Joint disease Flashcards
Two categories of joint disease
Mechanical
Affecting articular cartilage
Mechanical category of joint disease
Hip dysplasia
Elbow dysplasia
Patellar luxation
Cranial cruciate ligament rupture
joint disease Affecting articular cartilage
Osteochondritis dissecans (OCD)
Degenerative joint disease (DJD)
AKA Osteoarthritis
Hip dysplasia is
Congenital malformation of hip (coxofemoral) joint
Large dog disease
Stress on the joints
Wear and tear→ osteoarthritis
Lack of stability → mobility issues, pain, lame
Subluxation to luxation
All of the above present as LAME and PAIN
hip dysplasia in young vs old animals
Young dogs
- More severe
- Pain, luxation
Old dogs
- Less severe
- Pain due to arthritis
Cause of hip dysplasia
Polygenic inherited condition
Environmental risk factors
Too rapid weight gain during growth
High BCS
Prior injury
OCD
Medical management to minimize onset of DJD
Controlled low-impact exercise
Weight control
Joint supplements
Pain management for hip dysplasia
Rest
NSAIDs
Joint supplements and therapeutic diets
Physical therapy
Low impact exercises
Weight control
Surgery
Surgical options for juvenile patients with hip dysplasia
Triple pelvic ostomy
Juvenile pubic symphysiodesis (JPS)
Surgical treatment for mature patients with hip dysplasia
Total hip replacement
Femoral head ostectomy (FHO)
prevention of hip dysplasia
Prevent occurrence
SELECTIVE BREEDING!!!
Appropriate diet selection
Avoid severe, intensive exercise, especially in large breed puppies
Prevent clinical onset
Weight control
Elbow dysplasia is caused by what joint abnormalities
Congenital- inherited condition
Caused by up to 3 different joint abnormalities
Fragmented medial coronoid process
Ununited anconeal process
Osteochondritis dissecans
Distal aspect of the humerus
Usually the medial condyle
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Clinical onset and presentation of elbow dysplasia
Age of onset of c/s depends on severity
Mild changes usually present in older animals
Arthritis
Treatment and prevention as per arthritis
Severe changes present in young animals
Mechanical issues cause pain and lameness
Surgery is an option
Causes of elbow dysplasia
Genetics
Environmental factors
Growing too fast during development
Obesity
Prior injury
The presence of osteochondritis dissecans (OCD)
Treatment of elbow dysplasia
Surgical treatment
Repair abnormal anatomy
Clean up joint, remove cartilage fragments if OCD
Medical management
Rest
NSAIDs
Joint supplements
Physical therapy
Controlled low impact exercise
Weight control
Prevention of elbow dysplasia
Selective breeding
Elbow certification of breeding animals through the OFA
Nutritionally balanced diet during growth
Prevent traumatic injury to joints
Weight control ← changes clinical presentation
Patella luxation is and common in
Slipping kneecaps
Toy, miniature and small breeds
Occasionally seen in cats as well
Patella luxation Disease progression and complications
Congenital
Chronic
Progressive
Starts with slipping patella
May alter movements (i.e. skipping)
Will eventually lead to arthritis
Increased risk of cruciate ligament rupture
Cranial cruciate ligament injury is
(very common, very important)
Cannot seen in radiographs so must diagnose through physical touch
Do a cranial drawer sign and tibial thrust
Should be no wiggling
Causes of cranial cruciate ligament injury
Usually a combination of
Degenerative disease and/or
Trauma
Can be made worse with a heavy BCS
Presentation of CCL injury
Waxing and waning lameness to non-weight bearing
Not an emergency; BUT….
Diagnostics for CCL
Exam with or without sedation
Radiographs
Treatment of CCL
Medical management
Small dogs
Rest + NSAIDs+ PT/rehab
Longer recovery
Risk rupture other limb
Will develop arthritis
Surgery
Small and large dogs
Faster recovery (may decrease the risk of rupturing the other CCL)
Can get a brace
Goal is to decrease inflammation and get them back to using the leg
Surgical repair options for CCL
Lateral suture
TightRope@ procedure
Tibial Plateau levelling osteotomy
Tibial Tuberosity Advancement
Why is post op care important for CCL injury
Post operative care is ESSENTIAL!!
Still requires physical therapy
Healing time is 10-12 weeks
Complications for CCL tears
Rupture of the other ligament
Usually within 1-2 years
Arthritis will occur with or without surgical repair
Osteochondritis dissecans (OCD) is common in
Developmental disease
Young /growing animals
Big dogs
Developmental defect in cartilage and/or endochondral bone
Osteochondritis dissecans (OCD) is caused by
Developmental defect in cartilage and/or endochondral bone
Cartilage is weak, abnormal
Interferes with articulation of joint
Cracks in cartilage
Small pieces in cartilage +/- bone break off
Less able to withstand normal forces
Osteochondritis dissecans (OCD) can predispose to
Can interfere with movement
Painful
Predispose to elbow dysplasia, hip dysplasia
Predisposed to arthritis
Shoulder
Osteochondritis dissecans (OCD) treatment/prevention
May require surgical removal of the fragments
Avoid risk factors
Careful diet selection
Controlled calorie and protein levels
Controlled exercise to prevent injury during growth
Degenerative joint disease (DJD)/ osteoarthritis (OA)/ aka arthritis is
DJD is one of the most commonly diagnosed disease in SA med
Arthritis = inflammation of the joint; may or may not include the synovium (synovitis)
Degenerative
Slow
Progressive
Any articular joint
Signalment for those with DJD/arthritis
Any animal
Older
Larder breeds
CATS
Obesity
Animals with history of prior injury or preexisting joint disease
Pathology of an inflamed joint
Damages cartilage releases pro-inflammatory molecules
Inflammation of the synovium causes more joint fluid; less viscous
Less cushioning so more damage
Stretching joint capsule triggers osteophyte formation
Thickened joint capsule restricts motion
Predisposing factors for DJD/arthritis
Normal wear and tear
Obesity
Intense exercise
Poor cartilage formation (e.g., OCD)
Joint dysplasia
Hips, elbows, platellas, chondrodysplasia
Prior trauma
DJD/arthritis present as
Painful
Lame
Stiff
Sore
Slow
Reduced jumping
Not wanting to use the stairs
DJD/arthritis commonly affect what joints
Dog
- Hips
- Stifle
- Elbows
- Carpi
Cat
- Thoraco-lumbar spine
- Elbows
- Hips
Arthritis of the intervertebral joint spaces is common in what animals
Cats
German shepherds
Animals with prior back injury
Cats usually have significant radiographic changes before diagnosed
Treatment of arthritis
Ongoing treatment
Controlled activity
Rest
Weight control
Prescription medications
NSAIDs
Librela and solensia
Joint supplements (ex., glucosamine)
NSAIDS are prescription medications
Solensia is good for
Arthritis
Feline specific monoclonal antibody
Binds to feline nerve growth factor
SQ injection -monthly
Has been tested in cats with IRIS stage 1 and 2 CRF
>7 months of age and >2.5kg
77% of owners reported an improvement on OA pain
Librela is good for
Canine specific monoclonal antibody
Binds to canine nerve growth factor
SQ injection- monthly
Licensed for use in animals >12 months of age
Prevention of arthritis
Selective breeding
Orthopaedic foundation for animals (OFA) certification for hips, and elbows for breeding animals
Weight control throughout life
Low impact regular exercise
Correct exiting joint issues
Avoid high nutrition diets that may lead to OCD
Joint supplements
Nutraceuticals
Make sure that they are pharmaceutical grade
Dose based on weight
