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3. Cat & Dog 2 > Conditions of the Shoulder Joint > Flashcards

Conditions of the Shoulder Joint Flashcards

1
Q

common conditions affecting the shoulder

A
  • Osteochondritis dissecans (OCD)
  • Luxation
    > Congenital
    > Traumatic
  • Medial instability
  • Bicipital tenosynovitis
  • Supraspinatus tendinopathy
  • Contracture of the infraspinatus
    *…
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2
Q

Osteochondritis dessicans
- what is this?
- pathogenesis

A
  • Failure of endochondral ossification resulting in focal thickening and eventual failure of the articular cartilage
  • excess pressure on articular surface > fibrous tissue formation
    > release of necrotic tissue and inflammatory mediators
    > formation of cartilage flap
    > synovitis
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3
Q

Osteochondritis Dissecans - what joints is it found in and how commonly?
- which locations in the joints?

A
  • Shoulder (frequent)
  • Elbow (frequent)
  • Hock (infrequent)
  • Stifle (rare)
  • Sacrum (rare)
    <><><>
  • Specific locations in each joint: generally weight
    bearing area
  • No other locations in dogs!
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4
Q

osteochondritis dessicans Pathophysiology in dogs
- where it hurts?
- signalment / age?
- bi vs unilateral?
- etiology?

A
  • Insidious or acute lameness localized to the shoulder
  • Large to giant dog breeds
  • Young and rapidly growing
    > 4-7 months (<1year)
  • Male-to-female ratio ~ 2:1
  • Often Bilateral (uni/bilateral lameness)
    <><><><>
    Polyfactorial
  • Hereditary > Polygenic
  • Dietary factors > Excessive energy, Excessive calcium
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5
Q

at what anatomic location do we see OCD in dogs?

A

Always caudal aspect of humeral head

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6
Q

osteochondrosis dessicans - Principles of Surgical Treatment - what do we do?

A
  • Remove the cartilage flap(s)
  • Freshen cartilage edges perpendicular to defect
  • Stimulate fibrocartilage formation
    > Curettage until bleeding
    > Drilling (i.e., forage)
  • Remove joint mice
    <><><><>
  • Hereditary: recommend spay
    or neuter
  • Asymptomatic?
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7
Q

osteochondrosis dessicans surgery
- Postoperative Management

A
  • Exercise restriction for 1-2 month
    > Allows healing of the defect with
    fibrocartilage
    <><><><>
  • ± NSAIDs
  • ± Disease modifying agents
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8
Q

OCD Postoperative Management prognosis

A

Prognosis: Good to excellent in 97% (shoulder)
* 75% not lame
* 22.5% minimal lameness
* 2.5% lame
<><><><>
* (Prognosis guarded for other locations)

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9
Q

Shoulder Luxation
- two ways it can arise, and what is more common?
- who is at risk?
- etiology?
- character of each?

A

Congenital (Most Frequent)
* Generally small breeds
* Multiple bone/soft tissue deformities
* Minor to No trauma
<><><><>
Traumatic (Rare)
* Often associated with violent chest trauma
* Significant pain and swelling
<><><><>
80% of all luxations are medial (18% are lateral)

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10
Q

is shoulder luxation generally medial or lateral

A

80% of all luxations are medial (18% are lateral)

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11
Q

Congenital shoulder Luxation
- is this a common type of luxation?
- how / why does it occur?
- when may it be diagnosed?

A
  • MOST FREQUENT
  • Laxity and stretching of joint capsule
  • Sometimes bone malformation
  • May be diagnosed late in life!
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12
Q

Congenital shoulder Luxation
- signs / symptoms
- reducible?

A
  • Acute / Chronic lameness
  • Shoulder muscles atrophy
  • Minimal-Moderate pain
  • Crepitation
  • Abnormal landmarks
    > Acromion and greater tubercle
  • May or may not be reducible
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13
Q

Traumatic shoulder Luxation
- signs, history
- reducible?

A

Acute non-weight bearing
* History of violent trauma
<><><><>
* SEVERE Pain and crepitation
* Abnormal landmarks
* Significant swelling
* Bruising/edema
* Never reducible without anesthesia

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14
Q

Shoulder Luxation Treatments
- which is appropriate for congenital vs traumatic?
- conservative (medical)
- Closed reduction/immobilization
- Open reduction/Stabilization
- Glenoid excision (Salvage)
- Arthrodesis (Salvage)
- Amputation (Salvage)

A

conservative (medical)
> congential: YES
> traumatic: NO
<><><><>
Closed reduction/immobilization
> congenital: NO
> traumatic: YES (Stable)
<><><><>
Open reduction/Stabilization
> congenital: NO
> traumatic: YES (unstable)
<><><><>
Glenoid excision (Salvage)
> congenital: YES
> traumatic: If FAILED
<><><><>
Arthrodesis (Salvage)
> congenital: Possible
> traumatic: Possible
<><><><>
Amputation (Salvage)
> congenital: Possible
> traumatic: Possible

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15
Q

can we attempt closed reduction in congenital luxations?

A

Do not attempt closed reduction in congenital luxations!

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16
Q

Closed Reduction / Immobilization for luxation
- when can we use it?
- what do we do? aftercare?
- contraindications?

A
  • ONLY FOR TRAUMATIC LUXATION
  • Closed reduction under general anesthesia
  • Immobilization for 2 weeks
    > Velpeau sling (MEDIAL)
    > Spica splint (LATERAL)
  • Exercise restriction for 2-3 months
    <><><>
    Contraindications:
  • Acute luxation associated with fracture
  • Unstable luxations
  • Chronic traumatic or congenital shoulder luxations
17
Q

Open Reduction / Stabilization for shoulder luxation
- what is this? what do we do?
- when is it used?
- what is our surgical approach?
- aftercare?

A
  • Re-enforcement of gleno-humeral ligaments with screws and heavy non-resorbable sutures
  • Mostly for TRAUMATIC LUXATION that failed closed reduction
    > Likely to fail for congenital
    <><><><>
    Open surgical approach
  • Medial shoulder for medial luxation
  • Lateral shoulder for lateral luxation
  • Prosthetic ligament reconstruction/ capsulorrhaphy
    > Heavy nonabsorbable polyester suture
    <><><><>
  • Immobilization: 2 weeks
  • Restricted exercise: 2-3 months
18
Q

Glenoid Excision Arthroplasty (Salvage)
- what is this procedure?
- indications?
- when do we use this?

A
  • Removal of the scapular neck and glenoid cavity to minimize bone to bone contact and create a pseudoarthrosis
    <><><><>
    Indications
  • Treatment of choice for congenital luxations
  • Chronic luxations
  • Failed conservative or surgical management
19
Q

congenital luxation prognosis for treatments:
- conservative:
- closed reduction:
- Open reduction and Capsulorrhaphy:
- Glenoid excision:

A
  • conservative: Fair
  • closed reduction: Poor (will re-luxate)
  • Open reduction and Capsulorrhaphy: Poor (likely to re-luxate)
  • Glenoid excision: Good (small)
20
Q

traumatic luxation prognosis for treatments:
- conservative:
- closed reduction:
- Open reduction and Capsulorrhaphy:
- Glenoid excision:

A
  • conservative: Poor
  • closed reduction: Good (60 to 80% good function)
  • Open reduction and Capsulorrhaphy: Good (60 to 80% good function)
  • Glenoid excision: Fair (large)
21
Q

Shoulder Arthrodesis
- what is this?
- how do we do it? aftercare?
- prognosis?

A

Salvage for luxation
* Fusion of the shoulder joint
* Limb immobilized in spica splint until evidence of healing (6-12 weeks)
* Physiotherapy after an additional month
* Prognosis: reasonable, relatively pain free function (not normal)

22
Q

Medial Shoulder Instability
- how common?
- what does it cause?
- how does it occur?
- who is at risk?
<><><>
- signs
- management
- Dx

A

Maybe one of the most common cause of shoulder lameness?
> Stretching/rupture of medial gleno- humeral ligaments
> Middle aged, Large breed
<><><><>
* Chronic, mild to severe lameness
* Minimally responsive to NSAIDs
* Muscle atrophy
* Pain on shoulder manipulation
* Abduction test:
> (Normal ≈30°- Abnormal ≈50°)

23
Q

Medial Shoulder Instability Dx

A
  • Rule out other causes…
  • Palpation (Abduction test) (Reliability??)
    > (Normal ≈30°- Abnormal ≈50°)
  • MRI / Arthroscopy
    > Rupture of the medial gleno-humeral ligament
24
Q

medial shoulder instability treatment
- should we treat?
- how? what are our options?
- prognosis?

A
  • Controversial
    <><>
    Conservative (LONG! 7 m)
  • REST and rehabilitation
  • Steroid injection or NSAIDS
  • Elbow Hobbles (prevents abduction)
  • Stem cell? PRP?
    <><>
    Surgical
  • Re-enforcement of medial gleno-humeral ligament
  • Rest (3-4 months) +/- hobbles
    <><>
    Prognosis
  • Good to guarded?
25
Q

Bicipital Tenosynovitis + Supraspinatus Tendinopathy
- who is at risk?
- prevalence?
- cause?

A
  • Medium to Large breeds
  • Middle-aged
  • Relatively frequent ?
    > Or is it shoulder instability ?
  • Trauma or overuse of the tendon(s)
26
Q

Bicipital Tenosynovitis + Supraspinatus Tendinopathy
* Clinical Signs
* Diagnosis

A

Clinical Signs
* Similar to shoulder instability
* Chronic shoulder lameness
* Pain on shoulder test
* Muscle atrophy
<><><>
* Ultrasound
* Arthroscopy
* MRI
* Radiology (not specific)
> Osteoarthrosis
> Mineralization
* Bicipital Tendon Test?

27
Q

Bicipital Tenosynovitis + Supraspinatus Tendinopathy
- treatment

A

Strict rest /Physiotherapy for 12 weeks
* (up to 7 months!)
<><><><>
Anti-inflammatory drugs
* Oral NSAIDS
* OR Depo-medrol IntraArticular (20-40 mg) ONCE
* OR Triamcinolone 5mg IA (repeated at 4 weeks)
<><><><>
* Shock wave therapy/Therapeutic ultrasound?
<><><><>
* Resection of the tendon if severe or failed medical (tenotomy/Tenorrhaphy) or tenodesis (attach to humerus)
<><><><>
* Prognosis favourable but frustrating

28
Q

Supraspinatus tendinopathy
- how does this occur?
- is it bad?
- how can we visualize?
- treatment?
- prognosis?

A
  • Mineralization of the supraspinatus tendon
  • May be incidental finding
  • Skyline radiograph – differentiate supraspinatus vs biceps
  • Treatment similar to biceps
    > (physio/rest, anti-inflammatory or tendon resection)
  • Prognosis favourable but frustrating
29
Q

Infraspinatus contracture
- how common?
- signs? symptoms?
- radiographs?
- treatment

A
  • Uncommon
  • No pain on manipulation but not able to internally rotate shoulder
  • Atrophy of infraspinatus muscle
  • Radiographs = normal
    <><><><>
  • Treatment – excise tendon attachment off humerus
  • Moderate exercise for 14 days, slow return to normal
    <><><><>
  • Px: Good with surgery
30
Q

Osteochondritis dissecans summary - affects who, prognosis

A
  • Large, young growing dogs
  • Frequent, good prognosis if treated early
31
Q

shoulder luxation
- tratments for congenital vs traumatic

A
  • Congenital: Medical or salvage
  • Traumatic: Reduction (open / close) or salvage
32
Q

shoulder conditions of young dogs

A
  • OCD
  • Congenital Lux
  • Traumatic Lux
33
Q

shoulder conditions of adult dogs

A
  • (Congenital Lux)
  • Traumatic Lux
  • medial instability
  • Bicipital tenosynovitis
  • Supraspinatus tendinopathy
34
Q

shoulder conditions of small breed dogs

A
  • Congenital Lux
  • (Traumatic Lux)
35
Q

shoulder conditions of large breed dogs

A
  • OCD
  • (Congenital Lux)
  • Traumatic Lux
  • medial instability
  • Bicipital tenosynovitis
  • Supraspinatus tendinopathy

3. Cat & Dog 2 (50 decks)

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