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SMALL ANIMAL > 20.9.2: Mature lame animal > Flashcards

20.9.2: Mature lame animal Flashcards

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5
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Breed signalment for elbow dysplasia

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Labs, Rotties, Bernese Mountain dogs, Newfoundlands

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6
Q

Breed signalment for humeral intracondylar fissure

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Spaniels, Frenchies

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7
Q

Breed signalment for infraspinatus contracture

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Spaniels

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8
Q

Breed signalment for lateral patella luxation

A

Flat coat retrievers

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9
Q

Breed signalment for medial patella luxation

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Many small breeds inc Frenchies, occasionally Labs and English Bull terries

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10
Q

Breed signalment for lumbosacral disease

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GSDs

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11
Q

Breed signalment for neoplasia

A

Large and giant breeds

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12
Q

Signalment for cellulitis

A

Outdoor entire male cat

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13
Q

Signalment and presentation of cruciate disease

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  • Extremely common - any dog with a hindlimb lameness has cruciate disease until proven otherwise
  • Occasionally seen in the overweight cat as part of a more severe stifle disruption
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14
Q

Signalment for patella subluxation

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  • Common condition
  • Seen less in cats compared to dogs; often traumatic but developmental in Abyssinian and Devon Rex
  • Common in small breeds: Yorkies, poodles, Frenchies, CKCS, English Bulldogs, Labs
  • Often asymptomatic
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15
Q

Which type of dogs is infraspinatus contracture typically seen in? How does this condition present?

A
  • Working dogs
  • A progressive condition
  • Present with characteristic limb posture
  • Managed by sectioning the tendon close to its insertion on the humerus
  • Prognosis is good
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16
Q

True/false: the shoulder is prone to soft tissue injuries due to its relatively instability compared to other joints.

A

True
Shoulder is innately unstable and relies on soft tissue for stability

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17
Q

Diagnosis of soft tissue conditions in the shoulder

A
  • Palpate shoulder ± pain elicited
  • Perform biceps tendon test
  • Can manipulate under GA but this is a bit subjective
  • Radiography - identify mineralisation of infra and supraspinatus tendons
  • Ultrasound - useful for biceps tendon
  • CT (with contrast) and MRI
  • Arthroscopy = gold standard; allows management and diagnosis
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18
Q

What is a general principle of treating soft tissue shoulder injuries?

A

Just rest - there is often very litttle you can do. These injuries are hard to treat but commonly get better of their own accord.

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19
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20
Q

Signalment for humeral intracondylar fissure

A
  • Spaniels inc Brittany and CKCS, Frenchies
  • Young to middle aged dogs
  • No sex predilection
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21
Q

Clinical signs of humeral intracondylar fissure

A
  • Chronic forelimb lameness or acute if associated with lateral, medial or bicondylar fracture
  • Muscle atrophy
  • Elbow swelling
  • Pain on manipulation of the joint and when pressure applied across the condyle
  • When the animal weight bears, the two parts spread apart slightly
  • Acute lameness associated with condylar fractures more often seen in the young puppy (14-16 weeks) jumping from sofa or owner’s arms. V common in the Frenchie with minimal trauma
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22
Q

Diagnosis of humeral intracondylar fissure

A
  • Radiography - multiple views required. Classically there is lateral condylar fracture and some new bone formed at the supratrochlear ridge as the body tries to compensate.
  • CT - modality of choice
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23
Q

Treatment options for humeral intracondylar fissure

A

Conservative management
* Rest
* NSAIDs

Surgical management
* Many possible techniques
* Large transcondylar screw common - these fractures will never heal so you need a very large screw

24
Q

Possible complications that can arise from large transcondylar screw placement (done to fix HIF)?

A
  • Seroma formation and infection around the screw head
  • Breakage of the screw (the fissure rarely heals)
  • Inadvertant penetration of the joint - very bad
25
Q

Presentation of carpal injuries

A
  • Variable presentations but usually associated with varying degrees of lameness, instability, and soft tissue swelling
  • Pain is not a consistent finding in chronic cases
  • Most common carpal injury = hyperextension (i.e. jump over wall and find large drop on other side)
26
Q

Describe how a carpal hyperextension injury would present

A
  • Palmar ligaments and palmar cartilage is damaged irrevocably
  • Carpus is swollen with varying degrees of palmargrade stance
  • Can also occur as a result of destructive arthritis (rheumatoid)
27
Q

Diagnosis of carpal injuries

A

In order to make the diagnosis, need to stress the carpal joint

28
Q

Treatment of carpal injuries

A
  • Fuse the whole joint (partial or pancarpal arthrodesis; generally don’t do partial as this just results in increased strain on the adjacent joints)
29
Q

Signalment and presentation for incomplete ossification of the radiocarpal bone

A
30
Q

Presentation of stenosing tenosynovitis of the abductor pollicus longus strain

A
31
Q

Signalment and presentation of plantar ligament degeneration

A
  • Breed predisposition: collies, esp Shelties
  • Insidious onset
  • Eventually will result in intertarsal subluxation with bilateral changes
  • Degeneration progresses to rupture and plantigrade stance
32
Q

Diagnosis and treatment of plantar ligament degeneration

A

Diagnosis
* Clinically and on radiographs: proximal intertarsal subluxation
* Mineralisation of the plantar ligament

Treatment
* Laterally applied plate and arthrodesis of the calcaneoquartal joint

33
Q

Signalment and prognosis for return to work of central tarsal bone fracture

A
  • Common in racing greyhounds
  • Can also see other combination of fractures and subluxations
  • Greyhounds with tarsal injuries rarely race again
34
Q

Signalment and presentation of gastrocnemius tendinopathy

A
35
Q

Signalment and presentation of gracilis contracture

A
  • Mature GSD
  • Characteristic gait
  • Progressive with no effective treatment although some success reported with adipose tissue, stem cells, and laser treatment
36
Q

What is the most common form of neoplasia to cause lameness in the mature animal? What are the predilection sites for this?

A

Osteosarcoma
* Proximal humerus
* Distal radius
* Proximal tibia
* Distal femur

37
Q

Clinical signs of neoplasia (e.g. osteosarcoma)

A
  • Insidious and poorly responsive to analgesia
  • Moderate to marked pain on palpation of the tumour site
  • May be accompanied by marked muscle atrophy
  • Moderate to marked soft tissue swelling
  • May be acute deterioration when the weakened bone fractures (pathological fracture; classically occurs with very minimal trauma)
38
Q
A

Cannonball chest metastases - would expect this dog to show dyspnoea

39
Q

Diagnosis of neoplasia e.g. osteosarcoma

A
  • Clinical signs and history highly suggestive
  • Radiography: both proliferative and destructive patterns
  • With an osteosarcoma, joint is usually stared
  • 3 views advised for radiography
  • Always radiograph chest to check for mets / CT is more sensitive for this
  • Can biopsy (Jamshidi needle) if struggling to reach diagnosis
40
Q

Treatment of limb neoplasia e.g. osteosarcoma

A
  • Make owner aware that unlikely treatment will be curative
  • Limb amputation offers immediate pain relief; is better tolerated in hindlimbs and in smaller dogs
  • All surgical treatment can be followed up by chemo e.g. carboplatin
  • Some clients will opt for medical management only (analgesia)
  • Perfectly acceptable for client to immediately opt for PTS
41
Q

Prognosis for limb neoplasia e.g. osteosarcoma

A
  • In the dog, generally poor due to lung mets
  • Average survival time without treatment = 1 month (as management of pain difficult, PTS)
  • With amputation alone = 4-5 months
  • With amputation + chemo = 9-10 months
  • Same tumour in cat carrier more favourable prognosis (22-24 months median survival time)
42
Q

Signalment and clinical presentation of nerve root tumours

A
  • Can occur in the brachial and lumbosacral plexus

Signalment
* Rare tumours of older dog (8+ y.o.); rarer in the cat

Presentation
* Chronic and insidious in nature
* Painful
* Marked muscle atrophy usually in one limb (monoparesis); there is neurogenic as well as disuse atrophy
* Careful palpation of axilla/ rectum may detect tumour

43
Q

Imaging modality for nerve root tumours

A
  • MRI is the imaging modality of choice
  • Can also do myelography (rad + contrast) or CT
44
Q

Treatment and prognosis for nerve root tumours

A

Treatment
* Surgical resection difficult; limb amputation often done
* Tumour may extend into spinal canal
* Recurrence common following incomplete surgical excision
* Adjuvant chemo or radiotherapy can be used

Prognosis
* Guarded, recurrence within one year likely
* Local disease, rarely spreads to other sites

45
Q

Signalment, presentation and treatment of cruciate rupture in the cat

A
  • Usually obese cat, minimal trauma
  • There is mineralisation intra-articular but this can also be seen in some normal cats
  • Extra-articular stabilisation can be performed but generally improve with rest only
46
Q

Signalment, presentation, and treatment of patella fracture and dental anomaly syndrome (PADS)

A
  • Patella fractures in the cat associated with retained deciduous teeth and variety of other ractyres
  • Familiar tendency; occurs in young cats often with no history of trauma
  • Unable to fix the stifle - these cats collapse when they bear weight (looks like femoral neuropathy)
  • Major ddx: medial patellar luxation.
  • Treatment: soft tissue suturing will be enough to produce a functional repair
47
Q

Signalment, presentation and treatment for capital physis separation in the cat

A
  • Seen in Russian blues, Burmese, British short hairs, and other large cats
  • Usually animals 6-7 months old
  • There is fracture/ separation of the femoral head physis (Salter Harris Type 1)
  • Treatment: stabilisation with wires or lag screw, or salvage procedures e.g. FHNE, THR
48
Q

Discuss the differences between primary and secondary osteoarthritis

A
  • Osteoarthritis = degenerative joint disease
  • Primary osteoarthritis is basically not seen in our patients; hereditary predisposition, no underlying cause identified
  • Secondary osteoarthritis is very common
49
Q

What conditions can osteoarthritis occur secondary to?

A
  • Developmental conditions e.g. hip and elbow dysplasia, patella luxation
  • Degenerative conditions e.g. cruciate disease
  • Inflammatory arthropathies e.g. rheumatoid arthritis, SLE, tick exposure
  • Trauma
  • Sepsis
  • (Crystal induced very uncommon in dog and cat)
50
Q

Pathophysiology of osteoarthritis

A
51
Q

Clinical signs of osteoarthritis

A
  • Walking stiffly
  • Lameness in one or several limbs
  • Joints swollen either as a result of effusion or periarticular fibrosis
  • Pain on manipulation
  • Reduced range of movement
  • Muscle atrophy
  • Consider if any systemic signs (pyrexia, general malaise)
52
Q

Diagnosis of osteoarthritis

A
  • Clinical exam is of great importance
  • Manipulation under GA
  • Radiography / CT
  • Joint taps (uncommon)
  • Arthroscopy / arthrotomy
  • Ultrasound of periarticular structures

Whatever you do, ALWAYS compare with the opposite limb

53
Q

Treatment options for management of osteoarthritis

A
  • NSAIDs
  • Opioids
  • NMDA receptor antagonists
  • Paracetamol
  • Monoclonal antibodies
  • Gabapentin
  • Grapiprant (EP4 receptor antagonist)
54
Q

Examples of selective COX-2 NSAIDs for treatment of osteoarthritis

A
  • Carprofen - licensed for long term in dog
  • Cimicoxib - licensed for long term in dog, not licensed in cat
  • Firocoxib - licensed for long term in dog, not licensed in cat
  • Mavacoxib - licensed for long term in dog, not in cat
  • Robenacoxib - licensed for long term in dogs and cats
55
Q

Examples of NMDA receptor antagonists that can be used in treatment of OA

A

Amantadine

56
Q

Examples of monoclonal antibodies that can be used in treatment of OA

A
  • Betinvetmab (Librela) - dog
  • Frunevetmab (Solensia) - cat
  • Both directed against nerve growth factor which plays a role in the inflammatory process
57
Q

Non-analgesic management of osteoarthritis

A
  • Environment: ramps, non-slip surfaces
  • Weight reduction in the overweight patient
  • Standard and consistent exercise on level surfaces -> more muscle = animal copes better
  • Hydrotherapy, physiotherapy
  • Laser therapy (lacks evidence)
  • Disease modifying drugs e.g. pentosan polysulphate (Cartrophen)
  • Cell-based / biological therapies e.g. PRP, stem cell therapy

If management + analgesia fail, consider PTS

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