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6th MELEAH Sur-Gur-RAYYY final lezzzz ace dis shit > Shoulder > Flashcards

Shoulder Flashcards

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1
Q

What are the Biceps Brachii proposed etiopathogenesis?

  • Repetitive _____ _____
  • Injury with _____ _____ disruption
  • Acute to chronic _______ of tendon and assocated synovial tissues also present ________
A
  • Repetitive strain microtrauma
  • Injury with tendon fiber disruption
  • Acute to chronic inflammation** of tendon and assocated synovial tissues also present **histopathologically
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2
Q

What is the origin and insertion for Biceps Brachii?

A
  • Origin:
    • supraglenoid tubercle (intra-articular)
  • Insertion:
    • medial tuberosity of proximal radius and adjacent ulna
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3
Q

Biceps Brachii travels in the ______ ______ and is constrained by ______ ______. The Joint capsule forms a _______.

_____ tissue surrounds the proximal ______

A

Biceps Brachii travels in the intertubercular groove​** and is constrained by **transverse retinaculum.** The Joint capsule forms a **bursa.** **Synovial** tissue surrounds the proximal **tendon.

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4
Q

Biceps brachii tendinopathy signalment?

A
  • Mature adult dogs
  • medium and large breed dogs
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5
Q

State the type of lameness for biceps brachii tendinopathy?

A

weight bearing lameness

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6
Q

Biceps Brachii Tendinopathy:

  • Physical examination findings
    • Muscle atrophy or none?
    • Pain or no pain?
    • Maximally flex shoulder and extend elbow
      • Deep palpation over intertubercular groove
      • Apply tension to biceps insertion
    • Standing exam, under load: tension to biceps
A
  • Muscle atrophy or none?
    • ​Yes muscle atrophy
  • Pain or no pain?
    • ​Pain
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7
Q

What views on rads do we look for with biceps tendinopathy?

A
  • Lateral/craniocaudal
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8
Q

The skyline view for biceps tendon with rads?

A

Cranioproximal-craniodistal

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9
Q

What is the treatment for acute biceps brachii tendinopathy?

A

Treatment – acute

  • Confinement for 4-6 weeks
  • Non-steroidal anti-inflammatory drugs
  • +/- Physical therapy
  • EBM lacking
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10
Q

What is the treatment for recurrent/persistent biceps brachii tendinopathy?

A
  • Intraarticular/Bicipital tendon sheath infiltrated corticosteroid injection
    • Methylprednisolone acetate (Depo-Medrol)
    • Sample for joint fluid analysis/culture
  • Strict confinement, 4-6 weeks
  • Physical therapy
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11
Q

What are the indications for biceps tendinopathy?

  • Refractory to _____therapy
  • ______ biceps tendon
  • Chronic ______ ______
  • Moderate to severe lameness
A
  • medical
  • ruptured
  • bicipital tenosynovitis
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12
Q

Biceps Tendinopathy prognosis

  • Medical treatment: ?
  • Surgical treatment: ?
    • State the procedure: ______: excellent results reported
    • State the procedure: _____: classic treatment
A
  • Medical treatment: good to poor
  • Surgical treatment: good to excellent
    • Tenotomy: excellent results reported
    • Tenodesis: “classic” treatment
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13
Q

What 2 anatomical references are with the rotator cuff?

A
  • Subscapularis tendon (medial)
  • Teres minor, supra- and infraspinatus (lateral)
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14
Q

Shoulder instability is caused by laxity in support structures for the shoulder, what are those support structures (4)?

A
  • Medial/lateral glenohumeral ligaments
  • Joint capsule
  • Subscapularis tendon (medial)
  • Teres minor, supra- and infraspinatus (lateral)
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15
Q

Repetitive microtrauma (“overuse” injury) can cause ______ instability

A

shoulder

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16
Q

~80% ______ shoulder instability

A

medial

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17
Q

What is the common signalment for shoulder instability?

A
  • Medium/large breed
  • Adult
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18
Q

When you have shoulder instability the patient has a poor response to _____ and _____

A

rest and NSAID

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19
Q

Describe the normal type of lameness with shoulder instabiltiy?

A

Variable lameness

  • Usually subtle, intermittent
  • Occasionally severe
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20
Q

Please answer the following in reference to shoulder instability:

  • Pain or No pain in reference to manipulation of joint?
  • _____ instabiltiy
    • EXAM REQUIRES SEDATION
    • Increased ______ angle
A
  • Pain on manipulation of joint
  • Medial instability
  • Increased abduction angle
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21
Q

Normal abduction angle= ____ degrees

Abnormal abduction angle = _____ degrees

A
  • Normal ~30 degrees
  • Abnormal ~50 degrees
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22
Q

What is the modality to evaluate the joint with shoulder instabiltiy?

A

Arthroscopy

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23
Q

Compare and contrast (MILD/MODERATE/SEVERE) treatment for shoulder instability:

Assign to each severity level?

  • who gets rest
  • who gets physical therapy
  • hobbles or no hobbles
  • velpeau sling
  • surgery + (what type)
  • arthoscopic radiofrequency shrinkage + how that works?
A
  • Mild
    • Rest, PT, hobbles
  • Moderate
    • Arthroscopic radiofrequency shrinkage of attenuated ligaments and joint capsule
      • Thermal insult induces repair
      • Weakens tissue before it strengthens
    • Rest, PT, hobbles
  • Severe
    • SX: Medial glenohumeral ligament reconstruction
    • Velpeau sling instead of hobbles
24
Q

When using hobbles for shoulder instability (mild and moderate cases only) post op rehab lasts ______; Activity restriction takes place for _____; and retraining begins in ______

A
  • Postop rehab 3 weeks
  • Activity restriction 3-4 months
  • Retraining begins in 4-6 months
25
Q

When treating severe shoulder instability we often have to use a _____ ____ for 2-4 weeks post op. Then followed by hobbles for __-__ months and recovery for __-__ months

A
  • Velpeau sling
  • hobbles 3-4 months
  • recovery 4-6 months
26
Q

________ contracture

  • Contracture: muscle shortening not caused by active contraction
  • Acute, traumatic disruption of muscle fibers
  • Normal muscle- tendon unit replaced with fibrous tissue
  • Fibrosis and contracture secondary to necrosis
A

Infraspinatus

27
Q

Describe the common signalment for Insfraspinatus contracture

A

Infraspinatus = I = I LOVE HUNTING

  • Active
  • Adult
  • Medium to large breed
  • Hunting breeds!!! (brittney and springer) (pointers)
28
Q

Compare and contrast when acute versus chronic lameness subsides with infraspinatus contracture?

A
  • Acute lameness
    • subsides in 10-14 days
  • Chronic lameness
    • static 2-4 weeks later
29
Q

What type of lameness is there with infraspinatus contracture?

A
  • NON PAINFUL
  • NON WEIGHTBEARING lameness
30
Q

Describe what happens in infraspinatus contracture with the elbow and antebracium?

The elbow is _______

The antebrachium is _______

A
  • Elbow-adducted
  • Antebrachium abducted
31
Q

This is a characteristic posture for _______ contracture causing a limited range of motion. Is there any pain on manipulation of joint: ____

A

infraspinatus, no pain!

32
Q
  • With infraspinatus contracture can the scapulohumeral joint be internally rotated?
  • What happens when the shoulder is rotated?
A
  • No! scapulohumeral joint cannot be internally rotated
    • scapula elevates when shoulder is rotated
33
Q

True or False:

Conservative treatment greatly improves infraspinatus contracture versus surgery

A

FALSE!! conservative treatment unhelpful

34
Q

What is the ideal treatment for infraspinatus contracture (3)? Prognosis?

A
  1. Tenectomy of infraspinatus tendon
  2. Release other capsular adhesions
  3. Physical therapy is ideal
  • Prognosis is excellent
35
Q

Traumatic shoulder luxation can happen to any age or breed of _____ and is rare in _____. There is a history of _____ or evidence of injury and ____ in onset

A

Traumatic shoulder luxation can happen to any age or breed of dog and is rare in cats. There is a history of trauma or evidence of injury and acute in onset

36
Q

Describe whether or not traumatic shoulder luxation is associated with pain and what type of lameness?

A
  • Non weight bearing lameness
  • Pain on palpation of shoulder
37
Q

Traumatic shoulder luxation causes malpositioning of the ______ ______.

  • Medial luxation: distal limb is ______
  • Lateral luxation: distal limb is ______
A
  • Traumatic shoulder luxation causes malpositioning of the greater tubercle.
  • Medial luxation: distal limb is abducted
  • Lateral luxation: distal limb is adducted
38
Q

Is lateral or medial traumatic shoulder luxation more common?

A

Medial Most common

39
Q

What type of splints/slings do we use for medial/latral/cranial/caudal traumatic shoulder luxation?

A
  • Medial Luxation
    • Velpeau sling
  • Lateral/Cranial/Caudal luxation
    • Spica
40
Q

WHAT is the treatment for traumatic shoulder luxation when theres no fractures and a closed reduction can be applied?

A

Stabilize the join with either a velpeau sling or spica splint depending on the area of luxation.

41
Q

If chronic recurrent unstable luxation occured with traumatic shoulder involvement and there’s accompanying fractures what treatment is indicated?

A

Surgery!

  • Open reduction + ligament repair
    • simple arthrotomy to evaluate and reduce the joint
    • Imbrication repair of capsule during closure
    • Glenohumeral ligament reconstruction
42
Q

What is the prognosis with traum. shoulder luxation?

______ reduction is generally successful to restore normal joint function

A
  • good to excellent
  • Closed
43
Q

Traumatic shoulder luxation open reduction procedure done is called this?

What is the goal?

A
  • Capsulorrhaphy and MGHL reconstruction
  • Goal is to maintain normal joint motion
44
Q

_______ ________ are indicated for the shoulder when theres severe DJD causing pain and severe comminuted fractures and intractable luxations

A

Salvage Procedure

45
Q

What are your 3 salvage procedures for shoulder?

A
  • Arthodesis
  • Glenoid Excision
  • Amputation
46
Q

Which salvage procedure is invasive and $$$ and results in a mechanical lameness known as “peg leg”. We have to perform this procedure with caution if the patient has ________(bi or unilateral) disease

A
  • Arthodesis
  • bilateral
47
Q

If the fracture is severely comminuted we often must institute ______ as a shoulder salvage procedure?

A

Amputation

48
Q

Always place a ______ bone graft in ______

A

Always place a Cancellous bone graft in ______arthodesis

49
Q

With glenoid excision be super careful about not penetrating or injuring this?

A

suprascapular nerve

50
Q

Congenital shoulder luxation is caused by a _____ of ______ and _____. The luxation is usually ______ (medial or lateral) and ______(uni or bilateral). With the presence of glenoid dysplasia sometimes +/-

A

Congenital shoulder luxation is caused by a laxity of capsule and ligaments The luxation is usually medial (medial or lateral) and unilateral(uni or bilateral)

51
Q

Describe the signalment for congenital shoulder luxation?

A
  • Small and toy breeds
  • 3-10 months of age
    • Exceptions (not focused on so dont worry about just adding it, shetlend sheep dog aka lacey, kirby collie, and elkhound)
52
Q

State whether or not trauma is reported, whether its acute or chronic lameness and the reoccurance in congenital shoulder luxation? (3)

A
  • Minimal or no trauma reported (Q)
  • Chronic lameness beginning at an early age
  • Lameness may be intermittent
53
Q
  • In terms of PE with congential shoulder luxation we are looking for the _____ ______ (aspect of humerus) relative to the ______(aspect of scapula).
  • Is the joint easily reduced and reluxated?
  • Can we reduce if glenoid dysplasia? What can we do and why?
    • yes or no to reduce
    • best to try ____
    • No ______ to preserve
    • _____ will all fail
  • Is there pain on manipulation
A
  • In terms of PE with congential shoulder luxation we are looking for the greater tubercle (aspect of humerus) relative to the acromion (aspect of scapula).
  • Is the joint easily reduced and reluxated? YES
  • Can we reduce if glenoid dysplasia?
    • NO we cant reduce
    • best to try a salvage procedure to attempt tx
    • No articulation to preserve
    • conservative/closed/open recution will all fail
  • Is there pain on manipulation? minimal
54
Q

Can we medically manage congential shoulder luxation in terms of a treatment option?

A

NOPE

55
Q

IF we can’t medically manage congential shoulder luxation in terms of a treatment option, what can we do if they have a normal glenoid??

A
  • SURGERYYYYY
  • Open reduction/capsulorrhaphy only (surgery)
  • Glenohumeral ligament reconstruction (surgery)

6th MELEAH Sur-Gur-RAYYY final lezzzz ace dis shit (15 decks)

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