Investigation and management of the mature lame animal - 1 Flashcards
List 4 possible causes of acute lameness in mature animal
sprains
acute cruciate rupture
fractures both pathological and traumatic
cellulitis
List 3 possible causes of chronic lameness
osteoarthritits
humeral intracondylar fissure
nerve root tumour
List 3 possible causes of intermittent lameness
patella luxation
dislocation of the tendon of origin of the long digital extensor
superficial digital flexor instability
List 3 acute on chronic causes of lameness
cruciate rupture
pathological fracture
condylar fracture subsequent to HIF
List 6 things to look for on clinical exam when approaching lame animal
reduced/ increased range of movement
instability to joints
pain on manipulation of joints/ long bones
crepitus on manipulation of joint/ long bones
muscle atrophy
neuro deficits
What should be your top differential for hindlimb lameness
cruciate disease- until proven otherwise
What does the shoulder rely on for stability
soft tissues- muscles, tendons, ligaments
what injuries is the shoulder prone to
prone to sprains, particularly the medial glenohumeral ligament and other soft tissue injuries
Describe how to diagnose shoulder soft tissue conditions
palpation of shoulder
any pain elicited?
biceps tendon test
manipulation under GA
Describe the biceps tendon test
apply pressure to the bicipital groove whilst retracting the shoulder and extending the elbow
- is there pain?
what is indicative of biceps tendon rupture on biceps tendon test
If it is possible to extend the elbow greater on one leg compared to other? This is indicative of either biceps tendon rupture or avulsion (tearing of the tendon from its bony origin)
Describe the imaging techniques you can use to investigate shoulder soft tissue conditions
radiography- mineralisation of the infra and supraspinatus tendons.
ultrasound- good to examine biceps tendon
CT and MRI
arthroscopy- gold standard
Describe infraspinatus contracture
abducts their elbow and are unable to weight bear- not painful
Describe how to treat infraspinatus contracture
Managed by sectioning the tendon close to its insertion on the humerus
The prognosis is good
what dogs are generally affected by infrasponatus contracture
working breeds such as spinger spaniels
Describe the signalment of humeral intracondyalr fissure (HIF)
Spaniels and french bulldogs
young to middle aged
list the clinical signs of HIF
Chronic forelimb lameness (can be acute)
Muscle atrophy and elbow swelling
Pain on manipulation of elbow
Minimal trauma can cause condylar fracture in young animals
Describe conservative management of HIF
rest
NSIADs
but always at risk of a condylar fracture with significant morbidity
Describe surgical management of HIF
Placement of large transcondylar screw - this is prone to significant number of complications
what is the most common carpal injury
hyperextension- The palmar ligaments and palmar cartilage are damaged irrevocably
how are carpal injuries generally treated
pancarpal arthrodesis (all the joints are fused)- as ligaments will never heal
why is a parital arthrodesis rarely used to treat carpal injuries
it results in strain on adjacent joints
Describe incomplete ossification of the radiocarpal bone
boxers and springers
Attempts to heal often fail as this is a similar pathology to HIF
Treat with pancarpal arthrodesis as healing of the bone very unlikely
Describe the signs seen with Stenosing tenosynovitis of the abductor pollicus longus
Chronic lameness seen in large exuberant dogs
Pain on carpal flexion
Soft tissue swelling medial carpus
Boney exostoses seen over the medial aspect of the radius in chronic cases
Describe how to treat Stenosing tenosynovitis of the abductor pollicus longus
steroid injection into tendon sheath
freeing or sectioning the tendon
Describe what is seen with plantar ligament degeneration
proximal intertarsal subluxation with bilateral changes
Degeneration progresses to rupture and plantigrade stance
Describe how to treat plantar ligament degeneration
Treat with laterally applied plate and arthrodesis of the calcaneoquartal joint.
Which dogs generally affected by gastrocnemus tendinopathy
older Labrador retrievers and Dobermanns
what does gastrocnemus tendinopathy cause
hyperflexion of the digits
characteristic clawing of foot due to lengthenin of gastrocneum but not the SDF tendon
Describe how to treat gastrocnemus tendinopathy
resect tendon and place calcaneal tibial screw or transarticular external fixator to support the repair or a pantarsal arthrodesis
When approaching treating open traumatic carpal/ tarsal injuries what should you treat first
soft tissue injury first
A temporary external fixator may help in the initial stabilisation of the joint
Describe gracilis contracture
mature German shepherd dog
characteristic gait
progressive with no effective treatment
Describe the signs seen with Iliopsoas myopathy
progressive hindlimb lameness
pain on extension and rotation of hip
describe how to treat Iliopsoas myopathy
Rest and NSAI
OR
section the muscle at its insertion on the lesser trochanter
what is the best way to diagnose humeral intracondylar fissure
CT scan- can’t always be seen on x-rays
Describe long digital extensor avulsion
joint effusion with a small bone fragment
Treat by reattaching the fragment or tendonesis to the proximal tibia
Describe long digital extensor tendon luxation
associated with TPLO surgery
treat by tendenosis OR securing the ligament to the tendon
Describe avulsion of the gastrocenemius
low grade trauma resulting in lameness and slight plantigrade stance
Treat by reattaching the gastrocnemius by direct suture or screw
Describe superficial flexor luxation
intermittent lameness
swelling over tip of calcaneus
can suture the torn retinaculum or place a screw
