Knee pain is predominant among osteoarthritis (OA) patients, but the mechanism is poorly understood. We investigated subchondral bone as a source of OA knee pain using immunohistochemistry. Fifteen medial-type OA knees with minimum involvement of the lateral compartment determined by X-ray as well as magnetic resonance imaging that received total knee arthroplasty (TKA) were involved. Each pair of the medial femoral condyle (MFC) and lateral femoral condyle (LFC) was compared obtained at the time of TKA. Osteocartilaginous MFC and LFC specimens were histologically examined and stained with antibodies against cyclooxygenase 1 (Cox-1), cyclooxygenase 2 (Cox-2), substance P, tumor necrosis factor-alpha (TNF-alpha), and neuron-specific class III beta-tubulin (TUJ1), a pan-neuronal marker. Formation of cystic lesions was more frequently seen in the MFC. The lesions were composed of vascular endothelial cells, osteoclasts, and mononuclear cells and were present in similar proportions between the MFC and the LFC. Four out of 15 MFC specimens were positive for Cox-1, 15 for Cox-2, and 13 for TNF-alpha. No LFC specimens were positive for any antibodies. Substance P-positive and TUJ1-positive fibers were found in the subchondral area of the MFC, but not in the LFC. Pathological changes in the subchondral bone can be a source of knee pain, which was detectable by the positive immunoreactivity of substance P, Cox-2, TNF-alpha, and TUJ1, in the subchondral bone of affected compartments. The relatively immediate reduction in pain obtained by TKA might account for the involvement of the subchondral bone in knee pain because most of the affected subchondral plate is excised in TKA (debridement effect of TKA).

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The purpose of this review is to summarize ligamentous injury of the wrist. Triangular fibrocartilage complex (TFCC), scapholunate ligament (SLL), and lunotriquetral ligament (LTL) are crucial to wrist stability. Damage to these ligaments causes changes in bone alignment and altered motion pattern. This may cause pain and eventually osteoarthritis. Imaging techniques of the wrist include conventional arthrography, computed tomography (CT) arthrography, conventional magnetic resonance imaging (MRI), and MR arthrography. Especially, MRI plays an important role in the assessment of TFCC, SLL, and LTL. Therefore, special attention is drawn to normal and abnormal MR imaging appearance of these ligaments in this review. Variety of treatment options dependent on classification of TFCC and ligamentous injury as well as role of imaging in the patient treatment are also discussed.

Intracranial subdural hematoma associated with intracranial hypotension is a rare complication of dural puncture and other procedures on the dura. This report describes the case of a 25-year-old man who developed intracranial subdural hematoma after resection of a thoracic spinal cord tumor. Intracranial subdural hematoma could result in severe and permanent neurologic deficit if it remains unrecognized. Severe and prolonged postdural puncture headache should be regarded as a warning sign of an intracranial subdural hematoma, and in those patients early investigation is recommended.