Conditions of the elbow (Yr 4)

Question 1

how will the gait change with elbow disease?

Answer 1

head lifted during stance phase on affected limb
shortened stance phase

Question 2

what is supination?

Answer 2

internal rotation

Question 3

what is pronation?

Answer 3

external rotation

Question 4

why do you need to take a flexed mediolateral projection of the elbow?

Answer 4

allow assessment of the anneal process, will be superimposed on a normal radiograph

Question 5

what are the two landmarks for arthrocentesis of the elbow?

Answer 5

immediately distal to medial or lateral epicondyle
caudolaterally along anconeal process

Question 6

what should be analysed on anthrocentesis of the elbow?

Answer 6

volume
colour/turbidity
total cell count
differential cell counts

Question 7

how will synovial cytology of osteoarthritis compare to that of immune mediated polyarthritis?

Answer 7

OA - low cellularity with mononuclear cells predominating
IMPA - highly cellular with neutrophilic inflammation

Question 8

what dogs is elbow dysplasia commonly seen in?

Answer 8

medium-large breed popular dogs - Labrador, Rottweilers, Bernese mountain dogs

Question 9

what are the four disease entities defined by elbow dysplasia?

Answer 9

fragmentation of medial aspect of the coronoid process (medial coronoid disease)
OCD of medial aspect of humeral condyle
uninvited anconeal process
elbow incongruity

Question 10

what are the two causes of elbow incongruency?

Answer 10

short radius
short ulna syndrome

Question 11

what causes a short radius leading to elbow incongruency?

Answer 11

premature closure of proximal/distal radial growth plates

Question 12

what causes short ulna syndrome leading to elbow incongruency?

Answer 12

premature close of the distal ulna physis

Question 13

how is elbow incongruency treated?

Answer 13

bone lengthening procedures (ulna is most commonly effected, so ulna osteotomy/ostectomy)

Question 14

what factors predispose animals to medial coronoid disease?

Answer 14

genetics
nutrition (rapid growth)
biomechanics (sites of greatest load)
males>females

Question 15

what are the two pathophysiological causes of medial coronoid disease?

Answer 15

elbow incongruency (short radius or ulna)
mechanical overload (disturbs endochondral ossification, becoming weak points which can fragment/fracture)

Question 16

can medial coronoid disease be seen on a radiograph?

Answer 16

no, medial coronoid changes are often superimposed

Question 17

how can medial coronoid disease be treated?

Answer 17

conservative - analgesia (NSAIDs, paracetamol…)
nutraceuticals, weight management, exercise control, physiotherapy
surgery (lots of options hence none are great)

Question 18

what are the two clinical signs of OCD?

Answer 18

lameness
joint effusion
(young growing dog)

Question 19

what is the pathogenesis of OCD?

Answer 19

disturbance of normal endochondral ossification due to abnormal blood supply leading to increased thickness of cartilage
this can lead to deep thickened cartilage undergoing necrosis and flap/defects developing

Question 20

how can OCD be treated?

Answer 20

removal and debridement of cartilage flap
autogenous bone transfer (take bone from another area and place it in defect)
synthetic osteochondral transplant

Question 21

what dogs is ununited anconeal process seen in?

Answer 21

bassets and German shepherds
males>females
often have medial coronoid disease and is bilateral

Question 22

how do patient with an ununited anconeal process present?

Answer 22

chronic thoracic limb lameness, exacerbated by exercise
large joint effusion

Question 23

what radiographic view is needed to image an ununited anconeal process?

Answer 23

flexed mediolateral view

Question 24

how can patient with ununited anconeal processes be treated?

Answer 24

conservative if mild lameness
surgery (reattachment, ulnar osteotomy…)

Question 25

what is another name for humeral intracondylar fissures?

Answer 25

incomplete ossification of the humeral condyle

Question 26

what breeds are predisposed to incomplete ossification of the humeral condyle?

Answer 26

spaniels, French bulldogs

Question 27

what is incomplete ossification of the humeral condyle?

Answer 27

humeral condyle fired from two separate centres of ossification, these should fuse at 12 weeks old
if this isn’t fully complete they can get a stress fracture

Question 28

what are the three ways a humeral intracondylar fissure present?

Answer 28

acute onset lameness (typically fracture)
chronic thoracic limb lameness
asymptomatic

Question 29

what are the indications for surgery for humeral intercondylar fractures?

Answer 29

persistent lameness of affected limb
evidence of early remodelling of lateral epicondylar crest

Question 30

how are symptomatic humeral intercondylar fissures without a fracture treated?

Answer 30

transcondylar screw (and lateral condylar plating)

Question 31

how is asymptomatic humeral intercondylar fractures treated?

Answer 31

tend to treat conservatively
prophylactic screw (70% complications)

Question 32

what breeds are humeral condylar fractures seen most commonly in?

Answer 32

French bulldogs and spaniels

Question 33

what age do humeral condylar fractures typically occur?

Answer 33

4-5 months old

Question 34

how are humeral condylar fractures treated?

Answer 34

transcondylar screw (bigger is better)