Lecture 6: Elbow Dysplasia

Question 1

T/F

Elbow dysplasia s the most common cause of K9 forelimb lameness affecting 1 in 15 dogs at tertiary referral

Answer 1

TRUE.

Question 2

What is the normal elbow anatomy of a dog?

Answer 2

three bone system, semi-independent movement of each bone

Question 3

T/F

The 3 bone system does not allow as much pronation/supination as would a a pure hinge joint

Answer 3

FALSE

it allows for more of those things

Question 4

T/F

The anatomy is complex, unforgiving, and allows for individual movement of each of the three bones resulting in a lot of issues

Answer 4

FALSE

anatomy is complex, unforgiving, all 3 must move together in flexion, extension, pronation, supination

Question 5

What is a fragmented medial coronoid process?

Answer 5

thought to be caused by excess force placed on the coronoid, secondary to unequal weight distribution between radius and ulna

Question 6

How common is a fragmented medial coronoid process?

When do the signs appear?

Answer 6

Thought to be most common/clinically significant component of ED

Appear 4-7 months, typically bilateral

Question 7

What is an ununited anconeal process?

Answer 7

when radius is linger than the ulna, humeral condyle forced into the anconeal process

Question 8

What breed has a predisposition for having a ununited anconeal process?

Answer 8

Most common in german shepards and basset hounds, not seen in small breeds.

Question 9

T/F

Ununited anconeal process is uncommon in small breeds because it is only a site of secondary ossification in large breeds

Answer 9

TRUE

Question 10

Osteochondritis/osteochondrosis dissecans

Answer 10

If you dont know this one just leave scrub

Question 11

What dictates normal growth of bones?

Answer 11

Hueter-Volkman law; compression forces inhibit growth and tensile forces stimulate it

Question 12

Joint incongruence is caused by:

Answer 12

radio/ulnar incongruence-> UAP

semilunar incongruence- mismatch of humoral condyle and ulna

Question 13

How do you diagnose ED vie PE findings?

Answer 13

effusion, pain on palpation, loss of ROM, standing/walking/running lameness, thickened joint capsule

often stand holding limb up

Question 14

What images do you look for radiographically for ED?

Answer 14

mediolateral,

hyper-flexed mediolateral,

15 degree supinated mediolateral,

true lateral of the coronoid process,

cranial cauadal

Question 15

T/F

Rads are the most important tool in diagnosing a fractured coronoid process resulting in ED

Answer 15

FALSE

They are not that helpful at all

Question 16

T/F

Congruence is difficult to measure unless very significant differences present

Answer 16

True

Question 17

Corroborative evidence of incongruence is:

Answer 17

osteophytes present on the dorsal aspect of anconeal process, medial compartment, and sclerosis of sub coronoid region and ulnar semilunar notch

Question 18

What is trochlear notch sclerosis associated with?

Answer 18

increased trochlear notch scelrosis is correlated with increasing severity of coronoid disease based on CT

Question 19

What is CT useful for?

Answer 19

looking at early subtle lesions

evaluating incongruence

subchondral bone changes

fast and inexpensive

Question 20

What is the best modality for evaluating elbows?

Answer 20

CT

Question 21

What do you do if clinical signs and image from CT are not matching up?

Answer 21

Arthroscopy can allow direct evaluation of the joint in question

Question 22

Which is better and why, arthroscopy or arthrotomy?

Answer 22

arthroscopy

superior field of view

minimal invasiveness

reduced Sx time

lower patient morbidity

faster recovery

reduced risk of infection, superior functional outcome in cases of FCP

Question 23

T/F

Arthroscopy allows diagnosis by visualization and plapation of FCP and OCD, however it does not allow debridement of unhealthy tissue

Answer 23

FALSE

it allows debridement and has a low complication ratge

Question 24

What is a subtotal coronoidectomy (SCO)?

Answer 24

can be done as mini-arthrotomy

removal of the diseased coronoid, improves radio graphic incongruence, 97% resolution of lameness by 24 weeks 7% infection rate

Question 25

UHow do you Tx a UAP?

Answer 25

removal if it is free floating

arthrotomy, slight increase in risk for elbow lx

repair often resutls in failure and pin needing replacement- not done anymore

Question 26

What is a dynamic ulnar osteotomy?

Answer 26

can be done as osteotomy or a partial ostecotomy

aloows ulna to realign and decrease inconguence

Question 27

Ulnar osteotomy creates a ____ rotation around the humoral condyle, altering the position of the ____ ____ down away from the joint surface

Answer 27

Ulnar osteotomy creates a CRANIAL rotation around the humoral condyle, altering the position of the CORONOID PROCESS down away from the joint surface

Question 28

T/F

Like a THR, a total elbow replacement is relatively easy to perform and has good results

Answer 28

FALSE

it is a last resort option, has high complication rates and is NOTHING LIKE A HIP JOINT

Question 29

T/F

You are better of amputating the limb than performing joint arthrodesis on the the elbow

Answer 29

TRUE

surgical fusion of the elbow is a n end stage salvage procedure, persistent lameness and loss function is common, better option is to lop it off

Question 30

What is the prognosis of UAP, FMC and OCD?

Answer 30

UAP- genrally good with dynamic ulnar osteotomy

FMC- 1/3 return to normal, 1/3 improve, 1/3 remain lame

OCD- generally improve with some residual lameness

Question 31

T/F

medical management is used to supplement the surgical Tx of ED

Answer 31

True