Musculoskeletal Flashcards
Musculoskeletal
Rehabilitation impact on tissues (bone)
- exercise increases bone metabolism and healing
Rehabilitation impact on tissues (cartilage)
- rest protects injured cartilage
- rigid immobilization damages articular cartilage
- controlled remobilization enhances cartilage recovery
Rehabilitation impact on tissues (ligaments)
- protected exercise boosts ligaments recovery rate
Rehabilitation impact on tissues (muscle)
- exercise strengthens, stretches, increases balance, alleviates pain, increases function, decreases depression
10 Parts to Rehabilitation (Why bother…)
- Assessing patient more completely
- Protecting Patients (from slipping, falling, etc)
- Assisting Patients (slings, harness)
- Relieving Pain
- Providing nursing care
- Strengthening
- Stretching
- Provide (non-noxious) sensory stimuli
- Training and education (everyone)
- Identifying and managing high-risk patients
5 points to decreasing pain during rehab
- anti-inflammatory measures
- edema control
- gate control theory
- dec. healing tissue stress
- improving posture and locomotion
Candidate for physical rehab? ( 7 points)
- non-ambulatory
- potential to become non-ambulatory
- potential to lose joint motion (contracture, etc)
- potential for irreversible changes to musculoskeletal system
- require specific form of protection ( not available to or managable by owner)
- severely overweight
- missing limbs
Recovery states of wound healing
- hemostasis (~hours)
- inflammatory (~days)
- repair/ proliferation (~weeks)
- remodeling/ maturation ( ~months)
Perthe’s Disease
- aseptic necrosis of the femoral head
- young small breed dogs
- severe lameness and limb disease
Canine Hip Dysplasia
- highly prevalent, osteoarthritic disease
- mild to severe pain
- hip laxity leads to clinical signs and progressive hip OA
What is the #1 risk factor for developing hip OA later in life
- passive hip laxity
Functional hip laxity influenced by:
- increased volumes of joint fluid
- thickened ligament of head of femur
- pelvic muscle mass
- hormonal
- weight and growth rates
- nutrition ( high Ca, Ph, Vit C)
T/F: there is no medical or surgical cure for Canine Hip Dysplasia… only palliative treatment
T
What is the best method to reduce frequency and severity of CHD?
- selective breeding
T/F: CHD is expressed on a scale from normal to severely abnormal
T
T/F: checking the dog at 2 years of age is an effective method to rule out hip OA later in life
F, hip OA arises progressively through life on a linear scale so looking at 2 years of age is not very helpful
T/F: CHD has a biphasic distribution
False
When testing for laxity, what does a finding of ‘no laxity’ indicate
- simply that you can’t find it on exam
- does not indicate that it is not present in the patient
Ortolani Sign
- the small click heard when the hip is abducted
- indicates reduction of the joint
Barlow Sign
- the glide or step felt when the hip is adducted
- indicates sub-luxation
How to read the difference between Ortolani and Barlow Signs
Barlow - Ortolani = 20-30*
- increased angle is an indicator of worse disease
danger of hip extension radiographs for hip OA
- has potential to hide laxity
Hip Disease (Clinical Signs)
- mild-severe lameness
- usuallly chronic and insidious lesions
- stiffness on rising and gait
- Bunny-hopping gait
- exercise intolerance
Hip Disease (Physical Exam)
- muscle atrophy
- protrusion of greater trochanter dorsal and lateral
- pain on hip extension or hip movement
- decreased hip range of motion
- crepitus
- ortolani signs
Hip Disease (medical/ Conservative treatment)
- weight management is the best
- exercise modification programs
- physical rehab
- essential fatty acids
Do dietary supplements or stem cells help treat Canine Hip Disease?
- no evidence to support that and they can actually be harmful
CHD - Exercise modification program examples
- cold and heat therapy
- maintain mobility and circulation
- inclines
- hydrotherapy
2 surgical options for CHD
- total hip replacement
2. femoral head and neck excision
Total Hip Replacement (indications)
- any disability from hip OA
- failure to achieve activity level desired by dog or o
- failure of medical management
- no skin bacterial disease
- no UTI
- no dental fractures
Total Hip Replacement (non-cemented adv.)
- no bone cement complications ( infection, immune rxn, breakage, neuropraxia)
- longer life span on implants
Total Hip Replacement (cemented adv.)
- less precise measurements preop
- implant stable as soon as cement cures
- technically easier
- no subsidence in straight femures
Total Hip Replacement (outcomes)
- can return to n function
- complication at 10-40%
- many mistakes are surgical mistakes or poor owner compliance
Femoral Head and Neck Excision
- gait will not be normal
- very good at removing pain
Femoral Head and Neck Excision (indications)
- femoral head and neck fractures
- aseptic necrosis of femoral head
- acetabular fractures
- hip luxations
- failed THR
Femoral Head and Neck Excision (Ostectomy)
- hold femur at 90
- cut caudal angle 35-45
- muscle flaps not helpful
Femoral Head and Neck Excision (outcome)
- correct ostectomy (no neck left, torchanter left intact)
- rehab. plan per owner
- limb use before surgery
Aseptic Necrosis of Femoral Head
- usually unilateral
- small dogs
- Etiology - heritable (toy poodle, terriers)
- Pathogenesis - blood supply is disrupted (circumflex femoral vain)
Aseptic Necrosis of Femoral Head (Clinilal presentation, tx, rec)
Clinical Presentation: - mild trauma @ 4-12 months of age - non-partial weight bearing Tx and Rec: - conservative doesn't work - FHO or THR
Hip Dysplasia in Cats
- 1.2% were clinical
Best preventative for Hip Disease
- don’t breed and keep thin
T/F: conservative treatment is only effective for less than half of hip disease.
F; conservative is good for ~75%
T/F: THR can restore normal function but is technical and has higher rates of complications
T
T/F: FHO can be successful but is ideal for smaller and requires rehabilitation
T
How to treat a dog with congenital/ traumatic elbow luxation?
- Severe OA? –>
Yes = Salvage via arthrodesis/ amputation
No
–> Avulsion frx? Articular frx? > 48-72hrs?
Yes = open reduction, lig reconstruction, fx repair
No = Closed Reduction
–> Stable
Yes = temp stabilization in extension
No = back to open reduction
How long to splint a dog treated for elbow luxation?
5-7 days
T/F: congential and traumatic elbox luxation are treated the same way
T
Signalment and History for Incomplete Ossification of Humeral Condyle (IOHC)
Signalment: spaniel breeds, 90% bilateral
History: front limb lameness and SH type 4 frx caused by minor/ no trauma
4 components of elbow dysplasia
- Elbow incongruence
- OCD of medial humeral condyle
- Fragmented coronoid process
- Ununited anconeal process
Treatment of Elbow Dysplasia (OC/ OCD)
- debridement –> defect will fill w/ fibrocartilage; resurfacing via osteochondral autograph
Treatment of Elbow Dysplasia (Elbow Incongruence)
- ulnar osteotomy
- controlled distraction surgery
Treatment of Elbow Dysplasia (Anconeal Process)
minimally displaced fragment –> proximal ulnar osteotomy
old or highly displaced frag –> removal of fragment
Treatment of Elbow Dysplasia (Coronoid Process)
fragment removal via arthroscopy
3 functions of cranial cruciate
- prevents cranial translation of tibia
- prevents medial patellar luxation
- prevents hyperextension of stifle
2 pathognomonic ortho exam findings for confirming CCL
- Drawer’s test
2. Tibia compression test (indirect drawer)
3 (maybe 4) most common surgery treatment methods for cranial cruciate repair
- Lateral Sutures (static)
- Tightrope (static)
- Tibial Plateau Leveling Osteotomy (TPLO)
- Tibial Tuberosity Advancement (TTA)
Lateral Sutures
- suture around fabella and through a hole in tibia
Tightrope
- much stronger suture than lateral, but braided
- potential for infection d/t braided
2 Reasons why medial meniscus more likely to be damaged than lateral meniscus?
- mid-body of meniscus attached to the MCL
2. caudal meniscal tibial ligament holds meniscus in place so no stretch/ less than lateral
Function of the meniscus
- force redistribution
2. joint stability
Rational behind meniscal release
- for an intact meniscus
- prevent future meniscal injury
- gets rid of hammock function
Rational behind meniscectomy
- for a torn meniscus
- remove source of pain
- save as much normal tissue as possible
2 radiographic views for CHD needed for surgery
- cross-table cranial-caudal
- open leg lateral
Shoulder OCD (common location, diagnosis, treatment, prognosis)
- inherited condition, usually bilateral
- caudomedial humeral head
Diagnosis: rads, CT, Arthroscopy
Treatment: conservative not helpful if OCD; flap removal and debridement via arthroscopy
Prognosis: good - excellent following surgery
Glenoid Dysplasia (signalment, clinical signs, treatment)
- toy breed dogs
- luxation usually medially
Clinical Signs: lameness, atrophy
Treatment:
–> Stabilization surgery doesn’t seem to work
–> Salvage procedure has fair prognosis (arthrodesis or excision arthorplasty)
Incomplete Ossification of Caudal Glenoid
- usually incidental finding
- may cause pain and lameness but usually d/t other conditions
- may see resolution after removal of fragment
Biceps Brachii Tendinopathy (signalment)
- adult, active large breed
Biceps Tendon ( origin, insertion)
origin - supraglenoid tubercle
insertion - prox. radius and ulna
Biceps Brachii Tendinopathy ( Diagnosis)
- pain @ biceps tendon
- (+) biceps test – flex shoulder, extend elbow
- shoulder drawer test
- biceps retraction test
Biceps Brachii Tendinopathy ( radiography and US)
- not super useful
- US only useful on lateral
Biceps Brachii Tendinopathy ( Treatment)
- medical for mild lameness ( rest and NSAIDs)
- surgical: tenodesis or biceps brachii transection
Supraspinadus tendinopathy
- mineralization of supraspinatus
- large breeds
- Diagnosis: low grade lameness, pain on palpation
- Treatment: NSAIDs, rest, Surgery for removal of tendon
Infraspinadous contracture
- active hunting dogs w/ acute onset distal limb abduction and foot circumduction
- Treatment: transection of tendon
- Prognosis: good - excellent
Medial - Joint Instability
- tearing of medial glenohumeral ligament, subscapular muscle, joint capsule Clinical Signs and Diagnosis: - lameness, pain on abduction - increased abduction - atrophy - measure angle of abduction
What is the most common cause of shoulder lameness in the young, large dog
OCD
T/F: incomplete ossification of the glenoid rarely needs treatment
T
T/F: Glenoid Dysplasia can become clinical at any age and requires arthrodesis or glendoid excision arthroplasty
T
What is the most common soft tissue injury in dogs?
Biceps Brachii Tendinopathy
Tibial Plateau Leveling Osteotomy (TPLO)
- change direction of joiint surfaces to change direction of joint contact force
Tibial Tuberosity Advancement (TTA)
- change direction of quadriceps pull to change direction of trans-articular force
Panosteitis (risk factors/ signalment)
- young, male, >23kg, during summer and fall
Panosteitis ( pathogenesis)
- fat necrosis in bone marrow
- vasc proliferation and local bone formation at nutrient foramen ( increase intraosseous pressure)
- further bone formation from congestion
Panosteitis (Clinical Signs and Dx)
- shifting leg lameness
- Rads: smoke in the chimney ( may look normal / thickened periosteum )
Panosteitis ( Tx)
- palliative only, good prognosis
Hypertrophic Osteodystrophy (HOD) (signalment)
- young, rapidly growing, male, large breeds
HOD ( pathogenesis)
- zone of abnormal trabeculae bone in metaphysis
- hemorrhage , inflammation, necrosis, and fibrosis
HOD ( clinical signs and diagnosis)
- exam = metaphyseal swelling, lameness, systemically ill, fever
- Rads = lucent line metaphysis, excessively enlarged meatphysis
HOD ( tx and prognosis)
- supportive only
- self limiting condition but can cause 2* growth deformities
OC (Risk factors)
- young, large - giant, males
- heritable
- overfeeding –> rapid growth
- high Ca and Vit. D
OC ( Pathogenesis)
- ischemia to certain location of subchondral bone causing death
OC ( Osteochondrosis Lesion)
- fate depends on size, vascularized?, extent of attachments
Reattach: only in animals <25 weeks of age
Detach: flap/ joint mouse –> OCD
OC ( Locations)
- Femur = condyle, head
- Humerus = medial condyle, head
- Tarsus = talus
OC ( Diagnosis)
- exam for joint effusion, pain on joint manipulation
- rads, ct, mri
OC (treatment)
- medical
- surgical:
- -> Palliative (currettage, abrasion arthoplasty)
- -> Restorative (osteochondral transplants, grafts, implants)
OC (prevention)
- selective breeding
- control of energy and diets while young
Retained Ulnar Cartilagenous Core
- core of cartilage from distal metaphysis into diaphysis of ulna
- 3-4 month old, large-giant breed
- dx on rads
- tx not necessary
- prg depends on degree of growth retardation
Swimmer Syndrome
- poorly understood
- 1-2 weeks of age
- decreased muscle tone forces sternal recumbency
- causes sternal and limb range of motion changes
- tx supportive
- prognosis good if treated aggressively with PT be <3-4 weeks of age
Carpal Laxity Syndrome
- either hypoextension or hyperextension of carpus
- 6-16 weeks in large breed dogs
- pathogenesis unknown
- tx: resolves spontaneously post 2 weeks… do not splint the limb
5 Signs of an Aggressive Bone Lesion on rad
- pattern of osteolysis
- cortical lysis
- irregular periosteal reaction
- long zone of transition
- quick rate of change
Normal coxo-femoral joint
- 50% coverage of dorsal acetabulum
2. parallel subchondral bone margins
Radiographic features of DJD
- increased synovial mass
- Periarticular new bone formation
- Decreased joint space
- Subchondral bone sclerosis
