20.9.2: Mature lame animal Flashcards
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Breed signalment for elbow dysplasia
Labs, Rotties, Bernese Mountain dogs, Newfoundlands
Breed signalment for humeral intracondylar fissure
Spaniels, Frenchies
Breed signalment for infraspinatus contracture
Spaniels
Breed signalment for lateral patella luxation
Flat coat retrievers
Breed signalment for medial patella luxation
Many small breeds inc Frenchies, occasionally Labs and English Bull terries
Breed signalment for lumbosacral disease
GSDs
Breed signalment for neoplasia
Large and giant breeds
Signalment for cellulitis
Outdoor entire male cat
Signalment and presentation of cruciate disease
- 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
Signalment for patella subluxation
- 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
Which type of dogs is infraspinatus contracture typically seen in? How does this condition present?
- 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
True/false: the shoulder is prone to soft tissue injuries due to its relatively instability compared to other joints.
True
Shoulder is innately unstable and relies on soft tissue for stability
Diagnosis of soft tissue conditions in the shoulder
- 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
What is a general principle of treating soft tissue shoulder injuries?
Just rest - there is often very litttle you can do. These injuries are hard to treat but commonly get better of their own accord.
Signalment for humeral intracondylar fissure
- Spaniels inc Brittany and CKCS, Frenchies
- Young to middle aged dogs
- No sex predilection
Clinical signs of humeral intracondylar fissure
- 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
Diagnosis of humeral intracondylar fissure
- 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
Treatment options for humeral intracondylar fissure
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
Possible complications that can arise from large transcondylar screw placement (done to fix HIF)?
- Seroma formation and infection around the screw head
- Breakage of the screw (the fissure rarely heals)
- Inadvertant penetration of the joint - very bad
Presentation of carpal injuries
- 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)
Describe how a carpal hyperextension injury would present
- 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)
Diagnosis of carpal injuries
In order to make the diagnosis, need to stress the carpal joint
Treatment of carpal injuries
- Fuse the whole joint (partial or pancarpal arthrodesis; generally don’t do partial as this just results in increased strain on the adjacent joints)
Signalment and presentation for incomplete ossification of the radiocarpal bone
Presentation of stenosing tenosynovitis of the abductor pollicus longus strain
Signalment and presentation of plantar ligament degeneration
- Breed predisposition: collies, esp Shelties
- Insidious onset
- Eventually will result in intertarsal subluxation with bilateral changes
- Degeneration progresses to rupture and plantigrade stance
Diagnosis and treatment of plantar ligament degeneration
Diagnosis
* Clinically and on radiographs: proximal intertarsal subluxation
* Mineralisation of the plantar ligament
Treatment
* Laterally applied plate and arthrodesis of the calcaneoquartal joint
Signalment and prognosis for return to work of central tarsal bone fracture
- Common in racing greyhounds
- Can also see other combination of fractures and subluxations
- Greyhounds with tarsal injuries rarely race again
Signalment and presentation of gastrocnemius tendinopathy
Signalment and presentation of gracilis contracture
- Mature GSD
- Characteristic gait
- Progressive with no effective treatment although some success reported with adipose tissue, stem cells, and laser treatment
What is the most common form of neoplasia to cause lameness in the mature animal? What are the predilection sites for this?
Osteosarcoma
* Proximal humerus
* Distal radius
* Proximal tibia
* Distal femur
Clinical signs of neoplasia (e.g. osteosarcoma)
- 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)
Cannonball chest metastases - would expect this dog to show dyspnoea
Diagnosis of neoplasia e.g. osteosarcoma
- 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
Treatment of limb neoplasia e.g. osteosarcoma
- 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
Prognosis for limb neoplasia e.g. osteosarcoma
- 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)
Signalment and clinical presentation of nerve root tumours
- 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
Imaging modality for nerve root tumours
- MRI is the imaging modality of choice
- Can also do myelography (rad + contrast) or CT
Treatment and prognosis for nerve root tumours
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
Signalment, presentation and treatment of cruciate rupture in the cat
- 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
Signalment, presentation, and treatment of patella fracture and dental anomaly syndrome (PADS)
- 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
Signalment, presentation and treatment for capital physis separation in the cat
- 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
Discuss the differences between primary and secondary osteoarthritis
- Osteoarthritis = degenerative joint disease
- Primary osteoarthritis is basically not seen in our patients; hereditary predisposition, no underlying cause identified
- Secondary osteoarthritis is very common
What conditions can osteoarthritis occur secondary to?
- 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)
Pathophysiology of osteoarthritis
Clinical signs of osteoarthritis
- 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)
Diagnosis of osteoarthritis
- 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
Treatment options for management of osteoarthritis
- NSAIDs
- Opioids
- NMDA receptor antagonists
- Paracetamol
- Monoclonal antibodies
- Gabapentin
- Grapiprant (EP4 receptor antagonist)
Examples of selective COX-2 NSAIDs for treatment of osteoarthritis
- 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
Examples of NMDA receptor antagonists that can be used in treatment of OA
Amantadine
Examples of monoclonal antibodies that can be used in treatment of OA
- Betinvetmab (Librela) - dog
- Frunevetmab (Solensia) - cat
- Both directed against nerve growth factor which plays a role in the inflammatory process
Non-analgesic management of osteoarthritis
- 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
