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Surgery > Elbow > Flashcards

Elbow Flashcards

1
Q

What is the typical signalment for OCD in the shoulder of the dog?

A

Developmental orthopedic disease

Biphasic age distribution
4-8 months (cartilage injury)
Middle age to older (secondary DJD)

May have bilateral disease
Young, male, large to giant breed dogs Heritable: DON’T BREED

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2
Q

Typical PE/ orthopedic exam finding for OCD in the shoulder?

A

Forelimb lameness
Head bob – “down on sound” Muscle atrophy

Pain on hyperextension of shoulder joint Pain on flexion of shoulder joint

May have unilateral lameness despite bilateral disease – one side worse

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3
Q

What’s the conservative managment of shoulder OCD and what are the specific indications of this?

A

Conservative management

Rest

Diet: control energy, calcium, vitamin D intake

NSAID

Indications – all must be true Small defect
Minimal to no lameness
Very young dog (< 6 months)

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4
Q

What is the standard of care for OCD in the shoulder?

A

Surgical treatment is the standard of care

Flap removal and joint lavage
Debridement of bone with curette or shaver

Defect heals with fibrocartilage Arthroscopy preferable to arthrotomy

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5
Q

What’s the prognosis for shoulder OCD?

A

Much better with surgery than without

Near-normal to normal function with surgery Pet dog – good to excellent
Working dog – fair to good
Assuming surgery is done prior to onset of DJD

DJD expected without surgery

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6
Q

Biceps Brachii Tendinopathy Etiopathology-

A

Repetitive strain microtrauma

Injury with tendon fiber disruption

Acute to chronic inflammation of tendon and associated synovial tissues

Both acute and chronic inflammation present histopathologically

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7
Q

What is the signalment of a biceps brachii tendinopathy?

A

Presentation
Mature adult dogs Medium and large breeds

Weight-bearing lameness Chronic, intermittent
Progressive
Lameness worsens with exercise Unilateral

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8
Q

Biceps Brachii Tendinopathy

Physical examination findings

A

Muscle atrophy

Pain

Maximally flex shoulder and extend elbow Deep palpation over intertubercular groove Apply tension to biceps insertion

Standing exam, under load: tension to biceps

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9
Q

What are the manipulations used during orthopedic exam?

A

Maximally flex shoulder and extend elbow

Deep palpation over intertubercular groove

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10
Q

What’s the relationship between the anatomy of the tendon and the ortho exam?

A

Palpate insertion of biceps tendon

Pressure there applies tension to biceps

Stretch in biceps tendon elicits pain

May also be done in lateral recumbency as in previous slide

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11
Q

What radiographic views are used?

A

Radiographs
Lateral/craniocaudal: rule out other diagnoses “Skyline” view: not used much
Arthrogram: also not used much

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12
Q

What’s the treatment for a moderate/acute biceps brachii tendiopathy?

A

Treatment – recurrent/persistent lameness

Moderate, acute signs

Intraarticular corticosteroid injection Methylprednisolone acetate (Depo-Medrol) Sample for joint fluid analysis/culture

Strict confinement, 4-6 weeks Physical therapy

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13
Q

Biceps Tendinopathy - Surgery

Indications?

A

Refractory to medical therapy

Radiographic changes

Mechanical deficits
Moderate to severe lameness

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14
Q

What are the surgical options for biceps brachii tendopathy?

A

Arthroscopic evaluation of the joint

Tenotomy of biceps tendon

Tenodesis of bicipital tendon

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15
Q

Biceps Tendinopathy - Prognosis for medical management?

A

Medical treatment: good to poor Lack of confinement
PT improves results (presumptively)

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16
Q

Surgical treatment of biceps teninopathy prognosis

A

Tenotomy: excellent results reported

5/6 dogs (prospective, short-term) JAAHA 2002 22/24 dogs (retrospective, ≥ 1 year) VCOT 2005

Tenodesis: “classic” treatment
Good results reported historically Arthroscopically assisted, 6/6 excellent JAAHA 2005

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17
Q

Definition and etiopathology of shoulder instability

A

Abnormally increased range of motion

Laxity in support structures of shoulder

Medial/lateral glenohumeral ligaments
Joint capsule
Subscapularis tendon (medial)
Teres minor, supra- and infraspinatus (lateral)

Repetitive microtrauma (“overuse” injury) ~80% medial shoulder instability

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18
Q

What is the most common direction of shoulder instability?

A

Medial

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19
Q

What’s the typical signalment and history of a dog with shoulder instability?

A

Signalment

Medium/large breed Adult

History

+/- Active dog

Variable lameness Usually subtle, intermittent Occasionally severe

Poor response to rest and NSAID

20
Q

What will you see on PE for a shoulder instability?

A

Muscle atrophy

Pain on manipulation of joint

Medial instability
Increased abduction angle

Exam requires sedation

Gross instability palpable

Normals not well-established

21
Q

What are normal angles and how do you acess the values?

A

Normal: ~30 degrees

Abnormal: ~50 degrees

Variability
Between breeds Between individuals

Compare with contralateral limb

22
Q

What are the typical diagnostics used for evaluting shoulder instability?

A

Radiographs
Standard views: rule out other conditions Normal or nonspecific degenerative changes No special fancy views described

MRI may underdiagnose severity

Arthroscopy
Best for evaluating joint
Diagnostic and therapeutic if PE is supportive

23
Q

What is the treatment for mild shoulder instability

A

Mild – Rest, PT, hobbles

24
Q

What is the treatment for moderate shoulder instability?

A

Arthroscopic thermal “capsulorrhaphy” Thermal insult induces repair
Weakens tissue before it strengthens

Rest, PT, hobbles

25
Q

What’s the treatment for severe shoulder instability?

A

Medial glenohumeral ligament reconstruction

Velpeau sling instead of hobbles

26
Q

When do you use a Hobbles and when not for shoulder instability?

A

Postop rehab 3 weeks

Activity restriction 3-4 months

Retraining begins 4-6 months

used for moderate and mild NOT SEVERE!!!!

27
Q

When do you use the Velpeau sling?

A

Velpeau sling 2-4 weeks postop

Followed by hobbles 3-4 months

Recovery 4-6 months

SEVERE SHOULDER INSTABILY

28
Q

Definition of a contracture

A

muscle shortening not caused by active contraction

Acute, traumatic disruption of muscle fibers

29
Q

What’s the etiology and pathogenesis of muscle contracture?

A

Contracture: muscle shortening not caused by active contraction

Acute, traumatic disruption of muscle fibers

Fibrosis and contracture secondary to necrosis

Similar lesion in supraspinatus also documented

30
Q

Is infraspinatus contracture painful?

A

NO!

31
Q

What is the typical signalment for infraspinatus contracture?

A

Active, adult, medium- to large breed dogs

Hunting breeds (spaniels, pointers, retrievers) overrepresented

32
Q

What is the typical stance of a dog with infraspinatous contracture?

A

Acute lameness, subsides in 10-14 days

Chronic, static lameness 2-4 weeks later

Nonpainful, non-weightbearing lameness

Elbow adducted, antebrachium abducted

33
Q

What’s the valve of conservative treatment in infraspinatous contracture?

A

NOT HELPFUL!!!

34
Q

What is the treatment for infraspinatous contracture? What’ s the prognosis?

A

Treatment
Conservative treatment unhelpful Tenectomy of infraspinatus tendon Release other capsular adhesions Physical therapy ideal

Prognosis Excellent

35
Q

What’s the signalment and history of a traumatic shoulder luxation?

A

Any age or breed of dog, rare in cats

History of trauma or evidence of injury

Acute onset

36
Q

How does the nomenclature of traumatic shoulder luxations work?

What is the most common?

A

Named for the position of the humeral head relative to the glenoid

Medial is most common

37
Q

What are the PE findings of a traumatic shoulder luxation?

A

Non-weight-bearing lameness
Pain on palpation of shoulder

Malpositioning of greater tubercle

Medial luxation: distal limb abducted

Lateral luxation: distal limb adducted

38
Q

In a medial luxation of the shoulder, which way will the limb go?

A

distal limb abducted

39
Q

In a lateral luxation of the shoulder, what will be the direction of the distal limb?

A

distal limb adducted

40
Q

What are the indications for a closed reduction of the shoulder?

A

Recent injury
No fractures
General anesthesia

Distract limb, move humerus toward glenoid

Stable joint: apply coaptation for 2 weeks Velpeau sling (medial luxation)
Spica (lateral, cranial, caudal luxation)

41
Q

What are the indications for surgical reduction of the shoulder?

A

Chronic/recurrent/unstable luxation

Accompanying fractures

42
Q

Open reduction + ligament repair for shoulder luxation means what?

A

Simple arthrotomy to evaluate/reduce joint Imbrication/repair of capsule during closure Glenohumeral ligament reconstruction

43
Q

Which glenohumeral ligament should be reconstructed for a given direction of luxation?

A

Medial repair for medial luxation

Lateral repair for lateral luxation

44
Q

What’s the prognosis following shoulder luxation?

A

Prognosis: good to excellent

Closed reduction generally successful Most luxations amenable to closed reduction Restores normal joint function

Open reduction
Capsulorrhapy and MGHL reconstruction Goal is to maintain normal joint motion Function typically good long-term

Mild DJD over time may follow trauma

45
Q

When would salvage procedures be recommended for shoulder luxations?

What are they?

A

Severe degenerative joint disease Severe, comminuted fractures Intractable luxation

Fair to good function

Arthrodesis
Invasive, expensive
Moderate mechanical lameness (“peg leg”) Use with caution with bilateral disease

Glenoid excision
Outcome similar to arthrodesis Less technically challenging

Amputation

46
Q
A

Surgery (11 decks)

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