ELBOW, RADIUS, ULNA: 52, 53, 54

Question 1

3 main extensor muscles of the elbow joint. Innervation?

Answer 1

-triceps brachii
-anconeus
-tensor fascia antebrachii

radial nerve

Question 2

2 main flexors elbow joint. Innervation?

Answer 2

• brachialis
• biceps brachii

muscolocutaneous nerve

additional contribution to flexion during swing is extensor carpi radialis innervated by radialis nerve

Question 3

collateral ligaments of the elbow anatomy and attachments

Answer 3

both have ONE origin on humeral epicondyle, and TWO insertion crura (cranial and caudal).

-medial CL: cranial crura radial tuberosity, caudal int ligament, ulna mainly but also radius
-lateral CL: cranial crura radius, caudal crura ulna

Question 3

collateral ligaments of the elbow anatomy and attachments

Answer 3

both have ONE origin on humeral epicondyle, and TWO insertion crura (cranial and caudal).

-medial CL: cranial crura radial tuberosity, caudal int ligament, ulna mainly but also radius
-lateral CL: cranial crura radius, caudal crura ulna

Question 4

what is the campbell’s test and what is it’s use?

Answer 4

test collateral ligaments stability (normal 17-50° supination, 31-70° pronation)

Question 5

most common presentation for traumatic luxation of the elbow joint

Answer 5

lateral luxation of the ulna in respect to the umerus

NB: radial head luxation with fracture proximal ulna is a monteggia fracture

Question 6

possible techniques to treat a elbow luxation

Answer 6

1) collateral ligaments repair
2) prostethic replacement of collateral ligaments

-joint immobilization
-(transarticular pinning - not used)
-flexible external fixators for 3-4 Weeks

Question 7

describe the possible types of congenital luxation of the elbow joint

Answer 7

1) humeroradial: lateral or caudolateral displacement of the radial head. medium large puppies ** BELL TAWSE procedure
2) humeroulnar (most common): lateral rotation and sub-luxation of ulna. small breed puppy
3) combined: no predisposition can be associated with generalized joint laxity

Question 8

time to ossification of anconeal process

Answer 8

14-15 weeks greyhound, up to 16-20 weeks german sheperd

Question 9

3 possibilities to treat an UAP

Answer 9

-fragment removal
-proximal ulnar osteotomy
-proximal ulnar osteotomy and anconeal process reattachment

Question 10

classification of flexor enthesiopathy

Answer 10

-primary (15-35%)
-concomitant

Question 11

how the medial coronoid process develops?

Answer 11

only by appositional ossification

Question 12

can both positive and negative radioulnar incongruence be related to medial coronoid process desease?

Answer 12

YES

Question 13

supination or pronation increases the load on medial coronoid process?

Answer 13

supination (mechanism at the base of the development of BURP)

Question 14

ARTHROSCOPIC GRADING SCHEME

Answer 14

RI- F- 4DU- 4DH- P1,5B

ritaglio fogli 4 Duprè 4 Dheli possibilmente tot billions

1) fragment location (ri radial incisure)
2) fissure (Fi) or fragment (F)
3) MCP outerbridge (0-5), diffuse D or focal F, Ulna (U)
4) Humeral outerbridge (0-5), diffuse D or focal F or osteochondritis OC, Humerus (H)
5) Direction of radioulnar incongruence (positive or negative), mm of displacement, location of radioulnar incongruence (apex A base B)

Question 15

phisical examination of dogs with MCP

Answer 15

elbow slightly abducted and manus and antebrachium slightly supinated (in theory supination closes articulation but seem to lead to caudal displacement of the peak contact on MCP).

Question 16

name some of the possible RX findings in dogs with MCPD

Answer 16

-trochlear notch sclerosis (40-86.7%)
-blurring cranial margin of the medial coronoid process
-anconeal osteophytosis (70%), radial head osteophytosis (37.3%), lateral epicondyle osteophytosis (56.5%)

Question 17

position of the 2 arthroscope portals for elbow arthroscopy

Answer 17

CAMERA: line beetween epycondile eminence and caudal ulnar margin, in the middle slightly distal

INSTRUMENT: distal and caudal to the camera port, over the MCP

EGRESS PORT: proximal to anconeal process

Question 18

maximum age at wich a distal ulnar osteotomy can be performed

Answer 18

4-6 MO

Question 19

where is the only proximal ulna physis?

Answer 19

olecranon

Question 20

age for physeal closure

Answer 20

radius+ulna 222/250 days (beagle)

Question 21

mean value of radius procurvatum in dogs

Answer 21

26.6° (14-39)

Question 22

RADIAL SHORTENING: possible surgical techniques (acute vs gradual)

Answer 22

1) dynamic elongation (young dogs), with elastic bands beetween humerus and radius, or ext circular fixators
2) acute radial elongation, with transverse cut or with saggital sliding osteotomy
3) shortening of ulna, predominantly for mature animals

Question 23

ULNAR SHORTENING (63% of all physeal insult): possible surgical techniques (acute vs gradual)

Answer 23

1) dinamic ulnar ostectomy (ostectomy gap greater than 1.5 diameter of the bone)
-low
-high, with intramedullary pin
or bioblique cut
2) semi controlled method for ulnar guiding, elastic bands or distraction fixators
3) distal radial physis stapling

NB: osteotomies instead of ostectomies in older patients.

Question 24

degree of radial valgus to predict succesful ulnar ostectomy

Answer 24

25°. if more usually the ulnar ostectomy is unsuccessful and necessitated additional surgery

Question 25

describe the 4 types of monteggia fractures

Answer 25

1) cranial luxation radial head
2) caudal radial luxation
3) lateral luxation radial head
4) fracture proximal part of the radius with cranial radius luxation