Joint conditions Flashcards
Is osteoarthritis an example of inflammatory or non-inflammatory arthritis? Is primary or secondary Osteoarthritis more common in dogs?
Non Inflammatory.
Secondary OSA is most common in dogs- also referred to as DJD- degenerative joint disease
Is septic arthritis an example of inflammatory or non-inflammatory arthritis? How do you treat it?
Inflammatory.
Treat by arthrotomy and joint lavage
What is the single most important element in the prevention or management of Osteoarthritis?
Weight management
NSAIDs are commonly used to treat Osteoarthritis. How do NSAIDs work?
Reduce pro-inflammatory mediators by inhibiting cyclooxygenase. (COX-2 is what you want to selectively inhibit). All NSAIDS have GI, renal and hepatic side effects and all are potentially toxic. Cats metabolize NSAIDS by glucuronidation, so NSAIDs are normally not indicated for cats.
What is the MOA of Omega-3 Fatty Acids for joint health?
Omega-3s compete with aracadonic acid as a substrate for COX-> produce less pro-inflammatory mediators. May decrease need for NSAIDs.
Osteochondrosis is a defect in _______ ossification.
What is the pathophysiology?
Osteochondrosis is a defect in endochondral ossification.
Path: Disruptions in anastamosis of vessels between the epiphyseal cartilage and bone create cartilage necrosis. This necrotic cartilage blocks the ossification wave, ad the necrotic cartilage cannot ossify.
Failure to ossify-> thickened cartilage.
Thickened cartilage acts as a stress riser-> fractures in cartilage.
T/F: For Osteochondritis Dessicans to manifest as a disease, you must have a combination of heritable and environmental factors.
True. Genetics, nutrition and trauma will influence OCD. Male dogs and large breed are predisposed. Do not breed dogs that exhibit disease.
If it is a developmental orthopedic disease it probably exhibits three characteristics. Describe them.
- Is heritable
- Is bilateral
- Has a biphasic age distribution
Can you diagnose biceps tendinopathy on radiograph?
Not really… maybe can see signs if you are experienced, but MRI and Arthroscopy is more diagnostic
In respect to shoulder instability in dogs, is medial or lateral instability more common?
Medial.
T/F: For shoulder instability, most cases will respond well to cage rest and NSAIDs.
FALSE. Cage rest and NSAIDs will often not improve the condition much.
How do you diagnose an abnormal abduction angle in a dog with medial shoulder instability?
Compare abduction angle to that of the contralateral limb. Abnormal is ~50 degrees
For shoulder instability, if you do not opt for surgery, what would the therapy include?
Velpeau sling followed by hobbles. LONG RECOVERY, 4-6 months.
T/F: Infraspinatus Contracture is a condition that can be diagnosed from “across the room.”
True. It is characterized by a specific posture of the forelimb. It is a non-painful, non-weightbearing lameness in which the elbow is adducted (drawn into the body) and the antebrachium is abducted (the forelimb is helf out away from the body)
What condition exhibits a “toed-out” posture?
Medial compartment dz/ elbow dysplasia
When I say UAP, you think ________.
Short Ulna!!!! Think U for Ulna.
When you hear FCP, you think ________.
Short Radius!!!
T/F: FCP is easily identified on radiographs?
False. Very difficult to id on rads bc the coronoid process is overlapped on every view you could take.
Gold standard for diagnosing is arthroscopy.
A bacterial arthritis as a result of surgery is an example or an inflammatory or non-inflammatory arthritis?
Inflammatory.
T/F: OCD and FCP are treated by arthroscopy surgery to remove fragments in the joint.
True. arthroscopy is the gold standard for visualizing the fractures and treating OCD and FCP. 90% of cases of FCP have concurrent OCD.
T/F: A medial meniscal release does not increase the risk of arthritis developing in a joint.
False. It does indeed increase the risk of arthritis developing.
T/F: Omega- 3 fatty acids act by increasing the amount of cartilage in a joint.
False! Omega 3s just act by converting cyclooxygenase
A dog has a patella that luxates occasionally on extension but reduces spontaneously when the joint is put through a full range of motion. What class of luxation?
Class 2
_______ measures the amount of pressure exhibits on the tibia during weight bearing and during the tibial compression test.
Cranial Tibial Thrust measures the amount of pressure exhibits on the tibia during weight bearing and during the tibial compression test.
In a joint with osteoarthritis, the joint space will:
a) increase
b) decrease
c) either increase or decrease
with osteoarthritis, the joint space can either increase or decrease….. why? No idea.
T/F: Early intervention with elbow dysplasia (UAP, FCP, OCD) reduces the likelihood of DJD.
False. Early intervention is best for correcting the dysplasia, and lifelong medical management should be expected. Early correction, however, doesn’t lower the patients chance of developing DJD later in life
T/F: For elbow dysplasia, arthroscopy is better than arthrotomy.
True. Arthroscopy is the gold standard treatment of choice for elbow dysplasia (OCD/ FCP)
T/F: Medial and lateral humeral condyles are expected to fuse by the age of 20 weeks.
False! Should be fused by 12 weeks.
A 4 month old brittany spaniel puppy comes into the clinic with a mild limp and on radiographs you see that the medial and lateral humeral condyles are not fused. What condition does this dog have?
Incomplete ossification of humeral condyles
T/F: With IOHC, diagnosis can be made with radiographs and it is important to assess contralateral limb.
True. Craniocaudal view on rads will show a fissure btw the lateral and medial condyles of the humerus and 90% of cases are bilateral… so you absolutely need to asses the other limb.
A case of IOHC without a fracture can be repaired using what device?
Lag screw
90% of traumatic elbow luxations are (medial/lateral) and are caused by avulsion/ rupture of ___________.
90% of traumatic elbow luxations are LATERAL and are caused by avulsion/ rupture of COLLATERAL LIGAMENTS. Soooo.. with dogs, the LATERAL COLLATERAL LIGAMENT is normally avulsed.
The _________ Test assesses the collateral ligaments for elbow luxations.
Campbell’s Test
T/F: Both the medial and the lateral collateral ligaments are normally avulsed in traumatic elbow luxations in cats. And cats normally require open reduction to correct.
True!
Postop care for correction of avulsed collateral ligaments causing traumatic elbow luxations require the leg held in (extension/ flexion) with (hobbles/ velpeau/ spica splint). or ESF.
Postop care for correction of traumatic elbow luxations require the leg held in EXTENSION with a SPICA SPLINT or ESF
Valgus stress moves the distal limb (medially or laterally)?
vaLgus moves the limb Laterally
You are testing the tarsus for collateral ligament injury. You apply valgus stress and the distal limb moves farther than normal, the (medial/ lateral) collateral ligament has been ruptured?
Medial!
What breed of dog can inherit propensity to develop a chronic and progressive tarsal hyperextension condition?
Shelties and collies
You have a patient with a hyperextension injury of the carpus. After your exam, you conclude that the antibrachiocarpal joint is healthy. How do you treat this injury? What if the antibrachiocarpal joint is not healthy?
Surgery- a partial carpal arthrodesis using a T plate or pins.
If the antibrachiocarpal joint is not healthy-> pancarpal arthrodesis
T/F: In puppies with Carpal Laxity Syndrome, the condition will spontaneously resolve within 1-4 weeks.
True!!
An 8 year old MN labrador comes into the clinic because the owners think something is wrong with the way he is walking. He presents with a “bunny hopping” gait and when he sits, he sits “to the side.” The owners also comment that he has some exercise intolerance. During the PE, there will be pain on extension of the hip joint, but no joint laxity is felt upon palpation. What condition does this dog likely have?
Bilateral Hindlimb lameness- Hip Dysplasia
Can also see a hip sway and a posture with most of the weight shifted forward.
What is Coxa Valga?
A adaptive response to stress over time- the angle of the femoral head to the diaphysis will get larger over time with hip dysplasia.
How old do dogs need to be before they can be OFA certified? PennHip?
OFA- 24 months
Pennhip- 16 weels
What score in PennHip is considered ideal?
DI
The result of JPS on a puppy with hip dysplasia is that the acetabulum will face farther (down/ up)?
The acetabulum will face more downward after JPS
What are the requirements for a dog with hip dysplasia to be considered for a TPO procedure?
- no evidence of DJD
- age 6-8 months
- clinical signs of hip dysplasia
- positive ortolani test
- low angle of reduction <30 degrees
For a dog that has severe laxity in hip dysplasia, what procedure should you use?
a) TPO
b) JPS
c) THR
d) FHO
e) capsulorraphy
d) toggle pins
Not TPO or JPS, bc they are only for moderate hip laxity.
Salvage procedures like THR or FHO is best for severe laxity.
Coxofemoral luxations are the most common joint for luxations. When a patient comes in to your clinic with a luxated hip, what is the first thing you do?
Take Radiographs to rule out other fractures before attempting reduction. Open reduction has more longer term success than closed reduction.
(Craniodorsal/ Caudoventral) hip luxations are the most common (90% of cases).
Craniodorsal- the gluteal muscles pull the femoral head up/ dorsally.
In a meniscal release, the (cranial/ caudal) pole of the (medial/ lateral) meniscus is cut.
The caudal pole of the medial meniscus is cut.
Peroneal nerve entrapment is a possible complication in __________ surgery to repair meniscal tears
Lateral Suture
_________ is a surgery on the knee that alters the angle btw weightbearing and tibial plateau to eliminate the shear strain. This eliminates _______ but doesn’t eliminate _______.
Tibial Osteotomy eliminates the tibial thrust, but doesn’t eliminate cranial drawer.
_______ surgery involves making a radial cut in the tibia and moving the proximal fragment so that instead of the weightbearing forces being parallel to the tibial axis, they become perpendicular.
TPLO
T/F: TPLO and TTA have a more rapid return of function of the stifle compared to lateral suture or tightrope procedures.
True.
T/F: Lateral Suture tends to work better in small dogs/ cats than it does in larger patients.
True
Patellar luxations are the most common congenital deformity seen in dogs, and especially common in small breed dogs. 98% of patellar luxations are (medial/ lateral) luxations?
98% of patellar luxations are MEDIAL Luxations. Lateral luxations are seen more often in large breed dogs.
T/F: The prognosis for a grade IV patellar luxation is guarded to poor regardless of treatment.
True. Recurrence and complications make this a very difficult condition to improve
