of parallel computational physics for use on Leadership Class Facilities (LCFs). In the course of the last year, FACETS has tackled many of the difficult problems of moving to parallel, integrated modeling by developing algorithms for coupled systems, extracting legacy applications as components, modifying them to run on LCFs, and improving the performance of all components. The development of FACETS abides by rigorous engineering standards, including cross platform build and test systems, with the latter covering regression, performance, and visualization. In addition, FACETS has demonstrated the ability to incorporate full turbulence computations for the highest fidelity transport computations. Early indications are that the framework, using such computations, scales to multiple tens of thousands of processors. These accomplishments were a result of an interdisciplinary collaboration among computational physics, computer scientists and applied mathematicians on the team.

  6. Ultra-steep side facets in multi-faceted SiGe/Si(001) Stranski-Krastanow islands

    PubMed Central

    2011-01-01

    For the prototypical Ge/Si(001) system, we show that at high growth temperature a new type of Stranski-Krastanow islands is formed with side facets steeper than {111} and high aspect ratio. Nano-goniometric analysis of the island shapes reveals the presence of six new facet groups in addition to those previously found for dome or barn-shaped islands. Due to the highly multi-faceted island shape and high aspect ratio, the new island types are named "cupola" islands and their steepest {12 5 3} side facet is inclined by 68°to the substrate surface. Assessing the relative stability of the new facets from surface area analysis, we find that their stability is similar to that of {113} and {15 3 23} facets of dome islands. The comparison of the different island shapes shows that they form a hierarchical class of geometrical structures, in which the lower aspect ratio islands of barns, domes and pyramids are directly derived from the cupola islands by successive truncation of the pedestal bases without facet rearrangements. The results underline the key role of surface faceting in the process of island formation, which is as crucial for understanding the island's growth evolution as it is important for device applications. PMID:21711579

  7. Milwaukee shoulder syndrome.

    PubMed

    Pandey, A; Das, S K; Kumar, P; Kumar, M; Meena, D; Garg, V

    2011-05-01

    Milwaukee shoulder syndrome or rapid destructive arthritis of the shoulder; is a particular form of arthritis which affects mainly elderly patients, predominantly women, with limited pain and sometimes neuropathic joints, rotator cuff tear, joint instability, mildly inflammatory or noninflammatory, blood-stained effusion, calcium apatite crystals, and marked joint and bone destruction. This is very uncommon condition and very sparsely reported and so far, there is no case report from India, hence, we report a case of Milwaukee shoulder syndrome from India.

  8. The spreading of a void on a facet during electromigration

    SciTech Connect

    Chu, X.; Bauer, C.L.; Mullins, W.W.; Klinger, L.M.

    1997-07-01

    A void of cross sectional area A may spread perpendicular to the applied electric field E{sub a} during electromigration because its leading surface develops a facet whose advance is limited by the supply of steps. If the facet is immobile (no step source) and the remaining surface is free to move, and if E{sub a}A is less than a threshold value, then the void assumes a stationary elongated shape dictated by a balance between capillarity and electric field. If E{sub a}A exceeds the threshold value, however, a balance is no longer possible, and the void spreads along the facet without arrest. If the facet has limited mobility, a balance is possible for all values of E{sub a}A, resulting in an elongated moving steady-state shape. The treatment simplifies the void shape as rectangular but preserves the essential features of capillarity and surface electromigration. The authors argue that the motion of a facet on a void along the outward normal requires defects (e.g., intersecting screw dislocations) that act as step sources since homogeneous nucleation of steps on the facet is expected to be negligible. Since voids in fine-line interconnects are often observed to be partially faceted, restricted void motion and resultant spreading which depend sensitively on crystallographic features, such as defect structure and grain orientation, may indeed limit the lifetime of fine-line interconnects in electronic devices.

  9. Treatment of Facet Injuries in the Cervical Spine.

    PubMed

    Khezri, Navid; Ailon, Tamir; Kwon, Brian K

    2017-01-01

    Facet injuries are common in the cervical spine. Many classification systems over the years have characterized the heterogeneity of these injuries. For unilateral facet fractures with minimal displacement and no neurological deficit, there is mounting evidence that better radiographic and clinical outcomes may be achieved with surgical treatment. Anterior and posterior approaches can both be utilized successfully for the surgical management of facet injuries. The anterior approach is well tolerated, allows one to address a disc herniation, and provides a high union rate with good sagittal alignment. The posterior approach allows for easier open reduction and biomechanically superior fixation.

  10. Surgical approaches for cervical spine facet dislocations in adults.

    PubMed

    Del Curto, David; Tamaoki, Marcel Jun; Martins, Délio E; Puertas, Eduardo Barros; Belloti, João Carlos

    2014-10-30

    The choice of surgical approach for the management of subaxial cervical spine facet dislocations is a controversial subject amongst spine surgeons. Reasons for this include differences in the technical familiarity and experience of surgeons with the different surgical approaches, and variable interpretation of image studies regarding the existence of a traumatic intervertebral disc herniation and of the neurological status of the patient. Moreover, since the approaches are dissimilar, important variations are likely in neurological, radiographical and clinical outcomes. To compare the effects (benefits and harms) of the different surgical approaches used for treating adults with acute cervical spine facet dislocation. We searched the Cochrane Bone, Joint and Muscle Trauma Group Specialised Register (9 May 2014), The Cochrane Central Register of Controlled Trials (The Cochrane Library, 2014 Issue 4), MEDLINE (1946 to April Week 5 2014), MEDLINE In-Process & Other Non-Indexed Citations (8 May 2013), EMBASE (1980 to 2014 Week 18), Latin American and Caribbean Health Sciences (9 May 2014), trial registries, conference proceedings and reference lists of articles to May 2014. We included randomised and quasi-randomised controlled trials that compared surgical approaches for the management of adults with acute cervical spine facet dislocations with and without spinal cord injury. Two review authors independently selected studies, assessed risk of bias and extracted data. We included one randomised and one quasi-randomised controlled trial involving a total of 94 participants and reporting results for a maximum of 84 participants. One trial included patients with spinal cord injuries and the other included patients without spinal cord injuries. Both trials compared anterior versus posterior surgical approaches. Both trials were at high risk of bias, including selection bias (one trial), performance bias (both trials) and attrition bias (one trial). Data were pooled for one

  11. Prevalence of the metabolic syndrome in Luxembourg according to the Joint Interim Statement definition estimated from the ORISCAV-LUX study

    PubMed Central

    2011-01-01

    Background The prevalence of the metabolic syndrome (MS) has been determined in many countries worldwide but never in Luxembourg. This research aimed to 1) establish the gender- and age-specific prevalence of MS and its components in the general adult population of Luxembourg, according to the most recent Joint Interim Statement (JIS) definition, by using both the high and low cut-off points to define abdominal obesity, and 2) compare and assess the degree of agreement with the Revised National Cholesterol Education Programme-Adult Treatment Panel III (R-ATPIII) and the International Diabetes Federation (IDF) definitions. Methods A representative stratified random sample of 1349 European subjects, aged 18-69 years, participated to ORISCAV-LUX survey. Logistic regression and odds ratios (OR) were used to study MS prevalence with respect to gender and age. The Framingham risk score (FRS) to predict the 10-year coronary heart disease (CHD) risk was calculated to compare the proportion of MS cases below or above 20%, according to both high and low waist circumference (WC) thresholds. Cohen's kappa coefficient (κ) was utilized to measure the degree of agreement between MS definitions. Results The prevalence of the MS defined by the JIS was 28.0% and 24.7% when using the low (94/80) and the high (102/88) WC cut-off points, respectively. The prevalence was significantly higher in men than in women (OR = 2.6 and 2.3 for the low and high WC thresholds), as were all components of the MS except abdominal obesity measured by both thresholds. It also increased with age (OR values in age categories ranging from 2.7 to 28 when compared to the younger subjects for low WC and from 3.3 to 31 for the high WC cut-offs). The 10-year predicted risk of CHD by FRS did not depend on the threshold used. Globally, excellent agreement was observed between the three definitions of MS (κ= 0.89), in particular between JIS and IDF (κ = 0.93). Agreement was significantly higher in women than in

  12. Prevalence of the metabolic syndrome in Luxembourg according to the Joint Interim Statement definition estimated from the ORISCAV-LUX study.

    PubMed

    Alkerwi, Ala'a; Donneau, Anne-Françoise; Sauvageot, Nicolas; Lair, Marie-Lise; Scheen, André; Albert, Adelin; Guillaume, Michèle

    2011-01-04

    The prevalence of the metabolic syndrome (MS) has been determined in many countries worldwide but never in Luxembourg. This research aimed to 1) establish the gender- and age-specific prevalence of MS and its components in the general adult population of Luxembourg, according to the most recent Joint Interim Statement (JIS) definition, by using both the high and low cut-off points to define abdominal obesity, and 2) compare and assess the degree of agreement with the Revised National Cholesterol Education Programme-Adult Treatment Panel III (R-ATPIII) and the International Diabetes Federation (IDF) definitions. A representative stratified random sample of 1349 European subjects, aged 18-69 years, participated to ORISCAV-LUX survey. Logistic regression and odds ratios (OR) were used to study MS prevalence with respect to gender and age. The Framingham risk score (FRS) to predict the 10-year coronary heart disease (CHD) risk was calculated to compare the proportion of MS cases below or above 20%, according to both high and low waist circumference (WC) thresholds. Cohen's kappa coefficient (κ) was utilized to measure the degree of agreement between MS definitions. The prevalence of the MS defined by the JIS was 28.0% and 24.7% when using the low (94/80) and the high (102/88) WC cut-off points, respectively. The prevalence was significantly higher in men than in women (OR = 2.6 and 2.3 for the low and high WC thresholds), as were all components of the MS except abdominal obesity measured by both thresholds. It also increased with age (OR values in age categories ranging from 2.7 to 28 when compared to the younger subjects for low WC and from 3.3 to 31 for the high WC cut-offs). The 10-year predicted risk of CHD by FRS did not depend on the threshold used. Globally, excellent agreement was observed between the three definitions of MS (κ= 0.89), in particular between JIS and IDF (κ = 0.93). Agreement was significantly higher in women than in men, and differed between

  13. Correlation between crystallographic orientation and surface faceting in UO2

    NASA Astrophysics Data System (ADS)

    Miao, Yinbin; Mo, Kun; Yao, Tiankai; Lian, Jie; Fortner, Jeffrey; Jamison, Laura; Xu, Ruqing; Yacout, Abdellatif M.

    2016-09-01

    Here coordinated experimental efforts to quantitatively correlate crystallographic orientation and surface faceting features in UO2 are reported upon. A sintered polycrystalline UO2 sample was thermally etched to induce the formation of surface faceting features. Synchrotron Laue microdiffraction was used to obtain a precise crystallographic orientation map for the UO2 surface grains. Scanning electron microscopy (SEM) was utilized to collect the detailed information on the surface morphology of the sample. The surface faceting features were found to be highly dependent on the crystallographic orientation. In most cases, Triple-plane structures containing one {100} plane and two {111} planes were found to dominate the surface of UO2. The orientation-faceting relationship established in this study revealed a practical and efficient method of determining crystallographic orientation based on the surface features captured by SEM images.

  14. Hydrothermal growth of multi-facet anatase spheres

    NASA Astrophysics Data System (ADS)

    Wu, Jin-Ming; Song, Xiao-Mei; Ma, Lu-Yao; Wei, Xiao-Dan

    2011-03-01

    Titania with various nanostructures can be synthesized by several F --mediated procedures. In this paper, we report the synthesis of a novel multi-facet microsphere consisting of etched single-crystalline anatase by simply immersing metallic Ti plates in an HF aqueous solution under hydrothermal conditions. The etched multi-facet sphere was found to grow through the nucleation and growth of truncated bipyramids on a previously precipitated one to assemble a microsphere, and its subsequent etching by HF to expose the thermodynamic stable {1 0 1} facets. The photocatalytic activity of such etched multi-facet sphere thin films was evaluated utilizing rhodamine B and sulfonic salicylic acid in water as target molecules and compared with commercial Degussa P25 titania nanoparticles.

  15. Correlation between Crystallographic Orientation and Surface Faceting in UO2

    SciTech Connect

    Miao, Yinbin; Mo, Kun; Yao, Tiankai; Lian, Jie; Fortner, Jeffrey; Jamison, Laura; Xu, Ruqing; Yacout, Abdellatif M.

    2016-09-01

    Here coordinated experimental efforts to quantitatively correlate crystallographic orientation and surface faceting features in UO2 are reported upon. A sintered polycrystalline UO2 sample was thermally etched to induce the formation of surface faceting features. Synchrotron Laue microdiffraction was used to obtain a precise crystallographic orientation map for the UO2 surface grains. Scanning electron microscopy (SEM) was utilized to collect the detailed information on the surface morphology of the sample. The surface faceting features were found to be highly dependent on the crystallographic orientation. In most cases, Triple-plane structures containing one {100} plane and two {111} planes were found to dominate the surface of UO2. The orientation-faceting relationship established in this study revealed a practical and efficient method of determining crystallographic orientation based on the surface features captured by SEM images.

  16. Specifying Valid Compound Terms in Interrelated Faceted Taxonomies

    NASA Astrophysics Data System (ADS)

    Analyti, Anastasia; Tzitzikas, Yannis; Spyratos, Nicolas

    In previous work, we proposed an algebra whose operators allow to specify the valid compound terms of a faceted taxonomy, in a flexible manner (by combining positive and negative statements). In this paper, we treat the same problem but in a more general setting, where the facet taxonomies are not independent but are (possibly) interrelated through narrower/broader relationships between their terms. The proposed algebra, called Interrelated Facet Composition Algebra (IFCA), is more powerful, as the valid compound terms of a faceted taxonomy can be derived through a smaller set of declared valid and/or invalid compound terms. An optimized (w.r.t. the naive approach) algorithm that checks compound term validity, according to a well-formed IFCA expression, and its worst-time complexity are provided.

  17. Innovative Facet Passivation for High-Brightness Laser Diodes

    DTIC Science & Technology

    2016-02-05

    Office P.O. Box 12211 Research Triangle Park, NC 27709-2211 high-power laser diodes, catastrophic optical damage, high energy lasers REPORT...factor bar) desired for military high energy lasers (HELs). COD of the front facet (laser mirror) is the main failure mechanism that constrains scaling... energy lasers (HELs). COD of the front facet (laser mirror) is the main failure mechanism that constrains scaling LD power by 10X over the SOA to 600 W

  18. Framework Application for Core Edge Transport Simulation (FACETS)

    SciTech Connect

    Malony, Allen D; Shende, Sameer S; Huck, Kevin A; Mr. Alan Morris, and Mr. Wyatt Spear

    2012-03-14

    The goal of the FACETS project (Framework Application for Core-Edge Transport Simulations) was to provide a multiphysics, parallel framework application (FACETS) that will enable whole-device modeling for the U.S. fusion program, to provide the modeling infrastructure needed for ITER, the next step fusion confinement device. Through use of modern computational methods, including component technology and object oriented design, FACETS is able to switch from one model to another for a given aspect of the physics in a flexible manner. This enables use of simplified models for rapid turnaround or high-fidelity models that can take advantage of the largest supercomputer hardware. FACETS does so in a heterogeneous parallel context, where different parts of the application execute in parallel by utilizing task farming, domain decomposition, and/or pipelining as needed and applicable. ParaTools, Inc. was tasked with supporting the performance analysis and tuning of the FACETS components and framework in order to achieve the parallel scaling goals of the project. The TAU Performance System® was used for instrumentation, measurement, archiving, and profile / tracing analysis. ParaTools, Inc. also assisted in FACETS performance engineering efforts. Through the use of the TAU Performance System, ParaTools provided instrumentation, measurement, analysis and archival support for the FACETS project. Performance optimization of key components has yielded significant performance speedups. TAU was integrated into the FACETS build for both the full coupled application and the UEDGE component. The performance database provided archival storage of the performance regression testing data generated by the project, and helped to track improvements in the software development.

  19. Smallest Archimedean Screw: Facet Dynamics and Friction in Multiwalled Nanotubes.

    PubMed

    Guerra, Roberto; Leven, Itai; Vanossi, Andrea; Hod, Oded; Tosatti, Erio

    2017-09-13

    We identify a new material phenomenon, where minute mechanical manipulations induce pronounced global structural reconfigurations in faceted multiwalled nanotubes. This behavior has strong implications on the tribological properties of these systems and may be the key to understand the enhanced interwall friction recently measured for boron-nitride nanotubes with respect to their carbon counterparts. Notably, the fast rotation of helical facets in these systems upon coaxial sliding may serve as a nanoscale Archimedean screw for directional transport of physisorbed molecules.

  20. Analysis on linac quadrupole misalignment in FACET commissioning 2012

    SciTech Connect

    Sun, Yipeng; /SLAC

    2012-07-05

    In this note, the analysis on linac quadrupole misalignment is presented for the FACET linac section LI05-09 plus LI11-19. The effectiveness of the beam-based alignment technique is preliminarily confirmed by the measurement. Beam-based alignment technique was adopted at SLAC linac since SLC time. Here the beam-based alignment algorithms are further developed and applied in the FACET commissioning during 2012 run.

  1. Joint Disorders

    MedlinePlus

    A joint is where two or more bones come together, like the knee, hip, elbow, or shoulder. Joints can be damaged by many types of injuries or diseases, including Arthritis - inflammation of a joint. It causes pain, stiffness, and swelling. Over time, ...

  2. Facet-Dependent Cr(VI) Adsorption of Hematite Nanocrystals.

    PubMed

    Huang, Xiaopeng; Hou, Xiaojing; Song, Fahui; Zhao, Jincai; Zhang, Lizhi

    2016-02-16

    In this study, the adsorption process of Cr(VI) on the hematite facets was systematically investigated with synchrotron-based Cr K-edge extended X-ray absorption fine structure (EXAFS) spectroscopy, in situ attenuated total reflectance Fourier transform infrared (ATR-FTIR) spectroscopy, density-functional theory calculation, and surface complexation models. Structural model fitting of EXAFS spectroscopy suggested that the interatomic distances of Cr-Fe were, respectively, 3.61 Å for the chromate coordinated hematite nanoplates with exposed {001} facets, 3.60 and 3.30 Å for the chromate coordinated hematite nanorods with exposed {001} and {110} facets, which were characteristic of inner-sphere complexation. In situ ATR-FTIR spectroscopy analysis confirmed the presence of two inner-sphere surface complexes with C3ν and C2ν symmetry, while the C3ν and C2ν species were assigned to monodentate and bidentate inner-sphere surface complexes with average Cr-Fe interatomic distances of 3.60 and 3.30 Å, respectively. On the basis of these experimental and theoretical results, we concluded that HCrO4(-) as dominated Cr(VI) species was adsorbed on {001} and {110} facets in inner-sphere monodentate mononuclear and bidentate binuclear configurations, respectively. Moreover, the Cr(VI) adsorption performance of hematite facets was strongly dependent on the chromate complexes formed on the hematite facets.

  3. Lumbar facet cyst resolution following anterior interbody fusion.

    PubMed

    Massey, Gene M; Caputo, Adam M; Michael, Keith W; Isaacs, Robert E; Brown, Christopher R

    2013-12-01

    Facet cysts are a relatively common source of neural compression in the lumbar spine. Open decompression and fusion are frequently used to treat the stenosis and instability associated with this pathology. Recently, anterior lumbar interbody fusion (ALIF) has increased in popularity for the treatment of lumbar degenerative conditions. ALIF may achieve indirect decompression of the neural elements with less surgical morbidity than conventional open approaches. To date, there are no published reports describing the use of indirect decompression or interbody fusion for the treatment of facet cysts. We report a patient who developed an L4-L5 facet cyst secondary to degenerative changes and spondylolisthesis. ALIF with posterior instrumentation was used to address his condition. Six months after surgery, the patient had complete resolution of his symptoms. MRI revealed complete resolution of the facet cyst. This patient provides previously unreported evidence that interbody fusion alone may result in facet cyst resolution. Clinical studies are needed to evaluate if interbody fusion can consistently relieve the symptoms associated with facet cysts without the use of direct decompression.

  4. A diffuse interface model of grain boundary faceting

    NASA Astrophysics Data System (ADS)

    Abdeljawad, Fadi; Medlin, Douglas; Zimmerman, Jonathan; Hattar, Khalid; Foiles, Stephen

    Incorporating anisotropy into thermodynamic treatments of interfaces dates back to over a century ago. For a given orientation of two abutting grains in a pure metal, depressions in the grain boundary (GB) energy may exist as a function of GB inclination, defined by the plane normal. Therefore, an initially flat GB may facet resulting in a hill-and-valley structure. Herein, we present a diffuse interface model of GB faceting that is capable of capturing anisotropic GB energies and mobilities, and accounting for the excess energy due to facet junctions and their non-local interactions. The hallmark of our approach is the ability to independently examine the role of each of the interface properties on the faceting behavior. As a demonstration, we consider the Σ 5 < 001 > tilt GB in iron, where faceting along the { 310 } and { 210 } planes was experimentally observed. Linear stability analysis and numerical examples highlight the role of junction energy and associated non-local interactions on the resulting facet length scales. On the whole, our modeling approach provides a general framework to examine the spatio-temporal evolution of highly anisotropic GBs in polycrystalline metals. Sandia National Laboratories is a multi-program laboratory managed and operated by Sandia Corporation, a wholly owned subsidiary of Lockheed Martin Corporation, for the U.S. DOE's National Nuclear Security Administration under Contract DE-AC04-94AL85000.

  5. A diffuse interface model of grain boundary faceting

    NASA Astrophysics Data System (ADS)

    Abdeljawad, F.; Medlin, D. L.; Zimmerman, J. A.; Hattar, K.; Foiles, S. M.

    2016-06-01

    Interfaces, free or internal, greatly influence the physical properties and stability of materials microstructures. Of particular interest are the processes that occur due to anisotropic interfacial properties. In the case of grain boundaries (GBs) in metals, several experimental observations revealed that an initially flat GB may facet into hill-and-valley structures with well defined planes and corners/edges connecting them. Herein, we present a diffuse interface model that is capable of accounting for strongly anisotropic GB properties and capturing the formation of hill-and-valley morphologies. The hallmark of our approach is the ability to independently examine the various factors affecting GB faceting and subsequent facet coarsening. More specifically, our formulation incorporates higher order expansions to account for the excess energy due to facet junctions and their non-local interactions. As a demonstration of the modeling capability, we consider the Σ5 <001 > tilt GB in body-centered-cubic iron, where faceting along the {210} and {310} planes was experimentally observed. Atomistic calculations were utilized to determine the inclination-dependent GB energy, which was then used as an input in our model. Linear stability analysis and simulation results highlight the role of junction energy and associated non-local interactions on the resulting facet length scales. Broadly speaking, our modeling approach provides a general framework to examine the microstructural stability of polycrystalline systems with highly anisotropic GBs.

  6. Facet-selective photodeposition of gold nanoparticles on faceted ZnO crystals for visible light photocatalysis.

    PubMed

    Wang, Xuewen; Wang, Wuyou; Miao, Yuanquan; Feng, Gang; Zhang, Rongbin

    2016-08-01

    Hexagonal prism-like ZnO crystals dominated with polar facets were synthesized using a hydrothermal method. The Gold (Au) nanoparticles were selectively photodeposited on the polar surfaces of faceted ZnO crystals as a result of anisotropic photocatalytic activities of the polar and nonpolar facets. The size of Au nanoparticles uniformly dispersed on the polar facets increased with increasing Au-loading amount. These Au-loaded ZnO crystals showed an additional visible light absorption band from 400nm to 800nm. The 0.1wt% Au-loaded ZnO crystals with visible light absorption peak at approximately 690nm exhibited the highest photocatalytic activity under visible light irradiation.

  7. Complete cervical intervertebral disc extrusion with spinal cord injury in the absence of facet dislocation: a case report.

    PubMed

    Yue, James J; Lawrence, Brandon D; Sutton, Karen M; Strugar, John J; Haims, Andrew H

    2004-05-01

    Complete cervical disc complex extrusion, defined as the extrusion of both cartilaginous end-plates, the entire nucleus pulposus, and portions of the anulus fibrosus, is rare. A case of complete cervical disc complex extrusion with spinal cord injury in the absence of facet dislocation or subluxation in an obtunded patient is reported. To report an unusual presentation of spinal cord injury and the occurrence of complete traumatic cervical disc complex extrusion in the absence of facet dislocation and normal plain radiographic findings. Traumatic cervical disc herniation occurs in 54% to 80% of patients with facet dislocation. A report of complete extrusion of a cervical intervertebral disc complex (cartilaginous endplate, anulus, and nucleus pulposus) with spinal cord injury in the absence of dislocation has not been described, to the best of the authors' knowledge. A clinical and radiographic review of such a case of complete traumatic cervical disc complex herniation in the absence of dislocation was performed. Plain radiographic imaging did not show any injury. A nondisplaced fracture of the left inferior facet joint was evident on computed tomography. The diagnosis of C4-C5 intervertebral disc extrusion was made only after magnetic resonance imaging. The vacuum effect of complete disc extrusion created a "white-out" appearance to the disc space on the sagittal T2 magnetic resonance image. The patient underwent anterior cervical discectomy and fusion with additional posterior cervical fusion. He subsequently regained functional strength against gravity in two of four limbs. He remains completely paraparetic in the left upper extremity and partially paraparetic in the left lower extremity. The case report highlights the occurrence of complete traumatic cervical disc extrusion in the absence of facet dislocation with normal plain radiographic findings and consequent spinal cord injury, which can accompany such an injury.

  8. Beyond Text Queries and Ranked Lists: Faceted Search in Library Catalogs

    ERIC Educational Resources Information Center

    Niu, Xi

    2012-01-01

    Since the adoption of faceted search in a small number of academic libraries in 2006, faceted library catalogs have gained popularity in many academic and public libraries. This dissertation seeks to understand whether faceted search improves the interactions between searchers and library catalogs and to understand ways that facets are used in…

  9. Beyond Text Queries and Ranked Lists: Faceted Search in Library Catalogs

    ERIC Educational Resources Information Center

    Niu, Xi

    2012-01-01

    Since the adoption of faceted search in a small number of academic libraries in 2006, faceted library catalogs have gained popularity in many academic and public libraries. This dissertation seeks to understand whether faceted search improves the interactions between searchers and library catalogs and to understand ways that facets are used in…

  10. Structural Equation Modelling of Multiple Facet Data: Extending Models for Multitrait-Multimethod Data

    ERIC Educational Resources Information Center

    Bechger, Timo M.; Maris, Gunter

    2004-01-01

    This paper is about the structural equation modelling of quantitative measures that are obtained from a multiple facet design. A facet is simply a set consisting of a finite number of elements. It is assumed that measures are obtained by combining each element of each facet. Methods and traits are two such facets, and a multitrait-multimethod…

  11. Faceted Visualization of Three Dimensional Neuroanatomy By Combining Ontology with Faceted Search

    PubMed Central

    Veeraraghavan, Harini; Miller, James V.

    2013-01-01

    In this work, we present a faceted-search based approach for visualization of anatomy by combining a three dimensional digital atlas with an anatomy ontology. Specifically, our approach provides a drill-down search interface that exposes the relevant pieces of information (obtained by searching the ontology) for a user query. Hence, the user can produce visualizations starting with minimally specified queries. Furthermore, by automatically translating the user queries into the controlled terminology our approach eliminates the need for the user to use controlled terminology. We demonstrate the scalability of our approach using an abdominal atlas and the same ontology. We implemented our visualization tool on the opensource 3D Slicer software. We present results of our visualization approach by combining a modified Foundational Model of Anatomy (FMA) ontology with the Surgical Planning Laboratory (SPL) Brain 3D digital atlas, and geometric models specific to patients computed using the SPL brain tumor dataset. PMID:24006207

  12. Use of land facets to design linkages for climate change.

    PubMed

    Brost, Brian M; Beier, Paul

    2012-01-01

    Least-cost modeling for focal species is the most widely used method for designing conservation corridors and linkages. However, these linkages have been based on current species' distributions and land cover, both of which will change with large-scale climate change. One method to develop corridors that facilitate species' shifting distributions is to incorporate climate models into their design. But this approach is enormously complex and prone to error propagation. It also produces outputs at a grain size (km2) coarser than the grain at which conservation decisions are made. One way to avoid these problems is to design linkages for the continuity and interspersion of land facets, or recurring landscape units of relatively uniform topography and soils. This coarse-filter approach aims to conserve the arenas of biological activity rather than the temporary occupants of those arenas. In this paper, we demonstrate how land facets can be defined in a rule-based and adaptable way, and how they can be used for linkage design in the face of climate change. We used fuzzy c-means cluster analysis to define land facets with respect to four topographic variables (elevation, slope angle, solar insolation, and topographic position), and least-cost analysis to design linkages that include one corridor per land facet. To demonstrate the flexibility of our procedures, we designed linkages using land facets in three topographically diverse landscapes in Arizona, USA. Our procedures can use other variables, including soil variables, to define land facets. We advocate using land facets to complement, rather than replace, existing focal species approaches to linkage design. This approach can be used even in regions lacking land cover maps and is not affected by the bias and patchiness common in species occurrence data.

  13. Separate and joint effects of diabetes mellitus and chronic kidney disease on the risk of acute coronary syndrome: a population-based cohort study.

    PubMed

    Chang, Yu-Tzu; Liu, Chih-Ching; Tsai, Liang-Miin; Li, Chung-Yi; Sung, Junne-Ming

    2014-12-01

    Patient with diabetes (DM) and chronic kidney disease (CKD) are at a higher risk of developing acute coronary syndrome (ACS). However, only a few studies have investigated the separate and joint effects of DM and CKD on the risk of ACS, especially population-based studies under age-, sex- and various cardiovascular risk factor-stratifications. By using a national diabetes cohort derived from the Taiwan National Health Insurance Research Database, we identified a total of 416,143 DM and 541,724 non-DM patients, including 51,208 DM/CKD and 8,894 non-DM/CKD patients, in 2000 who did not have a history of ACS (ICD-9: 410.X, 413.9, 411.1) before 2000. We then prospectively investigated the incidence of ACS by linking to inpatient claims data from 2000 to 2007. A Cox proportional hazard model was used to estimate the relative risk of ACS in individuals with DM and/or CKD under various stratifications. Age- and sex-specific incidence rates were similar between the non-DM/CKD and DM/non-CKD groups, except for female patients under 45 years, in whom DM was associated with a higher risk of ACS than CKD (8.21 vs. 3.82 per 1000 person-years). In the group aged <45 years, the DM/non-CKD patients were associated with a higher relative hazard of ACS than those in the non-DM/CKD group when compared with the non-DM/non-CKD group (men: adjusted hazard ratios [AHR]:1.77; 95% confidence interval [CI]:1.61-1.93 vs. 1.42 [95% CI: 0.73-2.73]; women 1.97 [95% CI: 1.76-2.20] vs. 1.13 [95% CI: 0.36-3.52]). This discrepancy in AHR was reduced with increasing age. The co-existence of DM and CKD further enhanced the AHR in a multiplicative independent manner. A significant age-modification effect was noted in the DM individuals regardless of their CKD status, but not in the non-DM/CKD group. In stratification by various cardiovascular risk factors, diabetes had a higher risk of ACS than CKD in patients with ≤2 selected risk factors, with the exception of the hyperlipidemia and hypertension

  14. Temporomandibular joint disorders.

    PubMed

    Buescher, Jennifer J

    2007-11-15

    Temporomandibular joint disorders are common in adults; as many as one third of adults report having one or more symptoms, which include jaw or neck pain, headache, and clicking or grating within the joint. Most symptoms improve without treatment, but various noninvasive therapies may reduce pain for patients who have not experienced relief from self-care therapies. Physical therapy modalities (e.g., iontophoresis, phonophoresis), psychological therapies (e.g., cognitive behavior therapy), relaxation techniques, and complementary therapies (e.g., acupuncture, hypnosis) are all used for the treatment of temporomandibular joint disorders; however, no therapies have been shown to be uniformly superior for the treatment of pain or oral dysfunction. Noninvasive therapies should be attempted before pursuing invasive, permanent, or semi-permanent treatments that have the potential to cause irreparable harm. Dental occlusion therapy (e.g., oral splinting) is a common treatment for temporomandibular joint disorders, but a recent systematic review found insufficient evidence for or against its use. Some patients with intractable temporomandibular joint disorders develop chronic pain syndrome and may benefit from treatment, including antidepressants or cognitive behavior therapy.

  15. Living Jointness

    DTIC Science & Technology

    1994-01-01

    reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of...COVERED 00-00-1993 to 00-00-1994 4. TITLE AND SUBTITLE Living Jointness 5a. CONTRACT NUMBER 5b. GRANT NUMBER 5c. PROGRAM ELEMENT NUMBER 6. AUTHOR...and the peacetime activities of all services other than participation in joint exercises. It challenges the existing joint command structure because

  16. PivotPaths: Strolling through Faceted Information Spaces.

    PubMed

    Dork, M; Riche, Nathalie Henry; Ramos, G; Dumais, S

    2012-12-01

    We present PivotPaths, an interactive visualization for exploring faceted information resources. During both work and leisure, we increasingly interact with information spaces that contain multiple facets and relations, such as authors, keywords, and citations of academic publications, or actors and genres of movies. To navigate these interlinked resources today, one typically selects items from facet lists resulting in abrupt changes from one subset of data to another. While filtering is useful to retrieve results matching specific criteria, it can be difficult to see how facets and items relate and to comprehend the effect of filter operations. In contrast, the PivotPaths interface exposes faceted relations as visual paths in arrangements that invite the viewer to `take a stroll' through an information space. PivotPaths supports pivot operations as lightweight interaction techniques that trigger gradual transitions between views. We designed the interface to allow for casual traversal of large collections in an aesthetically pleasing manner that encourages exploration and serendipitous discoveries. This paper shares the findings from our iterative design-and-evaluation process that included semi-structured interviews and a two-week deployment of PivotPaths applied to a large database of academic publications.

  17. Facets of psychopathy, heart rate variability and cognitive function.

    PubMed

    Hansen, Anita Lill; Johnsen, Bjørn Helge; Thornton, David; Waage, Leif; Thayer, Julian F

    2007-10-01

    The aim of the present study was to investigate whether the four facets of Hare's Psychopathy Checklist-Revised (PCL-R; Hare, 1991; Bolt, Hare, Vitale, & Newman, 2004) were related to physiological and cognitive mechanisms. Fifty-three male prisoners participated in this study. Physiological responses were measured as heart rate variability (HRV) and heart rate (HR). Cognitive functions were measured using a continuous performance test (CPT; California Computerized Assessment Package, Abbreviated version) and a working memory test (WMT); based on Baddeley & Hitch (1974). The regression analysis of the HRV revealed that the interpersonal facet explained most of the variance during baseline (28%), CPT (16%), and WMT (12%). This was also true for the HR data during baseline (28%), CPT (20%), WMT (10%), and recovery (13%). The antisocial facet explained 10% of the variance only during baseline. Subjects scoring high compared to low on the interpersonal facet also showed better cognitive functioning. The study suggests that the different facets were differently associated with both physiological and cognitive functions.

  18. Facet tropism: comparison of plain film and computed tomography examinations.

    PubMed

    Cox, J M; Aspegren, D D; Trier, K K

    1991-01-01

    This study compares the findings of plain film X-ray and computed CT examination in the diagnosis of facet orientation and the presence of tropism. Twenty consecutive patients having lumbar disc disease with sciatica were studied utilizing plain X-ray as well as CT scanning. A chiropractic radiologist read the films to determine if facet facings were sagittally, semi-sagittally or coronally oriented on both CT and plain X-ray study. CT was accepted as the most accurate method to determine the true facet orientation, and plain X-ray interpretation of facet orientation was compared to the CT reading. There was a statistically significant relationship in diagnosing tropism between plain film X-ray and CT readings, with a predictive accuracy that ranged from 58-84% across the three segmental levels. However, the exact concordance of plain film X-ray and CT readings for right and left facet facings was very low. This raises the question of how the profession defines diagnostic accuracy.

  19. Factors Associated with the Outcome of Ultrasound-Guided Trochanteric Bursa Injection in Greater Trochanteric Pain Syndrome: A Retrospective Cohort Study.

    PubMed

    Park, Ki Deok; Lee, Woo Yong; Lee, Jihae; Park, Min-Ho; Ahn, Jae Ki; Park, Yongbum

    2016-05-01

    Trochanteric bursa injections of corticosteroids and local anesthetics have been shown to provide pain relief for the treatment of greater trochanteric pain syndrome (GTPS). However, symptom recurrence and incomplete symptom relief are common. The reason for the variation in response is unclear but may be related to disease-, treatment-, or patient-related factors. To determine whether there are factors related to patient, treatment, or disease that can predict either the magnitude or duration of response to ultrasound-guided trochanteric bursa injections for GTPS. Retrospective evaluation. A university hospital outpatient center. Potential study participants were patients who underwent ultrasound-guided trochanteric bursa injection at an outpatient rehabilitation department. Follow-up interviews were performed in a hospital visit at 1, 3, and 6 months after injection. The Harris Hip Score and the Verbal Numeric Pain Scale were used to evaluate clinical effectiveness of pain reduction and functional improvement at baseline, 1, 3, and 6 months after treatment. Clinical data and ultrasound findings were obtained to assess the possible predictive factors for a good and durable response to ultrasound-guided trochanteric bursa injection. Patients receiving ultrasound-guided trochanteric bursa injections had a statistically significant improvement in pain and hip function at 1, 3, and 6 months after the last injections. Of the 137 patients, 110 (80.3%), 95 (64.9%), and 77 (56.2%) patients achieved successful outcomes according to their 1, 3, and 6-month follow-up evaluations, respectively. Univariate analysis showed that patients with knee osteoarthritis and lumbar facet joint or sacroiliac joint pain experienced less therapeutic effect than those without the conditions at 6 months post-injection. Logistic regression analysis showed that the significant outcome predictors at the 6-month follow-up were facet joint or S-I joint pain (odds ratio = 0.304, P = .014) and knee

  20. Genetic correlations among facets of type A behavior and personality.

    PubMed

    Johnson, Andrew M; Schermer, Julie Aitken; Vernon, Philip A; Jang, Kerry L

    2012-08-01

    The purpose of this study was to examine the phenotypic, genetic, and environmental relationships between multiple dimensions of Type A behavior and personality. Adult twins (N=247 pairs) completed a self-report personality measure and a work style questionnaire that measured six facets of Type A behavior: impatience, anger, work involvement, time urgency, job dissatisfaction, and competitiveness. Univariate results suggest that only the job dissatisfaction facet of Type A behavior was explained by non-genetic (environmental) factors. Multivariate results suggest that all of the genetically determined facets of Type A behavior show some correspondence with at least one of the personality factors found in the study, suggesting that some of the phenotypic (observed) relationships could be due to common genetic factors.

  1. New surfaces stabilized by adsorbate-induced faceting

    NASA Astrophysics Data System (ADS)

    Kaghazchi, Payam; Jacob, Timo; Ermanoski, Ivan; Chen, Wenhua; Madey, Theodore E.

    2012-07-01

    Faceting is a form of self-assembly of single-crystal surfaces at the nanometer-scale in which an initially planar surface converts to a ‘hill-and-valley’ structure, exposing new faces of low-index surfaces. Our recent studies revealed that, upon annealing in O2, three-sided nanoscale pyramids form on Ir(210) exposing smooth {311} and partially restructured (110) faces. Through a combination of scanning tunneling microscopy and density functional theory, we identify this structure to be a stepped double-missing-row reconstruction, which is only stable on nanopyramidal facets, not on a planar Ir(110) surface. This faceting-enabled stabilization of a hitherto unstable surface points to a new approach to prepare nanoscale model catalysts for structure-sensitivity studies in heterogeneous (electro-)catalysis with high selectivity and reactivity.

  2. On the creep constrained diffusive cavitation of grain boundary facets

    NASA Astrophysics Data System (ADS)

    Tvergaard, Viggo

    CREEP rupture in a polycrystalline metal at a high temperature, by cavity growth on a number of grain boundary facets, is studied numerically. An axisymmetric model problem is analysed, in which a cavitating facet is represented as disk-shaped, and the model dimensions are taken to represent spacings between neighbouring cavitating facets. For the grains both power law creep and elastic deformations are taken into account, and the description of cavity growth is based on an approximate expression that incorporates the coupled influence of grain boundary diffusion and power law creep. The cases considered include creep-constrained cavity growth at low stresses, where the voids link up to form grain boundary cracks at relatively small overall strains, as well as the power law creep dominated behaviour at higher stress levels, where rupture occurs at large overall strains. The numerical results are compared with results based on various simplified analyses.

  3. Unilateral facet subluxations: an example of a missed post-traumatic unilateral facet subluxation — a case report

    PubMed Central

    Tuling, Jeffrey R; Hsu, William H

    1999-01-01

    Unilateral facet injuries occur in 4-16% of patients with cervical spine injuries, (of which unilateral facet subluxations occur as a subgroup in this population). These injuries arise in motor vehicle accidents because of flexion-distraction forces, or flexion of an already rotated head. Due to the common presentation of a lack of neurological signs and symptoms, delayed diagnosis of unilateral facet subluxations are common. As a result, it is imperative that the proper diagnosis is made so that patient care can be made more effective with ultimately less sequelae. For the clinician, diagnosis can be aided by the use of radiographic analysis. Adequate radiographic analysis is an important tool to accurately assess whiplash associated disorders. Radiographic findings of facet subluxations are subtle on routine views. Utilizing oblique views, the diagnoses are usually evident. Therefore, oblique views are very useful in the clinical setting. This case report will describe a 29-year-old female with a missed unilateral facet subluxation, radiographic findings and characteristics, and the clinical utility of oblique views in patients suffering from whiplash associated disorders. ImagesFigure 1Figure 2Figure 3Figure 4Figure 5Figure 6

  4. Large conservation gains possible for global biodiversity facets

    NASA Astrophysics Data System (ADS)

    Pollock, Laura J.; Thuiller, Wilfried; Jetz, Walter

    2017-06-01

    Different facets of biodiversity other than species numbers are increasingly appreciated as critical for maintaining the function of ecosystems and their services to humans. While new international policy and assessment processes such as the Intergovernmental Science-Policy Platform on Biodiversity and Ecosystem Services (IPBES) recognize the importance of an increasingly global, quantitative and comprehensive approach to biodiversity protection, most insights are still focused on a single facet of biodiversity—species. Here we broaden the focus and provide an evaluation of how much of the world’s species, functional and phylogenetic diversity of birds and mammals is currently protected and the scope for improvement. We show that the large existing gaps in the coverage for each facet of diversity could be remedied by a slight expansion of protected areas: an additional 5% of the land has the potential to more than triple the protected range of species or phylogenetic or functional units. Further, the same areas are often priorities for multiple diversity facets and for both taxa. However, we find that the choice of conservation strategy has a fundamental effect on outcomes. It is more difficult (that is, requires more land) to maximize basic representation of the global biodiversity pool than to maximize local diversity. Overall, species and phylogenetic priorities are more similar to each other than they are to functional priorities, and priorities for the different bird biodiversity facets are more similar than those of mammals. Our work shows that large gains in biodiversity protection are possible, while also highlighting the need to explicitly link desired conservation objectives and biodiversity metrics. We provide a framework and quantitative tools to advance these goals for multi-faceted biodiversity conservation.

  5. Treatment of isolated cervical facet fractures: a systematic review.

    PubMed

    Kepler, Christopher K; Vaccaro, Alexander R; Chen, Eric; Patel, Alpesh A; Ahn, Henry; Nassr, Ahmad; Shaffrey, Christopher I; Harrop, James; Schroeder, Gregory D; Agarwala, Amit; Dvorak, Marcel F; Fourney, Daryl R; Wood, Kirkham B; Traynelis, Vincent C; Yoon, S Tim; Fehlings, Michael G; Aarabi, Bizhan

    2015-10-30

    OBJECT In this clinically based systematic review of cervical facet fractures, the authors' aim was to determine the optimal clinical care for patients with isolated fractures of the cervical facets through a systematic review. METHODS A systematic review of nonoperative and operative treatment methods of cervical facet fractures was performed. Reduction and stabilization treatments were compared, and analysis of postoperative outcomes was performed. MEDLINE and Scopus databases were used. This work was supported through support received from the Association for Collaborative Spine Research and AOSpine North America. RESULTS Eleven studies with 368 patients met the inclusion criteria. Forty-six patients had bilateral isolated cervical facet fractures and 322 had unilateral isolated cervical facet fractures. Closed reduction was successful in 56.4% (39 patients) and 63.8% (94 patients) of patients using a halo vest and Gardner-Wells tongs, respectively. Comparatively, open reduction was successful in 94.9% of patients (successful reduction of open to closed reduction OR 12.8 [95% CI 6.1-26.9], p < 0.0001); 183 patients underwent internal fixation, with an 87.2% success rate in maintaining anatomical alignment. When comparing the success of patients who underwent anterior versus posterior procedures, anterior approaches showed a 90.5% rate of maintenance of reduction, compared with a 75.6% rate for the posterior approach (anterior vs posterior OR 3.1 [95% CI 1.0-9.4], p = 0.05). CONCLUSIONS In comparison with nonoperative treatments, operative treatments provided a more successful outcome in terms of failure of treatment to maintain reduction for patients with cervical facet fractures. Operative treatment appears to provide superior results to the nonoperative treatments assessed.

  6. Ceramic joints

    DOEpatents

    Miller, Bradley J.; Patten, Jr., Donald O.

    1991-01-01

    Butt joints between materials having different coefficients of thermal expansion are prepared having a reduced probability of failure of stress facture. This is accomplished by narrowing/tapering the material having the lower coefficient of thermal expansion in a direction away from the joint interface and not joining the narrow-tapered surface to the material having the higher coefficient of thermal expansion.

  7. Optical fiber end-facet polymer suspended-mirror devices

    NASA Astrophysics Data System (ADS)

    Yao, Mian; Wu, Jushuai; Zhang, A. Ping; Tam, Hwa-Yaw; Wai, P. K. A.

    2017-04-01

    This paper presents a novel optical fiber device based on a polymer suspended mirror on the end facet of an optical fiber. With an own-developed optical 3D micro-printing technology, SU-8 suspended-mirror devices (SMDs) were successfully fabricated on the top of a standard single-mode optical fiber. Optical reflection spectra of the fabricated SU- 8 SMDs were measured and compared with theoretical analysis. The proposed technology paves a way towards 3D microengineering of the small end-facet of optical fibers to develop novel fiber-optic sensors.

  8. Kinetic faceting and anomalous coarsening in elastically inhomogeneous multiphase systems.

    PubMed

    Perez, Danny; Lewis, Laurent J

    2007-02-16

    With a view of finding a route toward microstructural stability in alloys, we numerically study the impact of elastic inhomogeneities on the growth of inclusions in multiphase systems. We show that growth can proceed either continuously at rough interfaces, or in a layer-by-layer fashion following an elastically induced kinetic faceting process. In the former case, the chemical potential of the inclusions is a smooth function of size, while in the latter case, elasticity increases the barrier for nucleation of new terraces on the facets, leading to an oscillatory behavior of the chemical potential and hence a strong resistance against coarsening, opening up the possibility to stabilize the structure.

  9. Development of an improved mirror facet for space applications

    NASA Technical Reports Server (NTRS)

    Schertz, Paul; Saifee, Shabbar; Lammert, Luke

    1991-01-01

    A fabrication technique was successfully developed for a metallic aluminum honeycomb, high-accuracy, lightweight, and long-life solar concentrator (mirror) for Advanced Solar Dynamic Space Power Systems. The program scope was limited to the development, fabrication, evaluation, and delivery of a solar concentrator facet (petal) that was sized for a 2-meter deployable solar concentrator. A surface accuracy of 1.0 mrad was achieved. The development incorporated tooling design, material selection, facet forming, adhesive selection, testing, and analysis. Techniques for applying levelizing, reflective, and protective optical coatings were also developed.

  10. From facets to facets: how does work function vary over a gold nanocluster?

    NASA Astrophysics Data System (ADS)

    Gao, Lingyuan; Souto, Jaime; Chelikowsky, James; Demkov, Alex

    Owing to their potential applications in catalysis, gold nanoclusters are a focus of intense research. The work function Φ, which can be measured using photoemission spectroscopy is a key parameter used to characterize the catalytic performance of the cluster. Φ is determined by the difference between the electrostatic potential just outside the metal surface and the Fermi energy of the cluster. We use a relativistic version of the real space first-principles code PARSEC to compute the work function of gold nanoclusters with dimensions on the order of a nanometer, which is similar in size to those used in experiment. We illustrate how the work function depends on the surface orientation of the nanocluster facets and compare our results with available experimental data We acknowledge supports from SciDAC program, Department of Energy, Office of Science, Advanced Scientific Computing Research and Basic Energy Sciences grant DE-SC0008877 for work on algorithms. Two of us (JRC and JS-C) acknowledge support for the work on nanostructures from grant from the U.S. Department of Energy: DE-FG02-06ER46286.

  11. Empirical Identification of the Major Facets of Conscientiousness

    ERIC Educational Resources Information Center

    MacCann, Carolyn; Duckworth, Angela Lee; Roberts, Richard D.

    2009-01-01

    Conscientiousness is often found to predict academic outcomes, but is defined differently by different models of personality. High school students (N = 291) completed a large number of Conscientiousness items from different models and the Big Five Inventory (BFI). Exploratory and confirmatory factor analysis of the items uncovered eight facets:…

  12. Facet-Dependent Photoreduction on Single ZnO Crystals

    PubMed Central

    2016-01-01

    Photocatalytic reactions occur at the crystal–solution interface, and hence specific crystal facet expression and surface defects can play an important role. Here we investigate the structure-related photoreduction at zinc oxide (ZnO) microparticles via integrated light and electron microscopy in combination with silver metal photodeposition. This enables a direct visualization of the photoreduction activity at specific crystallographic features. It is found that silver nanoparticle photodeposition on dumbbell-shaped crystals mainly takes place at the edges of O-terminated (0001̅) polar facets. In contrast, on ZnO microrods photodeposition is more homogeneously distributed with an increased activity at {101̅1̅} facets. Additional time-resolved measurements reveal a direct spatial link between the enhanced photoactivity and increased charge carrier lifetimes. These findings contradict previous observations based on indirect, bulk-scale experiments, assigning the highest photocatalytic activity to polar facets. The presented research demonstrates the need for advanced microscopy techniques to directly probe the location of photocatalytic activity. PMID:28001412

  13. Facet-Dependent Photoreduction on Single ZnO Crystals.

    PubMed

    Debroye, Elke; Van Loon, Jordi; Yuan, Haifeng; Janssen, Kris P F; Lou, Zaizhu; Kim, Sooyeon; Majima, Tetsuro; Roeffaers, Maarten B J

    2017-01-19

    Photocatalytic reactions occur at the crystal-solution interface, and hence specific crystal facet expression and surface defects can play an important role. Here we investigate the structure-related photoreduction at zinc oxide (ZnO) microparticles via integrated light and electron microscopy in combination with silver metal photodeposition. This enables a direct visualization of the photoreduction activity at specific crystallographic features. It is found that silver nanoparticle photodeposition on dumbbell-shaped crystals mainly takes place at the edges of O-terminated (0001̅) polar facets. In contrast, on ZnO microrods photodeposition is more homogeneously distributed with an increased activity at {101̅1̅} facets. Additional time-resolved measurements reveal a direct spatial link between the enhanced photoactivity and increased charge carrier lifetimes. These findings contradict previous observations based on indirect, bulk-scale experiments, assigning the highest photocatalytic activity to polar facets. The presented research demonstrates the need for advanced microscopy techniques to directly probe the location of photocatalytic activity.

  14. Personality Facets and RIASEC Interests: An Integrated Model

    ERIC Educational Resources Information Center

    Armstrong, Patrick Ian; Anthoney, Sarah Fetter

    2009-01-01

    Research examining links between personality and interest have typically focused on links between measures of the five factor model and Holland's RIASEC types. However, the five factor model of personality can be divided in to a larger set of narrow domain personality scales measuring facets of the "big five" traits. Research in a number of fields…