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749 - Ex 1 > Elbow - Duerr > Flashcards

Elbow - Duerr Flashcards

1
Q

Joint with WB fxn

A

Humeroradial

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2
Q

Joint that restricts motion to sagittal plane

A

Humeroulnar

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3
Q

Joint responsible for transverse plane pronation/rotation

A

Proximal radioulnar

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4
Q

This articulates with the radial head

A

Capitulum (Lateral)

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5
Q

This articulates with the medial portion of ulnar coronoid process

A

Trachlead (medial)

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6
Q

Coronoid disease

A

FCP or MCD - this is the most common in dogs! 99% of dogs that we see with severe OA of elbow is due to MCD

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7
Q

Ununited Anconeal Process

A

UAP

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8
Q

Osteochondrosis dissecans

A

OCD

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9
Q

FCP - how do we dx?

A

Rads, CT, scope

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10
Q

UAP - how do we dx?

A

Rads

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11
Q

Incongruity - how do we dx?

A

CT, scope

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12
Q

OCD - how do we dx?

A

CT

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13
Q

What can we do on PE to test elbow instability?

A

Full flexion, hyperextension, Campbell Test (carpus and elbow held at 90 degrees and then you sup/pronate)

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14
Q

Incongruity plays an important role in ___/___.

A

FCP/UAP

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15
Q

What is incongruity? What 3 places does it occur?

A

The joint surfaces “don’t match”

  1. Humeroulnar –> Notch incongruity
  2. Proximal radioulnar –> Step
  3. Humeroradial
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16
Q

What does a short radius do?

A

Puts pressure on coronoid process

FCP

Radioulnar incongruency

17
Q

What does a short ulna do?

A

Puts pressure on anconeal process

UAP

Radioulnar incongruency

18
Q

What kind of incongruity would cause FCP and UAP?

A

Trochlear notch incongruity (small notch)

Pressure on both coronoid and anconeal process

19
Q

How do we correct UAP?

A

Ulna OsteOtomy - triceps pull restores elbow congruity by pulling the ulna proximally

Cut bone

20
Q

How do we correct FCP?

A

Ulna OsteCtomy - allows shortening of ulna

Remove bone

21
Q

What is MCD?

A

Medial compartment dz - aka FCP (old name)

22
Q

Whats the pathogenesis of Coronoid Disease?

A

Unknown

There is a genetic component that has been proven

Incongruity can be a factor

Very diverse disease

23
Q

Signalment: large breed dogs (labs, GSD, Rotties, Goldens, etc). Usually 6-18 months

Hx: variable lameness that is worse after exercise, stiff gait after rising, “lazy” but will still play, often bilateral so its hard to notice

PE:

  • abnormal stance
  • pain on palpation (hyperflexion, extension and medial compartment pressure/palpation)
  • crepitus, reduced ROM & swelling in older, arthritic patients
A

Coronoid Dz!

24
Q

What do you look for on rads of pt with suspected MCD?

A
  • discontinuity of the coronoid process
  • osteophytes on anconeal process and cranial aspect of the proximal portion of the radial head
  • ulnar sclerosis
  • A/P view –> can see fragment sometimes
25
Q

Tx of MCD - Arthroscopy

A
  • arthroscopic debridement

- ulnar ostectomy for incongruity

26
Q

Are we “fixing” the problem of MCD with Arthroscopy?

A

NO! We are just slowing the progression… O’s need to know this and understand there is long-term OA management ahead of them

27
Q

Prognosis of congenital FCP (MCD) in young dog?

A

Depends on severity of DJD

  • Sx rec to slow down arthritis progression and dec lameness
  • this is NOT a cure!
28
Q

How does the congenital form and adult-onset form of Coronoid dz differ?

A

Congenital: (Common!)

  • puppy with severe ED but little DJD -> may need CT for dx
  • adult dog with moderate ED but severe DJD -> rads are adequate for dx

Adult-Onset form - rare!

  • any mid-older aged dog with minimal rad changes
  • traumatic in origin?
  • congenital but not clinically?
  • need CT or arthroscopy for dx
29
Q

FCP - Summary
You need to ID early! ‘Normal’ rads ___ ___ R/O ED. Good PE and ideally CT esp for adult-onset. _____ ____ needed regardless of tx! Tx options vary but include fragment excision. Advise O about the severity of dz and lack of ______ procedures

A

do NOT

Medical Management

Salvage

30
Q

How do we Tx Humeral OCD? Whats the prognosis?

A

Tx:

  • excision of cartilage flap
  • curettage and microfracture/-picking of the subchondral bone
  • OATS

Prognosis:

  • DJD is inevitable
  • Medical OA management longterm
31
Q

Define UAP

A

Anconeal process that doesn’t unite by week 20

32
Q

Signalment of UAP pts:

A

Young, large/giant breed dogs (GSD< berners)

Males:Females 2:1

20-35% are bilateral

33
Q

Pathogenesis of UAP?

A

Nutrition, genetic, trauma, OCD?

Incongruity (ED) - short ulna

Incongruity (traumatic)
- premature closure of distal ulnar physis

Concomitant dz –> FCP 15%

34
Q

UAP - PE and Dx

A

PE:

  • mild-moderate lameness
  • pain on hyperextension
  • joint effusion

Rads:
- do a flexed view –> this eliminates superimposition of the humerus

CT/Arthroscopy:
- evaluate for FCP and incongruity

35
Q

All dogs with ED will become ___

A

Arthritic!

Do everything to preserve the joint!

36
Q

Elbow injuries are best diagnosed with ____ particularly in young animals, however, when the animal is older ____ are usually sufficient since you should see _____. That is unless you are dealing with ______.

The prognosis for ED is ____ and hence the vet should focus on _____ OA management.

____ is easily diagnosed with ____ after _____, however, it can occur together with ____ which is why a _____ is preferred

A

CT

Rads

OA

Adult-onset

Poor

Long-term

UAP

Rads

20wks

FCP

CT

37
Q

You have a dog with severe elbow OA –> on rads you do not see UAP (lucent line) –> what would you think they have?

A

MCD!! Most common

*OCD is rare

749 - Ex 1 (21 decks)

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