Muscle strains and tendon strains Flashcards
1
Q
Where do muscle strains occur?
A
- Myogenous (fiber interface)
- Myotendinous
- Tenoosseous
2
Q
Definition of a strain
A
- Avulsion fracture
- Tendon rupture
- Musculo-tendinous junction
- Myogenous (muscle actually rips)
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)
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)
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)
6
Q
Supraspinatous myopathy (mineralized or non-mineralized)
A
- Acute or chronic strain to muscle and tendon
- Chronically can lead to mineralization
7
Q
Signalment of supraspinatus myopathy dogs
A
- Sporting dogs; hunting, sled dogs; agility/coursing; and working dogs
- Avalanche rescue
8
Q
Physical examination findings for supraspinatus myopathy
A
- Minimal to no discomfort on direct palpation
- Typically discomfort on biceps palpation
9
Q
Diagnostics for supraspinatus myopathy
A
- Radiographs (including skyline view!)
- Ultrasound
- MRI not as much
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
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
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)
13
Q
Tenosynovitis Biceps brachii tendon/tendon strain/disruption
A
- Tendon and synovial pathology of the tendon of origin
14
Q
Relevant anatomy to Biceps brachii tendon strain
A
- Supraglenoid tubercle
- Intra-articular
15
Q
Biomechanics of the biceps brachii tendon
A
- Flexor of the elbow
- Also extensor of the shoulder
16
Q
What causes injury to biceps tendon?
A
- Chronic strain to acute strain/ruptures (partial or complete ruptures are rare)
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
18
Q
History for tenosynovitis of the biceps tendon
A
- Weight-bearing lameness exacerbated with activity
- Shifting with bilateral disease (seen with supraspinatus too)
19
Q
Physical examination findings for tenosynovitis of the biceps tendon
A
- Shoulder flexion
- Shoulder/elbow extension with digital pressure on the lesser tubercle
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)
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
Cause and pathogenesis of fibrotic myopathy of the infraspinatus
- Trauma
| - Compartment syndrome (hemorrhage within a muscle belly)
26
Signalment of fibrotic myopathy of the infraspinatus tendon
- Sporting/hunting breeds
- Activity related acute lameness
- Resolution of acute pain and classic lameness to non-painful pathognomic
27
Clinical signs of fibrotic myopathy of the infraspinatus tendon
- Adducted elbow
- Paw externally rotated/abducted
- Circumducted swing phase of the gait
28
Treatment for fibrotic myopathy of the infraspinatus tendon
- Surgical transection of the fibrotic tendon and muscle segment
- Insertional point of the tendon that gets fibrosed
- Immediate results intraoperatively
29
Post-op care for fibrotic myopathy of the infraspinatus
- Restrict activity for 2-3 weeks
| - Resume normal activity afterwards
30
Prognosis for fibrotic myopathy of the infraspinatus tendon
- Excellent
31
Who gets iliopsoas muscle strain?
- Rottweilers, Doberman Pinscher, Sheltie, Lab, Chow, Greyhound
- Agility, sporting, working, family dogs
32
Etiology for iliopsoas muscle strain
- Strain (acute or chronic; repetitive motion)
| - Myofascial pain syndrome/trigger point
33
Onset and level of lameness with iliopsoas strain
- Moderate to severe lameness; persistent or intermittent
| - Acute or insidious onset
34
Physical examination findings of iliopsoas pain
- 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
Diagnostics for iliopsoas pain
- Radiographs (unremarkable to mineralization at level of lesser trochanter)
- Ultrasound has a hypoechoic pattern if the muscle is strained
- Don't MRI anything
36
Other findings for iliopsoas pain
- 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
Treatment for iliopsoas pain
- 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
What comprises the common calcaneal tendon?
- Gastrocnemius and superficial digital flexor
| - Common tendon: biceps brachii, gracilis, and semitendinosis
39
Etiology of calcaneal tendon disease
- Acute trauma (lacerations or supraphysiologic) or degeneration
40
Who gets degeneration of the calcaneal tendon?
- 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
Physical examination findings of calcaneal tendon disease
- Lameness
- Flexed hock
- Plantigrade stance
- +/- flexed digits
- pain
- Thickening of the tendon
42
Diagnostics for calcaneal tendon disease
- Radiology (dystrophic mineralization may be seen) and ultrasound
43
Surgical management of the calcaneal tendon
- 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
Gracilis and semitendinosus myopathy breed
- German Shepherd, Belgian Shepherd, St. Bernard, Doberman Pinscher
45
Gait of dogs with gracilis and semitendinosus myopathy
- Short stride
- Medial rotation of the paw
- External rotation of the hock
- Internal rotation of the stifle
- +/- pain on palpation
46
Clinical signs of myopathies of gracilis and semitendinosus
- Limited range of motion
- Abduct hip, extend stifle and hock
- "Slaps" foot down during swing phase (like string halt)
- Development of fibrotic band
47
Treatment for myopathies of gracilis and semitendinosus
- Surgical resectioning with medical management is not rewarding
- Redevelopment in 100% of patients
48
Panosteitis - who gets?
- Young, rapidly growing dogs
| - Many breeds; German shepherd dogs and basset hounds over-represented
49
What happens with panosteitis?
- Endosteal remodeling of long bones
| - Nutrient foramina
50
Clinical appearance of panosteitis
- Shifting leg lameness
- Mild, moderate, to severe
- Pain on deep palpation of long bones
51
Treatment for panosteitis
- 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
Diagnostics for panosteitis
- Radiographs
