Ortho ligaments and tendons + miscellaneous bone

Question 1

What are ligaments and tendons made of

Answer 1

Type 1 collagen 98% in proteoglycan matrix

= made by fibroblasts

Question 2

What is the difference in blood supply to tendons and ligaments

Answer 2

Poor to both
Better to tendons since comes from multiple sites rather than the just insertion points

Question 3

How do tendons and ligaments heal

Answer 3

Scar tissue
Very slow healing; gets back to only 60% by 6 weeks

Always susceptible to re-injury

Question 4

Ligament injury types; sprains - how we treat them

Answer 4

type I = minimeal tearing, some internal haemorrhage - just rest and support for 2 weeks

type II = partial tearing and stretching of fibres; with haemorrhage - do surgical repair = suture ligament or prosthetic

Type III = complete rupture or avulsion of attachment; surgical repair and prosthetic replacement; may need arthrodesis in some instances

Question 5

How are collated ligaments usually injured

Answer 5

Trauma e.g RTA

Question 6

What is a stressed radiograph useful for

Answer 6

Proving instability in a joint and checking at which level it is
By tying above and below the joint and pulling in opposite directions to stress

Question 7

How do we treat collateral ligament injuries

Answer 7

Surgery unless no instability
Primary repair of ligament; then reinforce with prosthetic repair and immobilise joint for a while then controlled mobilisation

Question 8

How should we deal with open ligament injuries

Answer 8

These are typically shear injuries from being dragged along floor by car

Need to reinforce joint and protect it
Don’t necessarily need surgery can just do external fixation and allow soft tissues to granulate

Question 9

What is an arthrodesis

Answer 9

Permanent rigid fusion of a join
Salvage procedure

Question 10

What are the two forms of carpal hyperextension

Answer 10

Acute rupture due to jump down injury; more paindul

Degeneratime form = insidious onset and less painful

Question 11

How do we treat carpal hyperextension due to ligament rupture/degeneration

Answer 11

Can’t do primary repair because more than one ligament usually affected
So do carpal arthrodesis (two types)

Question 12

What are the two types of carpal arthrodesis

Answer 12

Partial carpal: = from radiocarpal bone down so will have most movement of the joint BUT often poor outcomes as these is still disruption at the top level

Pancarpal arthrodesis spans the entire carpus

Question 13

What are the two forms of plantar ligament rupture

Answer 13

Traumatic assocaited with jump down

Degenerative form; typically in Shetland sheedogs

Question 14

What does an animal with plantar ligament rupture/degeneration look like

Answer 14

See deviation in tarsus like an extra joint

Question 15

Treatment options for plantar ligament rupture

Answer 15

Partial tarsal arthrodesis splanning distal joints; ideally do this since retain more movement

Pantarsal arthrodesis will give no movemet

Question 16

Which animals do we tend to see congenital shoulder luxation

Answer 16

Small breed dogs
= rare

Question 17

How can we treat congenital shoulder luxation

Answer 17

Some cope with conservative

Others need excisional arthroplasty or arthrodesis (salvage)

Question 18

Why can we only do conservative or salvage proceudres for congenital shoulder luxation

Answer 18

Because joint is very dysplastic

Question 19

Which direction do most hip luxations go in

Answer 19

Craniodorsal
Need 2 views to tell which direction

Question 20

Diagnosis of hip luxation

Answer 20

Clin exam = shortened limb, inward leg torsion, see ilial crest/greater trochanter/tuber icschium in a striaght line not a trianlge

Radiographs

Question 21

Management of hip luxation

Answer 21

Usually closer reduction; put animal in lateral recumbency, externally rotate femur pull distally and internally rotate back in
Then must do range of motion tests for instability and and X rays

Ehmer sling applied to dogs; cats crate rested

Question 22

Indications for open reduction of hip luxation

Answer 22

Articular fractions
Chronic luxation
Other injuries present e.g on other leg that prevents overloading hat leg
Unsuccessful closed reduction/reluxation

Question 23

Open reduction techniques for hip luxation

Answer 23

Most common = toggle pin fixation

Prosthetic capsule
Iliofemoral suture
Transarticular pin not recommended since pin can snap and joint moves so is loose

Question 24

What are the salvage surgery options for hip luxation

Answer 24

Femoral head and neck excision
Total hip replacement

Need to consider earlier if underlying hip dysplasia or for non-reconstructbale articular frctures

Question 25

Which tendon has a degenerative disase of chronic mineralisation

Answer 25

Common calcineam tendon

Question 26

What drugs might be involved in tendon injury

Answer 26

Corticosteroids
Fluoroquinolones

Question 27

What does it mean if we can flex the hock while stifle maintained in extension

Answer 27

There is a common calcineum tendon rupture

Question 28

How does an animal look with SDF tendon rupture

Answer 28

very flat toes

Question 29

Some tehcniques for repairing tendon ruptures

Answer 29

Locking loop (for flatter tendons)
Three loop pulley for rounder ones

Question 30

What sutures do we use to repair tendon ruptures

Answer 30

Probably permanent e.g prolene
Monofilament

PDS could be okay but doesn’t last as long

Question 31

What breed typically get biceps tendon luxation

Answer 31

Lurchers

Question 32

Treating biceps tendon luxation

Answer 32

Surgery; sutures/plates

Question 33

If we feel a popping when manipulating the shoulder what might this be

Answer 33

Biceps tendon luxation

Question 34

What signs do we get with bicipital tenosynovitis and which individuals

Answer 34

Active, large breed dogs

Insidious onset chronic front limb lameness
Pain on direct palpation (medial to greater tubercle)

Question 35

How can we do the biceps test for pain (e.g in bicipital tenosynovitis)

Answer 35

Flex shoulder and extend elbow to do max extension of the tendon and look for pain response

Question 36

Treatment of bicipital tenosynovitis

Answer 36

Usually conservative
For non-responsive cases can do biceps tendon release via arhtroscopy

Question 37

puppy carpal laxity/hyperflexino presentation and treatment

Answer 37

3-4 months old
Non-painful

Self resolve and ensure eating correct diet

Question 38

When do we typically see quadriceps contracture

Answer 38

Associated with femoral fractures in young growing animals since muscle gets involves in the fracture and callus causing bowstring effect as femur elongates

Mild cases rehab
Severe arthrodesis

Question 39

When do we typically see infraspinatus contracture

Answer 39

Working dogs
Damage by single episode or repeat trauma
Can’t get full extension of shoulder giving tpical leg out postureT

Question 40

Treatment of infraspinatus contracture

Answer 40

Tenotomy of infraspinatus tendon

Question 41

Treatment of gracilis contracture

Answer 41

Can’t really- partial myotomy gives temporary alleviation but tends to recur

Non-painful

Question 42

What are the 2 indications for arthrodesis

Answer 42

Joints so arthritic they are painful and can’t do resection or joint replacement

Non-reconstructable articular fractures

Question 43

How to do an arthrodesis

Answer 43

Remove cartilage at end of either bone, pack with autologous bone graft and use stable fixation under compression

Want fixation at an anitomical angle

Question 45

How do dogs with avascular necrosis of the femoral head present

Answer 45

Severe pain on hip flexion/extension
Unilateral (unlike many hip dysplasia cases)
Musle wastage

Question 46

What are the radiographic findings with avascular necrosis of the femoral head/neck

Answer 46

First see lucent areas of lysis (related to reperfusion injury after initial damage and avascularity)

Then get collapse and mushrooming

Question 47

What are the treatment options for avascular necrosis of the femoral head

Answer 47

Conservative; but not good if very painful
Surgery =total hip replacement or femoral head and neck excision

Question 48

What is panosteitis and how do they present

Answer 48

Focal areas of endosteal bone proliferation
Present as shifting lameness from multiple limbs, dull, anorexic/pyrexic from pain
+ painful bones on deep palpation

Question 49

Which individuals are most prone to panosteitis

Answer 49

Young dogs 5-18mo
GSDs mostly
M > F

Question 50

What does panosteitis look like on histopath

Answer 50

Very pink on H and E due to intramembranous ossification (hence ‘eosinophilic panosteitis’

See stromal cell proliferation
Medullary adipocyte degeneration

Question 51

Radiography findings with panosteitis and which sites are most typical

Answer 51

Patchy increase in density of medullary bone with whorls of new bone formation like a thumbprint

Lose cortex/medullary distinction since medulla much more dense

Classic in distal humerus, prox ulna

Question 52

Management of panosteitis

Answer 52

Conservative with pain management
Can recur until they are 18 months

Question 53

Which breeds do we see craniomandibular osteopathy in and what age

Answer 53

Terriers; mostly westies, also scotties, bostons, cairn

Young - 3-8 mnths old

Question 54

Signs of craniomandibular osteopathy

Answer 54

Enlarged mandibles, limited mouth opening, pain on attempting to open mouth
[main ddx = broken jaw]

Radiography: proliferative new bone on madibles, TMJs, bullae

Question 55

Treatment of craniomandibular osteopathy

Answer 55

Conservative: analgesia, anti-inflammatories, sterois, liquid food/feeding tube, hospitalisation

Good prognosis since self limiting but may need euthanasia due to severe pain

Question 56

What is metaphyseal osteopathy and which individuals do we see it in

Answer 56

= hypertrophic osteodystrophy at metaphyses
Seen in large and giant breeds age 2-8 months
Inclear aetiology

Question 57

Radiographic signs with metaphyseal osteopathy

Answer 57

Sclerotic line adjacent to physis with radiolucent zone adjacent to this

Periosteal new bone formation

Question 58

Treatment of metaphyseal osteopathy

Answer 58

Conservative: balanced diet, painkiller, rest, can use antibiotics if concerned about infection

Self-limiting but risk of GP closure and angular limb deformity

Question 59

What is Marie’s disease

Answer 59

= hypertrophic osteopathy; where there is new bone formation around distal bones secondary to throacic disaese
90% have pulmonary neoplasia

Question 60

What orthopaedic sign can we see in pulmonary neoplasia cases

Answer 60

Marie’s disease; hypertrophic new bone formation around distal bones