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ch 70 muscle and tendon disorder Flashcards

1
Q

What are the common classifications of muscular injury?

A

Contusions (blunt injuries), strains (indirect injuries), lacerations (sharp injuries)

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2
Q

Where do muscle strains most commonly occur?

A

At the musculotendinous junction

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3
Q

When do strains occur?

A

After powerful active contraction of the muscle occurs simultaneous with passive extension of the muscle unit

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4
Q

What muscles appear to be more prone to injury?

A

Muscles that cross 2 or more joints

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5
Q

What are the 3 stages of muscular injury?

A

Stage I: myositis and bruising, architecture intact
Stage II: myositis and some tearing of the facial sheath
Stage III: tearing of the fascial sheath, muscle fiber disruption, hematoma formation

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6
Q

Where are stage I and II injuries more likely?

A

Power group of muscles (triceps, biceps femoris, quads, tensor fascia lata, semitendinosus, semimembranosus)

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7
Q

Where are stage III injuries more likely?

A

Long head of triceps, gracilis, gastrocnemius, tensor fascia lata

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8
Q

What are the two processes by which muscle heals?

A

Direct regeneration of myofibrils, production of fibrous scar tissue

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9
Q

What determines the balance of these two processes (Direct regeneration of myofibrils, production of fibrous scar tissue)?

A

Source of myoblasts, intact extracellular matrix, adequate vascularization, adequate innervation, limited stress across the healing wound

Increased fibrosis = inadequate ECM, poor vascularization, poor innervation, increased stress across healing wound

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10
Q

Under what conditions will myofibrils lead to quick and complete repair?

A

Surviving sarcolemal nuclei, intact endomysium

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11
Q

When does hematoma form?

A

immediately

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12
Q

At what time point does cellular infiltration and phagocytosis occur following injury?

A

6-12hr

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13
Q

At what time point does healing commence and how does this happen?

A

48hr after injury

invasion of capillaries and myoblast proliferation followed by myofiber formation

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14
Q

During what time post-injury does fibroblast proliferation and collagen scar formation occur?

A

4-6d

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15
Q

By what day is the damaged area filled w/ a new collagen network

A

Day 10

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16
Q

Until what day does tissue strength continue to increase?

A

Day 14 (entire process slows down after this point)

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17
Q

What is the primary goal of treatment of muscle injury?

A

Maximize direct myofibril repair while minimizing scar formation by minimizing early disruptive effects of inflammation, edema

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18
Q

By what percentage can the ability of the muscle to produce tension be reduced w/ excessive scar tissue formation instead of myofibril repair?

A

50%

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19
Q

What are the recommendations within first 48 hours?

A

Cold compresses and NSAIDs with light compression bandages

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20
Q

Why is early mobilization following muscular injury important?

A

To ensure proper myofibril orientation

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21
Q

When should surgery be instigated for muscle trauma?

A

Advanced stage II and stage III strains to eliminate gaps and appose muscle to optimize healing without scar formation;
when initial inflammatory phase has receded (2-3d following injury)

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22
Q

principles of surgery for muscle strain?

A

Remove hematoma, debride necrotic material, muscle apposition

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23
Q

What type of suture material should be used with surgery for muscle strain? What pattern?

A

Long-term absorbable monofilament; horizontal mattress tension relieving sutures;
once sufficient tension sutures are placed to hold the bulk of muscle, additional appositional sutures applied through fascial sheaths

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24
Q

What duration of rest is recommended following surgical repair of muscle?

A

4w

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25
Q

Ruptures of what muscles occur in racing greyhounds?

A

Avulsion of the origin of the long head of the triceps brachii; rupture of the gracilis m

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26
Q

PE findings for rupture of long head of triceps brachii?

A

Depression present caudal and distal to scapula

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27
Q

Treatment options for Avulsion of the origin of the long head of the triceps brachii; rupture of the gracilis m

A

Conservative (may not reach same performance level) or reattaching muscle belly to scapula

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28
Q

What does avulsion of tendon of insertion of triceps result in?

A

Severe thoracic limb disability due to loss of elbow extension

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29
Q

What is avulsion of triceps tendon associated with?

A

Trauma or intratendinous corticosteroid injection

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30
Q

How can avulsion of the origin of the long head of the triceps brachii; rupture of the gracilis m be repaired?

A

Can use synthetic graft; elbow must be extended throughout healing (transarticular ex fix or transosseous screw)

31
Q

What is the diagnostic clinical sign associated w/serratus ventralis rupture?

A

Dramatic dorsal displacement of the scapula

32
Q

In what other breeds has rupture of the gracilis muscle been described?

A

GSD, foxhounds, greyhounds

33
Q

Where can rupture of the gracilis muscle occur?

A

Musculotendinous jxn, or origin or insertion can avulse from its attachment

34
Q

Clinical signs of rupture of the gracilis muscle

A

Large hematoma on medial aspect of the thigh, bruising +/- depression if complete or significant rupture

35
Q

Treatment of choice for rupture of the gracilis muscle

A

Surgical repair/reattachment

35
Q

Treatment of choice for rupture of the gracilis muscle

A

Surgical repair/reattachment

36
Q

What maneuvers can diagnose iliopsoas and pectineus muscle strain?

A

Extension and internal rotation of the hip, digital pressure over the area of the iliopsoas on the lesser trochanter

37
Q

What is muscle contracture?

A

The abnormal shortening of muscle tissue, rendering the muscle highly resistant to stretching

38
Q

Why does shortening occur?

A

Part of replacement of the majority of muscle tissue by fibrous connective tissue

39
Q

What causes of muscle contracture have been implicated?

A

Compartment syndrome, infection, trauma, repetitive strain injury, fracture, prolonged immobilization, various primary muscle diseases

40
Q

what muscles are most commonly affected by contracture?

A

Infraspinatus, quadriceps femoris, gracilis, semitendinosus

41
Q

What other muscles have been reported to be affected by contracture?

A

Sartorius, supraspinatus, teres minor, iliopsoas, brachialis

42
Q

What is the most common type of dog affected by infraspinatus contracture?

A

Medium sized working or athletic dogs

43
Q

Clinical progression for infraspinatus contracture?

A

Transient lameness 4-6w prior to contracture; weight bearing lameness or gait anomaly (circumduction of affected forelimb as it is advanced, carpal flip), usually pain free

44
Q

How do dogs w/ infraspinatus contracture hold the affected limb at rest?

A

Abducted shoulder, adducted elbow, lower limb abducted and externally rotated

45
Q

Treatment of choice for infraspinatus contracture

A

Tendinectomy of the tendon of insertion and surrounding fibrous adhesions

46
Q

When does quadriceps contracture most commonly occur?

A

Following femoral fracture, particularly in young dogs

47
Q

When is risk of quadriceps contracture increased?

A

If fracture management results in immobilization or poor use of limb during healing

48
Q

Clinical signs of quadriceps contracture?

A

Inability to flex stifle or tarsus, leg held straight out in extension

49
Q

What occurs histologically in cases with quadriceps contracture?

A

Fibrotic replacement of muscle fibers; eventually periarticular fibrosis and joint ankylosis develop

50
Q

How successful is surgical intervention for quadriceps contracture

A

Limited success (breaking down adhesions + muscle lengthening procedure); usually results in amputation

51
Q

What dogs get gracilis contracture?

A

German shepherds, middle age (3-7y)

52
Q

What is the characteristic gait of gracilis contracture?

A

Limb raised in jerk-like fashion with hyperflexion of tarsocrural joint and internal rotation of metatarsus

53
Q

Physical exam findings for dog with gracilis contracture?

A

firm gracilis and enlarged tendon of insertion

54
Q

Conservative or surgical treatment recommended for gracilis contracture?

A

Conservative – near 100% recurrence with surgery

55
Q

Who gets semitendinosus contracture? What does it look like?

A

German shepherds, signs and treatment identical to gracilis contracture

56
Q

Who gets flexor carpi ulnaris contracture? (aka carpal flexion syndrome)

A

Puppies 6-24 weeks

57
Q

Clinical signs of flexor carpi ulnaris contracture?

A

Inability to extend carpus, tendon of insertion is tight

58
Q

Is flexor carpi ulnaris contracture reversible?

A

Yes – spontaneous resolution with reduced activity and carpal support bandages; recovery in 2-3 weeks

59
Q

What does tendon healing rely on?

A

Influx of new fibroblasts to produce new collagen

60
Q

How does tendon healing occur in paratenon-lined tendons?

A

In paratenon-lined tendons has vascular beds and there is influx of undifferentiated cells from paratenon

61
Q

What are examples of paratenon-lined tendons?
aka vascular tendon

A

triceps and gastroc

62
Q

How does tendon healing occur in sheathed tendons (avascular tendons)

A

In sheathed tendon (avascular tendon: DDF)- relies on intrinsic blood supply for healing, so lower healing potential

63
Q

What does gap formation in tendon healing lead to?

A

Scar/fibrous formation

64
Q

When does the tendon lose holding power?

A

5 days

65
Q

When does tendon fibroplasia and collagenation occurs?

A

2 weeks, during these steps gradual increase in strength

66
Q

For how long does suture provide all strength and resistance of gap formation or elongation?

A

3 weeks, otherwise gap formation = scar formation

67
Q

How long before the strength of the tendon achieves 56% of its strength?

A

6 weeks, its sufficient to exercise

68
Q

How strong is the the tendon a year following repair?

A

79%

69
Q

Recommendations to avoid further damage to tendon in surgery?

A

Needles or K-wires inserted through body of tendon to reduce manipulation of edges

70
Q

What suture type on tendons?

A

Monofilament synthetic long-term absorbable or nonabsorbable

71
Q

What suture pattern you can use for flat or rounded tendons?

A

Flat tendons: Kessler (locking loop), Krackow; Rounded tendons: three-loop pulley

72
Q

What suture to provide final apposition?

A

Finer gauge suture, horizontal mattress sutures

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