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Y4 SA - Orthopaedics > Common conditions of the elbow > Flashcards

Common conditions of the elbow Flashcards

1
Q

List 5 developmental conditions of the elbow

A

Medial coronoid disease (MCD)
Ununited anconeal process (UAP)
Osteochondritis dissecans (OCD)
Elbow Incongruency
Humeral Intracondylar Fissure (HIF)

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2
Q

List 3 traumatic conditions of the elbow

A

Condylar fractures
Proximal ulna/radius fractures
Luxation/collateral ligament rupture

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3
Q

List 2 degenerative conditions of the elbow

A

Flexor enthesiopathy
Osteoarthritis

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4
Q

How might the subjective gait analysis highlight an elbow condition?

A

Shortened stance phase
Head lift during stance phase on affected limb

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5
Q

Describe the possible findings on the clinical exam of a patient with elbow disease

A

Muscle atrophy
Joint effusion
Periarticular thickening (chronic)
Pain/crepitus on elbow manipulation
Assess range of motion

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6
Q

What should be done before proceeding with diagnostic imaging?

A

Accurate localisation of lameness

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7
Q

Describe the anatomical features of the normal elbow

A

Humerus
Radius
Ulnar
Coronoid process
Anconeal process
Olecranon
Lateral and medial epicondyle
Humeral condyle

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8
Q

How is the anconeal process visualised on radiography?

A

Flexed mediolateral projection

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9
Q

Describe arthroscopy of the elbow joint

A
  • Most sensitive modality
  • Requires equipment and expertise
  • Can assess cartilage: not possible with radiography or computed tomography
  • Allows concurrent diagnostics and surgical intervention
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10
Q

Describe arthrocentesis of the elbow

A
  • Simple and quick diagnostic test
  • Aseptic preparation of skin
  • Typically use 1” – 1.5” 21g - 23g hypodermic needle
  • Collect sample in EDTA
  • Prepare smear on a slide
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11
Q

Where are the landmarks for arthrocentesis of the elbow?

A

Immediately distal to medial or lateral epicondyle
Caudolaterally along anconeal process

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12
Q

Which features of synovial fluid can be analysed?

A

Volume
Colour/turbidity
Total cell counts
Differential cell counts
Cytology

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13
Q

How might osteoarthritis appear on cytology compare to IMPA?

A

OA – low cellularity mononuclear cells predominate
IMPA/BIA – Highly cellular with neutrophilic inflammation

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14
Q

In which patients is elbow dysplasia most commonly seen?

A

A VERY common disease of popular medium-large breed dogs
Labradors, Rottweilers, Bernese Mountain Dogs

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15
Q

Name the 4 diseases defined by IEWG that come under the term elbow dysplasia

A
  1. Fragmentation of the medial aspect of the coronoid process/medial coronoid disease
  2. OCD of the medial aspect of the humeral condyle
  3. Ununited anconeal process
  4. Elbow incongruity
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16
Q

What are the two causes of elbow incongruency?

A

Short radius
Short ulna syndrome

17
Q

Describe the features of a short radius

A

Premature closure of the proximal or distal radial growth plate
Contribution to medial coronoid disease

18
Q

Describe the features of short ulna syndrome

A

Premature closure of the distal ulna physis
Contribution to medial coronoid disease and ununited anconeal process

19
Q

Describe how elbow incongruency is treated

A

Bone Lengthening Procedures:
Osteotomies to improve congruency
Needs to be carried out in young dogs
Most common: short ulna syndrome

20
Q

Describe the factors contributing to medial coronoid disease

A

Genetics
Nutrition
Biomechanics - Sites of greatest load
Gender - Males 2:1 females

21
Q

Describe the pathophysiology of medial coronoid disease

A
  1. Incongruency:
    - Short radius documented in 45% of elbows with MCD
    - Short ulna documented in 14% of elbows with MCD
  2. Mechanical overload:
    - Disturbance of normal endochondral ossification
    - Weak points between retained cartilage and subchondral bone
    - Subsequent fissure and fracture formation
22
Q

Describe diagnostic imaging of medial coronoid disease

A

Do not expect to see the fragment on standard radiographic views
- can look normal
- may see osteophyte formation on the radial head and caudal aspect of the anconeal process

23
Q

How can medial coronoid disease be diagnosed?

A

CT scan
Arthroscopy

24
Q

Describe conservative management of medial coronoid disease

A
  1. Analgesia
    - NSAIDs
    - Paracetamol/codeine
    - Amantadine, gabapentin, tramadol …
  2. Nutraceuticals
  3. Weight control
  4. Controlled exercise
  5. Physio/hydrotherapy
25
Q

Describe surgical management of medial coronoid disease

A
  • Fragment removal
  • Subtotal coronoidectomy
  • Biceps ulnar release procedure (BURP)
  • Load-transfer procedures
  • Bone resurfacing procedures
  • Total elbow replacement (TER)
  • Elbow arthrodesis
26
Q

What are the clinical signs of osteochondritis dissecans?

A

Lameness
Joint effusion

27
Q

How is OCD diagnosed?

A

Radiography
Arthroscopy
Arthrotomy

28
Q

Describe the pathogenesis of OCD

A
  • Interruption to the blood supply going to cartilage
  • So cartilage doesn’t become bone
  • Instead get the formation of a cartilage cleft within the growing bone
  • Cartilage derives its nutrition from joint fluid not blood supply so when there is more cartilage its harder for the joint fluid to diffuse
  • Area of cartilage becomes necrotic and mechanically unstable -> fissure formation
29
Q

How is OCD treated?

A
  • Cartilage flap removal + debridement of subchondral bone
  • Osteochondral Autogenous Transfer (OATS) = Transfer of host osteochondral graft from unaffected site
  • Synthetic osteochondral transplant
30
Q

In which patients is ununited anconeal process most commonly seen?

A

Breeds predisposed include Bassets, GSDs, BMD, mastiffs
Bilateral in 20% - 35% of cases
Male 2:1 Female

31
Q

Describe the pathogenesis of ununited anconeal process

A

Secondary centre of ossification only present in 16% of dogs
Joint incongruency (short ulna)

32
Q

How will ununited anconeal process present on clinical exam?

A

Thoracic limb lameness:
- Chronic
- Exacerbated by exercise
Joint effusion larger than that seen with MCD

33
Q

How will ununited anconeal process present on radiography

A

Flexed mediolateral view
Consolidation of AP not present until between 16 & 20 weeks in GSD
Earlier in Greyhounds (14 – 15 weeks)

34
Q

How is ununited anconeal process treated?

A

Conservative if mild lameness (may be especially true with Bassets)
Surgery

35
Q

Describe surgery for ununited anconeal process

A
  1. Removal of anconeus - Only considered if other treatment options failed as causes instability - Older dogs with severe OA
  2. Anconeal process reattachment
  3. Ulnar osteotomy
  4. Proximal ulnar osteotomy + reattachment
36
Q

How can you differentiate Incomplete ossification of the humeral condyle (IOHC) from a Humeral Intracondylar Fissure

A

Humeral condyle formed from two separate centres of ossification:
Fusion typically occurs at ~12 weeks of age
Adult onset of clinical signs - ?stress fracture aetiology

37
Q

How will a patient with a humeral intercondylar fissure present?

A

Either:
- Acute onset lameness typically secondary to fracture
- Chronic thoracic limb lameness
- Asymptomatic

38
Q

How will a humeral intercondylar fissure present on diagnostic imaging?

A

Radiography: Large fissures can be seen on standard craniocaudal radiographic projections
Computed tomography:
- More sensitive than radiography
- Allows 3D-Multiplanar Reconstruction

39
Q

What are the surgical indications for humeral intercondylar fissure?

A

Persistent lameness in the affected limb
Early remodeling can be detected on the lateral epicondylar crest

Y4 SA - Orthopaedics (7 decks)

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