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Ortho > Muscle strains and tendon strains > Flashcards

Muscle strains and tendon strains Flashcards

1
Q

Where do muscle strains occur?

A
  • Myogenous (fiber interface)
  • Myotendinous
  • Tenoosseous
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2
Q

Definition of a strain

A
  • Avulsion fracture
  • Tendon rupture
  • Musculo-tendinous junction
  • Myogenous (muscle actually rips)
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3
Q

General physical examination findings of muscle strains

A
  • Heat
  • Swelling (acute strain)
  • Pain
  • Fibrous tissue (chronic strains)
  • Loss of tissue continuity (tendon or muscle belly)
  • Alteration in function: lameness (weight-bearing to non-weight bearing)
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4
Q

What determines medical vs surgical treatment for strains?

A
  • Chronic vs acute injury (acute has a chance to repair; if chronic and fibrotic, you have to medically manage)
  • Mild vs severe strain (rupture)
  • Muscle belly (hard to repair) vs tendon vs myotendenous
  • Minor (e.g. pectineus) vs major muscle function (e.g. gastrocnemius)
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5
Q

Therapy for acute strains

A
  • Ice injury 1st (24-72 hours or even longer)
  • Heat >72 hours
  • NSAIDs 5-7 days
  • Methocarbamol 5-7 days
  • Hydrotherapy (movement! After swelling and pain goes down)
  • Soft support bandage for acute swelling
  • Primary surgical repair of muscle (acute) or resection of fibrous tissue (chronic; release)
  • Stress protection (short-term immobilization)
  • Restricted activity/gradual return to function (have to be rested; 6-8 weeks)
  • Physical rehabilitation (acupuncture works well with muscle injuries; iliopsoas strains)
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6
Q

Supraspinatous myopathy (mineralized or non-mineralized)

A
  • Acute or chronic strain to muscle and tendon

- Chronically can lead to mineralization

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7
Q

Signalment of supraspinatus myopathy dogs

A
  • Sporting dogs; hunting, sled dogs; agility/coursing; and working dogs
  • Avalanche rescue
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8
Q

Physical examination findings for supraspinatus myopathy

A
  • Minimal to no discomfort on direct palpation

- Typically discomfort on biceps palpation

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9
Q

Diagnostics for supraspinatus myopathy

A
  • Radiographs (including skyline view!)
  • Ultrasound
  • MRI not as much
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10
Q

Treatment for supraspinatus myopathy tendinopathy (non-mineralized and no displacement of the biceps tendon)

A
  • Medical management (NSAIDs, platelet rich plasma injections)
  • Methocarbamol
  • If enlargement and displacement without mineralization, he’ll recommend platelet rich plasma and physical rehabilitation (2 weeks after initiation)
  • Restrict activity for 6 weeks; physical rehabilitation
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11
Q

Treatment for supraspinatus myopathy tendinopathy (mineralized)

A
  • Arthroscopy combined with partial tenectomy
  • Breakdown of capsular adhesions
  • Restricted activity for 6 weeks, physical rehabilitation
  • DON’T USE platelet rich plasma in a mineralized tendon
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12
Q

Treatment for supraspinatus myopathy tendinopathy (no mineralization, but biceps tendon displacement)

A
  • If enlargement and displacement without mineralization, he’ll recommend platelet rich plasma and physical rehabilitation (2 weeks after initiation)
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13
Q

Tenosynovitis Biceps brachii tendon/tendon strain/disruption

A
  • Tendon and synovial pathology of the tendon of origin
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14
Q

Relevant anatomy to Biceps brachii tendon strain

A
  • Supraglenoid tubercle

- Intra-articular

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15
Q

Biomechanics of the biceps brachii tendon

A
  • Flexor of the elbow

- Also extensor of the shoulder

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16
Q

What causes injury to biceps tendon?

A
  • Chronic strain to acute strain/ruptures (partial or complete ruptures are rare)
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17
Q

Signalment for tenosynovitis of the biceps tendon

A
  • Racing greyhounds, larger hunting breeds (e.g. Labrador retrievers, spaniels, pointers, etc.)
  • Agility/coursing dogs, sled dogs, and avalanche rescue dogs, family pets
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18
Q

History for tenosynovitis of the biceps tendon

A
  • Weight-bearing lameness exacerbated with activity

- Shifting with bilateral disease (seen with supraspinatus too)

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19
Q

Physical examination findings for tenosynovitis of the biceps tendon

A
  • Shoulder flexion

- Shoulder/elbow extension with digital pressure on the lesser tubercle

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20
Q

Diagnostics for tenosynovitis of the biceps tendon

A
  • Radiographs (can do a skyline view)
  • Ultrasound (looking for changes of the biceps tendon)
  • Arthroscopy (can see it directly)
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21
Q

When to do medical vs surgical treatment of biceps tendon tenosynovitis?

A
  • Medical reserved for cases where there isn’t a lot of change to the Biceps tendon
  • Surgical where there is a partial rupture
22
Q

Medical treatment of the biceps tendon strain

A
  • NSAIDs
  • Adequan IM (8 injections over 4 weeks)
  • Restrict activity for 4-6 weeks
23
Q

Arthroscopy for partial ruptures of the biceps tendon

A
  • Tendon transection and release
  • Restricted activity for 4 weeks
  • Transhumeral ligament on the distal end of the intertubercular groove can help that tendon anchor in that spot
24
Q

Fibrotic myopathy of the infraspinatus

A
  • Fibrotic pathology affecting the tendon of insertion

- Tendon runs over the lateral joint capsule of shoulder

25
Q

Cause and pathogenesis of fibrotic myopathy of the infraspinatus

A
  • Trauma

- Compartment syndrome (hemorrhage within a muscle belly)

26
Q

Signalment of fibrotic myopathy of the infraspinatus tendon

A
  • Sporting/hunting breeds
  • Activity related acute lameness
  • Resolution of acute pain and classic lameness to non-painful pathognomic
27
Q

Clinical signs of fibrotic myopathy of the infraspinatus tendon

A
  • Adducted elbow
  • Paw externally rotated/abducted
  • Circumducted swing phase of the gait
28
Q

Treatment for fibrotic myopathy of the infraspinatus tendon

A
  • Surgical transection of the fibrotic tendon and muscle segment
  • Insertional point of the tendon that gets fibrosed
  • Immediate results intraoperatively
29
Q

Post-op care for fibrotic myopathy of the infraspinatus

A
  • Restrict activity for 2-3 weeks

- Resume normal activity afterwards

30
Q

Prognosis for fibrotic myopathy of the infraspinatus tendon

A
  • Excellent
31
Q

Who gets iliopsoas muscle strain?

A
  • Rottweilers, Doberman Pinscher, Sheltie, Lab, Chow, Greyhound
  • Agility, sporting, working, family dogs
32
Q

Etiology for iliopsoas muscle strain

A
  • Strain (acute or chronic; repetitive motion)

- Myofascial pain syndrome/trigger point

33
Q

Onset and level of lameness with iliopsoas strain

A
  • Moderate to severe lameness; persistent or intermittent

- Acute or insidious onset

34
Q

Physical examination findings of iliopsoas pain

A
  • Discomfort/pain on internal rotation of the femur with extension of the coxofemoral joint
  • Discomfort/pain deep palpation ventromedial to ilium
  • +/- discomfort on deep palpation of the lesser trochanter
  • +/- discomfort or pain on rectal palpation
35
Q

Diagnostics for iliopsoas pain

A
  • Radiographs (unremarkable to mineralization at level of lesser trochanter)
  • Ultrasound has a hypoechoic pattern if the muscle is strained
  • Don’t MRI anything
36
Q

Other findings for iliopsoas pain

A
  • Intermittent spasticity/lameness
  • Hip dysplasia or cruciate ruptures responding to iliopsoas treatment (myofascial pain syndrome/trigger point)
  • Many cases also have concurrent pectineal myopathies (pain on palpation; fasciculations)
37
Q

Treatment for iliopsoas pain

A
  • NSAIDs for 7-10 days
  • Methocarbamol 7-10 days
  • Exercise modification for 4-6 weeks with physical therapy
  • Acupuncture (stretching is very important)
  • Myotenectomy for non-responsive cases
38
Q

What comprises the common calcaneal tendon?

A
  • Gastrocnemius and superficial digital flexor

- Common tendon: biceps brachii, gracilis, and semitendinosis

39
Q

Etiology of calcaneal tendon disease

A
  • Acute trauma (lacerations or supraphysiologic) or degeneration
40
Q

Who gets degeneration of the calcaneal tendon?

A
  • Labs, Doberman pinschers, Collies, Shelties
  • Repetitive motion injury in labs and Aussies
  • Immune mediated in Collies and shelties?
  • Drugs or metabolic disease (steroids either exogenous or endogenous; fluoroquinolones in people)
41
Q

Physical examination findings of calcaneal tendon disease

A
  • Lameness
  • Flexed hock
  • Plantigrade stance
  • +/- flexed digits
  • pain
  • Thickening of the tendon
42
Q

Diagnostics for calcaneal tendon disease

A
  • Radiology (dystrophic mineralization may be seen) and ultrasound
43
Q

Surgical management of the calcaneal tendon

A
  • Primary repair
  • Lengthening or augmentation (v-y plasty; fascia lata graft; tendon transposition from deep digital flexor, peroneus longus and brevis, or semitendinosus; prosthetics like small intestinal submucosa, polypropylene mesh, calcaneal tendon allograph)
  • Post-op care
44
Q

Gracilis and semitendinosus myopathy breed

A
  • German Shepherd, Belgian Shepherd, St. Bernard, Doberman Pinscher
45
Q

Gait of dogs with gracilis and semitendinosus myopathy

A
  • Short stride
  • Medial rotation of the paw
  • External rotation of the hock
  • Internal rotation of the stifle
  • +/- pain on palpation
46
Q

Clinical signs of myopathies of gracilis and semitendinosus

A
  • Limited range of motion
  • Abduct hip, extend stifle and hock
  • “Slaps” foot down during swing phase (like string halt)
  • Development of fibrotic band
47
Q

Treatment for myopathies of gracilis and semitendinosus

A
  • Surgical resectioning with medical management is not rewarding
  • Redevelopment in 100% of patients
48
Q

Panosteitis - who gets?

A
  • Young, rapidly growing dogs

- Many breeds; German shepherd dogs and basset hounds over-represented

49
Q

What happens with panosteitis?

A
  • Endosteal remodeling of long bones

- Nutrient foramina

50
Q

Clinical appearance of panosteitis

A
  • Shifting leg lameness
  • Mild, moderate, to severe
  • Pain on deep palpation of long bones
51
Q

Treatment for panosteitis

A
  • Self-limiting (early, middle, and late phases)
  • Diet (large breed puppy food)
  • NSAIDs PRN
  • Time
  • Can reoccur over several weeks to months or years
52
Q

Diagnostics for panosteitis

A
  • Radiographs

Ortho (10 decks)

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