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MSK Flashcards

1
Q

Pathophsyiology of Perthe’s disease

A

Avasucalr necrosis of the femoral head

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2
Q

Signalment of Perthe’s disease

A

Toy, small dogs
Inherited in Manchester terriers
Under 6 months

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3
Q

Dx of Perthes disease

A

Pain on extension
Crepitus
Radiography: Radiolucent necrosis of femoral head, misshapen, reduced muscle mass

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4
Q

Tx of Perthe’s disease

A

Fermoral head and neck excision
Or total hip replacement

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5
Q

Metaphyseal osteopathy clinical signs

A

Unable to walk
Painful swelling and pitting oedema at Metaphyseal region
Signs of systemic illness (pyrexia)
Poor prognosis

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6
Q

Craniomandibular osteopathy signalment

A

Aka Lion Jaw (painful swelling)
Small terriers particularly the West Highland and Cairn less than 6 months

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7
Q

Panosteitis signalment

A

Young German Shepard dogs

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8
Q

Panosteitis clinical signs

A

Shifting lameness
Waxing and waning signs
Depress and pyretic

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9
Q

Diagnostic consideration in Panosteitis

A

Clinical signs and radiographic signs may not coincide (ask owner to bring dog back couple weeks later)
Usually self limiting

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10
Q

Radiographic signs of Panosteitis

A

Subtle
Loss of trabecular pattern in medulla
Common on the humerus
Periosteal reaction around diaphysis

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11
Q

Ddx for Rickets

A

Nutritional hyperparathyroidism in animals on all meat diets

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12
Q

What is a valgus deformity?

A

Lateral deviation of feet

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13
Q

What is a varus deformity

A

Medial deviation of feet

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14
Q

Two methods to overcome angular limb deformities:

A
  1. Young dogs: Prevent growth on side where growth plate is still open
  2. Mature dogs: Straighten limb with open or closed wedge osteotomy
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15
Q

What should be calculated before correcting a limb deformity with an osteotomy

A

Centre of rotation of angulation (CORA)
- Determines the place where definitive correction should be performed

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16
Q

What deformity is short ulna syndrome

A

Most common
Valgus (external rotation of paws)

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17
Q

What is Osteochondrosis

A

Developmental disorder causing failure of mineralisation of the articular cartilage possibly associated with joint incongruity

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18
Q

Most common site for Osteochondrosis

A

Elbow

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19
Q

What aspect of the joint is elbow dysplasia seen on

A

The medial compartment

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20
Q

The 3 main manifestations of elbow dysplasia

A
  • Medial coronoid process disease / fragmentation
  • Osteochondrosis (medial humeral condyle)
  • Ununited Anconeal Process
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21
Q

Elbow dysplasia signalment

A

Labrador, GSD
Young dogs with consequences into adulthood

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22
Q

Elbow dysplasia signs

A

Chronic lameness (worse on rising)
Abducted limbs
Externally rotated limbs
Joint effusion

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23
Q

Radiographic views for elbow dysplasia

A

Flexed mediolateral + craniocaudal

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24
Q

Radiographic findings for elbow dysplasia

A

Signs of degeneration
secondary changes like trochlea notch sclerosis, new bone on the anneal process

UAP = seen on flexed view
MCP = needs CT often

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25
Q

Shoulder osteochondrosis signalment and signs

A

Young lab or border collie
Lame on rising
worse after exercise
pain over shoulder (extension)

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26
Q

Radiographic views and findings in Shoulder osteochondrosis

A

Mediolateral and caudocranial
Thick cartilage, poor ossification
Mineralised cartilage flap ==> remove fragment and debride

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27
Q

Ddx for stifle osteochondrosis

A

Cruicate disease

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28
Q

Radiographic views and findings in stifle osteochondrosis

A

Mediolateral and caudocranial
flattened condyle
Joint effusion

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29
Q

View to take if lateral hock osteochondrosis can’t be visualised on X-ray?

A

Flexed ML - move calcaneus

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30
Q

Best treatment for shoulder soft tissue disease

A

Rest
Also steroids intra-articular

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31
Q

Signalment of Humeral intracondylar fissure

A

Spaniels!!! And French bulldogs
Young to middle aged

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32
Q

Diagnostic of choice for Humeral intracondylar fissure

A

CT is best
Radiography requires multiple views

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33
Q

Treatment for Humeral intracondylar fissure

A

Can rest but always prone to fracture…
LARGE Prophylactic transcondylar screw placed for life (lots of complications)

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34
Q

Treatment for Carpal hyperextension injuries (traumatic) and tarsal subluxations (often degenerative)

A

arthrodesis

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35
Q

Common bone neoplasia

A

Osteosarcoma

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36
Q

Radiographic signs of Osteosarcoma

A

Proliferative and destructive
Joint spared (unlike other bone tumours)
All will have mets

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37
Q

How to obtain biopsy of osteosarcoma

A

Jamshidi needle
From centre of lesion

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38
Q

Distinctive sign of nerve cell tumour

A

Unilateral muscle atrophy

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39
Q

What is Feline PADS

A

Patella fracture and dental anomaly syndrome

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40
Q

Signs of PADS

A

Non healing patella fractures
Retained deciduous teeth

41
Q

Ddx for PADS and how to tell difference

A

Medial patella luxation

MPL = hopping gait
PADS = collapsing gait as they can’t fix the stifle

42
Q

What is capital physis separation in cats?

A

Burmese cats
Fracture of the femoral head and epiphysis remains in acetabulum

43
Q

3 common causes of acute on chronic lameness

A

Cruciate rupture
Pathological fractures due to osteosarcoma
Condylar fracture due to HIF (Spaniels)

44
Q

Best treatment for hip luxation

A

Toggle pin
can also do transarticular pin (removed 3 weeks later)

45
Q

Up to multi limb lameness on key points

A

need to do chest sheets too

46
Q

What joints can arthoplasties be performed in

A

Hip and Temporomandibular joint

47
Q

What is the biphasic presentation of hip dysplasia

A

Young: Hip subluxation
Mature: Osteoarthritis

48
Q

Best test for hip dysplasia

A

Ortolani test for hip laxity

49
Q

Ortolani protocol

A

Stifle pushed to subluxate hip
Leg/s abducted and if click heard => hips were lunated and femur fell back into acetabulum

50
Q

What is the significance of a positive Ortolani sign

A

If this test is positive, the dog has hip dysplasia regardless of radiographic findings

51
Q

How is hip dysplasia typically treated

A

Conservatively
Analgesia, weight reduction, diet and appropriate excercise

52
Q

What procedures can be used in young dogs with hip dysplasia

A

Under one year = Double or triple pelvic osteotomy
Under 16 weeks = Pubic symphysiodesis

53
Q

What procedures can be used in older dogs with hip dysplasia

A

Salvage techniques like FHNO or THR

54
Q

What 3 views are taken in the PennHIP scheme

A

Under GA
Hip extension to show osteoarthritis
+ compression and distraction views to calculate distraction index

55
Q

How does osteochondrosis develop (elbow dysplasia)

A

Incongruity => failure of articular cartilage ossification => cartilage thickens => separates from underlying bone => synovial fluid contacts bone => inflammation

56
Q

Signs of elbow dysplasia

A

*Chronic lameness (worse on rising)
*Abducted and externally rotated limbs (relieve pressure on medial comportment)
*Pain on manipulation (esp flexion with UAP)
*Joint effusion
*Muscle atrophy

57
Q

What imaging modality is best for a fragmented corned process

A

CT

58
Q

Surgery options for FCP (not conservative management) 4

A

Surgical:
1. Removal of fragment, ulna osteotomy to correct incongruence
2. Off loading the medial comportment to reduce weight bearing (PAUL or sliding medial humeral osteotomy)
3. Arthrodesis (hard to get correct limb length)
4. Elbow replacement

59
Q

Surgery options for OCD

A

Generally surgical removal of fragment and fixing of deficit
Deficit: OAT (autograft) or SOR (synthetic) joint surface replacement

60
Q

Surgery options for UAP

A

Reattach fragment with screw

61
Q

WHAT views are taken in the kennel club elbow dysplasia scheme

A

Two mediolateral views: flexed and neutral
max score = 3 per elbow

62
Q

Signalment for medial and lateral patella luxation

A

Lateral = Large breeds and flat coat retriever
Medial = more common. Small breeds, labs, EBTs

63
Q

Signs of patella luxation

A

Skipping/hopping lameness
Stiff, awkward gait
Poorly extending knees
Usually no pain

64
Q

Simple grades of patella luxation

A
  1. Can be luxated
  2. Spontaneously luxes alone
  3. Can be corrected
  4. Can’t be corrected
65
Q

Major ddx for patella luxation

A

Skipping terrier syndrome
Behavioural

66
Q

What are the cons of a sulcoplasty

A

Expose subchondral bone and initiate joint inflammation
Hyaline cartilage replaced with weaker fibrocartilagenous

67
Q

What other procedure can deepen the groove without a sulcoplasty

A

Synthetic trochlea buttress (Ridgestop)

68
Q

surgical correction for patella luxation

A

Tibial tuberosity transposition/translocation = moves the patellar tendon into the trochlear groove

69
Q

What does the cranial cruciate ligament prevent

A

Forwards movement of the tibia

70
Q

Which meniscus is damaged with a cranial cruciate rupture

A

Medial meniscus (attached to the tibia so can be damaged by femur movement)

71
Q

Signs of cruciate disease

A

Rising lameness
Swelling to the medial stifle (medial buttress)
Pain on extension and flexion
Thick joint capsule = thrust and draw test hard to detect as joint more stable!

72
Q

Hand placement for tibial thrust

A

Finger along patella tendon to tibial tuberosity
Other hand flexes the hock and keeps the stifle extended

73
Q

Hand placement for cranial drawer

A

*Femur grasped: thumb on lateral fabella and finger on patella
*Tibia grasped: thumb on fibular head and finger on tibial tuberosity

74
Q

Signs of cruciate disease on radiographs

A

Joint effusion (soft tissue density)
Loss of the sub patella fat pad
Osteoarthritic changes
o periosteal new bone to fabellae (first step)
o new bone on poles of the patella (white arrow)
o steep tibial plateau
o trochlea ridges (green arrow)

75
Q

Which surgical technique stops the cranial drawer

A

Lateral suture/ DeAngelis suture

76
Q

Purpose of a Tibial plateau levelling osteotomy (TPLO)

A

Prevents forward movement of the tibia by changing tibia plateau angle
Closing wedge osteotomy can help too

77
Q

Purpose of the Tibial tuberosity advancement

A

Decreases the angle between the plateau and patella tendon => when the quadriceps contract it forces the tibia back into a normal position

78
Q

Most common cause of multi limb lameness

A

Immune mediated polyarthritis

79
Q

Signs of IMPA

A

Generalised lameness
* Poor movement generally with short stride lengths
* Swollen and painful joints
* There may be accompanying muscle pain
* The animal may be systemically unwell with a pyrexia

80
Q

Best test for IMPA

A

Joint taps - tap at least 4 distal joints

81
Q

Joint tap sign of IMPA

A

Lots of neutrophils in multiple joints (esp + pyrexia)

82
Q

Joint tap signs of septic joint

A

High degenerative neutrophils and leucocytes in usually one joint
+/- bacteria
Septic PA, vector borne (Lyme (Borrelia burgdorferi))

83
Q

Joint tap signs of OA

A

Monocytes

84
Q

What 3 causes of IMPA can be investigated with serology

A

o RF (rotenoid factor) for rheumatoid arthritis (not diagnostic)
o ANF (anti nuclear factor) for SLE (not diagnostic alone)
o Borrelia (TBF), Ehrlichia too

85
Q

Tubes for joint taps

A

EDTA for cell count and cytoloy
plain for TP

86
Q

What are the subdivision of immune mediate polyarthrtisi

A

Non-erosive
- T1 = No underlying disease
- T2 = Infection elsewhere
- T3 = GIT disease
- T4 = Neoplasia

Erosie = rheumatoid arthritis

87
Q

List the common causes of non-erosive polyarthritis

A

Endocarditis
Vaccine reactions
Systemic lupus erythematosus
Breed associated (Star Pei, Akitas)

88
Q

Name the two erosive forms of poly arthritis (Cats and dogs)

A

Rheumatoid arthritis

Feline erosive proliferative and non-proliferative polyarthritis

89
Q

Signs of Rheumatoid arthritis

A

Destruction
Loss of articular srufaces
Collapse of joint space
Sub luxation
Poor prognosis

90
Q

Treatment for IMPA

A

Treat underlying cause if possible
Immunosupression (prednisalone)

91
Q

Should NSAIDs be given for IMPA?

A

Avoid if giving steroids as can lead to gastric ulcers
choose other pain relief (paracetamol, opiates, Librela)

92
Q

Signs of septic arthritis in young and old dogs

A

Young = multiple joints
Older = single joint, typically elbow

93
Q

Common secondary causes of osteoarthritis

A

Developmental conditions (elbow/hip dysplasia, osteochondrosis, patella luxation)
Degenerative conditions (cruciate disease)
Inflammatory arthropathies (rheumatoid arthritis, systemic lupus)
Trauma
Sepsis

94
Q

What is the pathophysiology of osteoarthritis

A

Weight bearing areas of the joint => fibrillation (fraying) of the articular cartilage => exposure of the subchondral bone to synovial fluid => inflammatory reaction => scleroses => osteophytes produced => joint re-modelling
also thickening of the joint capsule and reduced movement

95
Q

Which COX receptor is more selective for pain

A

COX2

96
Q

Which NSAIDs are COX2 selective

A

Carprofen
Firocoxib
Cimicoxib
Rodenacoxib (Onsior)

97
Q

what other analgesia is available

A

o Opiates = for severe flare ups
o Amantadine = NDMA antagonist (similar to ketamine). For when NSAIDs aren’t providing adequate analgesia in dogs
o Paracetamol is a useful adjunct with NSAIDs (Dogs ONLY)
o Librela (Dog) or Solensia (Cat) are directed against nerve growth factor

98
Q

Ddx for non healing nail bed infection

A

neoplasia
Nail Paronychia= bacterial infection. Remove nail to drain + ABS
Nail Onychomycosis = fungal infection. Remove nail to drain + Afs

99
Q

Claw amputation leads to lameness

A

Lameness results if remove
○ >2 digits
○ Either of central 2 digits: P3 and P4 are the weight bearing digits

Small animal (11 decks)

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