Elbow Flashcards
1
Q
Elbow dysplasia signalment? Often uni or bilateral?
A
- Biphasic meaning (young and old)
- Large giant breeds
- bilateral
2
Q
When we say elbow dysplasia it can either be due to these 2 things?
A
- Medial compartment disease
- ununited anconeal process
3
Q
What 3 conditions can patients with medial compartment disease (elbow dysplasia)?
A
- Fragmented medial coronoid process
- Osteochondritis dissecans
- medial humeral condyle
- Joint incongruity
4
Q
Which condition is a condition with ununited anconeal process and medial compartment disease?
A
- Incongruity
5
Q
When we get DJD, where is the first place we will see osteophytes?
A
Anconeal process
6
Q
OCD is most commonly on the ____ ____ ____
A
medial humeral condyle
7
Q
FCP most commonly involves ____ ____ ____
A
medial coronoid process
8
Q
- A mismatch in articular surfaces is known as ______
- Involves
- ______ discrepancy (radius vs ulna)
- ______ discrepancy (humeral condyle vs trochelear notch)
- _____ or _____ (radius during weight bearing)
A
- A mismatch in articular surfaces is known as incongruity
- Involves
- Length discrepancy (radius vs ulna)
- Diameter discrepancy (humeral condyle vs trochelear notch)
- Static or Dynamic (radius during weight bearing)
9
Q
In terms of uneven joint surface, it changes the _____ distribution acorss joint and focused _____ leads to pathology
A
- weight
- stress
10
Q
In terms of a normal stance in the thoracic limb, is the radius or ulna the main weight bearing bone?
A
- radius
11
Q
German shepherds are especially predisposed to this elbow dysplasia problem?
A
Ununited anconeal process
12
Q
In terms of Age for development of ortho dz and elbow dysplasia
- Young dogs - pain due to ______ in _____ ____
- Old dogs- pain due to _______
A
- Young dogs - pain due to defect in joint surface
- Old dogs- pain due to osteoarthritis
13
Q
Development of ortho dz and elbow dysplasia is fequently _______(uni or bilateral) 35% of the time. Is it heritable or not (what should we avoid if so?)
I
A
- bilateral
- it is heritable don’t breed!
14
Q
For development of ortho dz and elbow dysplasia:
Large and giant breeds
- _______breeds especially are noted for UAP
- ______(males or females are predisposed)
A
- GSD
- Males
15
Q
For development of ortho dz and elbow dysplasia, what age is this most frequent in? Also state the type of lameness which is often aggravated by _____
A
- 5-12 months of age
- Chronic progressive lameness aggravated by activity
16
Q
For development of ortho dz and elbow dysplasia, _______(uni or bilateral) disease may DELAY presentation
A
17
Q
Do you often get pain upon manipulation of the joint with elbow dysplasia?
A
Yes!
18
Q
In terms of pain with elbow dysplasia
- UAP: pain on _______ (anconeal pressure)
- MCD: _______ + _______ (medial compartment)
A
- UAP: pain on extension (anconeal pressure)
- MCD: flexion + supination (medial compartment)
19
Q
With elbow dysplasia there is a characteristic posture mostly seen with this type of elbow dysplasia?
A
MCD
20
Q
We often hear ______ wth osteoartritis bc of osteophytes
A
crepitus
21
Q
What postural abnormality do you see with MCD?
- “_____ ____”
- Elbow ______(abducted or adducted)
- offloads the _______ compartment
- External _____of limb
A
- “Toed out”
- Elbow adducted
- offloads the medial compartment
- External rotation of limb
22
Q
What condition is this in and name the posture?
A
- Toed out
- MCD posture
23
Q
Often incongruity is a proposed etiology with UAP and FCP: state whethere it is short or long radius or ulna?
A
- UAP:
- SHORT ULNA
- LONG RADIUS
- FCP
- Short radius
- Long ulna
24
Q
- With radioulnar incongruity it’s often a _______ discrepancy
- shortened ____ displaces ______ proximally
- Excess force on developing _____ _____
- Focused _____ result in separation
A
- With radioulnar incongruity it’s often a length discrepancy
- shortened ulna displaces humerus proximally
- Excess force on developing anconeal process
- Focused stress result in separation
25
Can standard OCD occur without incongruity?
YEP
26
With UAP incongruity, a short ____ displaces _____ \_\_\_\_\_ proximally, causing a failure to _____ and stress on _____ \_\_\_\_\_
With UAP incongruity, a short **ulna** displaces **humeral condyle** proximally, causing a failure to **fuse** and stress on **anconeal process**
27
What breed is often seen with UAP, causing a separation of the _____ center of ossification
LORETTA :-(
anconeal
28
True facts about UAP:
* Normally uses to ulna at \_\_\_-\_\_\_ weeks
* If the anconeal process has not fused by ____ weeks = UAP
* Normally uses to ulna at **16-20** weeks
* If the anconeal process has not fused by **24** weeks = UAP
29
Proposed etiologies of FCP is a error in _____ \_\_\_\_\_, current \_\_\_\_\_presumed to be caused by \_\_\_\_\_
Proposed etiologies of FCP is a error in **endochondral ossification**, current **microtrauma** presumed to be caused by **incongruity**
30
FCP incongruity is caused by short _____ displacing the \_\_\_\_\_(state bone) \_\_\_\_\_\_(prox or distal?). You get stress on _____ \_\_\_\_\_ and _____ results from added stress
FCP incongruity is caused by short **radius** displacing the **humerus**(state bone) **distally** prox or distal?). You get stress on **coronoid process and fragmentation** results from added stress
31
Failure of endochondral ossification causes \_\_\_\_
OCD
32
What radiographic view is highly diagnostic for UAP?
* flexed lateral view
33
OCD is often well positioned and best viewed on _______ view for radiographs.
craniocaudal
34
With FCP, ______ may be the only sign we see
sclerosis (abnormal hardening)
35
With FCP, what is seen in the lateral view versus craniocaudal view of rads?
* Coronoid overlies radial head (lateral view)
* Coronoid lies partially over ulna (craniocaudal)
36
What imaging modality is excellent for FCP?
CT scan
37
In general, _________ has largely replaced CT
arthroscopy
38
What is the **_gold standard_** viewing modality for elbow dysplasia?
**_Arthroscopy_**
39
90% of the time, OCD is ossiciated with \_\_\_\_\_
FCP
40
What do we do for surgical treatment of UAP? (2)
1. Fragment excision
2. Osteotomy (of ulna) + Fixation (screw)
41
With UAP fragment excision (sx tx)
* IS it acceptable for older dogs eith DJD
* ______ remains
* yes it's acceptable
* instability
42
How is the prognosis wth UAP fragment excision for a pet versus a athletic working dog?
Guarded to fair for function as a pet (long terms)
Guarded for athletic working dog
43
With a osteotomy + fixation with UAP surgical treatment:
Osteotomy allows distraction of \_\_\_\_\_
* Restoration of \_\_\_\_\_: _____ lengthens
* Encourage ____ of _____ process
* Fragment may not ___ long term
Prognosis:
* \_\_\_\_\_
Osteotomy allows distraction of **ulna**
* Restoration of **congruity-ulna** lengthens
* Encourage **union of anconial** process
* Fragment may not **fuse** long term
Prognosis:
* **excellent**
44
What is the gold standard treatment for FCP/OCD
* Arthroscopic
45
Can medical management be used alone for elbow dysplasia? What is the best chance for these guys?
No! It should always be paired with something. Best chance for a good prognosis is early dx and tx, medical managment is used long term due to DJD but the best is **_ARTHROSCOPY \> arthrotomy + MM_**
46
True or False:
TX via arthrotomy is better than arthroscopy for elbow dysplasia?
FALSE
Arthrotomy is worse than arthroscopy
47
With elbow dysplasia we said the earlier the dx the better the prognosis, if dx early can we prevent DJD?
NO!!!! Early prevention does not prevent DJD
48
What is expected long term in terms of treatment for elbow dysplasia: _____ \_\_\_\_\_
medical management
49
Is it better to have a dog with hip dysplasia or elbow dysplasia in large breeds?
hip dysplasia, eventually elbow dysplasia needs to be euthanized
50
In terms of treatment for elbow incongruity what do we know?
dvanced training needed for surgical treatment, so refer it
51
Incomplete ossification of the humeral condyle results from failure of this?
failure of union between the medial and lateral portions of the humeral condyle
52
Union of the medial and lateral portions of the humeral condyle are complete by _____ weeks
12
53
What breeds, gender, and age are predisposed to incomplete ossification of humeral condyle, is it usually uni or bilateral?
* Spaniel breeds most common
* males
* usually young to young adult
* Bilateral but may only show clinically as a unilateral\*\*
54
Are there often clinical signs seen with IOHC, if so state them.
* NO CS often incidental finding
55
Describe the type of lameness for IOHC
* Mild lameness indicates \_\_\_\_\_\_
* worse after \_\_\_\_\_\_
* state whether or not weight bearing??
* Acute lameness indicates **_\_\_\_\_\_\_ \_\_\_\_\_\__**
* state whether or not weight bearing??
* Mild lameness indicates **_micromotion_**
* worse after **_activity_**
* **indicates weight bearing**
* Acute lameness indicates **_pathological fracture_**
* Non weight bearing lameness
56
IOHC 90% of the time is \_\_\_\_\_\_(uni or bilateral) which why you always have to check the _____ \_\_\_\_\_
IOHC 90% of the time is **_bilateral_** which why you always have to check the **_contralateral limb_**
57
* What is the preferred treatment for IOHC?
* if no fracture: _____ only
* Which one is contraindicated?
* Prognosis?
* Surgery (preferred tx)
* if no fracture: **single large lag screw only**
* **Medical therapy contraindicated**
* Prognosis with tx: excellent
58
90% of traumatic elbow luxations are \_\_\_\_\_\_(medial or lateral) due to this anatomical aspect?
lateral due to large medial epicondyle
59
For elbow luxation: normal mediolateral motion is \_\_\_\_\_
* Constrained by _____ \_\_\_\_\_ in flexion
* Constrained by ______ in extension
For elbow luxation: normal mediolateral motion is **_minimal_**
* Constrained by **_collateral ligaments_** in flexion
* Constrained by **_olecranon_** in extension
60
For traumatic luxation
* Dogs : _____ \_\_\_\_\_\_ minimum
* Cats: both ______ \_\_\_\_\_\_
* Dogs : **_lateral collateral_** minimum
* Cats: both **_collateral ligaments_**
61
With traumatic luxations, always take radiographs in this view because it shows the direction of the luxation?
* craniocaudal
62
For tramatic luxation, what type of reduction is idea for acute luxation of a normal joint or chronic luxation attempt
closed reduction
63
For tramatic reduction, concurrent fractures and unsuccessful attempts at previously correcting a luxation or recurrent luxations cause us to do an ______ reduction
open
64
In a closed reduction for tramatic luxation we can access the collateral ligaments by performing this test?
Cambells test
65
For the cambells test we compare it to the contralateral limb:
* the elbow and carpus is put at ___ degrees.
* _____ takes place with lateral collateral ligament
* _____ takes place with medial collateral ligament
For the cambells test we compare it to the contralateral limb :
* the elbow and carpus is put at **_90_** degrees.
* S**_upination_** takes place with lateral collateral ligament
* **_Pronation_** takes place with medial collateral ligament
66
With a closed reduction, why do we flex and extend through ROM?
* to move the \_\_\_\_\_\_
to move hematoma
67
With traumatic luxation if the jont is unstable we do a ______ reduction
open
68
What type of reduction is the best reduction in cats?
* open reduction
69
For traumatic luxation post, the leg is maintained in \_\_\_\_\_\_\_. The _______ provides stability.
* Spica splint \_\_-\_\_ weeks (stable closed reduction)
* Flexible ESF \_\_-\_\_ weeks (open/unstable reduction)
For traumatic luxation post, the leg is maintained in **extension**. The **olecranon** provides stability.
* Spica splint **2-3** weeks (stable closed reduction)
* Flexible ESF **3-4** weeks (open/unstable reduction)
70
After the traumatic luxation, after apparatus is removed
* Exercise restriction \_\_-\_\_ weeks
* physical therapy
* 4-6 weeks
71
This splint maintains the limb in standing position
Spica splint
72
For tramatic luxation the prognosis is good to excellent after a stable ______ reduction versus fair with an _____ reduction (better for thse types?)
* Good to excellent: closed
* Fair: open reduciton (better for small or less ctive dogs)
73
TER stands for?
CUE stands for?
both are _____ procedures
* TER: total elbow replacement
* CUE: canone unicompartmental elbow
* salvage
74
CUE: canone unicompartmental elbow is a _____ joint replacement. _____ joint resurfacing. Primarily for end stage \_\_\_\_\_. 90% \_\_\_\_\_\_
CUE: canone unicompartmental elbow is a **_partial_** joint replacement. **_M_****_edial_**joint resurfacing. Primarily for end stage **_MCD_**. 90% **_improved_**
75
These are used in what procedure for what?
Canine unicompartmental elbow (resurfacing in the medial compartment region)
76
What does a total elbow replacement replace? what 3 components?
parts of the jumerus, ulna, and radius
77
This salvage procedure is technically challenging , require extensive preoperative planning, costly and only done at Iowa state
Total elbow replacement
78
What are 2 examples of potentially catastophic complications for total elbow replacement?
* Fracture Joint luxation
* Infection Implant loosening
79
Complete fusion of joint at standing angle requires an elbow \_\_\_\_\_\_
arthrodesis
80
\_\_\_\_\_\_ contraindicated with severe contralateral disease
Amputation
81
When you do elbow arthrodesis it can leave the with a limited fucntion "\_\_\_\_ \_\_\_\_"
peg leg
82
What correction is this to the elbow?
Elbow Arthrodesis
