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Ortho > Joint dysplasias > Flashcards

Joint dysplasias Flashcards

1
Q

What are four components of canine elbow dysplasia?

A
  • OCD of the medial side of the humeral condyle
  • Ununited anconeal process
  • medial coronoid process disease
  • Medial compartment disease (ulnar-radius incongruency)
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2
Q

Heritability of elboe dysplasia

A
  • Considered heritable
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3
Q

OFFA

A
  • Organization that certifies dogs’ hips, elbows, etc.
  • Sole purpose is to certify breeding programs
  • Very biased information
  • True incidence may be much higher than what we are led to believe
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4
Q

Pathogenesis of osteochondritis dissecans

A
  • Review Dr. Hines’s notes
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5
Q

What are aspects of elbow osteochondritis dissecans?

A
  • Hypertrophic cartilage (medial side of the humeral condyle on the weight-bearing surface)
  • Chondromalacia
  • Incomplete ossification
  • Weight-bearing forces to cartilage flap formation
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6
Q

Pathogenesis of medial coronoid process

A
  • Incongruous growth where the radius grows slower than the ulna
  • Leads to overloading of the medial side of the coronoid process of the ulna
  • Can overload a small spot, leading to disease
  • Incongruency
  • Conformation
  • Myotendonous interaction (?)
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7
Q

What types of pathology can be seen with medial coronoid process disease?

A
  • Fragmentation
  • Chondromalacia
  • Chondromalacia/osteomalacia
  • Incomplete fissure
  • Concurrent erosions
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8
Q

What is prognosis based on for medial coronoid process disease?

A
  • Erosion based

- If there is a lot of erosion, there’s a poor prognosis for lame free function

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9
Q

Pathogenesis of ununited anconeal process?

A
  • Asychronous growth of the proximal ulna and radius
  • Growth rate of the radius is greater than that of the ulna
  • Shearing forces from the humeral condyle
  • Results in what is similar to a Salter Harris Type I fracture
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10
Q

Who gets ununited anconeal process?

A
  • Only dogs with a separate center of ossification for the anconeal process
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11
Q

Pathogenesis of medial compartment disease

A
  • Incongruency (mild to severe)
  • Overloading of the medial compartment of articular surfaces, resulting in marked cartilage erosions
  • Can be concurrent with medial coronoid process disease
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12
Q

Who gets OCD on the medial side of the humeral condyle?

A
  • Large breeds, especially retrievers, Bernese Mountain dogs, Rottweilers
  • Males > females
  • Same signalment as medial coronoid process disease
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13
Q

What age is usually diagnosed with OCD on the medial side of the humeral condyle?

A
  • Usually not apparent before 5-8 months of age
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14
Q

Clinical signs for OCD of the medial side of the humeral condyle?

A
  • Slight to moderate lameness, stilted gait; worse after exercise, prominent after resting
  • Discomfort on marked flexion/extension
  • “popping” sensation on flexion/extension of the joint to crepitus
  • +/- pain with deep palpation over the medial collateral ligament (with a flexed elbow)
  • Mild joint effusion (feel between lateral epicondyle and humeral condyle
  • Externally rotated paw to unload the medial compartment onto the lateral compartment when standing or sitting
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15
Q

Appearance of OCD on the medial humeral condyle

A
  • Can be unilateral or bilateral
  • Lesion will be on the weight bearing surface (more medial aspect of the medial coronoid process)
  • Might see osteophytes coming off the medial epicondylar ridge
  • Can be osteophytes on the dorsal border of the anconeal process or off the radial head
  • Make sure you know how this differs from medial coronoid process disease
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16
Q

What type of imaging should you do to diagnose OCD of the medial humeral condyle?

A
  • Bilateral elbow radiographs

- Mediolateral view and craniocaudal view

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17
Q

What is typical signalment of coronoid disease?

A
  • 5-8 months of age
  • Can have “jump down syndrome” where there are clinical signs in dogs >1 year of age (3-5 years is typical)
  • Subclinical fissured coronoid that then fragments when jumping down?
  • Large breed dogs (retrievers, Bernese mountain dogs, Rottweilers, Males >females)
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18
Q

Clinical signs of medial coronoid process disease

A
  • Same as medial side of humeral condyle OCD
  • Popping sensation on flexion/extension of the joint to crepitus
  • +/- pain with deep palpation over the medial collateral ligament with a flexed elbow
  • Mild joint effusion
  • Externally rotated paw when standing or sitting
  • Slight to moderate lameness, stilted gait; worse after exercise, prominent after resting
  • Discomfort on marked flexion or extension
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19
Q

Medial coronoid disease radiographic diagnosis

A
  • Bilateral radiographs
  • Similar radiographic lesions, but the kissing lesion on the humeral condyle is unique
  • More on the laterial ridge of the medial condyle
  • Based on exclusion of other elbow dysplasia diseases (OCD, Ununited anconeal process)
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20
Q

If you rule out OCD and ununited anconeal process on radiograph, what’s left for elbow dysplasia disease?

A
  • Medial coronoid process disease
  • Incongruency or medial compartment disease
  • Can differentiate with CT scan
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21
Q

How would you differentiate medial compartment disease from medial coronoid process disease?

A
  • CT
  • Can see a fragmented coronoid (Medial coronoid process disease)
  • If you do an arthrotomy, you can see erosions with medial compartment disease
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22
Q

Who gets ununited anconeal process?

A
  • German shepherds, Basset Hounds, St. Bernard

- Dogs with separate centers of ossification of the anconeal process

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23
Q

When do you see clinical signs of ununited anconeal process?

A
  • Usually not prior to 7-8 months of age

- 5-8 months for coronoid process disease

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24
Q

Clinical signs of ununited anconeal process disease

A
  • Slight to moderate lameness
  • Circumducted forelimb gait (to avoid flexing the elbow)
  • Externally rotated paw when standing or sitting
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25
Q

Diagnosis of ununited anconeal process?

A
  • True crepitus of flexion extension**
  • Huge amounts of joint effusion
  • Externally rotated paw when standing or sitting
  • Bilateral radiographs showing failure of the ossification center to fuse with olecranon (5-5.5 months of age)
  • Mild to moderate osteoarthritis
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26
Q

Which shot is best to see the UAP?

A
  • Flexed lateral
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27
Q

Treatment for medial coronoid process disease?

A
  • Arthroscopy or arthrotomy to remove the osteochondral fragment
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28
Q

Treatment for OCD of the medial humeral condyle

A
  • Arthroscopy/arthrotomy to remove the flap
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29
Q

Treatment for ununited anconeal process

A
  • High osteotomy of the anconeal process (get rid of shear force??)
  • Arthroscopy or arthrotomy to remove the AP if they are very degenerative
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30
Q

Treatment for medial compartment disease

A
  • Arthroscopy for debridement, curettage, and micro-fracture (increase blood flow)
  • Sliding humeral osteotomy (shifts the distal end of the humerus medial to load axis more on the lateral side)
  • Proximal ulnar abduction osteotomy (shifts load bearing from medial to lateral compartment)
  • Canine unilateral elbow (implant on the humeral condyle and trochlear notch of the ulna to give a new surface)
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31
Q

What should be done in addition for all elbow dysplasia cases, surgery or not?

A
  • Multimodal management!!

- Individualized patient method!!

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32
Q

What are some extreme surgical treatments for advanced cases of elbow dysplasia that surgery and multimodal OA doesn’t improve function?

A
  • Elbow replacement surgery
  • Arthrodesis (fusing the joint, but elbow is a high mobility joint)
  • Amputation (won’t work with bilateral disease)
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33
Q

Prognosis for lame-free function of OCD of the medial humeral condyle

A

Good

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34
Q

Prognosis for lame-free function of medial coronoid disease with no or minimal erosions

A
  • Good to very good
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35
Q

Prognosis for lame-free function of medial coronoid disease with marked erosions

A
  • Fair to poor

- May require osteotomy (SHO, PAUL)

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36
Q

Prognosis for lame-free function of Ununited anconeal process with a high ulnar osteotomy

A
  • Very good to excellent
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37
Q

Prognosis for lame-free function of ununited anconeal process where you remove the fragment (vs without erosions or medial coronoid disease and with)

A
  • Without erosions and MCD: Very good

- With erosions and MCD: Guarded

38
Q

Prognosis for lame-free function of medial compartment disease with minimal erosions

A
  • Good
39
Q

Prognosis for lame-free function of medial compartment disease with erosions

A
  • Guarded
40
Q

Prognosis for lame-free function of medial compartment disease with PAUL/SHO

A
  • Good to very good (with the early, short-term results)
41
Q

What is a main point with canine hip dysplasia?

A
  • Common cause of radiographic secondary osteoarthritis in dogs
  • Subclinical disease in the majority of dogs with canine hip dysplasia
42
Q

Signalment for canine hipsyaplasia

A
  • Most commonly reported in large to giant breed dogs
  • Can see in smaller breeds
  • Can also see in Maine Coon cats
43
Q

Bilateral vs unilateral disease for CHD

A
  • Most often bilateral
44
Q

Etiology of canine hip dysplasia

A
  • Multifactorial ultimately
  • Genetic (polygenic, non-Mendelian trait)
  • Nutritional (unrestricted diets and obesity)
  • Other theories aren’t confirmed (Rapid growth rates; collagen disorder, abnormal muscle development with decreased pectineus development leading to decreased abduction of the hip)
45
Q

Pathogenesis of canine hip dysplasia

A
  • Laxity of joint capsule and ligamentum teres

- Lots of force applied to a very narrow point

46
Q

Diagnosis of hip dysplasia

A
  • History
  • Clinical gait examination
  • Complete PE
  • Radiographs
47
Q

History of CHD

A
  • Continuously vs intermittently demonstrating clinical signs
  • Stiff to rise, warms out (stop and sit)
  • Just stops and sits down (doesn’t develop lameness)
  • Uncomfortable at night
48
Q

Clinical gait examination with CHD

A
  • Narrowed pelvic limb stance
  • Gait abnormalities include “pelvic swing” - side opposite of OA
  • “Bunny hop” to avoid extension
49
Q

Complete PE in CHD

A
  • Neurologic examination
  • Stifle exam to rule out OCD, patella luxation, genu valgum
  • Hip palpation and manipulation (extension, flexion; abduction, adduction; internal, external rotation; Ortolani maneuver in young patients**)
50
Q

What view for radiographs of canine hip dysplasia?

A
  • VD
  • Lateromedial views too
  • For clinical evaluation or OFA certification (VD only)
  • Can also do PennHIP
51
Q

PennHIP evaluation

A
  • Extended
  • Compression
  • Distraction view
  • Abduct the limbs together to distract out the hips to see a spacing between the femoral head and acetabulum
  • Anything above 0.3 has a higher statistical probability of developing OA
52
Q

What is the problem with both typical radiographic views and PennHIP?

A
  • Won’t tell you about clinical development or clinical sequelae
53
Q

Non-surgical treatment of canine hip dysplasia

A

*TREAT THE DOG AND NOT THE RADIOGRAPH (Often radiographic findings are incidental)

  • Estimated that 76-86% of immature dogs with severe HD can develop normal range of motion, minimal gait abnormalities after 1 year of age
  • Treatment for immature dogs or adults with debilitating clinical signs with HD is based on relieving patient discomfort) - Multimodal OA treatment first and then possibly surgery
54
Q

First line treatment for CHD

A
  • Trial response to multi-modal osteoarthritis management for 4-6 weeks
  • Weight control, exercise modification, pharmaceuticals/DMOAs
  • Juveniles and adults
  • PHYSICAL REHABILITATION**
  • Poor or worsening response: may pursue surgical options
55
Q

Second line of treatment for CHD

A
  • Surgery
56
Q

Goals of surgery for CHD in immature or mature HD patients

A
  • Discomfort free movement
  • Improve congruency of the articular surfaces of the hip
  • Mimic normal congruency and function of the hip
57
Q

What are determinants of CHD surgery?

A
  • Dog’s life style: house pet vs hunting, herding, field-trial, lure-coursing, etc.
  • Body size
  • Financial cost to the owner
58
Q

Juvenile surgeries for HD

A
  • Triple pelvic osteotomy (ventroversion of the acetabulum by rotating the femoral head ventrally or prematurely closing the physis)
  • Double pelvic osteotomy
  • Pubic symphysiodesis
  • CONTROVERSIAL for a dog that might have evidence of CHD because odds are good that the dog will do just fine
59
Q

Adult surgeries for CHD

A
  • Femoral head and neck ostectomy (excisional hip arthroplasty)
  • Total Hip replacement (more for a working dog)
60
Q

Who can get a femoral head and neck ostectomy, size wise?

A
  • ANY SIZE DOG
61
Q

Will any of the surgical procedures for CHD cure the dog of the disease?

A
  • NO

- All surgical procedures are salvage procedures!

62
Q

Who gets patellar luxation (dogs)?

A
  • Dogs and cats
  • Toy, miniature, large and giant breed dogs
  • Congenital or traumatic (but likely traumatic issue even has an element of congenital issues)
63
Q

What direction is most common for patellar luxation?

A
  • Medial (75-80%)
  • 20-25% are bilaterally affected, medially
  • Even in those that are bilaterally affected, it’s most common to have one be more severely affected
64
Q

Sequela to patellar luxation

A
  • Chondromalacia
  • Osteoarthritis (radiographic); minimal to non-existent in small dogs and cats
  • Lameness (mechanical)
  • Cranial cruciate ligament rupture (in 15-20%)
65
Q

What should you always check for with dogs with luxating patellas?

A
  • Cranial cruciate ligament!
66
Q

Who gets patellar luxation (cats)?

A
  • many breeds
67
Q

What direction are most patellar luxations for cats?

A
  • Medial (85%)
68
Q

How serious are most patellar luxations?

A
  • RARELY clinical
  • Most often incidental
  • Usually congenital
  • 50% bilaterally affected
69
Q

Treatment for most cats with patellar luxation?

A
  • Weight loss!
70
Q

What usually causes medial luxations of the patella?

A
  • Usually congenital (anatomical alignment abnormalities; femur, tibia, quadriceps musculature)
  • Clinical grades: I, II, III, and IV
71
Q

What are the over-arching goals of surgery for medial patellar luxation?

A
  • Realignment, stabilization of the patella in the trochlear groove
72
Q

What grade PL do neonates and older puppies tend to get?

A
  • Grade III and IV

- Can get an “ectopic” patella, which is nowhere where it should be

73
Q

What grade PL do young to mature dogs get?

A
  • Grade II and III

- Often congenital but had a traumatic episode

74
Q

What grade PL do older animals get?

A
  • Grade I to II

- often incidental

75
Q

When can dogs get a subclinical grade I-III?

A
  • Any age
76
Q

Grade I MPL?

A
  • Infrequent luxation (subluxation)
  • Self-reducing
  • Infrequent lameness or absent
77
Q

Grade II MPL?

A
  • Luxation occurs more frequently than I
  • Patella easily reduces with minimal manual manipulation
  • Intermittent lameness
  • Skeletal abnormalities (can be subclinical)
78
Q

Grade III MPL

A
  • Patella is luxated most of the time
  • Manual reduction seldom results in reduction of patella
  • Frequent lameness
  • Advanced musculoskeletal developmental abnormalities (can sometimes be subclinical)
79
Q

Grade IV MPL

A
  • Ectopic patella
  • Severe/persistent lameness
  • Severe musculoskeletal abnormalities
80
Q

Exam findings of patellar luxation

A
  • Intermittent or persistent lameness (“acrobatics”)
  • Non-painful patellar manipulations (usually)
  • +/- Mild crepitus
  • Variable musculoskeletal abnormalities with tibia, femoral condyles, “Patella alta”
81
Q

Is the positive sit test a very reliable finding for patellar luxation?

A
  • Not really
82
Q

What is an occasional finding for severe cases of MPL?

A
  • May walk/run on forelimbs only
83
Q

What are the surgical principles for patellar luxation?

A
  • Realign quadriceps tendon and patella to trochlear groove

- Stabilize the patella to stay reduced in the trochlear groove during stifle movement

84
Q

What are three surgical procedures that may be used to stabilize a luxating patella

A
  • Imbrication of the joint
  • “Deepen” the trochlear groove
  • Tibial tubercle transposition
85
Q

Imbrication

A
  • Of joint capsule and periarticular tissues (retinacular imbrication) to tighten the joint and keep the patella in position
86
Q

“Deepen” the trochlear groove

A
  • Trochlear chondroplasty
  • Excisional trochleoplasty (sulcoplasty)
  • Wedge recession trochleoplasty
  • Block recession trochleoplasty
87
Q

Tibial tubercle transposition

A
  • Osteotomy and transposition
88
Q

Complications of patellar luxation stabilization

A
  • Recurrent luxations (50%)
  • Infection (rare)
  • Osteoarthritis (minimal with small dogs and cats)
  • Cranial cruciate ligament rupture (?)
89
Q

Prognosis for lame-free function of patellar luxation post surgery?

A
  • Grade I-III: Good to very good

- Grade IV: Variable (dependent on skeletal deformation

90
Q

What can make a recurrent luxation more likely with patellar luxation stabilization?

A
  • Grade IV

- More challenging in larger breeds than small breeds

Ortho (10 decks)

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