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LOCO SA Flashcards

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1
Q

What is a key differential for HL lameness in the dog?

A

cranial cruciate ligament disease

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2
Q

Is cranial cruciate ligament disease commonly seen in cats?

A

No it is rare!

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3
Q

What is this showing?

A

The cranial cruciate ligaments of the stifle- one is normal the other one has undergone degenerative weakening.

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4
Q

What are the 3 causes for cranial cruciate ligament rupture?

A
  • traumatic avulsion
  • traumatic rupture
  • degenerative weakening
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5
Q

What is the most common cause of cranial cruciate ligament rupture?

A

degenerative weakening

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6
Q

What is the pathogenesis of cranial cruciate ligament degenerative weakening?

A

Complex!

involves conformation changes, abnormal biology including inflammation and apoptosis, and abnormal muscle and joint conformation

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7
Q

Cranial cruciate ligament rupture often goes hand in hand with damage to the…

A

meniscus

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8
Q

Which meniscus usually undergoes the most damage?

A

the medial meniscus

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9
Q

If there is meniscus damage, is it more painful when the stifle is in flexion or extension?

A

Extension

crushes the meniscus

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10
Q

The menisci convert compression into …

A

Tension (sexual tension?)

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11
Q

Where is the meniscal blood supply located/ distributed

A

Outer rim

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12
Q

What are the menisci? What are their poles?

A

2 C shaped fibrocartilage,

triangular with caudal and cranial poles

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13
Q

What ligaments do the menisci have?

A

The medial has:
- medial collateral
- meniscotibial

the lateral has:
- meniscofemoral

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14
Q

Is the onset of cranial cruciate ligament disease acute or chronic at presentation

A

Varies

can present itself acutely and can also be more insiduous

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15
Q

What is the positive sit test?

A

When the affected leg of a dog is out to the side (cranial cruciate)

not pathognomic

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16
Q

lumbosacral disease can sometimes look like..?

A

HL lameness

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17
Q

Dogs with cranial cruciate disease tend to not want to flex their stifles so instead they …?

A

circumduct their leg

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18
Q

What are the 2 stability tests we use to assess the stifle?

A
  • the cranial draw
  • the tibial thrust
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19
Q

Which is the most reliable stability test for assessing the stifle?

A

the cranial draw

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20
Q

Which is the most well tolerated stability stifle test?

A

the tibial thrust

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21
Q

Can you get false positives and false negatives with the cranial draw stability test?

A

Yes
false positive: if torsion twist

False negative: incorrect technique

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22
Q

Can you diagnose a cranial cruciate rupture with radiographs?

A

No, but you can see secondary signs!

  • stifle effusion
  • osteophytes
  • distal displacement of the popliteal sesamoid bone
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23
Q

which radiographic views are important for assessing cranial cruciate ligament damage ?

A

orthogonal views (lateral and VD)

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24
Q

When aligning the stifle for radiographs which structures should you use as reference?

A

The fabellae

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25
Q

What are these?

A

These are osteophytes-

Radiographically this is what they look like

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26
Q

How do you treat cranial cruciate ligament rupture?

A
  • you can start with 8 weeks of conservative treatment (rest and anti-inflammatories)
  • if this does not work–> SURGERY
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27
Q

If you have meniscal injury and cruciate ligament rupture- what is the treatment?

A

Surgery

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28
Q

What is the ONLY role of surgery in cranial cruciate ligament?

A

To stabilise the joint
stop/reduce tibial thrust

(Surgery will not prevent OA)

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29
Q

Whenever surgery of the cranial crucial is being performed what must you MANDATORILY INSPECT?

A

the menisci

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30
Q

What are the 3 surgical techniques used for stabilising a cranial cruciate ligament rupture?

A
  • intra-articular
    -extra-articular
  • osteotomy techniques
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31
Q

Describe the intra-articular technique used for cruciate ligament rupture?

A

intra-articular graft through a bone tunnel

doesnt work well

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32
Q

What is this surgical technique?

A

Extra-articular

put a band around the joint to stabilise- the suture will snap off at 2 months, but by that time fibrous tissue should have been laid down around the joint.

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33
Q

What is the principle of surgical osteotomy techniques used for cruciate ligament rupture?

A

Flatten the tibial plateau

eliminate tibial thrust

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34
Q

What are the two osteotomy techniques used?

A

TPLO- tibial plateau levelling osteotomy

TTA - tibial tuberosity advancement

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35
Q

What is this surgical technique and what is it for?

A

TPLO

cranial cruciate rupture

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36
Q

What is this surgical technique?

A

TTA

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37
Q

What are the 2 common stifle problems seen in SA?

A
  • Cranial crucial ligament rupture (due to degenerative disease)
  • Patellar luxation
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38
Q

What is more common lateral or medial patellar luxations?

A

Medial patellar luxations

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39
Q

Patella luxation- is it congenital or developmental?

A

developmental

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40
Q

The patella is a sesamoid bone found in which muscle tendon?

A

the quadriceps muscle tendon

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41
Q

If the patella is not in the groove during development what happens?

A

the groove does not develop- it needs pressure

abnormal depth
abnormal alignment

image shows a flat surface instead of a groove

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42
Q

What is the pathophysiology of patellar luxation?

A

the quadriceps develop incorrectly–> uneven pressure on physis of bones—> bone deformities

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43
Q

Patellar luxations tend to occur in what type of dogs?

A

Small dogs

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44
Q

What is the typical lameness of patellar luxation?

A

INTERMITTENT

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45
Q

Do patellar luxations tend to have effusion?

A

minimal

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46
Q

If a dog has genu valgum - will the patella be medially or laterally luxated?

(gum so legs ‘stick’ together)

A

laterally

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47
Q

If a dog has genu varum - will the patella be medially or laterally luxated?

A

medially

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48
Q

if you push on patellar and there is pain ‘retropatellar pain’ this may suggest..

A

cartilage damage

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49
Q

A history of intermittent skipping should make you think of…

A

patellar luxation

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50
Q

patellar luxation grading: if a patella is in the groove at rest but can intermittently pop out- what grade?

A

Grade 1- not clinically important

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51
Q

patellar luxation grading: if a patella is NOT in the groove at rest and the patella can never be returned inside the patellar groove?

A

Grade 4- surgery required

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52
Q

patellar luxation grading: if a patella is in the groove at rest but can stay out of the patellar groove?

A

Grade 2- these vary from mild- to severe

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53
Q

patellar luxation grading: if a patella is NOT in the groove at rest but can still be returned to the groove?

A

Grade 3- persistently abnormal stifle joint- lameness can be SUBTLY surprisingly!

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54
Q

If patellar luxation is a high grade what type of X-rays do we do?

A

entire limb radiographs

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55
Q

This radiograph looks NORMAL- however it is showing a patellar luxation

A

patellar luxations can look normally radiographically

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56
Q

Which grades of patellar luxation generally require surgery?

A

Grade 3
Grade 4

(Grade 2- if severe)

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57
Q

What influences the prognosis with patellar luxations?

A

The grade

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58
Q

What influences the choice of surgery for correcting a patellar luxation?

A
  • not just the grade
  • evidence of pain
  • Owner awareness that OA will NOT be prevented
  • unilateral surgery in a bilateral disease
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59
Q

What are the treatment options for a dog with grade 1 or 2 patellar luxation, with no pain and no lameness but an instable patella?

A

physiotherapy

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60
Q

If a dog has grade 2 patellar luxation with weekly lameness (and retropatellar pain)- what would be the treatment?

A

surgery

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61
Q

What are the surgical treatment options for patellar luxations?

A
  • trochleoplasty
  • chondroplasty (rare)
  • wedge resection
  • block resection
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62
Q

What surgery is this

A

wedge resection to deepen the patellar groove

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63
Q

What surgery is this?

A

Block recession sulcoplasty

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64
Q

What technique is this?

A

trochleoplasty- terrible technique, rasp off the cartilage causing alot of OA-

other techniques are better

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65
Q

What is this surgery called?

A

Chondroplasty- need to do it if animal is less than 6months old

RARELY DONE

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66
Q

Following a wedge/block resection - you will almost always need to do what other surgery?

A

Most cases, the tendon is deviated so will need to be realigned with a TTT (tibial tuberosity transposition)

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67
Q

What is this?

A

TTT
Tibial tuberosity transposition

you transpose the tibial tuberosity to realign the femus with the tibia

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68
Q

Can you do a TTT in a skeletally immature patient?

A

May influence bone growth!

Best wait >10months

or do a two stage surgery

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69
Q

What are the broad categories of Arthritis?

A
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70
Q

In the immune mediated arthritis which category is most common, erosive or non erosive?

A

non- erosive

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71
Q

In IMPA, is one or several joints commonly affected?

A

multiple joints affected

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72
Q

If a patient presents with swollen joints and systemic signs what are the most likely causes of arthritis?

A
  • Inflammatory causes:
    1ry or secondary
  • Infectious
  • (Neoplasia)
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73
Q

What infectious causes may lead to IMPA?

A

Ehrlichia, Heartworm , Leishmaniosis

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74
Q

What features may you see with IMPA on clinical exam?

A
  • ligamentous laxity
  • effusions
  • swollen joints
  • 35% lame
  • MULTIPLE joints effected
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75
Q

How can we investigate polyarthropathy?

A
  • arthrocentesis (most common)
  • X rays (not very helpful)
  • synovial biopsy
76
Q

If we suspect IMPA what can we do to investigate?

A
  • do an arthrocentesis to differentiate between septic and immune mediated
  • X rays?
  • synovial biopsy
  • Look for underlying cause!! (bloods, PCR..)
77
Q

Is lactate higher in Septic arthritis or Immune mediated arthritis?

A

Septic arthritis

78
Q

How can you tell the difference between septic and immune mediated arthritis?

A

Do an arthrocentesis

  • Septic typically has higher total protein ( >4%) Vs immune mediated has 2.5-3%)
  • may have higher neutrophil count in septic athritis (> 90%) Vs (10-95%) in immune mediated
79
Q

You take an arthrocentesis from a joint with arthritis- what is the left showing and the right showing ?

A

Left: high neutrophil count—> Inflammatory type

Right: high mononuclear cell count—> non- inflammatory

80
Q

re radiographs useful for assessing non-erosive arthritis?

A

No- may see effusion…

81
Q

Borrelia (lyme disease), Systemic Lupus Erythmatoid, and drug associated arthritis are all examples of erosive or non erosive immune mediated arthritis?

A

These are non - erosive

82
Q

Erosive IMPA can look like… arthritis

A

septic arthritis

83
Q

What does this represent?

A

a carpus with erosive arthritis

note the sclerosis and erosion present compared to this healthy carpus

84
Q

What is the pathophysiology of erosive IMPA Vs non- erosive

A

Erosive : chronic synovitis–> granulation tissue—> collagenase and proteases lead to bone destruction

Non- erosive: immune hypersensitivity response type 3—> antibody and antigen deposits in the synovium—> chemotaxis for neutrophils and macrophages

85
Q

Radiography: erosive vs non-erosive

A

non erosive–> effusion maybe?

erosive: sclerosis and erosion

86
Q

What is more common erosive or non-erosive IMPA?

A

non-erosive

erosive accounts for 1% of PA

87
Q

Why do we want to differentiate between erosive and non erosive disease?

A

erosive disease requires more aggressive treatment and has a worst prognosis

88
Q

What is this?

A

Septic arthritis - affects LA and SA

89
Q

What is the prognosis for IMPA type 1 (idiopathic)?

A

56% can be cured
18% on lifelong treatment
12% relapse

90
Q

Causes for septic arthritis

A
  • trauma (ie horses)
  • hematogenous spread
  • spread from local tissue
  • iatrogenic Ie aseptic procedure
91
Q

What is this showing?

A

osteochondritis dissecans

Problem with vasculature during endochondral ossification leads to a thickened area of bone

92
Q

What is this showing?

A

Osteochondritis Dissecans- underrunning of necrotic tissue- flap of cartilage on top

93
Q

What is this showing? Which breed does this typically affect?

A

Osteochondritis dissecans- note the flap!

LARGE DOGS

94
Q

If you can’t see whether a shoulder or elbow joint has Osteochondrosis dissecans what can you do?

A

contrast arthrogram

95
Q

What is this showing? Are they always this obvious?

A

Osteochrondrosis dissecans- not sometimes you cant see it radiographically- so you may need contrast

96
Q

What is this showing? What type of dog does this typically affect?

A

Shoulder luxation

97
Q

What is this test called?

A

The bicipital test

It is used to see whether the animal has bicipital disease-
Shoulder is flexed and the elbow is extended- if it can fully extend that means it has bicipital disease.

98
Q

What is bicipital disease?

A

degeneration of the biceps tendon

99
Q

Which letter represents the Medial coronoid process?

A

A

100
Q

Elbow dysplasia is an umbrella term for ….. diseases

A

developmental

101
Q

All elbow dysplasias lead to what other disease?

A

OA

102
Q

What is the aetiopathogenesis of elbow dysplasia?

A

growth mismatch between radius and ulna- leading to radial ulnar incongruity

103
Q

If during elbow development, the radius is too short, where will there be more pressure at the elbow joint?

A

At the MCP

104
Q

If druign elbow development you have a long radius - where in the joint will there be most pressure?

A

the anconeal process

105
Q

Why is elbow dysplasia a big problem in dogs?

A
  • euthanasia in 41%
  • bilateral in 60%
106
Q

Where is the Medial coronoid process and where is the anconeal process on this picture?

A
107
Q

What does this photo show?

A

Open physis:
- radius
- olecranon

(the humeral physis is not visible on this picture)

108
Q

If the humerus is relatively too large at the humero ulnar joint- what do you call this dysplasia?

A

humero trochlear notch - humero ulnar confilct

109
Q

Elbow dysplasia is frequently lateral or bilateral?

A

bilateral

110
Q

How many views do you need to take for elbow dysplasia?

A

3:
1 cranio caudal
1 mediolateral flexed
1 mediolateral neutral

111
Q

What is this?

A

elbow arthroscopy

112
Q

Can you see the disease on this picture?

A

this is a diseased medial coronoid process

113
Q

Is the medial coronoid easy to diagnose via radiography?

A

No, we diagnosise it by elimination- if no UAP or OCD then MCP!

114
Q

What is this? Can you see the cartilage?

A

This is a CT- you cannot see cartilage on CT

115
Q

What elbow dysplasia is this?

A

Ununited anconeal process

116
Q

What is this showing? It is an elbow dysplasia

A

ununited anconeal process with CT and arthroscopy

117
Q

How can you surgically treat an Ununited anconeal Process? (3)

A

1) remove the anconeal process (leads to OA)

2) osteotomy of the ulnar

3) or cut ulnar to relieve pressure and add a pin to allow the anconeal process to heal! (this is the best) see pic

118
Q

How can you surgically treat an Ununited anconeal Process? (3)

A

1) remove the anconeal process (leads to OA)

2) osteotomy of the ulnar

3) or cut ulnar to relieve pressure and add a pin to allow the anconeal process to heal! (this is the best) see pic

119
Q

What does this show?

A

OCD of the humerus

120
Q

Is OCD of the humerus common?

A

uncommon

121
Q

OCD in the dog commonly affects which joints?

A
  • Elbow
  • shoulder
    (Stifle and tarsus)
122
Q

What leads to MCP?

A

microfracture due to overload

123
Q

What are these pictures showing?

A

CT scans of MCP

124
Q

What is the best treatment for MCP?

A

arthroscopy >

arthrotomy and conservative treatment (omega 3, regularised exercise, weight control…)

125
Q

All types of elbow dysplasias lead to …

A

OA!

126
Q

Lameness may implicate which 2 systems

A

neurology
orhtopaedics

127
Q

Locomotor conditions are characterised by 2 things

A
  • lameness
  • gait abnormality
128
Q

Hip dysplasia is common in…

A

large breed dogs

129
Q

What is the pathophysiology of hip dysplasia?

A

Born normal

then at 30 d–> hip laxity in joint

leads to pain–> inflammation—> bone remodelling—> OA

130
Q

Does feeding/ body weight affect OA in hip dysplasia?

A

YES!!

131
Q

Dogs with hip dysplasia usually present at what age?

A
  • 6-7 months
  • or older when they have OA
132
Q

What are the key clinical findings on PE that point to hip dysplasia?

A
  • PAIN when extending the hip or abducting the hip

-(muscle atrophy
- clunking)

133
Q

If the dog is old, make sure not to confuse hip dysplasia with …

A

cranial crucial ligament disease

134
Q

What leg position is needing for Xrays of hip dysplasia?

A
  • VD extended
  • lateral pelvis
135
Q

Is this a good radiograph for assessing hip dysplasia?

A

YES

136
Q

Is this a good radiograph for assessing hip dysplasia

A

no, pelvis is rotated , ilial wing larger on the right compared to the left side. Obturator foramen is bigger

137
Q

Is this a good radiograph for assessing hip dysplasia?

A

No, pelvis is straight but femurs are not straight

138
Q

What is the normal acetabular coverage of femoral head ?

A

50%

139
Q

Can a dog with severe OA still have good hip function?

A

YES

treat the dog not the radiograph

140
Q

Ortolani test is used to assess

A

hip dysplasia

push down into hip joint then abduct-> if clunks then hip dysplasia

141
Q

Bardens Test assesses..

A

hip dysplasia

(if >0.5cm femur lift out of joint then hip dysplasia)

142
Q

What is the first line treatment for dogs with hip dysplasia ( young and old)?

A

Conservative management:
1) short regular exercise
2) diet ‘keep lean’
3) hydro
4) Omega 3
5) NSAIDs

143
Q

What prophylatic surgeries do we have for hip dysplasia if conservative management fails?

A
  • pelvic osteotomy
  • Juvenile pubic symphysodesis
144
Q

What definitive surgeries do we have for hip dysplasia if conservative management fails?

A

arthroplasties:

Total hip replacement
Femoral head and neck excision

145
Q

Why is screening for hip dysplasia problematic

A
  • based on radiographic signs
    (looking at primary disease and OA) so NOT CLINICALLY RELEVANT
  • does not measure laxity
  • hip dysplasia is polygenetic (so a dog with good radiographic score may carry bad genes!)
146
Q

What clinical findings may there be with a dog with Legg Calve Perthes?

A
  • same as hip dysplasia:
    pain on hip extension and abduction
    muscle atrophy
147
Q

What is the pathogenesis of Legg Calve Perthes?

A
148
Q

How do you treat Legg Calve Perthes

A

SURGERY OBLIGATORY:

  • FHNE
    (THR)
149
Q

What radiographic views may you use for Legg Calve Perthes?

A

VD frog leg
lateral

150
Q

What is the most common hock problem?

A

Trauma

151
Q

Casting tape is applied to which layer?

A

a light 2ndary layer

152
Q

How many layers are involved in a bandage?

A

3

153
Q

What is the primary layer of a bandage?

A

Allevy, Melolin

  • covers and protects skin
  • absorbs discharge
154
Q

What is the second layer of a bandage?

A
  • cotton wool or cast padding
  • conforming gauze is wrapped around
155
Q

What is the 2nd layer of a bandage for?

A

support, absortion and pressure

156
Q

What is the 3rd layer of a bandage?

A

elastic gauze/ Vet wrap

allows consistent pressure to outer layers

157
Q

If you put too little casting tape on what is the risk?

A

rubs and sores

158
Q

If you put too much casting tape on what is the risk?

A

movement of bone fragments
delayed healing

159
Q

What is this?

A

A Robert Jones bandage contains alot of cotton wool

Leave open if possible

160
Q

What are the indications for a Robert Jones bandage?

A
  • temporary immobilisation
  • reduces swelling
  • cotton wool loosens over time and stability is lost
161
Q

What is this?

A

a splint used for bandage support

162
Q

What is the difference between a Robert Jones and a Modified Robert Jones?

A

Modified Robert Jones uses cast padding instead of cotton wool

163
Q

How many layers of cast padding are there in a Modified Robert Jones? On which layer is the splint applied?

A
  • 3
  • after the 2nd layer of cast padding
164
Q

The Modified Robert Jones can offer temporary immobilisation IF it is…

A

SPLINTED

165
Q

Should both the Robert Jones bandage and the Modified RJ be left open ended?

A

preferably yes

166
Q

Casts can be ….

A

bivalve or one-piece

167
Q

What are longer term immobilisation techniques?

A
  • casts (bivalve or full)
  • immobilisation devices : Schroeder Thomas Splint
    Spica Splint
168
Q

Why would be opt for a bivalve cast?

A
  • fracture management
  • allows easy inspection
169
Q

Accurate application of a bivalve cast requires…

A

GA

170
Q

For a cast should toes be in out out?

A

in

171
Q

Which are the 4 forces acting on fractures? Which ones respond well to external co-aptation?

A

Bending
Rotation/ torsion
Shear/ compression
Distraction / Avulsion

Bending and torsion respond well

172
Q

As distraction forces in a fracture do not response to external coaptation- what can we do instead?

A

sling

173
Q

What are unsuitable fractures for coaptation?

A
  • comminuted
  • unstable spiral or oblique
174
Q

What are suitable fractures for coaptation?

A

some simple oblique or spiral
simple transverse
paired bone- ulna or fibula intact

175
Q

We need to immobilise a fracture….

A

above and below the fracture

176
Q

External co-aptation is unsuitable for (3)

A
  • fractures above the stifle and elbow
  • articular fractures
  • fractures involving growth plates
177
Q

Consider reduction for a fracture is the is atleast …% overlap between fracture ends on both orthogonal views

A

50 %

178
Q

Can you apply casts on distal radius and ulna?

A

No

179
Q

Can you cast a sighthound?

A

no- too little soft tissue coverage

180
Q

Can you cast a dystrophic dog or Obese dog?

A

No- bandages do not stay on

181
Q

What is the ideal patient for casting and bandaging?

A
  • juvenile with high healing potention
  • atleast 50% coverage of both bone ends
  • stable closed fracture
  • one intact paired bone
182
Q

If a dog has had a RTA and has a broken radius, what can you do?

A
  • first apply bandage
  • Make a cast after 2-3 days once swelling has gone done
183
Q

In fracture management: …alignment is more important that… alignment

A

joint alignement> bone alignement

184
Q

If you have a fracture in the radius you would need to cast from ..

A

above the elbow to the floor

185
Q

Always cast a limb in a normal standing position and that allows normal…

A

weight bearing

186
Q

Complications of external coaptation are common and include

A
  • soft tissue injuries
  • mal union
  • non-union in toy breed antebrachium
  • swelling (dont bandage to the tips!)

vet med 4 (11 decks)

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