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Joint Diseases of the Forelimb > Carpal Luxation and Medial Collateral Ligament Injury > Flashcards

Carpal Luxation and Medial Collateral Ligament Injury Flashcards

1
Q

What are the 3 levels Hyperextension and subsequent subluxation or luxation can occur at?

A

The antebrachiocarpal level proximally.

The intercarpal level in the middle.

And the carpometacarpal level distally.

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2
Q

What are the 2 most common injuries to the canine carpus leading to loss of palmar support and carpal hyperextension?

A

Damage to the flexor retinaculum
The palmar fibrocartilage

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3
Q

What is the typica history leading to carpal hyper extension/subluxation?

A

There is typically a history of trauma, like jumping or falling from a height, but non-traumatic aetiology, e.g. in relation with immune-mediated arthropathies, is possible.

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4
Q

Order these from least - most common level for carpal luxation?
antebrachiocarpal
Carpometacarpal
Middle carpal

A

antebrachiocarpal (10-31%), carpometacarpal (40-47%) level.
middle carpal (22-50%)

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5
Q

In one study, how many cats with hyperextension injury had the antebrachial joint involved?

A

50%

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6
Q

What degree of lameness is often seen with carpal hyperextension/luxation?

A

Following an acute injury, the animals are often non-weight bearing initially, but then symptoms can become more subtle with only mild lameness

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7
Q

What is seen on CE with carpal luxation/hyperextension? (4)

A

Swelling and tenderness of the carpus,
Discomfort on palpation
Possibly crepitus
Altered ROM.

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8
Q

What imaging is needed to assess carpal luxation/hyperextension/what is being ruled out?

A

Orthogonal radiographs with standard dorsopalmar and mediolateral views of both carpi are indicated to assess for bony injuries or pre-existing degenerative joint disease.

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9
Q

Are stress radiographs important for assessing carpal hyperextension/subluxation?

A

Yes, stress radiographs are necessary to accurately assess carpal integrity and to identify the exact level of joint instability.

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10
Q

What degree of hyperextension during stress radiography indicates a dx?

A

15-20

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11
Q

How successful is conservative management of hyperextension?

A

Rare to be

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12
Q

What are generally considered as the best treatment option for carpal hyperextension? (2)

A

Pancarpal arthrodesis
Partial carpal arthrodesis

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13
Q

Medial collateral ligament injury of the feline carpus:
Carpal Medial ligament deficiency results in what instability? (2)

A

Valgus
Dorsopalmar

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14
Q

Medial collateral ligament injury of the feline carpus:
Which direction of instability is more obvious on exam with a medial ligament deficiency?

A

Dorsopalmar

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15
Q

Medial collateral ligament injury of the feline carpus:
What +ve sign is present with dorsopalmer instability of the carpus?

A

Radiocarpal drawer

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16
Q

What x rays are taken with Medial collateral ligament injury of the feline carpus? (2) What is ruled out?

A

Mediolateral and dorsopalmar radiographs are taken to rule out fractures and to assess for pre-existing degenerative joint disease.

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17
Q

Medial opening of the radiocarpal joint in valgus stress radiographs more pronounced in dogs or cats?

A

Dogs

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18
Q

What is the treatment of choice for feline medial collateral ligament rupture resulting in either subluxation or luxation?

A

Primary surgical reconstruction including placement of a ligament prosthesis

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19
Q

Following feline medial collateral ligament rupture, how can temporary immobilisation be performed?

A

a splint, cast or transarticular ESF is required for 3 - 4 weeks after primary repair

20
Q

How long does it take for recovery back to near full leg function with feline medial collateral ligament rupture? What is likely to develop?

A

Several months

OA expected to develop

21
Q

Area medial or lateral collateral ligament injuries more common in dogs?

A

Medial but still rare

22
Q

What are the 2 parts of the medial collateral ligament?

A

Straight + oblique

23
Q

Straight part of the medial collateral ligament:
A) Origin?
B) Insertion?
C) Which aspect is it closely attached to the sheath of the abductor pollicus longus tendon?

A

A) prominent unnamed tubercle on the medial aspect of the distal radius
B) O the most medial part of the palmar process of the radial carpal bone.
C) Dorsal

24
Q

Oblique part of the medial collateral ligament:
A) Originates?
B) Runs obliquely under the tendon sheath of… where?

A

A) On the styloid process of the radius
B) runs obliquely under the tendon sheath of the abductor pollicus longus muscle to the palmaromedial surface of the radial carpal bone.

25
Q

When is the straight part of the medial collateral ligament taught?

A

Extension

26
Q

When is the oblique part of the medial collateral ligament taught?

A

Flexion

27
Q

What is the degree of lameness with medial collateral ligament injury?

A

Usually weight-bearing lame

28
Q

What is found on CE with medial collateral ligament injuries? (3)

A
  • Swelling on medial aspect of joint
  • Painful ROM
  • Valgus instability
29
Q

What imaging should be performed to investigate medial collateral ligament injury?

A

Plain + stressed x rays

30
Q

What is the treatment recommendation for medial collateral ligament damage?

A

Ligament prosthesis

31
Q

What needs to be provided post op with medial collateral ligament damage?

A

Postoperative support is required for four to six weeks, using either external coaptation with a splinted modified Robert Jones bandage or cast, or a transarticular ESF.

32
Q

How can gradual return to function after medial collateral ligament injury be aided?

A

Physiotherapy

33
Q

What does long term prognosis of medial collateral ligament injury depend on?

A

Developmental/clinical consequence DJD

34
Q

How common are complete luxations of carpal bones/joints?

A

RARE

35
Q

What is the likely needed treatment of complete carpal bone/joint luxation?

A

Pancarpal arthrodesis

36
Q

Individual bones of the carpus may luxate partially or completely.

Which carpal bones are more commonly involved? (3) Which direction

A

The bones most commonly involved are the radial carpal bone or carpal bones I and II. Usually they displace dorsally.

37
Q

How can individual bone luxations of the carpus be managed non-surgically? What is the main issue?

A

Closed reduction may be possible followed by external immobilisation for 2 to 4 weeks.

Most closed reductions do not have good soft tissue healing and subluxation typically recurs.

38
Q

What is the main way of achieving satisfactory outcomes of individual carpal bone luxations?

A

carpal arthrodesis

39
Q

When do Luxation and proximal displacement of the accessory carpal bone occur?

A

When the two ligaments attaching the bone distally to the base of metacarpals IV and V tear or avulse

40
Q

What is luxation of the accessory carpal bone is found in association with palmar luxation or subluxation of which joint?

A

Antebrachiocarpal joint

41
Q

Tears of the palmar carpal fibrocartilage and palmar transverse carpal ligament often occur..?

A

Simultaneously

42
Q

Luxation of the accessory carpal bone:
A) Animal posture?
B) What is palp on accessory carpal bone?
C) What is demonstrated in the flexor carpi ulnaris muscle?

A

A) Plantigrade
B) No prominence
C) Laxity

43
Q

Is the following sentence true or false?

External immobilisation of the limb, to relocate the bone should be attempted soon after accessory carpal bone luxation is diagnosed.

A

False - External immobilisation of the limb does not relocate the bone and therefore does not result in success.

44
Q

What position is the carpus for open accessory carpal bone relocation?

A

Flexed

45
Q

What a are the possible methods of surgical repair of the accessory carpal bone?

A

Suture of the palmar carpal fibrocartilage
Wiring the caudal tip of the accessory carpal bone to the base of metacarpal V,
Both.

46
Q

If surgery of accessory carpal bone luxation fails. What is next step?

A

arthrodesis of one or all levels of the carpus is necessary to stabilise the joint.

Joint Diseases of the Forelimb (10 decks)

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