Lecture 15: Sx of the Elbow I (Exam 3)

Question 1

Define arthrosis

Answer 1

Denotes a joint but has also been defined as a degenerative dx of a joint

Question 2

Define polyarthritis

Answer 2

Inflammation affecting several joints

Question 3

Define osteoarthritis or osteoarthrosis

Answer 3

Non inflammatory DJD characterized by articular cartilage degeneration, marginal bone hypertrophy, & synovial membrance changes

Question 4

Define ankylosis

Answer 4

Result of DJD or inflammatory dx

Question 5

What is the leading cause of forelimb lameness in dogs

Answer 5

Canine elbow dysplasia

Question 6

Describe canine elbow dysplasia

Answer 6

A polygenic trait w/ both hereditary & envi influences

Question 7

What causes elbow dysplasia

Answer 7

• OCD
• Fragmented coronoid process
• Medial compartment disease
• Ununited anconeal process
• Incomplete ossification of humeral condyle

Question 8

What is commonly seen in immature large dogs

Answer 8

• Loss of elbow ROM (evidence of DJD)
• Presence of elbow dysplasia

Question 9

What is fragmented coronoid process

Answer 9

• Separation of a small portion of the medial coronoid process of the ulna
• Can be osteonecrosis of the coronoid or fissures w/in the medial coronoid

Question 10

What is the common signalment of FCP px

Answer 10

• Large dogs
• Dx starts when immature (noticeable around 5 to 7 M)

Question 11

What is found during PE of a px w/ FCP

Answer 11

• May walk w/ shortened steps
• May have symmetrical or asymmetrical muscle atrophy
• Joint effusion & periarticular soft tissue
• Can have decreased ROM
• Pain on hyperextension
• Crepitation
• Manipulation of joint is painful
• Shoulder not flexed & extended during elbow manipulation

Question 12

What radiographic views should be done for FCP

Answer 12

• Craniocaudal
• Lateral
• Flexed lateral
• Oblique craniocaudal to eval the lateral profile of the medial coronoid process

Question 13

What is this showing

Answer 13

Question 14

What will be seen on diagnostic imaging of FCP

Answer 14

• Earliest xray sign: sclerosis of distal aspect of trochlear notch
• Blunting of the medial coronoid process
• Rarely see visible fragments
• Osteophytes w/ coronoid & anconeal processes

Question 15

How is FCP diagnosed

Answer 15

Presence of osteoarthritis

Question 16

T/F: Joint incongruence has a high rate of + & - if < 3 mm

Answer 16

True

Question 17

Describe the use of compute tomography for FCP

Answer 17

• More accurate than radiographs
• Can dx incomplete fragmentation of the medial coronoid (doesn’t reach cartilage surface)

Question 18

What is this showing

Answer 18

Question 19

What is this showing

Answer 19

Question 20

What is the most valuable tool for dxing FCP

Answer 20

Arthroscopy

Question 21

What is important info for clients w/ dogs that have elbow dysplasia

Answer 21

• Strong evidence for hereditary component
• Always radiograph both elbows
• Surgical removal of bone & cartilage pieces may improve function of limb
• Surgical tx doesn’t alter progression of DJD
• May not be working or competitive sporting dogs

Question 22

Who is candidates for FCP surgery

Answer 22

Young dogs

Question 23

Describe arthroscopic treatment of FCP

Answer 23

• Superior visualization & magnification of the joint
• Less invasive
• Lower postop morbidity
• Provides greater opportunity for topical tx of osteoarthritic lesions

Question 24

What is done if there are fragments in a FCP

Answer 24

Subtotal coronoidectomy (+ fragment removal)

Question 25

What are two other ways to tx FCP

Answer 25

• Release of biceps insertion on the ulna
• Release of ulnar insertion of the biceps brachii may decrease transarticular forces

Question 26

What is this showing

Answer 26

Question 27

Describe open sx for FCP

Answer 27

• Tenotomy of the pronator teres m & incising medial collateral lig
• Muscle splitting tech to preserve supporting tendons & ligs (limits exposure)
• Osteotomy of the medial epicondyle for best exposure

Question 28

What is this showing

Answer 28

Question 29

What is this showing

Answer 29

Question 30

Describe Radial ulnar incongruence

Answer 30

• Elevation of coronoid above level of the radial head
• Suggested cause of fragmentation of MCP & medial compartment dx
• Asynch growth btw/ radius & ulna causes increased forces across the medial compartment which leads to bone fragmentation & cartilage damage

Question 31

What is a common signalment of dogs w/ radial ulnar incongruence

Answer 31

Same as FCP

Question 32

What is found during PE w/ px that have RUI

Answer 32

• May walk w/ shortened steps
• Symmetrical or asymmetrical muscle atrophy
• Joint effusion & periarticular soft tissue swelling
• Pain on hyper extension
• Crepitation (If advanced OA present)
• Manipulation of joint is painful
• Shoulder is not flexed & extended during elbow manipulation

Question 33

What will be seen in diagnostic imaging of px w/ RUI

Answer 33

• Plain film radiograph or CT
• Incongruence > 4 mm
• MCP will appear proximal to the radial head

Question 34

What has more accuracy in eval incongruence of RUI

Answer 34

CT

Question 35

What is the surgical tx of RUI

Answer 35

Restore norm congruence btw/ the proximal articular surfaces of the radius & ulna (shortening ulna or lengthening the radius)

Question 36

Stopped @ slide 47