Final: OA/ OCD, Shoulder, Elbow Flashcards
When would you use a DCP (dynamic compression plate) on a carpal injury?
When you want to perform a pancarpal arthodesis because the antebrahiocarpal joint is abnormal and all 3 joints need to be fused (do in conjunction w/removal of all cartilage and cancellous bone graft)
Place on dorsal surface
BEST TREATMENT FOR CARPAL LUXATIONS, antebrachial carpal injuries
More commonly done tha partial carpal arthodesis
What are the indications for surgical treatment of a shoulder luxation?
Chronic/recurrent/unstable luxation
Accompanying fractures (e.g. HBC injuries)
What is the most mobile joint in the carpus? Tarsus?
Antebrachiocarpal joint
Tibiotarsal/Talocrural joint
I.e. these are least likely to be affected by luxations
What is the recommended treatment for collateral injury of the tarsus/carpus?
Surgical mgmt- reconstruction/replacement of the ligamenets
Splint + rest not helpful alone, ESF can help joint stay stable while soft tissue trauma is healing
What are the 3 steps to surgically repairing a shoulder luxation?
- Arthrotomy (to evaluate/reduce joint)
- Glenohumeral ligament (MGHL) repair
- Imbrication/repair of capsule (during closure)
What are the 5 risk factors for OA?
Advanced age
Size and growth rate (large breed dogs)
Obesity
Repeated trauma and mechanical stress
Breed/genetics
Which of the following are medial and which are lateral on the tarsus?
Trochlea of the talus
Calcaneous
Metatarsal bone I
Metatarsal bone V
Central tarsal bone
_Medial:_Trochlea, MT I, central tarsal bone
Lateral: Calcaneous, MT V
T/F: Excess weight will accelerate the expression of OA/DJD.
True
No such thing as too thin for any dog w/OA
Why are corticosteroids not recommended with DJD?
Steroids depress chrondrocyte metabolism and alter the matrix and can affect collagen formation, so they have long term deleterious effects
What is the typical signalment for congenital shoulder luxation?
Small or Toy breed dog
3-10 months of age
Shetland sheepdog, Collie, Elkhound too
What can you do to treat pain due to end-stage OCD in the tarsocrural joint?
Tarsocrural arthodensis
Fuse in standing angle, remove articular cartilage, pack w/bone graft, rigid fixation
What does it indicate if a dog is chewing at his toes that are peaking out of the bottom of a bandage?
Bandage too tight
What is the purpose of curettaging in OCD surgery?
To stimulate fibrocartilage
What type of disease (infectious, non-infectious nonerosive, non-infectious erosive, non-inflammatory) shows the following radiographic signs:
Joint space collapse
Multiple joints affected
No bony changes
Noninfectious Nonerosive
What breeds are predisposed to infraspinatus contracture?
Hunting breeds
(Spaniels, Pointers, Retreivers)
GSD are particularly predisposed to what form of elbow displasia?
UAP
How many tarsal bones are there?
7
Which portion of the tarsal collateral ligament is taut only in extension? Which is taut in both flexion and extension?
Long- Extension only
Short- Extension and flexion
What type of incongruity is associated with UAP? FCP?
UAP- short ulna + long radius
FCP- short radius + long ulna
What diagnostic can you use to definitively establish whether joint disease is inflammatory or not?
Arthrocentesis
Shoulder instability will cause medial instability and an increased ______ angle. Normal is ___ degrees, abnormal is over ___ degrees. Many clinical causes fall between these values.
Abduction
30
50
What surgical treatment is indicated for shoulder OCD?
Via arthroscopy:
First remove flap and lavage joint
Then debride bone with curette/shaver
What are 3 options for post-op immobilization after a calcanean tendon repair?
External fixator
Splint
Giant lag screw (from calcaneous to tibia)
Often combo of these
What stess laterally deviates the limb? Medially?
VaLgus= Lateral
Vargus = Medial
What supporting structure(s) is/are most commonly affected with shoulder instability?
Medial structures: Medial glenohumeral ligament, Suprascapularis tendon
Where do OCD lesions on the tarsus occur?
Talus
What joint condition is this posture associated with? Describe the posture in terms of what is adducted and what is externally rotated.
MCD (medial compartment disease)
“Toed out” posture
Elbow adducted
Toes/rest of limb abducted
Taking strain of medial compartment
Is osteoarthritis/osteoarthosis inflammatory or not?
Non-inflammatory DJD
What surgery is this? When is it indicated? Describe what’s going on.
Partial carpal arthodesis
When antebrachiocarpal joint is healthy
Middle and carpometacarpal joints are fused using a T-Plate (or pins)
If IOHC (incomplete ossification of the humeral condyle) presents to you with no displacement or fractures, how do you treat?
Single lag screw through condyles
T/F: End-stage DJD is OCD.
False, end stage OCD = DJD
What motions elicit pain in a dog with OCD of the shoulder? What radiographic view is diagnostic
Hyperextension
Flexion
Lateral view (early on will see flattening of humeral head, eventually a saucer-shaped divit/flap forms)
OCD is a bilateral disease. Does it usualy present with bilateral lameness?
No, unilateral
Which ligaments need to be ‘replaced’ during collateral ligament replacement surgery on the carpus? Tarsus?
Carpus= short ligaments (medial = straight and 2 oblique ligs, lateral= straight only)
Tarsus= short and long ligaments
Tarsus = Two; carPus = pus(sy cats) are short
What nutritional supplements help to with inflammation? Which one prevent further damage?
Anti-inflammatory = Omega 3 FAs
Chrondroprotectants = Glucosamine/Chondroiten, Avocado Soybean Unsaponifiables (ASU)
What is the most stable option for primary tendon repair after a calcanean rupture?
3-loop pulley
What constrains mediolateral motion of the elbow in flexion? Extension?
Collateral ligaments
Olecranon
Does early intervention prevent elbow DJD?
No
Prognosis is better w/small flap and small duration of CS but will need to medically manage DJD longterm
What type of disease (infectious, non-infectious nonerosive, non-infectious erosive, non-inflammatory) shows the following radiographic signs:
Soft tissue swelling
Dimished joint space
Bony changes (e.g. periarticular osteophytosis, subchondral bone plate possibly sclerotic)
Non-inflammatory (specifically DJD)
What are your treatment options for a traumatic elbow luxation without joint disease where closed reduction was successful?
Split
Modified ESF
(Open reduction and ligament reconstruction if these fail)
What is the common signalment for biceps brachii tendinopathy? How does it typically present?
Sig: Mature adult medium or large breed dog
CS: Chronic, intemittent progressive WEIGHT BARING lameness that worsens with exercise and is unilateral
What procedure is required for definitive treatment of hyperextension injuries? What if the antebrachiocarpal joint is involved?
Arthodensis of affected joint and joinst distal to it
Panarthrodesis (antebrachiocarpal joint)
What conditions are involved in elbow displasia? Which are included in the component of “Medial compartment disease”?
UAP (ununited anconeal process)
Incongruity
OCD (osteochondritis dissecans, of the medial humeral condyle)
FCP (fragmented medial coronoid process, of the ulna)
MCD= FCP+OCD+Incongruity
Elbow displasia is a collection of separate but related diagnoses. What is the typical presentation and progression?
Biphasic distribution (age)
Large/Giant dog breeds
Often bilateral
Chronic, progressive lameness (often worse w/exercise)
Natural progression to osteoarthritis
Does surgical intervention with tarsus OCD prevent the development of OA? Is it always better than medical management?
No
No, medical management might be as good as an arthotomy and fragment removal
Tarsus is not a very forgiving joint
What is expected if you do not surgically treat shoulder OCD?
DJD
How do you assess the collateral ligaments of the elbow?
Campbell’s test
Elbow and carpus at 90deg, supination to assess lateral ligament, pronation for medial ligament
Compare to contralateral limb
What stance does complete rupture of the common calcanean tendon cause? Which tendon is usually affected with a partial rupture? What does this look like?
Plantigrade
SDF- partial hyperextension of hock, flexion of digits
What type of disease (infectious, non-infectious nonerosive, non-infectious erosive, non-inflammatory) shows the following radiographic signs:
Sclerotic or lytic subchondral bone
Bony changes (e.g. periarticular done formation)
Joint space changes (e.g. narrowing, capsule distension)
Soft tissue swelling
Inflammatory (infectious)
When is fusion of the humeral condyle normally complete? What breed is prediposed to IOHC?
12 weeks
Spaniel breeds (Males)
What are your treatment options for a traumatic elbow luxation in conjunction with severe joint disease?
Total elbow replacement
Arthrodesis
What does acute NWB lameness in a dog with IOHC indicate?
Pathologic fracture
What is the treatment for congenital shoulder luxation with a normal glenoid?
Open reduction/capsulorrhaphy
Glenohumeral ligament reconstruction
T/F: IOHC is usually bilateral.
True
(90% have bilateral lesions)
What is the best diagnostic modality for asssessing shoulder instability?
Arthroscopy
What is muscle shortening not caused by active contraction?
Contracture
What is the purpose of exercise modulation for OA?
Maintain muscle mass
What rad view is required to diagnose UAP?
Flexed lateral
After preforming a closed reduction of a shoulder luxation, what spint would you use if the luxation had been medial? What is it was lateral? Cranial? Caudal?
Medial = Velpeau
Lateral, Cranial, Caudal = Spica
When manipulating the joint of a dog with elbow displasia, pain is felt on ______ with UAP, and ______ as well as ______ with MCD. _______ indicates osteoarthritis.
Extension (anconeal pressure)
Flexion and supination
Crepitus
What is the recommened procedure for infraspinatus contracture?
Tenectomy of infraspinatus tendon
(Also release other capsular adhesions)
When is an intraarticular corticosteorid injection indicated for biceps brachii tendinopathy? What should you do in conjunction with (before) this?
When there is recurrent or persistent lameness
Sample joint fluid for analysis/culture
Hyaline/Articular cartilage is 10% _____ and 90% ______.
Chrondrocytes
Extracellular matrix
What type of disease (infectious, non-infectious nonerosive, non-infectious erosive, non-inflammatory) shows the following radiographic signs:
Joinst space collapse
Bony changes (e.g. subchondral bone proliferation, new bone formation)
Soft tissue swelling
Multiple joints affected
Noninfectious erosive (e.g. Rheumatoid arthritis)
What is the source of pain in young dogs with elbow displasia? Old dogs?
Young- defect in joint surface (friction)
Old- OA
What do you do to look for a pain response in a dog with suspected biceps brachii tendinopathy?
Maximally flex shoulder and extend eblow
Deeply palpate over intertubercular groove
Apply tension to biceps insertion
(If standing then apply tension to biceps insertion)
Stretch in biceps tendon elicits pain
In terms of prognosis, how would you order the following joints from best to worst?
Stifle,Shoulder, Elbow, Tarsus
Shoulder > Stifle > Elbow > Tarsus
What is generally more successful, open or closed reduction of shoulder luxation?
Closed
What are the 2 options for surgical treatment of UAP? Which is more appropriate for a dog with OA?
Fragment excision - better for dog with OA
(Ulnar lengthening) Osteotomy + Fixation
What is true about the centers of ossification in the ulna of dogs with UAP?
Have a separate ossification center on the anconeal process
What procedure is indicated if the PE is highly suggestive of a bicept tendinopathy?
Arthroscopy
(+ Lateral/craniocadual rads)
What is CREPI?
Crepitus
Rage of Motion
Effusion
Pain
Instability
Is arthroscopy or arthrotomy better for medical management of elbow displasia?
Arthroscopy
OA progresses despite treatment
What are the 3 salvage procedures for the shoulder?
Arthodensis (joint fusion)
Glenoid incision
Amputation
___ is used to evaluate bone while ____ is beter for evaluating tendons and ligaments.
CT
MRI
Hyperextension injury of the carpus/tarsus causes damage to which ligaments?
Palmar/Plantar support ligaments
What type of injury do these stress views of the carpus indicate?
Medial collateral injury
(Valgus stess opens the joint medially because MCL is deficient but vargus pressure does not open the joint because the LCL is fine)
What is the gold standard for diagnosing FCP and OCD?
Arthroscopy
Does osteochondrosis occur in young or old dogs?
Young
What are the 2 surgical procedures for biceps tendinopathy? Give a basic description of each.
Tenotomy: cutting tendon (much easier and good results)
Tendoesis: cutting tendon and moving it to another position (better results)
What are the 2 options to keep the leg in extension after reduction of elbow luxation?
Spica splint for stable, closed reduction (q2-3 weeks) - shoulder joint must be immobilized
Flexible ESF for open/unstable reduction (q 3-4weeks)
With a medial traumatic shoulder luxation the distal limb is _____, with a lateral luxation the distal limb is _____. Medial is most common.
Abducted
Adducted
When you manipulate the shoulder, will a dog with infraspinatus contracture be painful?
No
Non-painful, NWB lameness
When infraspinatus contracture occurs, the elbow is ______ and the antebrachium is _______.
Adducted
Abducted
What type of injury does this stance indicate?
Hyperextension injury of the carpus
What can you use to prevent a dog from abduction his shoulder? What more rigid thing do you need to use for severe shoulder instability, post-op?
Hobbles
Velpeau sling (q2-4 weeks, followed by hobbles q3-4mo)
Which of the following are medial and which are lateral on the carpus?
Ulnar carpal bone
Metacarpal bone I
Sesamoid bones
Metacarpal bone V
Short radial collateral ligaments
Short ulnar collateral ligaments
Medial: MC I, Sesamoids, Short radial collateral ligaments
Lateral: MC V, Ulnar carpal bone, Short ulnarcollateral ligaments
Excess of what nutrient can lead to OCD?
Calcium
What would make it impossible to reduce a congenital shoulder luxation?
Glenoid dysplasia
What are the 3 salvage procedures for the elbow?
Canine Unicompartmental Elbow (CUE)
Total Elbow Replacement (TER)
Arthrodesis
