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RUSVM Small Animal Surgery 1 > Shoulder > Flashcards

Shoulder Flashcards

1
Q

What are the etiologies of biceps brachii tendinopathy?

A

Repetitive strain microtrauma
Injury with tendon fiber disruption

Acute to chronic inflammation of tendon and associated synovial tissues

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2
Q

What structures does the biceps brachii tendon run through?

A

Origin: Supraglenoid tubercle (intra-articular)

Travels in intertubercular groove
Constrained by transverse retinaculum
Joint capsule forms bursa

Synovial tissue surrounds proximal tendon

Insertion: medial tuberosity of proximal radius and adjacent ulna

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3
Q

Signalment for biceps brachii tendinopathy ?

A

Mature adult dog

Medium and large breeds

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4
Q

Presentation of biceps brachii tendinopathy?

A

Weight bearing lameness

  • chronic, intermittent
  • progressive
  • worsens with excercise
  • unilateral

Painful — maximally flexed shoulder and extended elbow, and on deep palpation over intertubercular groove

Muscle atrophy

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5
Q

Diagnosis of biceps tendinopathy?

A

Radiographs
— lateral/craniocaudal to rule out other diseases
—cranioproxminal-craniodisoal “skyline” — not commonly used

Arthrogram

Ultrasound

MRI
-cross sectional anatomy of all soft tissues

Arthroscopy gold standard
— lateral/craniocaudal radiographs + arthroscopy

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6
Q

What is the treatment for acute biceps tendinopathy?

A

Confinement for 4-6weeks
NSAIDS
+/- physical therapy

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7
Q

What is the treatment for recurrent/persistent lameness due to biceps tendinopathy?

A

Moderate, acute signs

Intraarticular/bicipital tendon sheath infiltrated corticosteroid injection — methylprednisolone acetate

Strict confinement for 4-6weeks
Physical therapy

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8
Q

What are the indications for surgery with biceps tendinopathy?

A

Refractory to medical therapy

Ruptured biceps tendon

Chronic bicipital tenosynovitis

Moderates to severe lameness

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9
Q

What is the surgical procedure to treat biceps tendinopathy?

A

Tenotomy of biceps tendon +/- tenodesis of bicipital tendon

Tenodesis —> fixation of the tendon in new location

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10
Q

What is the prognosis for biceps tendinopathy?

A

Medical treatment — good to poor

Surgical treatment
Tenotomy — excellent results
Tenodesis — good, excellent assisted arthroscopically

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11
Q

What are there support structures of the shoulder joint? Laxity of these structures will lead to shoulder instability.

A

Medial/lateral glenohumeral ligaments

Joint capsule

Subsapularis tendon (medial)

Teres minor, supra- and infraspinatus (lateral)

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12
Q

Most shoulder instability is (medial/lateral)

A

Medial (80%)

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13
Q

Signalment and presentation of shoulder instability?

A

Medium/lg breed
Adult

Active dogs
Variable intermittent lameness

Poor response to rest and NSAIDS

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14
Q

Physical exam finding with shoulder instability?

A

Muscle atrophy
Pain on manipution of joint

Medial instability
— increased abduction angle
—> normal is 30 degrees
—> abnormal 50 degrees

Compare to contralateral limb!

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15
Q

How do you confirm shoulder instability?

A

Radiographs — rule out other conditions, may see some degenerative changes

MRI — can underdiagnose severeity

Arthroscopy***
—> diagnostic and therapeutic if PE is supportive

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16
Q

Treatment for shoulder instability?

A

Mild — REST, PT , hobbles (3weeks post op0

Moderate — arthroscopic radiofrequency shrinkage of attenuated ligaments and joint capsule
—rest, PT, and hobbles

Severe — medial glenohumeral ligament reconstruction (suture anchors or bone tunnels and monofilament nylon)
— velpeau sling (2-4weeks post op)

17
Q

What are the causes of infraspinatus contracture?

A

Contracture= shortening of muscle, not caused by active contraction

Acute, traumatic disruption of muscle fibers
Normal muscle is replaced with fibrous tissue

18
Q

What is the presentation of infraspinatus contracture?

A

Acute lameness
Nonpainful, non-weight bearing lameness

External rotation of shoulder and internal displacement of elbow

19
Q

What is the treatment for infraspinatus contracture?

A

Conservative treatment unhelpful

Tenectomy of infraspinatus tendon

Release of other capsular adhesion

Physical therapy ideal

20
Q

What is the signalment for traumatic shoulder luxation?

A

Any age or breed of dog, rare in cats

History of trauma or evidence of injury

Acute onset

21
Q

What are physical findings consistent with traumatic shoulder luxation?

A

Non-weight bearing lameness

Pain on palpation of shoulder
Malpositioning of greater tubercle

Medial luxation: distal limb abducted
Lateral luxation: distal limb adducted

22
Q

T/F: A medial traumatic shoulder luxation means the humeral head is medial to the glenoid

A

True

23
Q

Treatment for shoulder luxation ?

A

Closed reduction

Open reduction + ligament repair

24
Q

How is a closed reduction done for a shoulder luxation?

A

Distract limb, move humerus toward glenoid

Stable joint: apply coaptation or 2 weeks
—velpeau sling (medial luxation)
—spica (lateral, crainial, caudal luxation)

25
Q

What are the indications for surgical treatment of shoulder luxation?

A

Chronic/recurrent/unstable luxation

Accompanying fractures

26
Q

How is shoulder luxation surgically repaired?

A

Open reduction + ligament repair
—simple arthrotomy to reduced joint
—imbrication/repair of capsule during closure
—glenohumeral ligament reconstruction

27
Q

Prognosis for shoulder luxation?

A

Good to excellent with both open and closed reduction

Mild DJD may occur over time

28
Q

What is indicated in shoulders with severe degenerative joint disease, severe comminuted fractures, or intractable luxation??

A

Salvage procedures

Arthrodesis— fix joint with plate and cancellous bone graft in joint

Glenoid excision — watch out for suprascapular nerve

Amputation

29
Q

T/F: congenital shoulder luxation is usually a lateral luxation

A

False

Medial
Also unilateral

30
Q

Signalment for congenital shoulder luxation?

A

Small and toy breeds
3-10months

Shetland sheepdog
Collies
Elkhounds

31
Q

What are your PE findings in congenital shoulder luxation?

A

Greater tubercle is medial to acromin
Joint is easily reduced and re-luxated

Glenoid dysplasia: reduction not possible
Pain on manipulation may be minimal

Lameness may be intermittent

32
Q

Treatment for congenital shoulder luxation?

A

ALWAYS surgical

Normal glenoid
—> open reduction/capsulorrhaphy only
—> gloneohumeral ligament reconstruction

Glenoid dysplasia (misshapen or absent)— salvage

RUSVM Small Animal Surgery 1 (39 decks)

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