Shoulder Flashcards
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
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
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.
4
Q
Biceps brachii tendinopathy signalment?
A
- Mature adult dogs
- medium and large breed dogs
5
Q
State the type of lameness for biceps brachii tendinopathy?
A
weight bearing lameness
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
7
Q
What views on rads do we look for with biceps tendinopathy?
A
- Lateral/craniocaudal
8
Q
The skyline view for biceps tendon with rads?
A
Cranioproximal-craniodistal
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
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
11
Q
What are the indications for biceps tendinopathy?
- Refractory to _____therapy
- ______ biceps tendon
- Chronic ______ ______
- Moderate to severe lameness
A
- medical
- ruptured
- bicipital tenosynovitis
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
13
Q
What 2 anatomical references are with the rotator cuff?
A
- Subscapularis tendon (medial)
- Teres minor, supra- and infraspinatus (lateral)
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)
15
Q
Repetitive microtrauma (“overuse” injury) can cause ______ instability
A
shoulder
16
Q
~80% ______ shoulder instability
A
medial
17
Q
What is the common signalment for shoulder instability?
A
- Medium/large breed
- Adult
18
Q
When you have shoulder instability the patient has a poor response to _____ and _____
A
rest and NSAID
19
Q
Describe the normal type of lameness with shoulder instabiltiy?
A
Variable lameness
- Usually subtle, intermittent
- Occasionally severe
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
21
Q
Normal abduction angle= ____ degrees
Abnormal abduction angle = _____ degrees
A
- Normal ~30 degrees
- Abnormal ~50 degrees
22
Q
What is the modality to evaluate the joint with shoulder instabiltiy?
A
Arthroscopy
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
- Arthroscopic radiofrequency shrinkage of attenuated ligaments and joint capsule
-
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
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
* Velpeau sling
* hobbles 3-4 months
* recovery 4-6 months
26
\_\_\_\_\_\_\_\_ 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**
Infraspinatus
27
Describe the common signalment for Insfraspinatus contracture
Infraspinatus = I = I LOVE HUNTING
* Active
* Adult
* Medium to large breed
* Hunting breeds!!! (brittney and springer) (pointers)
28
Compare and contrast when acute versus chronic lameness subsides with infraspinatus contracture?
* Acute lameness
* subsides in 10-14 days
* Chronic lameness
* static 2-4 weeks later
29
What type of lameness is there with infraspinatus contracture?
* NON PAINFUL
* NON WEIGHTBEARING lameness
30
Describe what happens in infraspinatus contracture with the elbow and antebracium?
## Footnote
The elbow is \_\_\_\_\_\_\_
The antebrachium is \_\_\_\_\_\_\_
* Elbow-**_adducted_**
* Antebrachium **_abducted_**
31
This is a characteristic posture for _______ contracture causing a limited range of motion. Is there any pain on manipulation of joint: \_\_\_\_
infraspinatus, no pain!
32
* With infraspinatus contracture can the scapulohumeral joint be internally rotated?
* What happens when the shoulder is rotated?
* No! scapulohumeral joint cannot be internally rotated
* scapula elevates when shoulder is rotated
33
True or False:
## Footnote
Conservative treatment greatly improves infraspinatus contracture versus surgery
FALSE!! conservative treatment unhelpful
34
What is the ideal treatment for infraspinatus contracture (3)? Prognosis?
1. Tenectomy of infraspinatus tendon
2. Release other capsular adhesions
3. Physical therapy is ideal
* Prognosis is excellent
35
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
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
Describe whether or not traumatic shoulder luxation is associated with pain and what type of lameness?
* Non weight bearing lameness
* Pain on palpation of shoulder
37
Traumatic shoulder luxation causes malpositioning of the ______ \_\_\_\_\_\_.
* Medial luxation: distal limb is \_\_\_\_\_\_
* Lateral luxation: distal limb is \_\_\_\_\_\_
* Traumatic shoulder luxation causes malpositioning of the **_greater tubercle_**.
* Medial luxation: distal limb is **_abducted_**
* Lateral luxation: distal limb is **_adducted_**
38
Is lateral or medial traumatic shoulder luxation more common?
**M**edial **M**ost common
39
What type of splints/slings do we use for medial/latral/cranial/caudal traumatic shoulder luxation?
* Medial Luxation
* **Velpeau sling**
* Lateral/Cranial/Caudal luxation
* **Spica**
40
WHAT is the treatment for traumatic shoulder luxation when theres no fractures and a closed reduction can be applied?
Stabilize the join with either a velpeau sling or spica splint depending on the area of luxation.
41
If chronic recurrent unstable luxation occured with traumatic shoulder involvement and there's accompanying fractures what treatment is indicated?
Surgery!
* Open reduction + ligament repair
* simple arthrotomy to evaluate and reduce the joint
* Imbrication repair of capsule during closure
* Glenohumeral ligament reconstruction
42
What is the prognosis with traum. shoulder luxation?
\_\_\_\_\_\_ reduction is generally successful to restore normal joint function
* good to excellent
* Closed
43
Traumatic shoulder luxation open reduction procedure done is called this?
What is the goal?
* Capsulorrhaphy and MGHL reconstruction
* Goal is to maintain normal joint motion
44
\_\_\_\_\_\_\_ ________ are indicated for the shoulder when theres severe DJD causing pain and severe comminuted fractures and intractable luxations
Salvage Procedure
45
What are your 3 salvage procedures for shoulder?
* Arthodesis
* Glenoid Excision
* Amputation
46
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
* Arthodesis
* bilateral
47
If the fracture is severely comminuted we often must institute ______ as a shoulder salvage procedure?
Amputation
48
Always place a ______ bone graft in \_\_\_\_\_\_
Always place a **Cancellous** bone graft in \_\_\_\_\_\_**arthodesis**
49
With glenoid excision be super careful about not penetrating or injuring this?
suprascapular nerve
50
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 +/-
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
Describe the signalment for congenital shoulder luxation?
* **_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
State whether or not trauma is reported, whether its acute or chronic lameness and the reoccurance in congenital shoulder luxation? (3)
* **_Minimal or no trauma reported (Q)_**
* Chronic lameness beginning at an early age
* Lameness may be intermittent
53
* 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
* 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
Can we medically manage congential shoulder luxation in terms of a treatment option?
NOPE
55
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??
* SURGERYYYYY
* Open reduction/capsulorrhaphy only (surgery)
* Glenohumeral ligament reconstruction (surgery)
