Ortho 1

Question 1

what is panosteitis?

Answer 1

a self limting disease of the long large bones of large and giant breed dogs (usually young animals/juveniles).

most commonly affects the ulna, then the radius, humerus, femur, and tibia

Question 2

what causes panosteitis?

Answer 2

exact cause is unknown; could be a result of high protein and calcium in the feed. dogs that weigh more are at an increased risk

Question 3

how do you diagnose panosteitis?

Answer 3

signalment, history, PE, and radiographs. no systemic signs of illness are present

on rads: patchy opacities (thumb marks)

Question 4

you see a 5mo bernese mountain dog with a painful right left forelimb. on radiographs you see circumscribed cortical bone opacities in the medullar of the ulna. how will you treat this dog?

Answer 4

exercise restriction, NSAIDs, or if severe pain, hospitalization and opioids. prognosis is good to excellent.

Question 5

what are the major risk factors for OA?

Answer 5

age: as chondrocytes age they produce lower quality matrix and they are less able to respond to the environment and are not able to repair themselves as well

obesity: increased load on the joints
spaying/neutering: increased risk of many ortho diseases

Question 6

briefly describe the pathogenesis of OA

Answer 6

there are changes in ALL tissues of the synovial joint: the articular cartilage, subchondral bone, osteophyte and entheophyte formation, synovial inflammation, and fibrosis

Question 7

difference between osteophyte and enthesophyte

Answer 7

osteophyte: outgrowth of bone at the margin of an articular surface

enthesophyte: a bone spur forming at ligament or tendon insertion into bone, growing in natural direction of pull of ligament/tendon

Question 8

OA is usually secondary to…

Answer 8

some other joint abnormality like instability, laxity, fracture, etc.

Question 9

clinical signs of OA in dogs and cats

Answer 9

dogs: reluctance to exercise, exercise intolerance, stiffness, lameness, inability to jump, behavioral changes, abnormal gait, muscle atrophy, joint swelling, joint effusion, crepitation, gradually worsening

cats: more hidden, reduction in activity, reluctance to jump, unkept appearance, not being able to jump as high

Question 10

what do you expect to see on rads with OA?

Answer 10

osteophytosis, enthesophytes, effusion, soft tissue swelling, subchondral sclerosis, intra-articular mineralization, subchondral cysts

Question 11

______ is the most valuble and cost effective means to assess joints

Answer 11

arthroscopy

Question 12

if there is any doubt about underlying disease process of the joints, you should

Answer 12

do arthrocentesis and evaluation

Question 13

best way to manage OA? (non surgical)

Answer 13

weight management
exercise modification
NSAIDs
solensia for cats
omega 3s

Question 14

what surgical treatment options are there for OA?

Answer 14

joint debridement and micropick, joint replacement, joint excision (femoral head osteotomy), arthrodesis (fusing joints), amputation

Question 15

osteochondrosis is a disorder of the process of ________

Answer 15

endochondral ossification

Question 16

describe the difference between these terms:
osteochondrosis latens
osteochondrosis manifesta
osteochondrosis dissecans

Answer 16

latens: an early microscopic lesion
manifesta: subclinical lesions on rads but clinically present
dissecans: cartilage flaps present, clinical signs present

Question 17

where does the dog tend to get osteochondrosis?

Answer 17

the humeral head, medial humeral condyle, on the femoral condyles, trochlear ridges of the talus

Question 18

what causes osteochondrosis?

Answer 18

usually inherited as polygenetic trait

joint morphology/conformation plays a part as well

rapid growth (large/giant breeds)

Question 19

describe the pathogenesis of osteochondrosis?

Answer 19

not fully understood, suspect an avascular necrosis of developing epiphyseal cartilage (damage to vessels)

could also be a defect in the subchondral bone

Question 20

a 6mo lab comes to you with lameness and exercise intolerance, mainly in the front legs. on PE, you find some joint effusion in the shoulder joints and the dog seems painful. differential? next steps for diagnosis?

Answer 20

osteochondrosis

i would do rads to look for: flattening of subchondral bone, concavity, sclerotic bone, mineralized cartilage flaps, joint mice

if available, arthoscopy is also a good option

Question 21

in which cases can you non surgically manage osteochondrosis? what does non surgical management include?

Answer 21

young dogs with mild clinical signs, no joint mice, or are in unimportant location

in dogs with advanced secondary OA where it’s hard to remove a flap (like on the talus)

NSAIDs, exercise restriction, crate confinement, dietary supplements like omega 3s, glucosamine, weight control, calorie restricted diet

Question 22

true or false: in young dogs with shoulder OCD, you should recommend vigorous exercise

Answer 22

true!

Question 23

what surgical options are available for treating oesteochondrosis?

Answer 23

arthrotomy or arthroscopy, flap excision and joint mouse retrieval

Question 24

what are the goals of doing a surgical procedure for oestochondrosis?

Answer 24

relieve clinical signs and restore pain free function
prevent or delay onset of secondary OA

Question 25

the least common location for OCD is

Answer 25

the stifle

Question 26

which locations for OCD have the best prognosis and which ones have the worst?

Answer 26

best: shoulder
medium: stifle, medial humeral condyle
talus: worst

Question 27

what are your differentials for an acute pelvic limb lameness in a small breed dog?

Answer 27

hip luxation, hip dysplasia, avascular necrosis of the femoral head, patellar luxation, CCLR, neoplasia, infection

Question 28

what is avascular necrosis of the femoral head and who gets this disease?

Answer 28

a non-inflammatory aseptic necrosis of the femoral head and neck, happens in small breed dogs. ages 4-11 months. the cause is not understood.

Question 29

avascular necrosis of the femoral head often presents as

Answer 29

a mild intermittent lameness shifting to an acute non weight bearing lameness

Question 30

on rads, avascular necrosis of the femoral head looks like an

Answer 30

apple core

left side is abnormal

Question 31

treatment for avascular necrosis of the femoral head

Answer 31

femoral head and neck excision
total hip arthroplasty

Question 32

true or false: rest and conservative therapy is very successful for avascular necrosis of the femoral head

Answer 32

false! it is successful less than 25% of the time

Question 33

differentials for an acute pelvic limb lameness in a young cat?

Answer 33

hip luxation, hip dysplasia, patellar luxation, CCLR, neoplasia, infection, and slipped capital femoral epiphysis

Question 34

what is “slipped capital femoral epiphysis”

Answer 34

a NON traumatic process, mostly in cats, esp in male neutered overweight cats, often bilateral

presents: lameness, poor jumping, weakness, crepitation, pain

Question 35

treatment options for slipped capital femoral epiphysis?

Answer 35

femoral head and neck excision
total rip replacement

** better with early surgical repair

Question 36

what rad view do you want to do if you are investigating a slipped femoral epiphysis?

Answer 36

frog leg view

Question 37

what is hypertrophic osteodystrophy?

Answer 37

occurs in young rapidly growing dogs, usually large breeds,

swelling of distal metaphyses of the radius, ulna, tibia

Question 38

a young large breed dog presents for fever, anorexia, pain, and inability to walk. on rads you see a double physis line. diagnosis?

Answer 38

hypertrophic osteodystrophy

Question 39

prognosis for hypertrophic osteodystrophy?

Answer 39

good! using symptomatic therapy, will see improvement in 7-10 days and the bony changes will take a few months to improve

Question 40

what is hypertrophic osteopathy and how is it different than hypertrophic osteodystrophy?

Answer 40

osteopathy: a periosteal reaction of the distal extremities, usually associated with primary or metastatic neoplasia (like in the lungs)

oesteodystrophy