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MSK2 > Small animal MSK diseases 5 > Flashcards

Small animal MSK diseases 5 Flashcards

1
Q

What results would be expected on serum biochemistry in a case of extraocular myositis?

A

CK usually normal

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2
Q

Outline the expected findings on orbital sonography/MRI in a case of extraocular myositis

A
  • Swollen extraocular muscles

- Used to eliminate retrobulbar abscess as a differential

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3
Q

Outline the findings on biopsy of affected muscle in a case of extraocular myositis

A

Lymphocytic inflammatory infiltrate, gives definitive diagnosis

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4
Q

Outline the treatment of extraocular myositis

A
  • Oral pred 1-2mg/kg SID (generally gives rapid and complete recovery)
  • Continue treatment for 4-6 weeks minimum
  • If relapse during tapering, add imuran or cyclosporin
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5
Q

Discuss the prognosis for extraocular myositis

A

Good prognosis for permanent recovery with proper therapy

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6
Q

List common diseases of the canine shoulder joint

A
  • Soft tissue injuries
  • Biceps tendon injuries e.g. biceps tendonitis
  • Osteochondrosis
  • Infraspinatous contracture
  • Fracture of scapula or proximal humerus
  • Osteoarthritis
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7
Q

List soft tissues that may be damaged in the shoulder joint

A
  • Medial and lateral glenohumeral ligament (collateral ligaments)
  • Subscapularis tendon
  • Muscles adhering to joint capsule e. g. infraspinatous
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8
Q

Outline the clinical signs of soft tissue injuries of the shoulder in dogs

A
  • Usually medium-large breeds
  • May lead to instability
  • Increased abduction angles
  • Cranial drawer may be present
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9
Q

What abduction angle indicates medial glenohumeral ligament damage?

A

> 45degrees

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10
Q

Outline the diagnosis of soft tissue injuries of the shoulder in dogs

A
  • Difficult
  • Arthroscopy possible, allows assessment of all structures within joint capsule
  • Assessment of abduction angles and cranial drawer under GA
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11
Q

List the treatment options for soft tissue injuries of the shoulder in dogs

A
  • No treatment found to be long lasting
  • Conservative: months
  • Surgical imbrication or reinforcement possible (debated)
  • Diathermy of medial aspect of joint capsule
  • Rest and NSAIDs as required, gradual reintroduction of exercise as well as physio/hydrotherapy
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12
Q

Outline the diagnosis of biceps tendon injury in small animals

A
  • Biceps test: pain on shoulder flexion with elbow extension
  • During flexion, place fingers on medial aspect of greater tubercle to identify pain
  • With complete rupture are able to extend elbow and shoulder to greater extent than normal due to lack of support from tendon
  • Arthroscopy allows identification easily
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13
Q

Where is biceps tendon injury normal located in small animals?

A

Usually partial tear at insertion on supraglenoid tubercle of capsule

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14
Q

Outline the treatment options for biceps tendon injury in small animals

A
  • Conservative: prolonged rest + NSAIDs
  • Intra-articular corticosteroid injection
  • Surgical release of biceps tendon at insertion if badly torn +/- re-attachment to proximal humerus with screw and spiked washer (tenodesis)
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15
Q

Describe the typical signalment for osteochondrosis in dogs

A
  • Young (6-10mo)
  • Medium to large breed dogs
  • Esp. border collies
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16
Q

Describe the clinical signs of osteochondrosis in dogs

A

Clear pain on shoulder manipulation, esp. flexion

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17
Q

What site is predisposed to osteochondrosis in dogs?

A

Caudal humeral head articulating surface

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18
Q

Outline the diagnosis of osteochondrosis in dogs

A
  • Radiography: subchondral lucency (caudal aspect of glenoid tuberosity may appear flattened)
  • Arthrogram: highlights flap, may indicate cartilage damage
  • Arthroscopy: direct visualisation of flap
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19
Q

Outline the treatment options for osteochondrosis in dogs

A
  • Surgical removal of flap (arthrotomy or arthroscopy, break into pieces and remove)
  • Conservative if not very lame
  • Gentle exercise to gradually remove flap naturally (but can form joint mass, but rarely causes problem and comes sound)
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20
Q

Discuss the prognosis for osteochondrosis in dogs

A
  • Good to excellent
  • Esp. if <12mo
  • Elbows and stifles poor
  • Hocks very bad
  • Shoulder generally good prognosis
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21
Q

Describe the clinical signs of mineralisation of forelimb muscles in small animals

A
  • May be incidental finding
  • May be associated with FL lameness and pain on firm palpation of region
  • Commonly in supraspinatus and infraspinatus (bicipital groove)
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22
Q

Outline the treatment options for muscle mineralisation in the FL of small animals

A
  • Conservative management (rest)

- Surgical excision possible (controversial)

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23
Q

Describe the typical signs of infraspinatus contracture in a dog

A
  • Flexed elbow with external rotation of limb

- Working dogs, repetitive trauma

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24
Q

Outline the treatment of infraspinatus contracture in dogs

A
  • Surgical sectioning of the tendon

- Leads to instant improvement, good long term prognosis

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25
Q

List the common diseases of the elbow joint in dogs

A
  • Elbow dysplasia
  • Osteoarthritis
  • Elbow fractures
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26
Q

What are the main underlying disorders in elbow dysplasia in dogs?

A
  • Fragmented medial coronoid process
  • Osteochondrosis dissecans
  • Ununited anconeal process
  • Fragmented medial epicondyle
  • Tendon enthesiopathy (bony exostosis in tendon)
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27
Q

Describe the characteristic appearance of elbow dysplasia

A
  • Abducted FLs
  • Externally rotated
  • Do not take full pressure on limb
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28
Q

List the factors that contribute to the development of elbow dysplasia

A
  • Genetic make up
  • Growth rate
  • Diet (high calcium)
  • Exercise
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29
Q

Outline the possible treatment for elbow incongruity resulting from a short ulna, that may lead to elbow dysplasia

A
  • Short ulna leads to anconeus coming up against caudal aspect of humeral condyles, leading to abnormal pressure on joint
  • Cut ulna (ulnar osteotomy) to bring into alignment and reduce incongruity
  • Several months required to heal
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30
Q

Which individuals are predisposed to fragmentation of the medial coronoid process?

A
  • Large breeds e.g. Rotties, Bernese mountain dog, Newfoundland, Staffies, retrievers
  • Males > females
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31
Q

Describe the clinical signs of FMCP in dogs

A
  • Signs usually 4-7mo
  • variable FL lameness, worse after rest, pain on rotation of antebrachium
  • Elbow flexion and rotation of antebrachium
  • Elbow joint effusion caudally, on trochlear ridge, adjacent to ulna
  • Outward rotation and abduction when standing
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32
Q

Describe the pathology seen with FMCP in dogs

A
  • Fissure/fragmentation of craniolateral part of MCP
  • Single fragment with attachments to annular ligament usually
  • +/- thickened cartilage, gross step between cranial border of articular surface of ulna and radius, eburnation resulting in “kissing lesion” on opposing humeral articular surface
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33
Q

Discuss the treatment options for FMCP in dogs

A
  • Conservative and surgical possible, but DJD progresses with both
  • Most treated conservatively initially, surgical if insufficient (rest, NSAIDs, neutraceuticals)
  • Surgical: arthrotomy/scopy to remove fragment, or proximal ulnar osteotomy to remove abnormal stresses on coronoid, or sliding humeral osteotomy to reduce pressure on fragmented coronoid and allow healing
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34
Q

Which breeds are predisposed to OCD underlying elbow dysplasia?

A

Newfoundlands and retrievers

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35
Q

Outline the clinical signs of osteochondrosis dissecans underlying elbow dysplasia

A
  • Onset 4-7mo
  • Same as for FMCP
  • Bilateral in 50-90% of cases
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36
Q

Discuss the aetiology of OCD underlying elbow dysplasia

A
  • Cause unsure
  • Increased incidence with increased energy intake (+/- increased Ca/P)
  • Growth rate
  • Birthweight
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37
Q

Discuss the management of OCD underlying elbow dysplasia

A
  • Conservative: rest, analgesia, neutraceuticals, balanced diet
  • Surgical: removal of flap, debride subchondral bone, blood and mesenchymal stem cell precursors encourage healing by fibrocartilage
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38
Q

Which breeds are predisposed to an ununited anconeal process?

A

GSD and Bassett Hounds

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39
Q

Describe the clinical signs of ununited anconeal process

A
  • Onset 4-12mo
  • Lameness, pain on elbow manipulation, crepitus
  • Joint effusion
  • Bilateral lameness in 11-47% of cases
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40
Q

Briefly outline the pathophysiology of an ununited anconeal process

A
  • Anconeal process is secondary centre of ossification, usually fuses by 120days
  • Failure to fuse after 20 weeks is abnormal, AP remains detached
  • Distal aspect of anconeus comes up against caudal aspect of humerus, leads to repeated trauma, no fusion, leads to breakage
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41
Q

Discuss the treatment for an ununited anconeal process

A
  • Conservative has poor prognosis
  • Surgical: removal (variable results, short term improvement, long term instability and DJD), re-attachment with lag screw and K-wire (NB poor reduction = incongruity, implant failure), ulnar osteotomy (good/excellent function in most cases), ulnar osteotomy and re-attachment (excellent outcome at 18mo with only mild increase in DJD)
42
Q

Which breeds are predisposed to humeral intercondylar fissue

A

Spaniels mainly (springer, cocker, cavvie), also Labs

43
Q

Outline the clinical signs of humeral intercondylar fissure

A
  • Chronic, low grade, intermittent lameness
  • May be acute, severe lameness if condyle fractures
  • Pain on elbow manipulation and pressure on condyle
  • Squeezing of condyles painful as close the fissure between the condyles
44
Q

Describe the diagnosis of humeral intercondylar fissure

A
  • Difficult to see on radiograph unless radiograph parallel to fissure, may see other changes e.g. extra bone proximal to condyle
  • CT imaging better
  • Must radiograph contralateral limb if identify condylar fracture in spaniels
45
Q

Outline the treatment options for humeral intercondylar fracture

A
  • Conservative: risk of fracture of condyle as a result of minimal trauma, poor choice
  • Surgical: prophylactic transcondylar lag screw
46
Q

List the different types of elbow fracture that may occur in dogs

A
  • Supracondylar
  • Unicondylar
  • Bicondylar
47
Q

What is meant by a supratrochlear fracture? What is the consequence of this?

A
  • Fracture through supratrochlear foramen

- epicondyles symmetrical, but gross instability in supracondylar area

48
Q

Where do unicondylar fractures typically occur in dogs?

A
  • Intra-articular

- Usually lateral condyle

49
Q

Outline the treatment of unicondylar fractures in young and older animals

A
  • Young: screw and k-wire

- Older: lag screw and plate on supratrochlear ridge

50
Q

Discuss the prognosis for unicondylar, supracondylar and intercondylar fractures in dogs

A
  • Favourable prognosis for uni and supracondylar fractures, 65-70% regain reasonable function
  • Intercondylar will not heal, requires support throughout life
51
Q

Explain what is mean by bicondylar fractures in dogs

A
  • Intercondylar articular fracture with supracondylar fracture
  • Can be transverse (T shaped) or oblique (Y shaped) supracondylar fracture lines
52
Q

Discuss the management of bicondylar fractures in dogs

A
  • Very challenging need to refer
  • Marked swelling and instability leads to collapse
  • Require a lot of implants
  • Guarded prognosis
  • Strict post op exercise restriction, but maintain ROM with passive physio and hydro
53
Q

List the common disorders of the antebrachium in small animals

A
  • Angular limb deformities
  • Fractures
  • Ligament injuries (mostly carpal joint)
54
Q

Describe the common presentation of metacarpal fractures in small animals

A
  • Fracture all bones usually

- Usually hx of heavy object falling on foot, trapping and twisting foot in hole

55
Q

Discuss the management of metacarpal fractures in small animals

A
  • If one or more metacarpal bones in tact, can place cast or bandage
  • If all 4 affected, need fixation: ESF, small plates and screws, IM pins and wires
  • Alignment not as important as other areas, but severe lack of alignment leads to valgus deformity and banana shape in caudocranial plane
56
Q

List common primary appendicular neoplasias

A
  • Osteosarcomas (proximal humerus, distal radius)
  • Fibrosarcoma, haemangiosarcoma, chondrosarcoma
  • Synovial cell sarcoma
57
Q

Describe the typical signs of appendicular neoplasia

A
  • Progressive lameness despite analgesia
  • Progressive muscle atrophy
  • Characteristic radiographic changes
58
Q

Compare the occurrence of primary and secondary appendicular neoplasias

A

Primary more common than secondary (metastatic) neoplasia

59
Q

Outline the treatment of appendicular neoplasia in small animals

A
  • Amputation/limb sparing + chemo e.g. carboplatin
  • Radiation
  • Palliation (short term, analgesia)
  • All treatment is palliative, PTS once QOL inadequate
60
Q

Describe the clinical signs of a nerve root tumour in dogs and cats

A
  • Chronic lameness (very severe)
  • Marked muscle atrophy
  • Older animals
  • +/- axillary mass
  • Neurological deficits
61
Q

Discuss the management of nerve root tumours in dogs and cats

A
  • Poor prognosis
  • Poor response to analgesia
  • PTS
62
Q

List the forelimb diseases common in cats

A
  • Elbow: osteoarthritis and synovial cysts
  • Pad/digital injuries
  • Fractures
  • Cat bites
  • Air gun pellet injuries (but often incidental finding)
63
Q

Which radiographic view is most useful to diagnose a UAP?

A

Flexed lateral elbow

64
Q

Which radiographic view is most useful to diagnose OCD of the elbow?

A

Craniocaudal elbow

65
Q

What would be expected on synovial fluid analysis in elbow dysplasia?

A

Normal or degenerative

66
Q

Outline the typical presentation for hyperextension injuries of the carpus in dogs

A
  • Large, active dogs
  • Hx of jump/fall from height
  • Soft tissue swelling
  • Uncomfortable on manipulation
  • Crepitus
  • Altered ROM in flexion and extension
67
Q

Which radiographic views are most useful for hyperextension injuries of the carpus in dogs, and what findings would be expected?

A
  • Dorsopalmar and mediolateral views of both carpi
  • Mediolateral exposure with manus stressed to maximal carpal extension
  • Joint angle exceeds 15-20degrees during stress radiograph
68
Q

Outline the treatment options for hyperextension injuries of the carpus in dogs

A
  • Conservative almost invariably unsuccessful

- Arthrodesis recommended (partial or pancarpal)

69
Q

Which radiographic views are most useful for the diagnosis of collateral ligament injuries of the carpus in dogs, and what findings would be expected?

A
  • Mediolateral and craniocaudal views, stressed views

- Enthesophytes may be seen at sites of ligamentous insertion

70
Q

Outline the treatment options for collateral ligament injuries of the carpus in dogs

A
  • Grade 1 or 2: external support 6-8 weeks, plus physio, NSAIDs, cryotherapy
  • Grade 3: surgery required, primary repair of torn ligament, placement of prosthetic ligament (suture), partial/complete arthrodesis
71
Q

List common hip disease of small animals

A
  • Hip dysplasia
  • Perthes disease
  • Osteoarthritis
  • Luxation
  • Fractures of proximal femur or pelvis
  • Muscle strains - uncommon (e.g. iliopsoas)
72
Q

Explain the pathogenesis of canine hip dysplasia

A
  • Macroscopically normal hips at birth, but changes begin within a few weeks
  • Rapid growth and abundant food promote expression of HD
  • Initially joint laxity due to incongruency of femoral head and acetabulum
  • increased joit effusion pushign femoral head out of acetabulum
  • Exacerbates subluxation
  • Microfractures occur esp. of dorsal acetabular rip
  • Damage to cartilage occurs
  • Fibrosis and incraeased gluteal muscle vol stabilises joint, animal comes sound
  • Later leads to DJD later in life
73
Q

What test can be performed in order to assess hip in a case of suspected hip dysplasia?

A

Ortolani test

74
Q

Describe the ortolani test

A
  • Used to assess hip laxity by assessing the angle of subluxation and angle of reduction
  • Performed under sedation/GA
  • Lateral or dorsal recumbency
  • Press down on femur to assess degree of subluxation
  • Then abduct the hip until pops back into acetabulum to give the angle of reduction
75
Q

Which radiographic views should be taken to assess hip dysplasia?

A
  • VD extended femur view
  • Lateral pelvis/LS junction, +/- flexed view
  • Frog leg view (NB this makes degree of subluxation look less significant)
76
Q

Discuss the treatment options for hip dysplasia in dogs and cats

A
  • Conservative management is mainstay
  • Surgery possible (but difficult to recommend as will improve without these
  • Immature dog: pectineus myotomy/myectomy, triple/double pelvic osteotomy, femoral head and neck excision, pubic symphysis possible
  • Mature dog: femoral head and neck excision, total hip replacement (both also cat)
77
Q

Explain how a pubic symphysis surgery can be used to treat hip dysplasia

A
  • Very young animals only
  • Damage pubic symphysis to form a fixed point, so pelvis rotates and captures femoral head
  • Must be 12-16wo
78
Q

Outline the conservative approach to hip dysplasia management

A
  • Weight control
  • Regular exercise to build muscle for joint stabilisation
  • Physio and hydrotherapy
  • Strategic analgesia
  • +/- neutraceutical
79
Q

List the criteria that would make an individual a candidate for triple pelvic osteotomy

A
  • Painful hips
  • Non-responsive to analgesia
  • Unstable but reducible hips
  • No/minimal remodelling or degenerative changes (indicated by clean clunk with ortolani test)
  • Mainly immature dogs 5-10mo
80
Q

Briefly outline the procedure for a triple pelvic osteotomy

A
  • Cut ilium, ischium and pubis
  • Acetabular segment rotated laterally to capture femoral head, stabilise hip and lead to clinical improvement and reduced DJD
  • Stabilise segment with plates based on degree of rotation as determined from Ortolani test
81
Q

Describe the typical radiographic appearance of Perthes disease

A
  • Mottled radiolucency of femoral head and neck

- Femoral head collapses into triangular shape

82
Q

List the treatment options for Perthes disease

A
  • Conservative management (rest, NSAIDs)
  • Femoral head and neck excision
  • Total hip replacement
83
Q

List common diseases of the stifle in small animals

A
  • Cranial cruciate ligament rupture (caudal possible but very uncommon)
  • Meniscal damage
  • Collateral/multiple ligament rupture
  • OCD
  • Patellar luxation
  • Fracture of femur, tibia, patella
84
Q

Describe the typical signs seen with cranial cruciate ligament disease in small animals

A
  • Avoidance of stifle flexion when sitting
  • Stiff to rise
  • Increased weight bearing on contralateral limb
  • Shift weight onto FLs
  • Hip hike on affected side
  • Circumduction of leg rather than flexing stifle
  • Shortened anterior (moving forward) phase of swing
  • May be muscle atrophy of affected legs, esp. quads
  • Stifle effusion possible (unclear edges of patella)
  • Medial buttress may be palpable
  • Pain on extension of limb
85
Q

What tests should be performed in a case of suspected cranial cruciate ligament disease in dogs?

A
  • Cranial drawer (sedate or GA only, painful even in normal)

- Cranial tibial thrust (possible in conscious)

86
Q

What are the 2 main aetiologies of cranial cruciate ligament disease in dogs?

A
  • Acute trauma

- Degenerate ligament (more common)

87
Q

In what planes are he the bands of the cranial cruciate ligament taut and how does this relate to the cranial drawer test?

A
  • Small craniomedial: taut in flexion and extension
  • Large caudolateral band: taut only in extension
  • Most partial tears involve smaller CMB, drawer only present in flexion
88
Q

Describe the use of radiography in the diagnosis of cranial cruciate ligament disease in dogs

A
  • Indicates disease in joint, rather than identifying underlying pathology in these cases
  • Joint effusion visible
89
Q

List the treatment options for cranial cruciate ligament disease in dogs

A
  • Conservative management
  • Arthrotomy or arthroscopy
  • Surgical: intra-extra articular or combined methods (e.g. extra-capsular suture), plateau levelling methods (CWO, TTA, TPLO_
90
Q

Outline the conservative management of cranial cruciate ligament disease

A
  • Analgesia, exercise modification, physio
  • Reasonable outcome for dogs <17kg
  • Poor recovery if meniscal damage present
  • Degenerate conditions persist e.g. concurrent meniscal injury
  • Rupture in other stifle within 2 years common
91
Q

Outline the use of intra-extra articular or combined surgical treatments for cranial cruciate ligament disease

A
  • Stability from prosthesis/tissue
  • Some loss of joint ROM
  • E.g. over-the-top technique (graft), tight-rope, extra-capsular suture (thread through and attach to condyle to act as ligament)
  • Often break as difficult to mimic correct insertion and origin of ligament
92
Q

Outline the use of plateau-levelling methods for the surgical treatment of cranial cruciate ligament disease

A
  • Eliminate tibiofemoral shear force
  • Stability only during weight bearing, cranial drawer still present when non-weight bearing
  • Preserves joint ROM
  • E.g. cranial Tibial closing wedge osteotomy (CWO), tibial plateau levelling osteotomy (TPLO), tibial tuberosity advancement (TTA)
93
Q

Compare the advantages/disadvantages of the different surgical approaches to cranial cruciate ligament disease

A
  • Better quicker after TPLO or TTA
  • Some advantages with TPLO evidenced
  • Extra-articular has lower complication rates (then TPLO, then TTA), but poorer success
  • Larger dogs and terriers benefit from invasive procedures
94
Q

Describe the typical presentation of meniscal injury

A
  • May be more painful/lame +/- audible click
  • Present at time of CrCL rupture (partial 5-25%, complete up to 80%)
  • Delayed meniscla injury up to 14%
  • Usually caudal horn of medial meniscus
  • Caudal longitudinal tear (bucket handle) and crushing of caudal horn most common
95
Q

Briefly outline the treatment of meniscal injury with CrCL rupture

A
  • Inner 2/3rds of meniscus avascular so healing is poor, consider partial meniscectomy
  • With TPLO, meniscus removed
96
Q

Describe the aetiologies of canine patellar luxation

A
  • Quad/extensor muscle malalignment
  • Shallow patellar groove due to patella not being present in groove during development
  • Bony deformities of femur and tibia
  • Usually congenital, occasionally traumatic
97
Q

Which breeds are predisposed to canine patellar luxation?

A
  • Terriers

- Large dogs (labs, mastiffs)

98
Q

Describe the clinical presentation of canine patellar luxation

A
  • Intermittent hopping lameness for a few steps, then normal
  • May be crepitus on manipulation
  • Medial patellar luxation most common (congenital)
  • Lateral luxation seen in large breeds or following trauma
  • Occasionally concurrent cruciate ligament rupture
99
Q

Describe grade 1 canine patellar luxation

A
  • Patella usually in trochlea

- Can be luxated, but immediately returns to trochlea

100
Q

Describe grade 2 canine patellar luxation

A
  • Patella usually in trochlea

- Can be luxated, tend to remain luxated unless replaced or stifle extended

MSK2 (29 decks)

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