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Small Animal (Poppy) > Adult Lameness > Flashcards

Adult Lameness Flashcards

1
Q

What is the most likely cause of hindlimb lameness in dogs?

A

Cruciate disease

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2
Q

Is cruciate disease commonly seen in cats?

A

No, occasionally seen in overweight cats or as part of severe stifle disruption

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3
Q

Which meniscus is injured in cruciate disease?

A

Medial (lateral meniscus attached to femur so moves with it and not injured)

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4
Q

Function of cranial and caudal ligaments

A

Stabilise stifle preventing tibia moving forward or backward relative to femur

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5
Q

Tibial compression test

A

Identifies if cranial cruciate ligament is ruptured (forward movement of tibia)

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6
Q

Cranial draw test

A

Identifies if cranial cruciate ligament is ruptured (forward movement of tibia)

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7
Q

Stabilisation techniques for cruciate disease

A

Lateral fabello tibial suture
TPLO

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8
Q

Aetiology of cruciate disease (3 theories account for high prevalence in canine population)

A

Angle of tibial plateau (steeper = greater strain on cranial cruciate, West Highland terrier)
Autoimmune disease
Intercondylar width (narrow distance between medial and lateral femoral condyles = greater strain on cranial cruciate, Labrador retriever)

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9
Q

What is 1? (Left canine stifle)

A

Cranial cruciate

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10
Q

What is 2? (Left canine stifle)

A

Lateral meniscus

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11
Q

What is 3? (Left canine stifle)

A

Medial meniscus

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12
Q

What is 4? (Left canine stifle)

A

Insertion of cranial cruciate and intermeniscal ligament

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13
Q

Is the cranial cruciate a single structure?

A

Yes, broad band

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14
Q

What movement does the cranial cruciate prevent?

A

Cranial movement of tibia in relation to femur when weight bearing, and limits internal rotation
Craniomedial component is taut in both extension and flexion, the caudolateral in extension only

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15
Q

What instability is caused with partial rupture of the cranial cruciate?

A

Instability in flexion only

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16
Q

Stifle menisci details

A

Two (lateral and medial) crescent shaped fibrocartilaginous structures
Broader at extremities where they have blood supply and innervation for pain and proprioception

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17
Q

Function of stifle menisci

A

Improve congruity of curved femoral condyles and flat surface of tibial plateau

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18
Q

Why can’t the medial meniscus move with the tibia?

A

Attached to medial collateral ligament

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19
Q

How is the tibial plateau angle measured?

A

Stifle and tarsus flexed at 90 degrees, superimpose femoral condyles

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20
Q

How does ‘normal’ tibial plateau angle vary between breeds?

A

Greater in smaller breeds

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21
Q

Acute presentation of cruciate disease

A

Traumatic injury
May be accompanied by other injuries (collateral ligament rupture in cat with dislocated stifle)
10/10 lame, tentatively weight bear after 3-4 days

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22
Q

Acute on chronic cruciate disease

A

Degenerative changes precede a more acute rupture

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23
Q

Chronic cruciate disease

A

Degenerative changes within cruciate, particularly seen in large breeds (most common presentation)
Lameness on rising
Swelling to medial aspect of stifle (medial buttress)
Swelling to stifle
Pain on extension and flexion
Palpable or audible click if concurrent meniscal injury

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24
Q

Why might there be stability in stifle with chronic cruciate disease? (Negative response to cranial drawer test or tibial thrust)

A

Periarticular fibrosis (thickened joint capsule)

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25
Q

What disease is shown in this radiograph?

A

Cruciate disease (joint effusion with loss of sub-patella fat pad, osteoarthritis changes)

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26
Q

First site of osteophyte formation in cruciate disease

A

Fabellae

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27
Q

Conservative management for cruciate disease

A

Rest and analgesia for dogs <5kg and cats

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28
Q

How long should conservative management approach be attempted in cruciate disease (if no improvement seen)?

A

6 weeks, might be meniscal tear if no improvement

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29
Q

Adjuncts to rest and analgesia in conservative management of cruciate disease

A

Braces to support unstable stifle
Physiotherapy
Weight loss

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30
Q

Candidates for surgical management of cruciate disease

A

Large and athletic dogs
Small dogs with steep tibial plateau angle (>30 degrees)
Strong index of suspicion of meniscal injury (e.g. meniscal click on manipulation of joint)

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31
Q

Surgical treatment options for cruciate disease that reconstruct/replace ruptured ligament

A

Fabello-tibial suture (DeAngelis suture)
Over the top (facia lata prosthesis)
Tightrope technique (Arthrex)

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32
Q

Surgical approaches to managing the tibial thrust in cruciate disease

A

TPLO/tibial plateau levelling osteotomy
TTA/tibial tuberosity advancement
TTT/triple tibial osteotomy

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33
Q

What surgical treatment of cruciate disease is this?

A

Fabellotibial suture

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34
Q

What surgical treatment of cruciate disease is this?

A

TPLO

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35
Q

What surgical treatment of cruciate disease is this?

A

Closing wedge osteotomy

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36
Q

What surgical treatment of cruciate disease is this?

A

TTA

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37
Q

Does TTA or TPLO give superior results?

A

TPLO

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38
Q

Do TPLO and TTA stop cranial drawer?

A

No, dynamic techniques which only stabilise the stifle during weight bearing

39
Q

How does TTA achieve stability in cruciate disease?

A

When tuberosity is advanced the pull of the quadriceps via the patella tendon is at right angles to the tibial plateau and this prevents cranial movement of the tibia when weight bearing

40
Q

Prognosis of cruciate disease

A

Good but arthritis changes inevitable
Meniscal tear develops in 10-15% of cases requiring surgery
25-40% of dogs rupture the cranial cruciate in the contralateral leg within one year of original injury

41
Q

How should a partial cruciate tear be managed?

A

Like a full rupture, considered non-functional

42
Q

Is patella luxation more commonly medial or lateral?

A

Medial (toy breeds, French bulldog and cavalier king charles spaniel)

43
Q

Which type of patella luxation is the most debilatating?

A

Lateral in larger dogs (flat coat retriever)

44
Q

Anatomy that predisposes to patella luxation

A

Femoral varus deformity

45
Q

Surgical management of patella luxation

A

Deepen femoral trochlear sulcus (sulcoplasty)
Adjust tension of soft tissues (loosen medial, tighten lateral)
Move attachment point of tendon

Straightening femur not recommended (invasive and moderate complication rate)

46
Q

Over what surface is there cartilage loss in patella luxation?

A

Medial femoral trochlear ridge and articular surface of patella

47
Q

Eburnation

A

Cartilage loss exposes underlying bone (marked crepitus)

48
Q

What surgical technique may be considered when patella luxation is leading to articular cartilage loss?

A

Prosthetic trochlear groove

49
Q

Downside of trocheoplasty in patella luxation

A

Exposes subchondral bone/initiates joint inflammation (osteophytosis progresses faster than with other surgeries)

50
Q

In what dog might you consider a distal femoral corrective ostectomy for patella luxation?

A

Larger dogs with excessive femoral varus deformity (grade III/IV) or those in which tibial crest translocation has failed

51
Q

What can be seen in this radiograph?

A

Medial patella luxation
Remodelling of the patella

52
Q

Use of CT in patella luxation

A

Produce transverse image and see exact location of patella
This CT shows medial luxation of patella, osteoarthritis in medial stifle and healed femoral malunion with limb shortening

53
Q

What species is this radiograph of and how do you know? What are the radiographic findings and likely cause? Is this common?

A

Cat
Long patella
Laterally luxated patella
Trauma (tear of medial/lateral retinaculum causing subluxation in opposite direction)
Common

54
Q

Surgical management of grade I medial patella luxation

A

Lateral capsular overlap (tighten retinaculum on lateral aspect of joint)

55
Q

Surgical management of grade II-IV patella luxation

A

Lateral capsular overlap
Medial release (medial desmotomy)
Trochlear groove (block recession or wedge sulcoplasty)
Tibial crest translocation

56
Q

What is the articular cartilage surface normally composed of and what is it replaced by after loss of cartilage following trocheoplasty?

A

Hyaline lost
Replaced by fibrocartilage (poor substitute)

57
Q

What type of trochlear groove recession is this?

A

Wedge recession

58
Q

What type of trochlear groove recession is this?

A

Block recession (preferred, deeper groove proximally)

59
Q

What plate is used in this femoral closing wedge ostectomy?

A

Supracondylar or hockey stick plate

60
Q

Major differential to medial patella luxation

A

‘Skipping terrier syndrome’
No abnormality detectable on clinical exam
Behavioural/stable but strained cruciate?
Monitor carefully

61
Q

Hip dysplasia development

A

Genetic predisposition but environmental factors (diet/exercise as a puppy)
Puppies born with normal hips (normal at ~3m)
Looseness/soft tissue laxity of hip joint (femoral head partially dislocates during exercise, clunk heard but not painful, weight on acetabular rim prevents development, femoral head also takes weight inappropriately)
Osteoarthritis develops in hip joint

62
Q

Dietary advice for a dog prone to hip dysplasia

A

Balanced mineral content (low level to increase osteoclast activity/skeletal remodelling, not too low to induce alimentary hyperparathyroidism with pathological fractures)
High quality proteins
Avoid excessive energy intake
Weight reduction (prevent and treat)

63
Q

Stride associated with hip dysplasia

A

Bunny hops and short strides

64
Q

What is indicative of hip dysplasia regardless of radiographic findings?

A

Ortolani sign

65
Q

Factors involved in hip dysplasia joint laxity (first clinical sign)

A

Joint capsule thickness
Integrity of teres ligament
Integrity of dorsal acetabular rim
Muscle tension
Synovial fluid (increased levels reduce congruency)

66
Q

What is Barden’s palpation?

A

Hip lift, greater trochanter lifted greater than 5-6mm = positive for hip dysplasia

67
Q

Ortolani test

A

Clinical assessment of joint stability
GA/heavy sedation
Dorsal recumbency
Angle of subluxation < angle of reduction

68
Q

Conservative management of hip dysplasia

A

Analgesia
Weight reduction
Appropriate diet

69
Q

Aim of early (young dog) surgical techniques in hip dysplasia

A

Improve joint congruency (TPLO, DPLO)

70
Q

At what age must pubic symphysiodesis be performed for hip dysplasia

A

<16w

71
Q

BVA hip dysplasia scheme

A

> 1y
Any dog
L/R marker, microchip/tattoo no. and date on radiograph
Maximum score 53 on each hip
Appropriate to breed from any dog with <median

72
Q

Techniques for older dogs with hip dysplasia

A

Pectineal myotomy
Femoral head and neck ostectomy (salvage)
Total hip replacement (salvage)

73
Q

Examination of the lame dog and cat

A

Signalment
History
Clinical exam (palpation, lameness, neuro.)

Treatment trial?
Radiographs?
Joint tap/arthrocentesis?
Blood tests/serology?
CT? MRI? Ultrasound?
Arthroscopy?
Biopsy?
Electromyography?

74
Q

Top 3 acute on chronic lamenesses in the mature animal

A

Cruciate rupture
Pathological fracture
Condylar fracture subsequent to HIF

75
Q

Which soft tissue in the shoulder is most prone to strains?

A

Medial glenohumeral ligament

76
Q

Bicipital tendonitis

A

Biceps tendon becomes inflamed or ruptures

77
Q

Shoulder soft tissue condition seen in working dogs

A

Infraspinatus contracture
(Rare, progressive, managed by sectioning tendon close to insertion point, good prognosis)

78
Q

What is a requirement for a shoulder CT?

A

Contrast enhancement

79
Q

Diagnosis of shoulder soft tissue conditions

A

Radiography
Ultrasound
CT/MRI
Gold standard: arthroscopy

80
Q

What is HIF?

A

Humeral intracondylar fissure

81
Q

Diagnostic method of choice in HIF?

A

CT

82
Q

Surgical management of humeral intracondylar fissure

A

Place large tronscondylar screw (CT to guide, probably never heal)

83
Q

Most common carpal injury and presentation

A

Hyperextension (e.g. landing from large drop)
Palmargrade stance, swollen carpus

84
Q

How can you determine whether a hyperextension is at antebrachiocarpal, intercarpal or carpometacarpal level?

A

Radiograph, stressed views helpful

85
Q

Treatment of carpal hyperextension injury

A

Partial or pancarpal arthrodesis (ligaments on palmar aspect will never heal)

86
Q

Condition and treatment (Boxer/Springer Spaniel)

A

Incomplete ossification of the radiocarpal bone
Pancarpal arthrodesis (healing unlikely, similar pathology to HIF)

87
Q

What is this cause of chronic lameness in large exuberant dogs?

A

Stenosing tenosynovitis of the abductor pollicus longus strain

88
Q

Carpal condition that is common in Collies, particularly the shetland sheepdog

A

Plantar ligament degeneration (causes proximal intertarsal subluxation with bilateral changes, progress to rupture and plantigrade stance)

89
Q

Prognosis for tarsal injuries in the racing greyhound (subluxations/fractures of calcaneus and calcaneoquartal joint)

A

Poor, rarely race again

90
Q

What causes a chronic, often bilateral, hindlimb lameness with characteristic clawing of foot?

A

Gastrocnemius tendinopathy

91
Q

Treatment of gastrocnemius tendinopathy

A

Most common: pantarsal arthrodesis

Resect tendon
Calcaneal tibial screw/transarticular external fixator

92
Q

What causes flipping movement of hindlimb outwards in mature german shepherd dog?

A

Gracilis contracture (progressive, no treatment)

93
Q

Concurrent condition seen with medial patellar luxation

A

Cranial cruciate ligament rupture

94
Q

7 month GSD
What condition is this?

A

Ununited anconeal process

Small Animal (Poppy) (20 decks)

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