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Introduction and Review of Biological Background
Published in Luke R. Bucci, Nutrition Applied to Injury Rehabilitation and Sports Medicine, 2020
Joints, or articulations, are the means by which different musculoskeletal tissues convert their functions into controlled movement by individuals. Joints connect bones together and allow movement of bones by muscles via tendons and ligaments. Three basic types of joints exist in the human body: fibrous synarthroses, cartilaginous amphiarthroses, and synovial diarthroses. Amphiarthroses are represented by the symphysis pubis and invertebral joints. Most joints encountered in injuries and sports medicine are diarthrotic, freely movable joints such as the knee, hip, ankle, elbow, wrist, fingers, thumb, and shoulder. The enthesis is the area of attachment of tendons, ligaments, and joint capsules onto bone, which is frequently injured in trauma. In general a typical joint structure consists of several basic parts: (1) bone; (2) articular cartilage; (3) joint cavity with synovial fluid; (4) synovium; and (5) joint capsule. Menisci, bursae, ligaments, tendons and associated blood vessels, nerves, and lymphatics complete the structures of joints. Joints are the focal point for many traumatic injuries to the human body, especially in sports medicine. In addition, degenerative joint conditions are a major health concern. The components of joints that have not been previously covered will be described briefly.
Biotensegrity
Published in Kohlstadt Ingrid, Cintron Kenneth, Metabolic Therapies in Orthopedics, Second Edition, 2018
Hackett began injecting bony insertions (i.e. entheses) of ligaments and tendons in 1939 and quickly became convinced that the majority of chronic low back pain was due to weakening of these structures. Hackett reported that 82% of his patients with chronic musculoskeletal pain considered themselves cured after treatment with prolotherapy (Hackett 1958 [30]. This led to a tradition of extensive needling and injection at entheses of the spine and peripheral joints to treat chronic pain and instability. Treatment location was most often guided by anatomic knowledge of ligament structure, pain referral patterns, pain to palpation at enthesis and subtle crepitus found on detailed palpation reminiscent of osteopathic examination methods. Yet the extensive injection patterns appeared too invasive for holistic practitioners, while appearing too imprecise for the serious science of allopathic medicine. Without established scientific evidence of a regenerative response to these injections or even the pathology being treated at these locations, prolotherapy existed on the periphery of medicine for decades. The most common injectant used in prolotherapy during this time was hypertonic dextrose (usually 15%–25%); the basic science and research-supported, clinical applications of dextrose prolotherapy were recently reviewed [33].
Inflammation in Psoriasis and Psoriatic Arthritis
Published in Siba P. Raychaudhuri, Smriti K. Raychaudhuri, Debasis Bagchi, Psoriasis and Psoriatic Arthritis, 2017
Enthesitis is considered a key feature of PsA. The enthesis is the attachment site of the joint capsule, tendon, or ligament to bone. MRI studies have shown that inflammation at the enthesis is more widespread than originally thought, involving the bone, synovium, and several contiguous structures. The concept of a synovio-entheseal complex (SEC) has been proposed, in which, in health, the synovium provides nourishment and lubrication to the entheseal fibrocartilage. When a mechanically stressed enthesis is injured, the associated inflammatory reaction would be manifested in the juxtaposed synovium. In a collagen-induced arthritis murine model, enthesitis and entheseal new bone formation were dependent on IL-23 and IL-22 contributed by double-negative T cells and γδ T cells [29]. The findings of increased vascularity at entheseal sites, particularly at places of microdamage and ensuing repair, suggest that local trauma may drive the entheseal inflammatory response. A recent report describing the development of unifocal PsA in identical twins following site-specific injury further provides additional support that biomechanical strain can trigger altered bone remodeling in a genetically susceptible host [30].
Prevalence of joint, entheseal, tendon, and bursal findings in young, healthy individuals by musculoskeletal ultrasound
Published in Scandinavian Journal of Rheumatology, 2023
JK Schreiner, D Scheicht, P Karakostas, F Recker, J Ziob, C Behning, P Preuss, P Brossart, VS Schäfer
Furthermore, a significant relationship was identified between the presence of at least one pathological enthesis and the BMI, as well as the presence of at least one pathological enthesis and the FMI. These findings indicate that entheses are more sensitive to physical stress caused by a higher BMI on the basis of increased fat mass and, considering the fact that entheseal hyperperfusion was the prevailing pathology found (89.5%; 17/19), react with an increased perfusion. Several studies analysing the association between BMI and entheseal findings support our results. A positive correlation between BMI and a total score for entheseal pathologies was observed in an ultrasound study including 80 healthy participants (r = 0.344; p = 0.022) (12). Eder et al (27) studied the differences in MASEI scores in patients with psoriatic arthritis, psoriasis alone, and healthy controls, observing a positive correlation between score values and BMI (r = 0.47; p < 0.001). Furthermore, in participants with a BMI > 30 kg/m2, no significant differences in the MASEI scores between the groups were detected (p = 0.18). To the best of our knowledge, no previous study has examined the detailed body composition parameters that contribute to a high BMI that may be related to entheseal pathology. Our study is the first to describe a significant association between the presence of at least one pathological enthesis and the FMI in healthy individuals.
A Story of Discovery and Change: What We Learned from Studying Nystagmus in Infancy and Childhood
Published in Journal of Binocular Vision and Ocular Motility, 2022
The current hypothesis is that surgical interference with peripheral extraocular proprioceptive nerve endings in the tendino-scleral tissue (“enthesis”) influences central ocular motor pathways, disturbance, which results in a lessened INS oscillation. Surgical disruption of the enthesial neuroanatomy results in longstanding beneficial effects on nystagmus and visual function.86,87 The neurological hypothesis for the “improvement” in the nystagmus is that there is a reduction of small-signal gain of the ocular motor plant by interfering with proprioceptive tension control. Enthesial nerves may partly be composed of palisade type non-twitch motoneurons and are likely involved in modulating the gain of sensory feedback from the eye muscles analogous to the gamma motoneurons, which control the gain of proprioceptive feedback in skeletal muscles. In addition, recent anatomic studies have clarified that each rectus extraocular muscle passes through a pulley located near the globe equator in Tenon’s fascia and diverges into the global and orbital layers.88 The enthesis is part of the global layer and thus plays an additional role in ocular motor proprioception. These results have led to the hypothesis that disruption of enthesial proprioceptive structures favorably affects the nystagmus oscillation
Cell-based therapies for the treatment of sports injuries of the upper limb
Published in Expert Opinion on Biological Therapy, 2021
Kwaku Baryeh, Vipin Asopa, Nardeen Kader, Nick Caplan, Nicola Maffulli, Deiary Kader
One of the reasons for the difficulty in treating these injuries is the complex organization of the area of insertion of tendons into the bone, the enthesis. The enthesis is comprised of four zones: tendon, unmineralized fibrocartilage, mineralized fibrocartilage, and bone [7]. Rotator cuff and epicondylar tendinopathy share common histological features [8]. Often, following surgical repair, fibrovascular scar tissue forms between tendon and bone, resulting in a weakened construct, and subsequent failure of repair [9]. This inability to restore the normal biology of the tendon has meant that, despite technical advances in surgical treatment, failure rates are still high. However, cell-based therapies have shown promise in their ability to restore the natural biology of damaged tendons [10].