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Orthopedic Medicine > Small Animal Muscle, Tendon, Ligament Injury > Flashcards

Small Animal Muscle, Tendon, Ligament Injury Flashcards

1
Q

how does the muscle tendon units activate joint motion

A

contraction

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2
Q

injuries to the muscle-tendon unit

A

strains

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3
Q

What are tendons made of

A

dense, parallel colalgen fibers (85% Type I)
proteoglycan matrix and fibroblasts

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4
Q

injuries to the ligaments are called

A

sprains

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5
Q

How do vascular tendons differ from vascular ones

A

Vascular: short and large, have paratenon (loose connective tissue with blood vessels)

Avascular: long, fine tendons, vessels penetrate tendon sheath (hypovascular)

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6
Q

What are examples of vascular tendons

A

short and large tendons like the triceps and achilles

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7
Q

What are examples of avascular tendons

A

long and fine tendons like the digital flexors and biceps

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8
Q

Paratenon

A

loose connective tissue with blood vessels present in vascular tendons

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9
Q

Are vascualar or vascular tendons sheathed

A

avascular- vessels penetrate the tendon sheath

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10
Q

What do ligaments do

A

support and stabilize joints
incapable of contracting
tolerate minimal elongation <10%
Relatively avascular = less healing capacities

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11
Q

Why do ligaments have less healing capacities

A

they. are relatively avascular

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12
Q

Most joints have collateral ligaments except

A

the hip joint

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13
Q

How do muscle and tendons heal

A

very similar to skin
tensile forces create a gap
gap healing results in scar tissue
scar tissue = poor function

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14
Q

How do vascular tendons heal

A

Tendon and paratenon (blood supply) laceration
-Collagen synthesis within days
-Collagen fibers realign (3-4 weeks)
80% normal within 1 year

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15
Q

How do avascular tendons heal

A

tendon and sheath (avascular) laceration
tendons distract in sheath = gap
Failure to do surgery = nonunion of tendon ends

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16
Q

complete rupture or avulsion of attachments
Complete dysfunction with strain or joint instability with sprain (luxation)

A

Third degree MT injury

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17
Q

Different classifications of MT injuries

A

First degree (Bruise) : hemorrhage but intact fibers (contusion- bruise)
Acute pain, inflammation + swelling, should resolve over 7-14d

Second degree (Partial Tear) : Hemorrhage + partial fiber disruption (variable elongation)
Acute pain, inflammation, swelling
Doesnt improve or worsen

Third degree (Complete) : complete rupture or avulsion of attachments
Complete dysfunction with strain or joint instability with sprain (luxation)

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18
Q

Hemorrhage + partial fiber disruption (variable elongation)
Acute pain, inflammation, swelling
Doesnt improve or worsen

A

Second degree MT injury

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19
Q

hemorrhage but intact fibers (contusion- bruise)
Acute pain, inflammation + swelling, should resolve over 7-14d

A

First degree MT injury

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20
Q

How do you diagnose ligament injury

A

-Visible instability/injury/stance abnormality
-Palpation (pain or swelling)
-Ultrasound/MRI
-Stress radiographs: standing, manual lateral/ medial force

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21
Q

Where can muscle tendon injuries occur

A

1) Origin and Insertion (avulsions)
2) Muscle belly
3) Tendon

but tend to occur most commonly at musculotendinous junction

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22
Q

Most common place for muscle tendon injuries to occur

A

commonly at musculotendinous junction

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23
Q

occurs when a piece of bone is pulled off at the origin/insertion of a tendon

A

avulsion fracture

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24
Q

How do you diagnose low grade MT injuries

A

Passive Range of Motion: oppsotive of function to elastic end feel

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25
Q

Biceps brachii does elbow flexion and shoulder extension, which means the passive range of motion is stretch on

A

Elbow extension
Shoulder flexion

26
Q

If you have elbow dysplasia, would elbow flexion or extension cause pain

A

Elbow extension

27
Q

You flex a dog’s shoulder and extend their elbow. If this elicits pain, what 4 things could be occuring

A

Supraspinatus myotendinopathy (Flexing Shoulder)

Shoulder OCD

Biceps myotendinopathy (flexed shoulder and extending elbow)

Elbow dysplasia (extending elbow)

28
Q

In the regeneration of muscle, new muscle cells develop from

A

undifferentiated satellite cells

29
Q

Scar tissue, the proliferation of fibrous tissue is likely to occur when

A

the endomysium is damaged

the less vascular supply available, the more scar tissue will form

30
Q

Muscle fibre regeneration will occur when

A

endomysium is intact

31
Q

What are surgical goals for MT injury healing

A

minimal gap formation = anatomic apposition and maintain that position

preserve blood supply = minimal trauma/implants

Preserve gliding function?

32
Q

How do you preserve the blood supply to enhance MT injury healing

A

-Atraumatic tissue/tendon handling
-Mobilization of healthy tendon ends
-Skin incision not over the injury
-If feasible, close the paratenon

33
Q

If you gap is _____ then this significantly impairs tendon healing *

A

> 3mm

need to choose a suture pattern that avoids gaps >3mm

34
Q

Why do gaps >3mm impair tendon healing *

A

decreased rigidity and ultimate tensile strength (10-42 days post operatively)
No significant increase in ultimate tensile strength and rigidity until 42 days after repair

repairs with gap >3mm have significantly weaker for at least 6 weeks after repair (compared to tnedons without gap)

35
Q

What suture should you ensure to your tendon repair has gaps that are <3mm

A

easy passing
good knot security
non-irritant
adequate strength
usually Nylon/ polypropylene 2-0/3-0

pattern: 3-loop pulley, baseball/locking loop (if 3-loop pulley not available)

36
Q

3-loop pulley suture pattern is prefered for

A

larger tendon repairs

37
Q

For flat tendons (ie gluteal), what suture patterns do you not want to do?

A

Ford-interlocking or Bunnell-Mayer (not good for 3mm gap)

Use: Baseball suture pattern

38
Q

For large tendons, what suture pattern do you want to use

A

3-loop pulley suture

39
Q

For flat tendons (ie gluteal), what suture patterns do you want to use

A

Baseball or continuous cruciate pattern

40
Q

For small tendons, what suture pattern do you want to use

A

Locking Loop (modified Kessler)
-Requires precise suture passage (otherwise becomes a mattress)
-Useful for flat tendons
-Close paratenon with simple pattern using fine suture

41
Q

Locking Loop (modified Kessler) is used for

A

Small tendon repair

-Requires precise suture passage (otherwise becomes a mattress)
-Useful for flat tendons
-Close paratenon with simple pattern using fine suture

42
Q

T/F: Tendon suture construct can withhold normal forces during walking

A

False- you need tendon immobilization

-gradually increase tension across tendon repair like walking bar cast/ex-fix
combine with early PT

43
Q

How do you gradually increase tension across a tendon repair in dogs

A

-gradually increase tension across tendon repair like walking bar cast/ex-fix
combine with early PT

44
Q

What commonly cause SDF/DDF injury in dogs

A

lawn edge sharp edges

45
Q

How do you fix SDF/DDF injury in dogs

A

1) Make sure the wound is clean: wet-dry bandages if needed (tendon retraction/identification can be problem if left too long)

2) Identify, repair each of the tendons separately
DDF/SDF= most important digit 3+4
If possible 3-loop pulley or small tendons (locking loop)

3) Post-op: walking bar for 6 weeks (change weekly) followed by soft padded for 2 weeks afterafter

4) Rehab exercises in walking cast, carpal flexion bandage, orthosis and during post-splint recovery (week 6-14 weeks)

46
Q

With DDF/SDF injury in dogs, why should you start with the repair of digits 3 and 4

A

because those are the weight bearing digits

47
Q

For DDF/SDF injury in dogs, what should you do for post-operative care

A

walking bar for 6 weeks (change weekly) followed by soft padded for 2 weeks thereafter

-if you go longer than 6 weeks, permanent damage to the joint = permanent immobilization

48
Q

For a complete traumatic disruption of major tendons, what general statement is correct?

Group of answer choices

A) These injuries are unlikely to cause a lasting lameness if treated with external coaptation
B) They generally should be treated surgically (to appose disrupted tendon ends) and supported for approximately 6 weeks thereafter with splints/casts.
C) These injuries can be treated with orthotics instead of surgery
D) Surgical repair with a locking loop is indicated

A

B) They generally should be treated surgically (to appose disrupted tendon ends) and supported for approximately 6 weeks thereafter with splints/casts.

49
Q

The 3-loop pulley suture pattern is reserved for

A

surgical repair of large, round tendons

50
Q

everything that attaches at the tuber calcus
-Gastrocnemius (lateral)
-SDFT (cap)
-Conjoined tendons of (medial): biceps femoris, gracilis, semitendinosus

A

Common calcanean tendon

51
Q

Common calcanean tendon is made of

A

-Gastrocnemius (lateral)
-SDFT (cap)
-Conjoined tendons of (medial): biceps femoris, gracilis, semitendinosus

52
Q

Does the DDFT or SDFT attach to the tuber calcis

A

SDFT

53
Q

What are the dwo different kinds of achilles tendinopathy

A

1) Acute, traumatic injury = true laceration, treat like any other tendon laceration

2) Chronic degenerative injury: hunting dogs, frequently bilateral, check for underlying disease (endocrine, coagulopathy)
Apposition of healthy tendon is difficult

54
Q

How might Achilles tendinopathy be bilateral

A

chronic degenerative injury seen in hinting dogs

check for underlying disease (endocrine, coagulopathy)

55
Q

How is surgical treatment of chronic degenerative Achilles tendinopathy

A

apposition of healthy tendon is difficult because it is chronic and degenerative

56
Q

Plantigrade stance AND flat paw with stifle in extension means that

A

there is a complete rupture of all components of the common calcaneal tendon

57
Q

Plantigrade stance (dropped hock) and crab-claw-like stance means

A

that the SF is intact

-tarsus flexes more (dropped) because gastronemius is main extender of the hock
-toes are flexes because SDFT is still intact

58
Q

How do you repair traumatic Achilles tendinopathy

A

-repair each tendon individually if possible
-3 loop pulley pattern w prolene suture (2-0)
-Additional epitenon/paratenon sutures (usually 3-0//4-0 PDS)
-Hock maintained in extension postop
Cast vs Ex-fix for 6 weeks max

At CSU: orhtosis and gradually increase ROM

alternative options: Orthoses, stem cell treatment, shockwave, laser, PRP

59
Q

Orthoses for Achilles tendinopathies

A

for early Type 2c- sole treatment
supportive post-op for surgical repair
downstage to sorts brace long term

avoid external coaptation and Ex-fix which cant introduce ROM over time

60
Q
A

Orthopedic Medicine (8 decks)

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