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Joints & Muscles

Biomechanical interaction of vertebral joints and paraspinal muscles, including the clinical significance of Modic changes on operative outcomes and fusion rates.

Overview

Orthopaedic management spans diverse pathologies requiring distinct surgical strategies. Corticosteroids may be required for the occasional patient with rheumatoid arthritis in whom myopathy is a prominent extra-articular manifestation of the disease [2]. Surgical excision of dysplasia epiphysealis hemimelica of the scapula resulted in no regrowth at two years and eight months, though patients may later consider total joint replacement due to restricted motion despite benign lesions and no regrowth after excision [7]. In the knee, patients with a preoperative duration of symptomatic medial knee overload/arthritis of two years or greater do not experience inferior patient-reported outcomes or clinical outcomes than patients with a symptom duration of less than 2 years at mid-term follow-up [5]. Autologous Matrix-Induced Chondrogenesis (AMIC) is an effective and safe method of treating symptomatic full-thickness chondral defects of the knee in appropriately selected cases [11].

Procedural outcomes and indications vary by technique and patient selection. Minimally invasive total hip arthroplasty is a safe surgical procedure without increases in operative time, blood loss, operative complication rates, and component malposition rates, though the beneficial effect on functional recovery needs proof [48]. Patients and clinicians can expect an average procedure survival of 12.5 years and a maximum of 21 years for medial opening wedge high tibial osteotomies for the treatment of knee osteoarthritis, where symptomatic relief is influenced by concurrent procedures and preoperative pain level [9]. Repair of both anterior capsulolabral lesions and supraspinatus tendon tears successfully restored range of motion and increased the force required for dislocation in human cadaveric shoulders [6]. Forty-seven (96 per cent) of forty-nine shoulders had a good clinical result after distal release of a deltoid muscle contracture [3].

Vascular compromise associated with isolated acromioclavicular joint dislocation is an indication for surgical intervention to restore the anatomy, as isolated acromioclavicular joint dislocation can be associated with vascular compromise [25]. Normal tendons do not rupture except at the musculotendinous junction or tendon insertion, typically occurring due to excessive weight application when the muscle is holding at maximum power [12]. Observed differences in knee scores between different study groups that have not been matched for various clinically relevant factors are at least as likely to represent differences in the patient populations as they are to represent differences in the operative technique or the design of the implant [17]. Understanding the current evidence and appropriate indications of emerging technologies in orthopaedic trauma is of critical importance for their utilization [23].

Anatomy & Pathophysiology

Kinematics and Muscle Function

The physiology of joints draws from previously published sources and recent findings, omitting unverified or controversial studies [1]. Erector spinae muscle fatigue modifies the flexion relaxation phenomenon, inducing a shift in load-sharing towards passive stabilizing structures [4], while changes in lumbar-stabilizing mechanisms in the presence of muscle fatigue are caused by modulation of lumbopelvic kinematics [30]. During bridging stabilization exercises in healthy populations, all back muscles contribute in a similar way to control spine positions and movements [26]. In contrast, individuals with low back pain demonstrate lower activation of thoraco-lumbar muscles during gait and anterior pelvic tilt, especially those reporting higher pain intensity [36]. Multifidus muscles of some individuals are active early enough to potentially increase collision-induced loading of the facet capsular ligaments during whiplash and startle [14]. Paravertebral extensor muscles play an important role in the context of cervical spinal cord injury [10], and head position relative to the spine is significantly correlated with spinal-pelvic parameters and the lower lumbar multifidus muscle in degenerative spinal kyphosis patients [34].

Lumbar and Cervical Pathology

Lumbar spine disease has novel associations with hip gluteal muscle pathology, specifically gluteal tears [15]. Gross degenerative changes in muscle microstructure and macrostructure are the same in the superficial and deep regions of the multifidus in patients with lumbar spine pathology [37]. Fat infiltration of the posterior paraspinal muscles is inversely associated with fat infiltration of the psoas muscle, potentially indicating a compensatory mechanism where the psoas compensates for weakened paraspinal muscles [39]. The presence of cervical Modic changes did not impact clinical outcomes in cervical spine procedures [41].

Facet and Glenohumeral Mechanics

When sitting, the flexion and extension distance and rotational displacement of lumbar facet joints are not affected by weight-bearing [31]. The rotator interval is central to normal glenohumeral kinematics, and any insult to its integrity alters shoulder motion throughout abduction [42]. Posterior and posterior superior labral injuries produce alterations in glenohumeral kinematics with implications for joint instability, increased joint loading, and potential joint damage [43].

Bone Physiology

The reviewed book 'The Biochemistry and Physiology of Bone' covers nearly every phase of normal bone physiology [44].

Classification

Other Considerations: The physiology of joints accounts is drawn largely from previously published sources, updated with recent findings while omitting unverified or controversial studies [1]. Classic Dupuytren disease and atypical non-Dupuytren disease are distinct clinical entities differing in presentation, etiology, treatment, and prognosis [8]. Observed differences in knee scores between unmatched study groups likely represent patient population variations rather than differences in operative technique or implant design [17]. Individuals with recurrent low back pain exhibit a trunk muscle activation pattern distinct from those without recurrent low back pain [19].

Joint & Muscle Physiology: Normal tendons rupture only at the musculotendinous junction or tendon insertion, typically due to excessive weight application while the muscle holds maximum power [12]. The elbow bears loads created by gravity and muscle contracture during dynamic arm swing movements [53]. Skeletal muscle structure, function, and injury mechanisms encompass the physiological basis of contraction, neuromuscular transmission, and responses to trauma and disuse [27]. The medial force ratio at the knee joint depends on both tibiofemoral alignment and the nature of the activity involved, precluding generalization to a single value [49].

Spinal & Extensor Mechanics: Erector spinae muscle fatigue modifies the flexion relaxation phenomenon, inducing a shift in load-sharing toward passive stabilizing structures [4]. Paravertebral extensor muscles play an important role in cervical spinal cord injury and may guide future therapeutic strategies [10]. The multifidus muscles of some individuals activate early enough to potentially increase collision-induced loading of the facet capsular ligaments [14]. During bridging stabilization exercises, all back muscles contribute similarly to control spine positions and movements in a healthy population [26].

Outcome & Measurement Standards: Forty-seven (96 per cent) of the forty-nine shoulders achieved a good clinical result after distal release of the contracture [3]. The PILLAR project provides a comprehensive online resource to standardize manual muscle measurements from MRI [28].

Clinical Presentation

Chronic Arthropathy and Systemic Manifestations: In rheumatoid arthritis, myopathy may present as a prominent extra-articular manifestation requiring corticosteroids in occasional patients [2]. For medial knee overload or arthritis, a preoperative symptomatic duration of two years or greater does not result in inferior patient-reported or clinical outcomes at mid-term follow-up compared to durations of less than two years [5]. Classic Dupuytren disease and atypical non-Dupuytren disease are distinct clinical entities differing in presentation, etiology, treatment, and prognosis [8].

Spinal and Paraspinal Muscle Dynamics: Erector spinae muscle fatigue modifies the flexion relaxation phenomenon, inducing a shift in load-sharing towards passive stabilizing structures [4]. Individuals with recurrent low back pain exhibit a trunk muscle activation pattern distinct from those without recurrent pain during active hip abduction [19]. In chronic low back pain, age and BMI affect the degree of paraspinal muscles proton density fat fraction, though diagnostic efficacy remains moderate [20]. Paravertebral extensor muscles play a critical role in cervical spinal cord injury [10], while paraspinal muscles in elderly frail patients screened by the FRAIL scale are worse than those in non-frail patients [33]. Further biomechanical and neuroanatomic studies are needed to elucidate the effects of lumbar spine disease regarding gluteal tears [15].

Acute Injury and Myopathy: Normal tendons rupture only at the musculotendinous junction or tendon insertion, typically due to excessive weight application when the muscle holds maximum power [12]. Immediate decompression is advisable for exercise myopathy of the extensor carpi ulnaris muscle, but recovery is unlikely if fasciotomy is delayed beyond twenty-four hours from symptom onset [16]. Early diagnosis, accurate reduction, and internal fixation are essential to avoid growth disturbance, articular incongruence, and functional disability in displaced fractures of the medial humeral condyle in children [32].

Outcomes and Assessment: Forty-seven (96 per cent) of forty-nine shoulders achieved a good clinical result following distal release of a deltoid muscle contracture [3]. Observed differences in knee scores between study groups not matched for clinically relevant factors likely represent population differences rather than variations in operative technique or implant design [17]. The Musculoskeletal Function Assessment questionnaire demonstrates good reliability, validity, and responsiveness, with superior content validity and no ceiling or floor effects compared to other questionnaires [21].

Investigations

Plain radiography: Computed tomographic scanning is valuable for diagnosing atlanto-axial instability caused by fracture of the atlantal arch when plain radiographs are inconclusive [38]. Isolated acromioclavicular joint dislocation can be associated with vascular compromise, which is an indication for surgical intervention to restore anatomy [25].

MRI: Pre-operative MRI findings do not preclude concomitant glenohumeral joint arthroscopy in patients with high-grade acromioclavicular joint separations [40]. Magnetic resonance imaging indicates that the donor site after autologous osteochondral mosaicplasty for cartilaginous lesions of the elbow joint is resurfaced with fibrous tissue [51]. MRI and CT can be reliably used for qualitative and quantitative analysis of paraspinal back muscles regarding fat content [46]. Age and BMI are important factors affecting the degree of paraspinal muscles PDFF in chronic low back pain patients, though their diagnostic efficacy is moderate [20]. SMI of RA is expected to be a promising imaging marker for predicting abnormal bone mass in middle-aged and elderly people with varying bone mass [29]. The PILLAR project provides a comprehensive online resource to standardize manual muscle measurements from MRI [28]. Corticosteroids may be required for the occasional patient with rheumatoid arthritis in whom myopathy is a prominent extra-articular manifestation of the disease [2].

CT: Computed tomographic scanning is valuable for diagnosing atlanto-axial instability caused by fracture of the atlantal arch when plain radiographs are inconclusive [38]. MRI and CT can be reliably used for qualitative and quantitative analysis of paraspinal back muscles regarding fat content [46].

Bone scan: A negative F-18-FDG PET/CT excludes septic shoulder arthritis with high probability [55].

Ultrasound: Ultrasound in dynamic and weight-bearing evaluations is useful to characterize meniscal extrusion in different pathologies, including OA, meniscal lesions, and in the follow-up of surgical procedures [50].

Other Considerations: Repair of both anterior capsulolabral lesions and supraspinatus tendon tears successfully restored range of motion and increased the force required for dislocation [6]. Surgical excision of dysplasia epiphysealis hemimelica of the scapula resulted in no regrowth at two years and eight months [7]. Paravertebral extensor muscles play an important role in the context of cervical spinal cord injury and may guide future therapeutic strategies [10]. Improved histology at the tendon-to-bone interface was correlated with improved final construct strength at the 12-week time point in rotator cuff repair using an interposition bioresorbable scaffold [13]. The multifidus muscles of some individuals are active early enough to potentially increase the collision-induced loading of the facet capsular ligaments during whiplash and startle [14]. Further biomechanical and neuroanatomic studies are needed to elucidate the effects of lumbar spine disease in relation to gluteal tears [15].

Treatment

Non-Operative

Conservative management includes corticosteroids for the occasional rheumatoid arthritis patient with prominent myopathy, despite these agents being undesirable as standard treatment [2]. Patients with symptomatic medial knee overload or arthritis of two years or greater duration do not experience inferior patient-reported or clinical outcomes compared to those with shorter symptom duration at mid-term follow-up after high tibial osteotomy [5]. Patients remaining on a prescription opioid after carpal tunnel release surgery reported worse outcomes compared to those who discontinued [52]. Close monitoring of paraspinal muscle activity during rehabilitation is recommended to enable timely adjustments to the treatment regimen in S-shaped adolescent idiopathic scoliosis [24].

Operative

Indications: Surgical intervention is indicated for distal release of a deltoid muscle contracture, which resulted in a good clinical result in forty-seven (96 per cent) of the forty-nine shoulders treated [3]. Excision is appropriate for dysplasia epiphysealis hemimelica of the scapula, though patients may later require total joint replacement due to restricted motion [7]. Immediate decompression is advisable for exercise myopathy of the extensor carpi ulnaris muscle, but recovery is unlikely if fasciotomy is delayed for more than twenty-four hours from the onset of symptoms [16]. Autologous Matrix-Induced Chondrogenesis (AMIC) is an effective and safe method for treating symptomatic full-thickness chondral defects of the knee in appropriately selected cases [11].

Surgical Approach / Technique: Repair of both anterior capsulolabral lesions and supraspinatus tendon tears successfully restored range of motion and increased the force required for dislocation in human cadaveric shoulders [6]. Surgical excision of dysplasia epiphysealis hemimelica of the scapula resulted in no regrowth at two years and eight months [7]. A relative motion extension (RME) program supports safe earlier recovery of hand function and motion when compared to a controlled active motion (CAM) program following repair of zones V and VI extensor tendons [45].

Implant Selection: Patients and clinicians can expect an average procedure survival of 12.5 years and a maximum of 21 years for medial opening wedge high tibial osteotomies, with effective pain relief influenced by cartilage treatment and preoperative pain score [9].

Other Considerations: Classic Dupuytren disease and atypical non-Dupuytren disease are distinct clinical entities that differ in presentation, etiology, treatment, and prognosis [8]. Improved histology at the tendon-to-bone interface was correlated with improved final construct strength at the 12-week time point when using an interposition bioresorbable scaffold with a vented anchor for primary rotator cuff repair in sheep [13].

Complications

Other Considerations: Corticosteroids are generally undesirable as standard treatment for rheumatoid arthritis but may be required for patients in whom myopathy is a prominent extra-articular manifestation [2]. Surgical excision of dysplasia epiphysealis hemimelica of the scapula resulted in no regrowth at two years and eight months, though the patient later considered total joint replacement due to restricted motion [7]. SARMs abuse increases the risk of harmful side effects such as liver injury, cardiovascular events, and tendon damage when consumed at doses higher than those that increase lean body mass [35].

Infection (PJI): Gender, rheumatoid arthritis, and long-term (greater than 1 year) corticosteroid use are risk factors for surgical site infection after shoulder arthroplasty [47].

Musculoskeletal & Biomechanical Complications: Erector spinae muscle fatigue modifies the flexion relaxation phenomenon, inducing a shift in load-sharing towards passive stabilizing structures [4]. Multifidus muscles of some individuals are active early enough to potentially increase collision-induced loading of the facet capsular ligaments [14]. A decline in maximum voluntary exertion (MVE) of paraspinal muscles may be a predisposing factor for imbalance observed in patients with degenerative spinal deformity [54].

Recovery

Light activity (weeks): Specific timelines for light activity, such as desk work or driving, are not explicitly defined in the provided evidence base. However, immediate decompression is critical for exercise myopathy of the extensor carpi ulnaris muscle, where recovery is unlikely if fasciotomy is delayed beyond twenty-four hours from symptom onset [16]. For patients with rheumatoid arthritis presenting with prominent myopathy, corticosteroids may be required [2].

Full activity (months): Evidence regarding specific month ranges for full activity return is not explicitly detailed in the provided bullets. Surgical excision of dysplasia epiphysealis hemimelica of the scapula resulted in no regrowth at two years and eight months [7]. Patients can expect an average procedure survival of 12.5 years and a maximum of 21 years for medial opening wedge high tibial osteotomies [9]. Forty-seven (96 per cent) of forty-nine shoulders achieved a good clinical result after distal release of a deltoid muscle contracture [3].

Complete recovery / outcome plateau (months): The provided evidence does not specify a distinct month range for the stabilization of pain, strength, and final functional outcomes. However, patients with a preoperative duration of symptomatic medial knee overload or arthritis of two years or greater do not experience inferior patient-reported or clinical outcomes compared to those with symptom durations of less than two years at mid-term follow-up [5]. Improved histology at the tendon-to-bone interface correlated with improved final construct strength at the 12-week time point [13].

Rehabilitation protocol: Close monitoring of paraspinal muscle activity during rehabilitation is recommended to enable timely adjustments to the treatment regimen for S-shaped adolescent idiopathic scoliosis [24]. Erector spinae muscle fatigue modifies the flexion relaxation phenomenon, inducing a shift in load-sharing towards passive stabilizing structures [4]. Repair of both anterior capsulolabral lesions and supraspinatus tendon tears successfully restored range of motion and increased the force required for dislocation [6].

Functional milestones: The Musculoskeletal Function Assessment questionnaire demonstrated good reliability, validity, and responsiveness, with better content validity than other questionnaires and no ceiling or floor effects [21]. SMI of RA is expected to be a promising imaging marker for predicting abnormal bone mass in middle-aged and elderly people with degenerate characteristics of lumbar and abdominal muscles [29]. Effective pain relief from medial opening wedge high tibial osteotomies is influenced by cartilage treatment and preoperative pain score [9]. Autologous Matrix-Induced Chondrogenesis (AMIC) is an effective and safe method of treating symptomatic full-thickness chondral defects of the knee in appropriately selected cases [11].

Other Considerations: Classic Dupuytren disease and atypical non-Dupuytren disease are distinct clinical entities that differ in presentation, etiology, treatment, and prognosis [8]. Clinical recurrence of Dupuytren's contracture was related to the electron microscopic findings of myofibroblasts in the nodules and fibroblasts containing prominent microtubules in the fascia, rather than the age of the patient, duration, or severity of disease [56].

Key Evidence

  • [L5] This account of the physiology of joints is drawn largely from previously published accounts and brings the material up-to-date with certain relatively recent findings, omitting unverified or controversial studies. (10.2106/00004623-196345050-00015)
  • [L4] While corticosteroids are undesirable as standard treatment for rheumatoid arthritis, they may be required for the occasional patient in whom myopathy is a prominent extra-articular manifestation of the disease. (10.2106/00004623-197658040-00027)
  • [L3] Forty-seven (96 per cent) of the forty-nine shoulders had a good clinical result after distal release of the contracture. (10.2106/00004623-199802000-00010)
  • [L4] The results suggest that erector spinae muscle fatigue modifies the flexion relaxation phenomenon, inducing a shift in load-sharing towards passive stabilizing structures. (10.1186/1471-2474-9-10)
  • [L4] Patients with a preoperative duration of symptomatic medial knee overload/arthritis of two years or greater do not experience inferior PRO or clinical outcomes than patients with a symptom duration of less than 2 years at mid-term follow-up. (10.1016/j.jisako.2022.03.003)
  • [L5] Repair of both pathologic conditions successfully restored range of motion and increased the force required for dislocation. (10.1016/j.arthro.2013.05.031)
  • [Case_report] The lesion was benign, and surgical excision resulted in no regrowth at two years and eight months, though the patient later considered total joint replacement due to restricted motion. (10.2106/00004623-198062020-00017)
  • [L4] Patients and clinicians can expect an average procedure survival of 12.5 years and a maximum of 21 years, with effective pain relief influenced by cartilage treatment and preoperative pain score. (10.1136/jisakos-2017-000169)
  • [L4] This finding underscores the importance of the paravertebral extensor muscles in the context of cervical SCI and may guide future therapeutic strategies. (10.1186/s12891-024-07808-0)
  • [L4] AMIC is an effective and safe method of treating symptomatic full-thickness chondral defects of the knee in appropriately selected cases. (10.1007/s00167-010-1042-3)
  • [L5] Improved histology was correlated with improved final construct strength at the 12-week time point. (10.1016/j.jse.2019.05.024)
  • [L5] These data indicate that the multifidus muscles of some individuals are active early enough to potentially increase the collision-induced loading of the facet capsular ligaments. (10.1186/1471-2474-9-80)
  • [L3] Further biomechanical and neuroanatomic studies may elucidate the effects of lumbar spine disease in relation to gluteal tears. (10.2106/jbjs.24.00012)
  • [L4] Immediate decompression is advisable, but recovery is unlikely if fasciotomy is delayed for more than twenty-four hours from the onset of symptoms. (10.2106/00004623-197759030-00022)
  • [L4] Observed differences in knee scores between different study groups that have not been matched for various clinically relevant factors are at least as likely to represent differences in the patient populations as they are to represent differences in the operative technique or the design of the implant. (10.2106/00004623-199706000-00009)
  • [L3] Our results suggest that individuals with rLBP possess a trunk muscle activation pattern that is different from that of individuals without rLBP. (10.1186/s12891-021-04538-5)
  • [L3] Although age and BMI are important factors affecting the degree of paraspinal muscles PDFF in CLBP patients, their diagnostic efficacy is moderate. (10.1186/s12891-024-07649-x)
  • [L3] The Musculoskeletal Function Assessment questionnaire demonstrated good reliability, validity, and responsiveness, with better content validity than other questionnaires and no ceiling or floor effects. (10.2106/00004623-199709000-00006)
  • [L3] Close monitoring of paraspinal muscle activity during rehabilitation is recommended to enable timely adjustments to the treatment regimen. (10.1186/s12891-025-08423-3)
  • [Case_report] Isolated ACJ dislocation can be associated with vascular compromise and we suggest that this is an indication for surgical intervention to restore the anatomy. (10.1111/j.1758-5740.2011.00140.x)
  • [L4] The findings concerning the relative muscle activity and the ratios of the back muscles support the assumption that during these bridging exercises, all back muscles contribute in a similar way to control spine positions and movements in a healthy population. (10.1186/1471-2474-7-75)
  • [L5] The PILLAR project provides a comprehensive online resource to standardize manual muscle measurements from MRI, which will facilitate comparisons between studies as the field moves towards automatization. (10.1186/s12891-023-07029-x)
  • [L4] SMI of RA is expected to be a promising imaging marker for predicting abnormal bone mass. (10.1186/s12891-023-06229-9)
  • [L3] Changes in lumbar-stabilizing mechanisms in the presence of muscle fatigue seem to be caused by modulation of lumbopelvic kinematics. (10.1186/1471-2474-11-112)
  • [L5] When sitting, the flexion and extension distance and rotational displacement of lumbar facet joints are not affected by weight-bearing. (10.1186/s12891-023-06698-y)
  • [L4] Early diagnosis, accurate reduction, and internal fixation are important to avoid growth disturbance, articular incongruence, and functional disability. (10.2106/00004623-198062070-00016)
  • [L3] The paraspinal muscles of elderly Frail patients screened by the FRAIL scale are worse than those of the non-Frail patients, and the ability of the FRAIL scale to distinguish paraspinal muscle morphology has important clinical significance. (10.1186/s12891-023-06144-z)
  • [L3] The study showed that the head position relative to the spine were significantly correlated to some spinal-pelvic parameters, and the lower lumbar multifidus muscle. (10.1186/s12891-021-04621-x)
  • [L4] Although SARMs may increase lean body mass at low doses, case reports suggest users consume them at much higher doses, increasing the risk of harmful side effects such as liver injury, cardiovascular events, and tendon damage. (10.1177/2325967123s00352)
  • [L3] However, individuals with LBP demonstrated lower activation of the thoraco-lumbar muscles during gait and anterior pelvic tilt, especially those reporting higher pain intensity. (10.1186/s12891-021-04287-5)
  • [L3] The results of our study did not support that the deep region of the multifidus is more degenerated in patients with lumbar spine pathology, as gross degenerative changes in muscle microstructure and macrostructure were the same in the superficial and deep regions of the multifidus. (10.1186/s12891-020-03791-4)
  • [L4] Computed tomographic scanning is valuable for diagnosing this pathology when plain radiographs are inconclusive. (10.2106/00004623-198668080-00024)
  • [L3] These results may be indicative of a potential compensatory mechanism where the psoas compensates for a loss in strength due to weakened paraspinal muscles to stabilize the spine segmentally. (10.1186/s12891-023-06967-w)
  • [L4] Pre-operative MRI's do not preclude concomitant GHJ arthroscopy. (10.1016/j.arthro.2010.04.030)
  • [L1] The presence of cervical Modic changes did not impact clinical outcomes in cervical spine procedures. (10.3390/ijerph191610158)
  • [L5] The rotator interval is central to normal glenohumeral kinematics, and any insult to its integrity alters shoulder motion throughout abduction. (10.1186/s12891-016-0898-x)
  • [L5] The PPS injury produces alterations in GH kinematics with implications for GH joint instability, increased GH joint loading, and potential joint damage. (10.1016/j.jse.2024.12.023)
  • [L5] The reviewed book 'The Biochemistry and Physiology of Bone' is a comprehensive milestone in orthopaedic education covering nearly every phase of normal bone physiology, though its figures are lacking and the price is high. (10.2106/00004623-198365020-00033)
  • [L1] The RME program supports safe earlier recovery of hand function and motion when compared to a CAM program following repair of zones V and VI extensor tendons. (10.1016/j.jht.2018.10.003)
  • [L4] MRI and CT can be reliably used for qualitative and quantitative analysis of paraspinal back muscles regarding fat content. (10.1186/s12891-020-03432-w)
  • [L3] Gender, rheumatoid arthritis, and long-term (>1 year) corticosteroid use affect SSI risk after shoulder arthroplasty. (10.1016/j.jse.2017.04.006)
  • [L1] MIS THA is a safe surgical procedure without increases in operative time, blood loss, operative complication rates and component malposition rates, though its beneficial effect on functional recovery needs proof. (10.1186/1471-2474-11-92)
  • [L4] The medial force ratio depends on both the tibiofemoral alignment and the nature of the activity involved and cannot be generalised to a single value. (10.1302/0301-620x.99b6.bjj-2016-0713.r1)
  • [L4] US in dynamic and weight-bearing evaluations is useful to characterize this anatomical abnormality in different pathologies, including OA, meniscal lesions, and in the follow-up of surgical procedures, providing important data to choose the best treatment to address patients affected by ME. (10.1530/eor-2024-0128)
  • [L4] However, magnetic resonance imaging indicates that the donor site is resurfaced with fibrous tissue. (10.1177/0363546507306465)
  • [L3] Patients remaining on a prescription after carpal tunnel release reported worse outcomes compared to those who discontinued. (10.1177/15589447211064365)
  • [L4] The elbow bears the load created by gravity and muscle contracture in dynamic arm swing movement. (10.5397/cise.2023.00101)
  • [L3] Furthermore, the decline in MVE of paraspinal muscles may be a predisposing factor for the imbalance observed. (10.1186/s12891-023-06747-6)
  • [L3] A negative F-18-FDG PET/CT excludes septic shoulder arthritis with high probability. (10.1016/j.jse.2025.01.047)
  • [L4] Clinical recurrence was related to the electron microscopic findings of myofibroblasts in the nodules and fibroblasts containing prominent microtubules in the fascia, rather than the age of the patient, duration, or severity of disease. (10.2106/00004623-198062030-00012)

References

[1] Physiology of Joints. The Journal of Bone & Joint Surgery. 1963. DOI: 10.2106/00004623-196345050-00015

[2] Rheumatoid arthritis with unusual myositis resembling muscular dystrophy. The Journal of Bone & Joint Surgery. 1976. DOI: 10.2106/00004623-197658040-00027

[3] Contracture of the Deltoid Muscle. The Journal of Bone and Joint Surgery (American Volume). 1998. DOI: 10.2106/00004623-199802000-00010

[4] Changes in the flexion relaxation response induced by lumbar muscle fatigue. BMC Musculoskeletal Disorders. 2008. DOI: 10.1186/1471-2474-9-10

[5] Preoperative symptom duration does not affect clinical outcomes after high tibial osteotomy at a minimum of 2-year follow-up. Journal of ISAKOS. 2022. DOI: 10.1016/j.jisako.2022.03.003

[6] Anterior Capsulolabral Lesions Combined With Supraspinatus Tendon Tears: Biomechanical Effects of the Pathologic Condition and Repair in Human Cadaveric Shoulders. Arthroscopy. 2013. DOI: 10.1016/j.arthro.2013.05.031

[7] Dysplasia epiphysealis hemimelica of the scapula. A case report.. The Journal of Bone & Joint Surgery. 1980. DOI: 10.2106/00004623-198062020-00017

[8] 1. Dupuytren’s Disease: Anatomy, Pathology, and Presentation. n.d..

[9] Symptomatic relief in medial opening wedge high tibial osteotomies for the treatment of knee osteoarthritis is influenced by concurrent procedures and preoperative pain level. Journal of ISAKOS. 2018. DOI: 10.1136/jisakos-2017-000169

[10] MRI-based assessment paraspinal extensor muscle fatty infiltration in acute cervical spinal cord injury patients - a retrospective study. BMC Musculoskeletal Disorders. 2024. DOI: 10.1186/s12891-024-07808-0

[11] Mid‐term results of Autologous Matrix‐Induced Chondrogenesis for treatment of focal cartilage defects in the knee. Knee Surgery, Sports Traumatology, Arthroscopy. 2010. DOI: 10.1007/s00167-010-1042-3

[12] Pectoralis Major Muscle: Function of Sternal Portion and Mechanism of Rupture of Normal Muscle: Case Reports.. The Journal of Bone and Joint Surgery. American Volume. 1961.

[13] A prospective study comparing tendon-to-bone interface healing using an interposition bioresorbable scaffold with a vented anchor for primary rotator cuff repair in sheep. Journal of Shoulder and Elbow Surgery. 2020. DOI: 10.1016/j.jse.2019.05.024

[14] Are cervical multifidus muscles active during whiplash and startle? An initial experimental study. BMC Musculoskeletal Disorders. 2008. DOI: 10.1186/1471-2474-9-80

[15] Spine-Abductor Syndrome: Novel Associations Between Lumbar Spine Disease and Hip Gluteal Muscle Pathology. Journal of Bone and Joint Surgery. 2024. DOI: 10.2106/jbjs.24.00012

[16] Exercise myopathy of the extensor carpi ulnaris muscle. Report of a case. The Journal of Bone & Joint Surgery. 1977. DOI: 10.2106/00004623-197759030-00022

[17] Demographic Biases of Scoring Instruments for the Results of Total Knee Arthroplasty. The Journal of Bone & Joint Surgery*. 1997. DOI: 10.2106/00004623-199706000-00009

[19] Trunk muscle activation patterns during active hip abduction test during remission from recurrent low back pain: an observational study. BMC Musculoskeletal Disorders. 2021. DOI: 10.1186/s12891-021-04538-5

[20] Association of MRI findings with paraspinal muscles fat infiltration at lower lumbar levels in patients with chronic low back pain: a multicenter prospective study. BMC Musculoskeletal Disorders. 2024. DOI: 10.1186/s12891-024-07649-x

[21] Comparison of the Musculoskeletal Function Assessment Questionnaire with the Short Form-36, the Western Ontario and McMaster Universities Osteoarthritis Index, and the Sickness Impact Profile Health-Status Measures. The Journal of Bone and Joint Surgery (American Volume)*. 1997. DOI: 10.2106/00004623-199709000-00006

[23] Chapter 3 Emerging Technologies in Orthopaedic Trauma. 2021.

[24] Paraspinal muscles activities in S-shaped adolescent idiopathic scoliosis during physiotherapeutic scoliosis specific exercise: a case–control study. BMC Musculoskeletal Disorders. 2025. DOI: 10.1186/s12891-025-08423-3

[25] Vascular Compromise Secondary to Acromioclavicular Joint Injury: A Case Report. Shoulder & Elbow. 2011. DOI: 10.1111/j.1758-5740.2011.00140.x

[26] Trunk muscle activity in healthy subjects during bridging stabilization exercises. BMC Musculoskeletal Disorders. 2006. DOI: 10.1186/1471-2474-7-75

[27] Chapter 64 Skeletal Muscle. 2019.

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