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MSK2 > Small animal MSK disease > Flashcards

Small animal MSK disease Flashcards

Examination of lame animals, joint disease

1
Q

Which breed of dog is predisposed to elbow dysplasia?

A

Labrador retriever

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2
Q

Which breed of dog is predisposed to cruciate disease?

A

West Highland White terrier

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3
Q

What conditions are more likely where there is chronic and progressive onset of lameness?

A
  • Osteoarthritis

- Degenerative cruciate disease

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4
Q

What conditions are more likely with acute onset of lameness?

A
  • Trauma
  • Infection
  • Foreign body
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5
Q

What conditions may present with acute worsening of a chronic lameness?

A
  • Cruciate rupture on patellar subluxation

- Pathological fracture resulting from bone neoplasia

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6
Q

Outline the importance of activity in the history for a lameness examination of cat or dog

A
  • Exercise tolerance and general activity important in cat, rarely show true lameness
  • Ability to jump in cats
  • Reluctance to negotiate stairs may indicate HL problem
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7
Q

Describe the common clinical course for panosteitis

A

Waxing and waning, shifting between different bones affected

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8
Q

Describe the common clinical course of a cruciate rupture

A

Acute lameness followed by slow improvement

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9
Q

Describe the common clinical course for patellar subluxation or superficial digital flexor tendon instability

A

Acute and intermittent signs, lame when slips out of position then sound when back into position

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10
Q

Describe the typical clinical presentation of foot pathology

A

Worse on harder surfaces

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11
Q

List the aspects of the examination of a small animal presented with lameness

A
  • Observation in consulting room
  • Dogs walked outside
  • Full clinical examination
  • Lameness examination
  • Neurological examination
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12
Q

Describe the appearance of paws in a fully weight bearing vs not fully weight bearing

A
  • Fully: paw spread

- Not fully weight bearing: paw slightly clenched

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13
Q

What may cause an inability to fix the stifle and how will this present clinically?

A
  • Damage to quads due to patellar fracture,
    rupture of patellar tendon, femoral nerve injury
  • Stifle will drop as put weight on limb
  • Stifle will flex
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14
Q

Describe a head nod in the assessment of lameness in the dog

A

Head nod on unaffected limb when walked as take more weight on normal leg, only used for forelimb

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15
Q

Describe the hip movement assessment in the identification of lameness in the dog

A

Used for hindlimbs, hip will rise higher and quicker on affected leg

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16
Q

What may indicate subtle neurological deficits when walking a dog for the assessment of lameness?

A
  • Catching nails (may hear this)

- turning in tight circles exaggerates the deficits

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17
Q

What may be indicated by respiratory deficits in a lameness work up in small animals?

A
  • Pulmonary osteopathy

- Metastatic disease from osteosarcoma

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18
Q

What may be indicated by urinary tract disease for a lameness work up in small animals?

A
  • Association with lumbosacral discospondylitis and resulting lameness
  • May be extension of urinary disease or prostatic disease
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19
Q

Explain the examination for prostatic disease in a lameness work up and describe how this may present in small animals

A
  • E.g. prostatic carcinoma that may have metastatic spread to long bones
  • May also have strang/dysuria, haematuria
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20
Q

Describe the appearance of neurogenic muscular atrophy

A
  • Marked, very rapid

- Follows pattern of innervation i.e. sciatic affects biceps femoris

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21
Q

Describe the examination of the feet and pads in a lameness work up in small animals

A
  • Palpate digits and pads individually
  • Twist each nail - blood or pain on twisting indicates nail injury
  • Any wear to nails may indicates dragging and in HL may suggest CDRM in GSD, lumbosacral disease, IVDD
  • Examine nail beds - common site of pulmonary adenocarcinoma metastasis in cats
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22
Q

Describe the examination of joints in a lameness work up in small animals

A
  • Plapate for effusions (esp. stifle)
  • Pain
  • Medial buttress to stifle indicates problem
  • Unsharp margins on patellar tendon indicates effusion
  • Instability e.g. in the cruciate using specific tests e.g. cranial drawer
  • Abnormal movement e.g. intertarsal subluxatoin, carpal hyperextension shown by palmar/plantar stance
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23
Q

Describe the examination of ligaments and tendons in a lameness work up in small animals

A
  • Palpate for swelling
  • Heat
  • Pain
  • Resulting instability if ruptured e.g. patellar higher than expected
  • May be unstable in their grooves
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24
Q

Outline the assessment of patellar instability in a lameness work up in small animals

A
  • May subluxate medially or laterally

- Often need to flex and extend stifle joint with pressure on patella to bring about subluxation

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25
Q

What tests are used to assess for cruciate rupture in small animals?

A
  • Cranial drawer

- Tibial thrust

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26
Q

Describe the examination of bones in a lameness work up in small animals

A
  • Palpate as well as radiograph
  • Squeeze: in panosteitis will resent this
  • Pain on gentle palpation may indicate neoplasia
  • Perform towards end of ecamination
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27
Q

Describe the neurological aspects assessed in the lameness work up of a small animal

A
  • Neck or thoracolumbar pain assessment
  • Palpate axillary region for mass e.g. nerve root tumour
  • Rectal examination if HL neurological deficits seen (palpate abnormalities in sacrum or rectal canal(
  • Check anal and rectal tone
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28
Q

Outline the use of radiography in the lameness work up of a small animal

A
  • Mainstay of further investigation
  • Good quality orthogonal views required
  • Examine for primary and secondary disease
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29
Q

Outline the use of synoviocentesis in the lameness work up of a small animal

A
  • Single joint if only this joint is swollen, suspicion of OA or septic arthritis
  • Multiple if polyarthritis suspected (worth tapping 2/3)
  • Examine in house with DiffQuik and send off
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30
Q

Outline the use of blood tests in the lameness work up of a small animal

A
  • Rheumatoid Factor (RF) for rheumatoid arthritis
  • ANA for SLE (may be indicated by leukopaenia, pain in muscles)
  • Borrelia burgdorferi serology or PCR of joint fluid
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31
Q

Outline the use of CT in the lameness work up of small animals

A
  • Useful for elbows as will clearly demonstrate FCP and humeral intercondylar fissure (common in Springers)
  • Also to visualise mineralisation of infra and supraspinatus tendons
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32
Q

Outline the use or MRI in the lameness work up of small animals

A
  • Better for soft tissues, good for stifles, shoulders and detection of foreign bodies
  • Also good for spine to examine for nerve root tumours, lumbosacral disease etc.
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33
Q

Outline the use of ultrasound in the lameness work up of small animals

A

Used occasionally e.g. bicipital tendon, Achilles and flexor tendons

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34
Q

Outline the use of arthroscopy in the lameness work up of small animals

A
  • Good for shoulder, elbow, stifle
  • Difficult for carpus and talocrural joint
  • Can be diagnostic and used to treat e.g. fragmented coronoid process
  • Difficult, equipment expensive
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35
Q

What additional tests may be used in the lameness work up of small animals?

A
  • Biopsy (any mass or swellings)
  • Nerve conduction studies
  • EMG
  • Muscle biopsy (e.g. for Labrador Retriever myopathy)
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36
Q

How would you approach a case of a lame small animal where nothing is found on diagnostic testing?

A
  • Treat with NSAIDs and rest and re-evaluate in 2 weeks, or 2 days if very lame
  • Call owner midway through period of waiting for next appointment and enquire after pet
  • Offer referral early
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37
Q

Describe the method for the cranial drawer test in small animals

A
  • Lying or standing (lying easier), sedated/GA or conscious (sed/GA better)
  • Index finger on patella, thumb on sesamoid behind stifle
  • Left index finger on tibial crest, thumb on head of fibula
  • Right hand holds stable, while apply pressure on fibula
  • Perform in various degrees of flexion and extension
  • If abnormal, tibia will move cranially
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38
Q

Describe the method for the tibial thrust test in small animals

A
  • Easier if joint is painful
  • Require practice and occasionally sedation or GA
  • Hold femur with right hand, place index finger on patella
  • Flex hock and tibia will move forward spontaneously
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39
Q

What conditions would the following history be indicative of?
Stiffness, particularly in the mornings, lameness worsens after exercise, and waxes and wanes, lame limb swaps between legs

A
  • Osteoarthritis
  • Hip dysplasia
  • Immune mediated polyarthritis
  • Septic arthritis
  • Perthes disease if hips
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40
Q

Describe the signs you would expect to find on clinical examination of a dog with arthritis

A
  • Lameness
  • Pain on manipulation of joints
  • Associated muscle atrophy
  • No neurological deficits
  • +/- systemic signs depending underlying cause
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41
Q

What is rheuamtoid arthritis?

A

Immune mediated erosive arthritis, leading to changes in subchondral bone

42
Q

What is the difference between primary and degenerative arthritis?

A
  • Primary has no underlying aetiology

- Degenerative is as a result of abnormal loading e.g. as a result of hip dysplasia

43
Q

Following a provisional diagnosis of osteoarthritis, what is an appropriate approach?

A

Trial therapy of rest and analgesia (NSAIDs) for 1-2 weeks

44
Q

List the tests used in order to form a definitive diagnosis of osteoarthritis

A
  • Further manipulation fo joints under sedation or GA e.g. Ortolani sign
  • Radiography
    Ultrasound
  • EMG, CT, MRI, scintigraphy possible
  • Arthrocentesis
  • Arthroscopy
  • Exploratory arthrotomy
  • Intra-articular or regional blocks
45
Q

Evaluate the use of intra-articular or regional blocks for the diagnosis of osteoarthritis

A
  • Need sedation
  • rarely performed in small animals
  • Never quite show normal movement expected, so cannot tell how much abnormal movement is from sedation or due to joint pathology
46
Q

What radiographic views are required for the diagnosis of osteoarthritis?

A
  • Depends on joint affected
  • Always require standard orthogonal views +/- stressed views
  • Radiograph opposite side for comparison
47
Q

What is the first sign that is likely to be seen on radiography that indicates joint disease?

A

Effusion, demonstrated by increased opactiy within the joint and smaller fat pad (lucent triangle)

48
Q

Discuss the use of ultrasound in the diagnosis of osteoarthritis

A
  • Good for peri-articular soft tissue structures, e.g. bicipital tendon
  • Can be used for detection of meniscal tears
  • Requires skilled operator
49
Q

What is the most likely underlying aetiology if only one joint is arthritic?

A

Septic or traumatic

50
Q

Outline the use of arthrocentesis in the diagnosis of arthritis

A
  • Single or multiple tapped depending on presentation
  • Collection in to plain, EDTA and blood culture medium if likely to be infected
  • Smears for cytology as well as count from EDTA sample
51
Q

What is the normal result for a mucin test of synovial fluid?

A

Add joint fluid to acetic acid, and forms tight clot

52
Q

What is the demonstration of foamy macrophages in synovial fluid indicative of?

A

Degenerative disease

53
Q

What would large numbers of neutrophils in synovial fluid be indicative of?

A

Sepsis and polyarthritis/autoimmune

54
Q

Compare the colour of synovial fluid found in normal joints, DJD, immune mediated arthritis, and bacterial infective arthritis

A
  • Normal: clear/pale yellow
  • DJD: yellow
  • Immune mediated arthritis: yellow (+/- blood tinged)
  • Bacterial infective arthritis: yellow (+/- blood tinged_
55
Q

Compare the clarity of synovial fluid found in normal joints, DJD, immune mediated arthritis, and bacterial infective arthritis

A
  • Normal: transparent
  • DJD: transparent
  • IMPA: transparent or opaque
  • Bacterial Infective arthritis: opaque
56
Q

Compare the viscosity of synovial fluid found in normal joints, DJD, immune mediated arthritis, and bacterial infective arthritis

A
  • Normal: very high
  • DJD: high
  • IMPA: low/ery low
  • Bacterial: very low
57
Q

Compare the mucing clot synovial fluid found in normal joints, DJD, immune mediated arthritis, and bacterial infective arthritis

A
  • Normal: good
  • DJD: good - fair
  • IMPA: fair - poor
  • Bacterial: poor
58
Q

Compare the formation of spontaneous clots of synovial fluid found in normal joints, DJD, immune mediated arthritis, and bacterial infective arthritis

A
  • Normal: no
  • DJD: +/-
  • IMPA: often
  • Bacterial: often
59
Q

Compare the protein content of synovial fluid found in normal joints, DJD, immune mediated arthritis, and bacterial infective arthritis

A

given in g/dL

  • Normal: 2-2.5
  • DJD: 2-3
  • IMPA: 2.5-3
  • Bacterial: >4
60
Q

Compare the white cell content of synovial fluid found in normal joints, DJD, immune mediated arthritis, and bacterial infective arthritis

A

given in x10^9/L

  • Normal: <2
  • DJD: 2-5
  • IMPA: 4-370
  • Bacterial: 40-267
61
Q

Compare the neutrophil content of synovial fluid found in normal joints, DJD, immune mediated arthritis, and bacterial infective arthritis

A

given as %

  • Normal: <5%
  • DJD: <10%
  • IMPA: 10-95%
  • Bacterial: >90%
62
Q

Compare the mononuclear cell content of synovial fluid found in normal joints, DJD, immune mediated arthritis, and bacterial infective arthritis

A

given as %

  • Normal: >95%
  • DJD: >90%
  • IMPA: 5-90%
  • Bacterial: <10%
63
Q

Compare the glucose content of synovial fluid found in normal joints, DJD, immune mediated arthritis, and bacterial infective arthritis

A

given as % of serum value

  • Normal: >90
  • DJD: N/A
  • IMPA: N/A
  • Bacterial: <50
64
Q

Outline the use of advanced imaging in the diagnosis of arthritis

A
  • CT and MRI

- May demonstrate bony changes, as well as underlying aetiology e..g elbowhip dysplasia

65
Q

Outline the use of arthroscopy in the diagnosis of arthritis

A
  • Reduced joint morbidity with this method
  • Magnified image
  • May be therapeutic as well as diagnostic depending on aetiology
66
Q

Outline the use of arthrotomy in the diagnosis of arthritis

A
  • Visualisation of joint

- Can take synovial biopsy is unsure of nature of arthritic/inflammatory change in joint

67
Q

What is the major disadvantage of arthrotomy for the diagnosis of arthritis?

A

Increases morbidity of joint (but often performed anyway)

68
Q

Outline the pathophysiology of osteoarthritis

A
  • Fibrillation of articular cartilage of weigh bearing areas leads to fissuring and ulceration
  • Microfracture leads to stiffening of subchondral bone and therefore abnormal loading
  • Abnormal loading then leads to joint remodelling
69
Q

What causes the pain associated with osteoarthritis?

A

Synovitis and exposure of the subchondral bone

70
Q

Describe the radiographic signs seen with osteoarthritis

A
  • Joint effusion
  • Osteophyte formation and bone remodelling
  • Enthesiophytes
  • Subchondral sclerosis
  • Subchondral cysts (more common on CT)
  • Muscle atrophy
71
Q

Describe the cycle of presentation of osteoarthritis in young animals

A
  • Primary disease leads to pain/instability, OA initiated leading to pain, lameness and restriction of movement
  • Muscular growth provides support and stabilises joint, limiting signs
  • Periarticular fibrosis occurs to increase stability
  • Initially painful, improves, then as ages arthritis will become more severe
72
Q

In which joints is osteoarthritis more significant?

A

Small, tight joints e.g. tarsus or elbow, vs. large “padded” joints e.g. stifle or hip, and worse in high mothion joints e.g. antebrachiocarpal joint vs carpometacarpal

73
Q

What are enthesiophytes?

A

Bony extensions into surrounding ligaments and tendons around a joint, are associated with severe arthritic change

74
Q

What are the 3 key treatment objectives for osteoarthritis?

A
  • Control pain
  • Achieve acceptable level of exercise
  • Limit progression of the disease
75
Q

Outline the general points included in a treatment plan for osteoarthritis

A
  • Weight control
  • Exercise modification +/- physio/hydro
  • Analgesia e.g. NSAIDs
  • Nutraceuticals
  • Salvage procedures in severe cases
76
Q

Outline how flare ups of osteoarthritis may be managed

A
  • Initial analgesia 7-10days of NSAIDs
  • Rest, only 5min walks 3x/day on lead to maintain movement
  • gradual reintroduction of exercise over 2-3 week period
  • Physio/hydro to maintain muscle bulk and aid stability of joint
77
Q

Outline the pharmaceutical management of osteoarthritis

A
  • NSAIDs mainstay
  • Corticosteroids for severe, non-responsive or end-stage cases
  • Gradually taper doses
  • May be life-long treatment, monitoring required
  • May add nutraceuticals
78
Q

Discuss the use of nutraceuticals in the management of osteoarthritis

A
  • Evidence lacking
  • 6 weeks before any beneficial effects
  • Chondroitin sulphate and glucosamine
  • Glucosamine has mild anti-iflamm as well as effect on chondrocyte metabolism
  • Essential fatty acids may be beneficial
  • Also turmeric and green-lip mussel
79
Q

List some additional research developments that have been suggested for the treatment of osteoarthritis

A
  • Micropicking
  • Joint resurfacign
  • Platelet rich plasma
  • Stem cell therapy
  • Gene therapy
80
Q

Outline micropicking in the treatment of osteoarthritis

A
  • Perforation of subchondral bone plate to allow cartilage to heal over it
  • Unclear if beneficial
81
Q

Outline joint resurfacing in the treatment of osteoarthritis

A
  • Full thickness defects
  • Fibrin plus and other biodegradabl scaffolds
  • Replace fragmented coronoid process, or fragmented surface of humerus
  • Specialist and expensive
82
Q

Outline the use of platelet rich plasma in the treatment of osteoarthritis

A
  • Variable results

- Take blood, concentrate platelets and re-inject back in to patient’s joint

83
Q

Outline stem cell therapy in the treatment of osteoarthritis

A

Harvest adipocytes and remove stem cells, grow on and inject into joint

84
Q

List the salvage procedures that may be used in the management of osteoarthritis

A
  • Removal of articular surfaces
  • Total joint replacement
  • Fusion of joint (arthrodesis)
85
Q

Outline the diagnosis of feline osteoarthritis

A
  • More difficult to detect, very vague signs, less inflammation vs. dog
  • Less jumping, depressed demeanour, reduced ability to groom
  • Rarely see overt lameness, but may do esp. elbow
  • Trial meloxicam and assess response
86
Q

Discuss the features that predispose to ligament sprain and rupture

A
  • Longitudinally orientated bundles of collagen fibre with greatest strength during tension
  • Very inelastic - >10% elongation leads to permanent damage
  • Cannot replace or repair ligaments
87
Q

What is meant by first degree ligament sprains?

A

Few collagen fibres damaged, minimal functional change

88
Q

Outline the prognosis and management of first degree ligament sprains

A
  • Rest 7-10 days, NSAIDs, +/- support

- Leads to full recover in most cases, although there will be permanent damage, generally no lameness

89
Q

What is meant by second degree ligament sprains?

A

Still grossly intact, but more fibres damaged, haematoma may form and some degree of functional deficit

90
Q

Outline the management and prognosis for second degree ligament sprains

A
  • Needs treatment to regain function
  • If stable, conservative and support dressing
  • Unstable: imbricate ligament, support dressing
  • 6-10 weeks healing, 3-6 months to regain function
91
Q

What is meant by third degree ligament sprains?

A

Interstitial disruption or avulsion, function completely lost, may not be regained

92
Q

Outline the management and prognosis for third degree ligament sprains

A
  • Needs treatment to regain function
  • Suture repair or ligament replacement, possible tension banding
  • 6-10 week healing, 3-6months to regain (partial) function
  • Joint may require arthrodesis ultimately
93
Q

What is a common cause of third degree ligament sprains and what structures are involved?

A
  • Often shearing injury e.g. RTA

- Damage includes collateral ligaments and cartilage

94
Q

Outline the generic conservative treatment of ligament sprains

A
  • Rest, oftenmonths
  • Reduce swelling using cold packs, massage and medication
  • External coaptation e.g. Robert Jones bandage, bespoke hinged dressing
95
Q

List the surgical options for management of ligament sprains

A
  • Primary ligament repair if enough left
  • Internal ligament splint/prosthetic replacement
  • Immobilisation with transarticular ESF
  • Arthrodesis
96
Q

When is the use of transarticular ESFs indicated with ligament sprains?

A

Where the joint is grossly unstable

97
Q

Which breeds of dog are predisposed to plantar ligament degeneration?

A
  • Shetland sheep dog
  • Collies
  • Racing Greyhounds
98
Q

Outline the common results of plantar ligament degeneration

A
  • Degeneration leading to subsequent rupture of the ligaments
  • Normally subluxation at level of proximal intertarsal joint
  • Often bilateral
  • In athletic dogs with traumatic rupture often also fracture of hock
99
Q

What management is required for cases of plantar ligament degeneration and rupture in dogs?

A

Arthrodesis of affected joint, commonly calcaneoquartal arthrodesis (sublux of proximal intertarsal) using plates

100
Q

Explain the typical pathophysiology of carpal ligament injuries

A
  • Collateral ligament injuries to antebrachiocarpal joint usually extension injuries
  • Naturally have a degree of valgus, therefore medial ligament rupture most serious and gives rise to valgus deformity

MSK2 (29 decks)

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