Juvenile Lameness

Question 1

Is specific juvenile disease in the cat common or rare?

Answer 1

Rare

Question 2

Juvenile disease associated with shifting lameness

Answer 2

Panosteitis

Question 3

What condition is ‘Perthe’s disease’ referring to?

Answer 3

Avascular necrosis of the femoral head

Question 4

Signalment and history in Perthe’s disease

Answer 4

Toy/small dog
<6 months old
Inherited in Manchester terrier
Lameness and muscle atrophy
Reluctant to jump/use stairs
Can be bilateral

Question 5

Clinical signs in Perthe’s disease

Answer 5

Muscle atrophy (gluteals)
Pain and crepitus on extension of hips

Question 6

Treatment for Perthe’s disease and associated prognosis

Answer 6

Femoral head and neck excision (loss of limb length, tilt pelvis to compensate, poor prognosis in large dogs) or total hip replacement (better prognosis)

Question 7

Metaphyseal osteopathy signalment

Answer 7

Dogs only
<6 months

Question 8

Metaphyseal osteopathy clinical signs

Answer 8

Severely painful swelling to metaphyseal region of limbs
Pyrexic/systemically unwell
Inappetent
Often unable to walk
Pitting oedema over metaphyseal region

Question 9

Radiographic appearance of metaphyseal osteopathy

Answer 9

‘Extra growth plate’ (ill-defined lucency to physis)
Perioesteal lifting with mineralisation

Question 10

How can metaphyseal osteopathy cause angular limb deformities?

Answer 10

Stops growth on one side of the growth plate

Question 11

Treatment for metaphyseal oesteopathy

Answer 11

Hospitalisation with multi-modal anaesthesia (opiates and CRIs)
NSAIDs initially, steroids if inflammation doesn’t reduce
IV fluids
Tube feeding if inappetent for 3+ days

Question 12

Prognosis for metaphyseal osteopathy

Answer 12

Guarded
Increased incidence of other autoimmune conditions when older

Question 13

Signalment for early cruciate disease

Answer 13

Large breeds (Mastiffs and Rottweilers)

Question 14

Are small or large breed dogs prone to juvenile patella subluxations?

Answer 14

Both

Question 15

Does septic arthritis affect single or multiple joints in the young animal?

Answer 15

Multiple

Question 16

What can cause polyarthritis, particularly in young animals?

Answer 16

Vaccination in dogs and cats
Calici virus in cats

Question 17

Which breed commonly suffers from humeral intracondylar fissure?

Answer 17

Spaniels

Question 18

Clinical sign of sesamoid disease

Answer 18

Pin point pain over flexor sesamoids in young dog

Question 19

Craniomandibular osteopathy signalment

Answer 19

Small terriers (West Highland and Cairn)
Has been reported in older dogs (Dobermann), occasionally causing lameness

Question 20

Craniomandibular osteopathy clinical signs

Answer 20

Soft tissue swelling and oedema to jaw and long bones
Systemically unwell and pyrexic
Chronic: progressively difficult to open mouth

Question 21

What disease is colloquially referred to as Lion Jaw?

Answer 21

Craniomandibular osteopathy

Question 22

Radiographic features of craniomandibular osteopathy

Answer 22

Palisading new bone to mandible/occipital crest/tympanic bullae (‘battlement like’)
Similar changes in long bones
Associated soft tissue swelling
Temporomandibular joint may be involved

Question 23

Treatment for craniomandibular osteopathy

Answer 23

Analgesia
Corticosteroids
Fluids/enteral support

Question 24

Prognosis for craniomandibular osteopathy

Answer 24

Guarded (difficult to manage, distressing for dog and owner)
Long term sequalae include reduced opening of mouth (difficulty eating/intubating)

Question 25

Signalment in panosteitis

Answer 25

<1 year GSD Male

Question 26

Panosteitis clinical signs

Answer 26

Depressed Pyrexic Pain on palpation of diaphysis Shifting lameness (previous episode in another limb)

Question 27

Radiographic signs in panosteitis

Answer 27

Loss of trabecula pattern Endosteal and periosteal new bone May be none

Question 28

Treatment for panosteitis

Answer 28

Rest NSAIDs

Question 29

Prognosis for panosteitis

Answer 29

Excellent Usually lasts a week and is self limiting Reassure owner

Question 30

What disease is shown in this radiograph?

Answer 30

Panosteitis

Question 31

Clinical presentation of rickets

Answer 31

Pain and swelling around physeal regions of long bones Reluctance to move

Question 32

Cause of rickets in the growing animal

Answer 32

Absolute lack of vitamin D (reduced exposure to sunlight or calcium/phosphorous imbalance)

Question 33

Treatment for rickets

Answer 33

Balanced diet (Vitamin D) Exposure to sunlight

Question 34

Differential for rickets

Answer 34

Nutritional secondary hyperparathyroidism (thin poorly mineralised cortices and folding fractures)

Question 35

Clinical presentation of pituitary dwarfism

Answer 35

German shepherd, Spitz, Manchester terrier Proportionate dwarfism Alopecia/hyperpigmentation Open physis No guard cells in coat Small testes/absent oestrus cycle

Question 36

Pituitary dwarfism affects the pars distalis, which hormone deficiencies occur?

Answer 36

Somatotropic, adenotrophic and thyroid stimulating hormone deficiencies

Question 37

Treatment of pituitary dwarfism

Answer 37

Cortisol, thyroxine and progestogens

Question 38

What is a valgus angular limb deformity?

Answer 38

Lateral deviation of the distal limb

Question 39

What is a varus angular limb deformity?

Answer 39

Medial deviation of the distal limb

Question 40

What causes an angular limb deformity?

Answer 40

Part of the growth plate closes prematurely

Question 41

Elbow osteochondrosis prognosis

Answer 41

Guarded

Question 42

Shoulder osteochondrosis prognosis

Answer 42

Good

Question 43

Stifle osteochondrosis prognosis

Answer 43

Poor

Question 44

Hock osteochondrosis prognosis

Answer 44

Poor

Question 45

Sites of osteochondrosis from common to rare

Answer 45

Elbow (very common) Hock (uncommon) Shoulder (rare) Stifle (rare) Lumbosacral (occasional)

Question 46

Underlying pathology of ostechondrosis

Answer 46

Failure of ossification of the articular cartilage

Question 47

Complication of ostechondrosis

Answer 47

Cartilage forms flap (osteochondrosis dissecans) Subchondral bone can fracture

Question 48

Elbow dysplasia

Answer 48

Broad term encompassing all manifestations of osteochondrosis seen in elbow Very common Manifestations: fragmented medial coronoid, osteochondrosis dissecans (lesion of medial humeral condyle), ununited anconeal process, incomplete ossification of medial humeral epicondyle

Question 49

Clinical signs of elbow osteochondrosis

Answer 49

Chronic lameness, worse on rising Pain on manipulation of joint particularly internal rotation (loads medial compartment) Pain on flexion with ununited anconeal process Joint effusion Muscle atrophy

Question 50

Elbow dysplasia radiography positions

Answer 50

Flexed mediolateral and craniocaudal (Extended mediolateral and craniocaudal view can also be helpful) Highlight caudal aspect on anconeal process which is first place changes will be seen

Question 51

Changes on elbow radiography in elbow dysplasia

Answer 51

Osteochondrosis of medial humeral condyle Fragmented medial coronoid Ununited anconeal process Ununited medial epicondyle (rare manifestation)

Question 52

Clinical signs of shoulder osteochondrosis

Answer 52

Lame on rising Worse after exercise Pain on shoulder extension Scapular muscle atrophy

Question 53

Radiographs for shoulder osteochondrosis

Answer 53

Heavy sedation/GA Mediolateral Craniocaudal (trough with body slightly rotated away from plate)

Question 54

Classic radiographic finding in shoulder osteochondrosis

Answer 54

Flattening of caudal third of glenoid

Question 55

Treatment of shoulder oteochondrosis

Answer 55

Surgical management (remove fragment and debride deficit edges, forage bone bed to encourage healing with fibrocartilage)

Question 56

Stifle osteochondrosis clinical signs

Answer 56

Chronic lameness, especially on rising Joint pain Joint effusion (Differential: early cruciate disease)

Question 57

Radiographs for stifle osteochondrosis

Answer 57

Mediolateral Caudocranial/craniocaudal (Superimpose femoral condyles)

Question 58

What is shown in this radiograph?

Answer 58

Stifle osteochondrosis (deficit to medial/lateral femorocondyle on caudolateral view, joint mouse in caudal joint pouch on mediolateral view, loss of subpatellar fat pad)

Question 59

How can the deficit be replaced in stifle osteochondrosis surgery after curetting deficit?

Answer 59

OAT (osteochondral autograft transfer) or SOR (synthetic osteochondral resurfacing)

Question 60

Diagnosis

Answer 60

OCD of medial trochlea of the talus (widened joint space, flattened aspect of caudal trochlea, sclerosis of subchondral bone, secondary arthritic changes)

Question 61

Surgical management of hock osteochondrosis

Answer 61

Removal of osteochondral fragment arthroscopically or with open arthrotomy Salvage procedure: pantarsal arthrodesis

Question 62

Medical management of osteochondrosis

Answer 62

Weight control NSAIDs

Question 63

Clinical signs of lumbosacral osteochondrosis

Answer 63

Usually no clinical signs Instability, disc extrusion/protrusion and back pain

Question 64

Young dog hip evaluation

Answer 64

PennHip