Intercarpal Research Articles

Kanamycin concentrations in synovial fluid after intramuscular administration in the horse

Six adult ponies were injected in the same intramuscular site with kanamycin sulphate (10 mg/kg). Two hours later, arthrocenteses of the right metacarpophalangeal, radio-carpal, intercarpal, tibio-tarsal and metatarsophalangeal joints were performed within 3 minutes. Arthrocenteses of the same joints on the left side were conducted 5 hours later. When expressed as a percentage of plasma drug concentration, differences in synovial fluid drug concentration between the joints sampled at 2 and 5 hours after injection were not detected.

An anatomic study of the innervation of the wrist joint and Wilhelm's technique for denervation

Innervation of the wrist joint has been clarified in this study by loupe dissection and histologic examination. The posterior interosseous nerve, the lateral antebrachial cutaneous nerve, the superficial branch of the radial nerve, and the dorsal branch and the perforating branches of the ulnar nerve innervate the wrist joint from the dorsal side. The anterior interosseous nerve, the palmar cutaneous branch of the median nerve, and the deep branch and the main trunk of the ulnar nerve innervate it from the palmar side. The findings indicate that surgical denervation of most of the articular nerves of the wrist joint is possible with the use of Wilhelm's procedure, but denervation of the palmar side of the intercarpal and carpometacarpal joints, which are innervated by the deep branch of the ulnar nerve, is not included in Wilhelm's technique.

Eosinophilic synovitis following the intra-articular injection of bacterial antigen in horses

Purified streptococcal M protein was injected into one intercarpal joint in three horses hyperimmunised with Streptococcus equi M protein vaccine. The contralateral joints were injected with pH adjusted polyionic solution. All antigen-injected joints developed a severe suppurative synovitis (mean synovial fluid nucleated cell count = 102,200 × 10 6 cells litre −1). Eosinophils were found in the synovial fluid and in synovial membrane biopsy specimens of two of the horses. Immune complexes were not demonstrated in the synovial membrane. Two horses are described that developed synovial fluid eosinophilia after the intra-articular injection of streptococcal antigen.

The incidence and severity of intercarpal ligament damage in the equine carpus.

The arthroscopic findings in 104 intercarpal joints in 76 horses were reviewed to determine the incidence and severity of changes in the medial intercarpal ligament. Damage to the intercarpal ligament was observed in 43 joints in 35 horses, ranging from mild fraying of the edges of the ligament to complete disruption of all fibres. This represented an incidence of 41% of joints being affected. In 9 joints examined arthroscopically primarily as a further diagnostic procedure, ligament damage was evident in all cases. In horses undergoing arthroscopic surgery primarily for the treatment of osteochondral chip or slab fractures, there was some correlation between the severity of articular cartilage damage and the presence of ligament damage.

Luxation and/or fracture of the first carpal bone in thoroughbred horses and its surgical resolution

Summary A syndrome involving luxation and/or fracture of the first carpal bone is described. Affected horses have a grade 1-3 lameness, which responds to intra-articular anesthesia of the intercarpal joint. Medical treatment has not be successful in relieving lameness, and the treatment of choice is surgical removal of the first carpal bone.

Tearing of the medial palmar intercarpal ligament in the equine midcarpal joint.

Tearing of the medial palmar intercarpal ligament is described in 45 intercarpal (midcarpal) joints in 42 horses (37 racehorses, 5 non-racehorses). Of the 37 racehorses, there were 20 Quarter Horses, 14 Thoroughbreds and 3 Standardbreds. The patients had been referred for arthroscopic surgery for removal of osteochondral chip fragments that had been diagnosed radiographically or diagnostic arthroscopy of a persistent carpal problem. The problem was unilateral in 39 horses and bilateral in 3. The presenting clinical signs were lameness and/or persistent synovial effusion. In one instance, the presenting complaint was haemarthrosis. Osteochondral chip fragments were present in the joint affected with tearing in 23 horses. In 6 horses in which osteochondral fragments were present in other joints, the degree of synovial effusion was greatest in the midcarpal joint with ligamentous tearing. In most of the 22 midcarpal joints where carpal chip fragmentation and ligamentous tearing were present concomitantly, the degree of clinical compromise was greater than normally seen with that degree of osteochondral fragmentation. A ligament was designated as torn when a defect was present in the ligament. This usually took the form of frayed fibres suspended in the irrigating solution, presenting a transverse type of defect in the dorsal aspect of the lateral portion of ligament. However, longitudinal tearing was present in 1 case and tearing was noted in the palmar aspect of the ligament in 2 other cases. The shredded fibres were trimmed in most cases and this allowed better definition of the amount of ligament considered to be torn. The degree of damage ranged from 10% to 100% of the width considered to be torn.(ABSTRACT TRUNCATED AT 250 WORDS)

関節疾患を有する黒毛和種牛における血清過酸化脂質濃度の変動

Clinical and biochemical changes were examined in a Japanese Black cow with a swelling of the intercarpal joint. Hematological examination revealed a marked increase in serum lipid peroxide concentration during the 7th to 4th weeks before the onset of clinical signs. No significant changes were found during the observation period in biological antioxidant factors, such as SOD, GSH-PX activity, or Se concentration. However, since the serum α-Toc concentration in this cow had been decreased before the onset, it may be considered that α-Toc was massively mobilized and consumed to suppress the production of peroxides which increased due to tissue damage resulting from the destruction of the cartilage caused locally by overload.

Extensor tendon rupture due to osteoarthritis of the distal radio-ulnar joint

Five cases of closed rupture of the finger extensor tendon due to osteoarthritis of the distal radio-ulnar joint were studied. Difficulty in extension began at the little finger and extended to the ring and long fingers. Pain and swelling in the dorsal aspect of the wrist preceded the tendon rupture. Osteoarthritic changes at the distal radio-ulnar joint were more severe than those at the radio-carpal and intercarpal joints. The distal end of the ulna showed the plus variant, as well as dorsal dislocation or subluxation. All patients underwent a tendon graft or tendon transfer, with excision of the distal ulna. The tendon rupture was thought to be caused mainly by friction between the displaced distal end of the ulna and osteophytes of the distal radio-ulnar joint.

Partial carpal and pancarpal arthrodesis in the dog: a review of 50 cases

ABSTRACTFifty‐six carpal arthrodeses were carried out in 50 dogs. Six of these had bilateral arthrodeses. A dynamic compression plate (DCP; Straumann Great Britain Ltd), placed on the dorsal aspect of the carpus, was used for fixation in all cases. The main indication for pancarpal arthrodesis was a hyperextension injury of the radiocarpal joint. Forty‐three pancarpal arthrodeses were performed in 40 dogs (a bilateral procedure was performed in three). Hyperextension injuries of the intercarpal and carpometacarpal joints were treated by partial carpal arthrodesis in 10 dogs; three of these had bilateral procedures. Seventy‐four per cent of dogs treated by pancarpal arthrodesis regained full limb function. Only 50 per cent of cases treated by partial carpal arthrodesis had a similar result.

Pulsed Carbon Dioxide Laser for Cartilage Vaporization and Subchondral Bone Perforation in Horses Part II: Morphologic and Histochemical Reactions

A pulsed carbon dioxide laser was used to vaporize articular cartilage in four horses, and perforate the cartilage and subchondral bone in four horses. Both intercarpal joints were examined arthroscopically and either a 1 cm cartilage crater or a series of holes was created in the third carpal bone of one joint. The contralateral carpus served as a control. After euthanasia at week 8, the treated and control joints were examined for gross changes, and samples of cartilage and subchondral bone, synovial membrane, and peripheral lymph nodes were examined histologically. Depletion of cartilage matrix glycosaminoglycan was assessed by safranin-O histochemical staining of the laser site and adjacent cartilage. Cartilage removal by laser vaporization resulted in rapid regrowth, with fibrous and fibrovascular tissue and occasional regions of fibrocartilage at week 8. The subchondral bone, synovial membrane, and draining lymph nodes appeared essentially unaffected by the laser cartilage vaporization procedure. Conversely, carbon dioxide laser drilling of subchondral bone resulted in poor penetration, extensive areas of thermal necrosis of bone, and significant secondary damage to the apposing articular surface of the radial carpal bone.

Pulsed Carbon Dioxide Laser for Cartilage Vaporization and Subchondral Bone Perforation in Horses Part I: Technique and Clinical Results

A carbon dioxide laser, used in a rapidly pulsed mode, was evaluated for intra-articular use in horses. Under arthroscopic guidance, a lensed 5 mm laser probe attached directly to a hand-held carbon dioxide laser was inserted into one intercarpal joint of eight horses. In four horses, a cartilage crater 1 cm in diameter was created to the level of the subchondral bone of the articular surface of the third carpal bone. In four horses, the laser was directed perpendicular to the articular surface of the third carpal bone and activated to penetrate the cartilage and subchondral bone. The intercarpal joint of the opposite carpus in each horse was subjected to arthroscopic examination and insertion of the laser probe for an equivalent time. The laser was not activated and these joints served as sham operated controls. The horses were evaluated clinically for 8 weeks, then euthanatized, and the joints were examined radiographically, grossly, and histologically. Pulsed carbon dioxide laser vaporized cartilage readily but penetrated bone poorly. Cartilage vaporization resulted in no greater swelling, heat, pain on flexion, lameness, or synovial fluid reaction than the sham procedure. Laser drilling resulted in a shallow, charred hole with a tenacious carbon residue, and in combination with the thermal damage to deeper bone, resulted in increased swelling, mild lameness and a low-grade, but persistent synovitis. The carbon dioxide laser is a useful intra-articular instrument for removal of cartilage and has potential application in inaccessible regions of diarthrodial joints. It does not penetrate bone sufficiently to have application in subchondral drilling.

Flexible implant arthroplasty of the radiocarpal joint.

The radiocarpal, distal radioulnar, and intercarpal joints can be affected individually or in combination. Selection of the appropriate treatment method is based on accurate evaluation of the extent and severity of involvement. The durability of flexible implant resection arthroplasty of the radiocarpal joint has been further enhanced by the use of titanium grommets to protect the implant midsection, by secure dorsal and palmar capsuloligamentous reconstruction to restrict the mobility of 30 degrees flexion/30 degrees extension and 10 degrees ulnar/10 degrees radial deviation, by 6 weeks' postoperative immobilization, and by avoidance of abusive hand usage.

A kinematic study of luno-triquetral dissociations

An analysis of carpal motion after sectioning the ligamentous support of the luno-triquetral joints was done by use of stereoradiographic methods. The ligaments were sectioned in two stages. In stage I, a complete sectioning of both the dorsal and palmar luno-triquetral ligaments and the interosseous membrane was done. Stage II consisted of further sectioning of both the dorsal radio-triquetral and dorsal scapho-triquetral ligaments. After both stage I and stage II ligament sectioning, all of the intercarpal joints exhibited altered kinematics. The changes were especially marked at the luno-triquetral joint where motion was increased in all planes of wrist motion. The essential lesion in producing a static palmar flexed intercalated segment instability was division of the dorsal radio-triquetral and dorsal scapho-triquetral ligaments in association with the luno-triquetral ligaments and interosseous membrane sectioning.

犬の慢性関節リウマチに対する関節固定術の応用

A 6-year-old female maltese showed a walk with its weight bearing on the intercarpal joints of both forelegs since approximately 50 days ago. This was soon followed by the wobbling of the bilateral hindlegs.Plain X-ray examination to the four legs revealed remarkable resorption of bones bilaterally in the elbow joints, intercarpal joints, stifle joints and tarsal joints. Antinuclear antibody reaction test and rheumatoid factor in this case were both negative. However, since the clinical condition of this dog satisfied seven of the eleven diagnostic criteria specified by the American Rheumatism Association, the diagnosis of rheumatoid arthritis was established. The initial treatments consisted of administration of steroid and aspirin. Arthrodesis of the both carpal and stifle joints was performed and the result was satisfactory. Also the local irradiation of low-energy laser beam might stop the pain in this patient.

Erosive arthritis in relapsing polychondritis

We report the case history of a 57 year old man who has suffered from typical deforming, relapsing polychondritis for 13 years. He has also developed erosive destructive seronegative polyarthritis involving some of his distal interphalangeal, proximal interphalangeal, metacarpophalangeal, intercarpal, wrist, intertarsal and metatarsophalangeal joints. The distribution of joint involvement in the small joints of the hands and feet is asymmetrical. Both hips and knee joints have also been involved necessitating bilateral total hip and right total knee replacement. The articular associations with relapsing polychondritis are discussed.

The third carpal bone

equal prevalence of distal radial carpal (DRC) and third carpal (C3) injury but in Standardbreds, C3 is more commonly damaged. The medial aspect of the intercarpal joint is highly susceptible to overload because of the greater load on the medial aspect of the joint and the hinge-type closing of the joint. The typical distalradial carpal (DRC) chip fracture occurs in the middle of its articular rim just lateral or adjacent to the attachment of a small ligament that courses distally and medially to merge with the capsular attachments to the face of the second carpal bone. The typical chip is therefore best visualized on the DLPMO and flexed lateral views. The flexed view is important to assess since loss of normal subchondral density extending palmarly away from the fracture is a sign of extensive articular damage and a poor prognosis. Thebest DRC chips are triangular in outline and relatively narrow along their articular margin. A second very common site of DRC injury is the dorsal lateral comer of the bone. This is the most common site for an osteophyte to develop (and subsequently fracture) in the horse. Such lesions can be difficult to diagnose radigraphically and are best seen on a well-positioned, well-exposed skyline or a wellpenetrated DMPLO projection. They are rarely found as a solitary lesion. Arthroscopic removal is the preferred management for most carpal fractures although it certainly should be acknowledged that many small carpal chips can be managed medically. If surgery is an option, in terms of the horse's value, repeated injections should be avoided and, in particular, repetitive corticosteroids should be avoided. Early intervention affords a better prognosis so a decision concerning surgery should be made shortly after diagnosis. Following ar throscopic surgery for atypical chip fracture, horses are rested for about two weeks with hand grazing only allowed. They then begin a program of handwalking that begins with five minutes/day and increases weekly by five minute increments until they are walking 30-40 minutes/day. Swimming is also a rehabilitative option that can begin any time after two weeks. Passive flexion is advised for the first month following surgery. Sodium hyaluronate is usually injected five to seven days following surgery and repeated when the horse returns to training if an effusion persists. A horse with a typical distal lateral radius chip fracture will start jogging about six weeks postoperatively, whereas most serious intercarpal injuries receive two to three times as long a convalescence. THE THIRD CARPAL BONE

Effect on force transmission across the carpus in procedures used to treat Kienböck's disease

A simplified two-dimensional articulating force analysis (rigid body spring model) examined how different surgical procedures used for treating Kienböck's disease modify the force distribution across the carpus. A two-dimensional model of a carpus was loaded through the metacarpals by forces of up to 143 Newtons. The resulting intercarpal displacement and joint loadings were calculated for the intact wrist and for different simulated surgical procedures. The predicted total amount of force transmitted through the radio-lunate joint of the intact wrist averaged a 32% of the total radio-ulno-carpal joint load. Limited intercarpal fusions were found to reduce compressive loading at the radio-lunate joint by no more than 15% of the original load. Capitate shortening was successful in relieving radio-lunate forces, however, it dramatically overloaded the adjacent scapho-trapezial and triquetral-hamate joints. By contrast, a 4 mm lengthening of the ulna (or shortening of the radius) resulted in a 45% reduction of radio-lunate load with only moderate changes in force at the midcarpal and radio-scaphoid joints. On the basis of this study, radial shortening or ulnar lengthening significantly unload the lunate and are rationale procedures in the treatment of Kienböck's disease. Limitations regarding direct clinical application of this mathematical model are also discussed.

Superoxide production by stimulated equine polymorphonuclear leukocytes‐inhibition by anti‐inflammatory drugs

Polymorphonuclear leukocytes (PMNLs) were isolated from an inflammatory exudate induced in the intercarpal joints of horses by an administration of carrageenin. Their superoxide production at rest and following stimulation with either serum-treated zymosan (STZ) or phorbol myristate acetate (PMA) was measured by cytochrome-c reduction. Stimulation of the cells increased the cytochrome-c reduction 10-15 times that of resting cells. The maxima were 20 nmol of reduced cytochrome-c per 10(6) cells per ml at 120 min (STZ) and 35 nmol of reduced cytochrome-c per 10(6) cells per ml at 60 min (PMA). The maximum inhibition of the cytochrome-c reduction by superoxide dismutase (Palosein) was 83.6% (STZ stimulation) and 72.1% (PMA stimulation). The non-steroidal anti-inflammatory drugs, phenylbutazone, salicylic acid, aspirin, sodium salicylate in addition to D-penicillamine and dimethylsulfoxide caused dose-dependent inhibition of the cytochrome-c reduction when the cells were stimulated by PMA. The maximum inhibitions were 64% and 36% for aspirin (10(-2) M), 32% and 17% for phenylbutazone (10(-3) M), 15% and 31% for dimethylsulfoxide (6.4 x 10(-1) M), 32% and 19% for salicylic acid (10(-2) M), 0% and 17% for sodium salicylate (10(-2) M) and 2.2% and 2.5% for D-penicillamine (10(-4) M) when the cells were stimulated by STZ and PMA, respectively.(ABSTRACT TRUNCATED AT 250 WORDS)

Arthritis in DBA/1 Mice Induced with Passively Transferred Type II Collagen Immune Serum

Arthritis was induced in DBA/1 mice by passive transfer of syngeneic anti-type II collagen (CII) serum concentrate. After transfer of serum containing 0.2 or 0.5 mg anti-CII auto-antibodies the first clinical signs of arthritis appeared 48 h after injection. Severe clinical arthritis was detected 96 h after injection. Immunohistochemical analyses of joints 48 h after serum injection revealed synovial foci in intercarpal and metacarpophalangeal joints of macrophage-like cells, expressing C3bi-receptors and major histocompatibility complex class II molecules, and infiltration of few CD4+ lymphocytes. Later (96 h after injection), the inflamed synovia were dominated by C3bi-receptor+ polymorphonuclear cells. In contrast to conventionally induced collagen arthritis (CIA), the inflammatory infiltrates, filling joint spaces and synovial tissue, were extensively dominated by polymorphonuclear cells, whereas macrophage-like cells expressing class II molecules and a few T cells were seen only in the periphery of the developing pannus. The anti-CII serum induced arthritis may be used as a model for studies of humoral mediated mechanisms operating in conventionally induced CIA as well as in rheumatoid arthritis.

Wrist Synovectomy in Juvenile Chronic Arthritis (JCA)

Synovectomy of 20 wrist joints in 15 patients with juvenile chronic arthritis (JCA) was performed and results were evaluated 3 (0.5-5) years after surgery. The surgical procedure consisted of synovectomy of the radiocarpal joint, around the ulnar head and in all intercarpal joints. Resection of the ulnar head was not performed. Results at follow-up showed that four wrist joints had been re-operated by arthrodesis because of persistent pain. In one case a spontaneous ankylosis had developed. These cases were not included in the re-examination. Of the remaining 15 cases, 12 were improved and 7 of these were totally pain-free. At follow-up, clinical examination revealed a mean improved grip strength (0.2 kp/cm2) and a mean decreased range of motion (10 degrees of flexion and extension, 16 degrees of pronation, supination unchanged). All wrist joints showed some radiographic changes preoperatively and at follow-up about half showed some further deterioration. This study indicates that the results of wrist synovectomy in patients with juvenile chronic arthritis do not differ significantly from results of wrist synovectomy in adult arthritic patients.