Reduced Joint Space Research Articles

Superior condylar displacement: Its diagnosis and treatment

Superior condylar displacement was induced with the application of unilateral unsupported muscle force, 19 an example of which was shown in Figs. 1 to 4. This superior displacement occurs in functional as well as dysfunctional temporomandibular joints. It is the contention of this article that superior condylar displacement can also take place by iatrogenic or natural causes and that it should be diagnosed and subsequently treated by inferior condylar repositioning. This condition is only one of the three basic types of condylar displacement (superior, anterior, and posterior) that can contribute to TMJ dysfunction. The diagnosis of superior condylar displacement should be made only with both condyles in the middle of their respective fossae. When the opposite condyle is retruded, the casts are mounted on an adjustable instrument, and a stent is fabricated to reposition the retruded condyle to a more concentric position in its fossa. New left and right TMJ radiographs will allow a comparison of the joint spaces to be made with both condyles in the middle of their fossae. When the joint space of the symptomatic side is obviously narrower than that of the previously retruded side, then superior condylar displacement of the painful side is likely. The condylar mechanism of the articulator is moved to almost a vertical position and an appropriate shim placed between the condylar sphere and stop. A unilateral acrylic resin stent is fabricated and placed over the teeth. Inferior condylar repositioning of the affected side should be immediate, with contact of the anterior teeth almost complete. Anterior opening indicates a misdiagnosis, and the stent should be removed. The diagnosis is confirmed and documented with TMJ radiographic evidence of inferior condylar repositioning and reduction of the patient's symptoms. The procedure was tried on healthy temporomandibular joints, and inferior condylar repositioning was not induced. The final conclusions can be drawn that the condylar mechanism permits superior displacement with unsupported muscle force but does not allow inferior displacement of the condyle in a healthy joint with muscle force. Naturally occurring superior condylar displacement results in pain and is diagnosed by observing the reduced joint space when compared to the opposite asymptomatic side. This comparison should be made only when both condyles are in the middle of their fossae. The treatment is to fabricate a stent on an articulator which has been set for inferior condylar repositioning. After a therapeutic trial of eight weeks, the acrylic resin stent should be duplicated in a simple unilateral full-arch gold onlay. Extensive reconstruction should be delayed usually for one year for further observation of the patient.

NECROSIS OF ARTICULAR CARTILAGE AFTER SLIPPING OF THE CAPITAL FEMORAL EPIPHYSIS

1. Six cases of necrosis of articular cartilage complicating slipping of the upper femoral epiphysis are reviewed: histological examination in one case showed death of the superficial two-thirds of the articular cartilage, with survival of a layer of basal chondrocytes. In all six cases, after severe initial reduction of joint space as seen radiographically, there was gradual return of joint space, suggesting some regeneration of articular cartilage. The prognosis after cartilage necrosis is therefore not always so bad as has been supposed. 2. Various hypotheses concerning the cause of cartilage necrosis complicating slipped epiphysis are reviewed. The precise cause remains unknown, but there is substantial evidence against its being a consequence of ischaemia of the femoral head.

Rehabilitation of Patients with Rheumatic Diseases - An Update

Rehabilitation stands to make a person fit again. Rheumatic diseases are a heterogeneousgroup of disorders that involve joint structures (synovium, cartilage and bone) and theirsurrounding soft tissues (skin, muscles, tendons and ligaments). This chronic process resultsin soft tissue and synovial swelling, erosion of cartilage and bone, rupture of tendons, ligamentsand joint capsule, reduction in joint space, muscle wasting and osteoporosis. Diseaseprogression can create marked joint instability, muscular weakness and a reduction of generalfitness. Rehabilitation of rheumatic patients includes multidisciplinary approach withpharmacotherapy, thermotherapy and cryotherapy, optimal rest, use of orthoses and functionalaids, exercises, surgery and patient education. The present article will highlight biomechanicalfactors in the causation of disability and an approach to rehabilitate this group of patients.doi: 10.3329/taj.v16i2.3890TAJ December 2003; Vol.16(2): 82-88

A Roentgenological Study of Asymmetry in Rheumatoid Arthritis: A Preliminary Communication

SummaryRoentgen films of 100 consecutive rheumatoid patients were analysed with regard to the asymmetry of the affection. Reduction of joint space and erosions were chosen as significant roentgen symptoms. The hands, the fore-feet, the ankles and the knees were examined. A statistical analysis of the finding in individual joints, and observation of the diagnostic symptoms separately did not show any significant difference. The individual groups also were considered to be too small for a reliable assessment. All the observations summarized, a highly significant difference was found, showing the right side to be more affected both for men and women. The hypothesis is forwarded, that the cause of the asymmetry is a secondary injury to the joints primarily affected by the rheumatoid process. A sufficiently large material to analyse the asymmetry of individual joints is now being collected. It is pointed out that in left-handed patients more affections should be found on the left side, if this hypothesis is co...

The treatment of tuberculosis of the hip : Key, Albert J., St. Louis. J. Missouri M. A., Nov., 1926, xxiii, 388

Between September 1986 and December 1993, 57 patients were seen with tuberculosis of the hip at Kenyatta National Hospital. The diagnosis was proven by histological examination in all and in 54 patients (9500) caseation was present. The sex ratio M:F was 2:l and ages ranged from 6 to 54 years (mean 30 years) with 26 patients between 21 and 40 years old. The common presentation was a swollen hip, a limp, decreased range of hip movements, fixed flexion deformity and pain. Three patients had protrusio acetabuli and three had subluxed or dislocated hips. Twenty-three patients were anaemic and the erythrocyte sedimentation rate (ESR) was raised in all (mean 65dhr; range 25-115dhr). The Mantoux test was positive in 46 (81%), while 17 of the patients (30%) were HIV-positive. Chest radiographs showed active or healed pulmonary tuberculosis in 26 (46%) of the patients. The hip radiographs showed osteopenia with early cyst formation in 43 (75%) and in 14 (25%) patients they demonstrated joint space narrowing and destruction. Treatment was antituberculous chemotherapy (thiacetazone and INAH for 18 months with streptomycin for the fmt 2 months), diagnostic arthrotomy and traction in abduction. Children with subluxed or dislocated hips were treated in hip spicas. Adductor tenotomy was performed in 17 patients, while five had arthrodesis, three had excisional arthroplasties and two had total hip replacements after chemotherapy. The 43 patients who presented with preserved joint spaces did well but the 14 who presented with reduced joint space, subchondral erosions and protrusio acetabuli or outright dislocation of the hip did poorly. Key Words : tuberculosis, hip, treatment