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Orthopedic Medicine > Small Animal Orthopedic Diseases > Flashcards

Small Animal Orthopedic Diseases Flashcards

1
Q

What structures can you palpate in the canine shoulder

A

Gretaer tubercle (lateral)
Acromion

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2
Q

What are the diagnostics to do once you locate a shoudler lamenesss in a dog

A

Exam: ROM/Pain, Abduction ange = muscle atrophy
Muscle pain = myopathy

Radiographs: OCD, arthritis, muscle calcificaition

Ultrasound: Biceps, Supraspinatus, MGHL/ Sub-scapularis

other: MRI, arthroscopy, CT, joint fluid analysis

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3
Q

What shoulder abnormalities can you identify on radiographs

A

OCD
Arthritis
Muscle calcification

if muscle problem w/o calcification then it is a muscle issue and do ultrasound

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4
Q

What shoulder abnormalities can you identify on radiographs

A

Biceps
Supraspinatus
MGHL/Sub-scapularis

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5
Q

When should you do joint fluid analysis of the canine shoulder

A

Septic arthritis (rare) or immune mediated diseases

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6
Q

What are the two joints in the dog where you need to evaluate shoulder abduction

A

Shoulder
Hip

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7
Q

When doing a physical exam on the dog’s shoulder what should you do

A

1) ROM and hyperextension/flexion
2) Shoulder abduction
3) Drawer motion
4) Individual muscles/tendons:
Passive flexibility (ie biceps test)
Pain
Atrophy

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8
Q

What are differentials for shoulder muscle atrophy in a dog

A

Typically due to lameness (ie arthritis)
but need to rule out other differentials
ie. Brachial plexus tumor or neurological issue

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9
Q

In dogs, You cannot extend the shoulder without _______ *

A

extending the elbow

but you can extend the elbow without extending the shoulder

thats how you differentiate the joints from each other

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10
Q

What might be occuring if a dog has pain on shoulder flexion

A

1) Shoulder problem
2) Supraspinatus issue

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11
Q

What might be occurring if a dog has pain upon shoulder extension

A

1) Shoulder problem
2) Elbow problem

you cannot extend the shoulder without extending the elbow

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12
Q

What causes shoulder OCD in dogs

A

genetics
nutrition (excessive Ca, high calorie/protein)

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13
Q

Shoulder OCD in dogs typically affects

A

large and giant breeds (juveniles)

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14
Q

Is lameness due to OCD in dogs typically unilateral or bilateral in dogs

A

lameness is typically unilateral but lesions can be bilateral

lameness may wax and wane or even disappear

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15
Q

What is the risk of having dogs with OCD lameness run around to fix the lameness

A

it may cause the OCD fragment to dislodge and fix the problem in short time but over time it will incorporate and cause secondary biceps tendonopathy (fragment in biceps groove) or synovial osteochondroma formation

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16
Q

What are differential diagnoses for dogs with shoulder OCD

A

Elbow dysplasia and panosteitis (juveniles)

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17
Q

How do you diagnose shoulder OCD in dogs

A

take multiple radiograph oblique views of both legs

pain on extension, FLEXION, and rotation of shoulder

CT is ideal but not required if rads are obvious

Arthrogram if rotated X-rays not helpful and CT not available

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18
Q

Dogs with shoulder OCD typically have pain when

A

their shoulder is flexed because that where flap rubs on scapula, however lots of dogs are also painful on flexion and rotation

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19
Q

How do you treat shoulder OCD in dogs

A

Surgically: Osteochondroplasty to remove the flap
or
Osteochondral Autograft Transfer System (OATS)

prognosis with surgically - excellent for caudal lesions
good for caudo-central lesions

follow up with OA preventative management

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20
Q

a surgical procedure to remove an osteochondral flap

A

osteochondroplasty

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21
Q

Out of all the OCD joint sites in dogs, what has the best prognosis

A

Shoulder

excellent prognosis for caudal lesions
good for caudo-central lesion

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22
Q

When might people consider Osteochondral Autograft Transfer System (OATS) for the treatment of shoulder OCD in dogs as opposed to osteochondroplasty?

A

If the lesion is caudo-central as opposed to caudal but this is pretty aggressive and not done often

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23
Q

pathology of the medial compartment/stabilizers of the shoulder in dogs
-Medial glenoid-humeral ligament
-Subscapularis

A

medial shoulder instability (syndrome)

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24
Q

What two structures are imparted with medial shoulder instability in dogs

A

1) Medial glenoid humeral ligament
2) Subscapularis

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25
Q

What causes medial shoulder instability

A

unknown but thought to be to repetitive microtrauma/overstretching as it is associated with adult athlete dogs: agility, flyball, hunting, etc.

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26
Q

What is the typical signalment of dogs with medial shoulder instability

A

adult athlete dogs: agility, flyball, hunting, etc.

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27
Q

What are the clinical signs of dogs with medial shoulder instability

A

-Mild to moderate shoulder instability
-Decreased performance
-Change in gait (stepping with 2 feet vs one foot when weaving through poles- athletic dogs)

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28
Q

How do you diagnose medial shoulder instability in dogs

A

1) Painful shoulder abduction (nonsedated)
2) Radiographs- mild OA or normal
3) Subjectively increased abduction angle when elbow and shoulder are extended
should be about 32.6 degrees
compare left and right
4) Arthroscopy
5) MRI
6) Ultrasound
7) Compare muscle atrophy to the opposite leg

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29
Q

How do you measure abduction angle seen with medial shoulder instability

A

1) Have the shoulder and elbow in extension
2) Abduct the leg (sedation)
3) Center the goniometer on shoulder joint
4) Line of humerus and parallel to scapular spine
5) Measure angle at goniometer
Normal is 32.6 +/- 2
make sure to compare left and right

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30
Q

What could give you a falsely positive abduction angle in a dog

A

not having the shoulder and elbow in extension
this could give you a false positive of 60 degrees

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31
Q

What is a normal shoulder abduction angle

A

Around 30 degrees

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32
Q

Do dogs need to be sedated to measure abduction angle to diagnose medial shoulder instability

A

YES

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33
Q

You notice an increase shoulder abduction angle in a dog, how do you confirm the diagnosis of medial shoulder instability

A

1) Arthroscopy: Intra-articular components of medial genoid humeral ligament and subscapularis

2) MRI: all inta-and extraarticular structures besides cartilage

3) Ultrasound: technically challenging but done a lot, needs a really good user

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34
Q

What are the grades of medial shoulder instability in dogs?

A

1: Abduction angle of 30-39. Arthroscopic findings of synovitis but no obvious MGHL/subscapularis pathology besides laxity/ joint capsule tearing

2: Abduction angle of 40-55. Arthroscopic findings of synovitis, fraying to partial disruption of of subscapularis tendon and/or MGHL

3: Abduction angle of >55 degrees
Arthroscopic findings of complete tearing of subscapularis and MGHL and subluxation of humeral head

4: Complete shoulder luxation, disruption of two structures, seen radiographically

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35
Q

Complete shoulder luxation, disruption of two structures, seen radiographically

A

Grade 4 Medial Shoulder Instability- Syndrome

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36
Q

Abduction angle of >55 degrees
Arthroscopic findings of complete tearing of subscapularis and MGHL and subluxation of humeral head

A

Grade 3 Medial Shoulder Instability- Syndrome

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37
Q

Abduction angle of 40-55. Arthroscopic findings of synovitis, fraying to partial disruption of of subscapularis tendon and/or MGHL

A

Grade 2 Medial Shoulder Instability- Syndrome

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38
Q

Abduction angle of 30-39. Arthroscopic findings of synovitis but no obvious MGHL/subscapularis pathology besides laxity/ joint capsule tearing

A

Grade 1 Medial Shoulder Instability- Syndrome

treat with rehab (hobbles), shockwave, PRP

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39
Q

What are the surgical options of medial shoulder instability (Grade 3-4)

A

1) Radiofrequency shrinkage: heat probe to do thermal oblate to shrink the tissues, not commonly performed over damage to cartilage

2) Prosthetic ligament reconstruction: attach on each side of joint, bone anchor and artificial ligament to replace the torn ligament

3) Tendon transposition (biceps)

4) Post-OP: hobbles/rehab

IS IT SURGERY OR JUST POST OP REHAB

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40
Q

How do you treat mild/moderate medial shoulder instability in dogs (Grades 1-2)

A

Rehab (Hobbles, Theraband, exercises, shockwave, PRP)

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41
Q

you notice metal opaque objects on the humeral head and scapula, what was likely being treated

A

Medial Shoulder Syndrome

Medial Shoulder Instability

Traumatic Shoulder Luxation

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42
Q

a term that implies both degeneration and inflammation of the tendon

A

tendinopathy

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43
Q

What causes biceps or supraspinatus tendinopathy

A

can be due to degeneration +/- inflammation

Hypovascular areas at origin/insertion
hypoxia leads to fibrocartilaginous transformation of the tendon

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44
Q

What causes fibrocartilaginous transformation of the tendon seen in tendinopathies

A

hypoxia at the hypovascular areas of origin/insertion

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45
Q

What are the different types of tendinopathies

A

Primary: tendinopathies die to repetitive microtrauma (large/active dogs), cause by trauma/overuse

Secondary: irriation/inflammation due to other joint diseases like OCD, supraspinatus, MSI
commonly seen in biceps tendinopathy

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46
Q

What is the origin of the biceps brachii muscle

A

Supraglenoid tubercle

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47
Q

What is the insertion of the biceps brachii muscle

A

Radial and ulnar tuberosities

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48
Q

What is the origin and insertion of the biceps brachii

A

Supraglenoid tubercle

Radial and ulnar tuberosities

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49
Q

What is the origin of the supraspinatus muscle

A

Supraspinous fossa

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50
Q

What is the insertion of the supraspinatus muscle

A

greater tubercle of the humerus

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51
Q

What is origin and insertion of the supraspinatus muscle

A

Origin: Supraspinous fossa

Insertion: Greater tubercle of the humerus

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52
Q

What is the typical presentation of biceps/supraspinatus tendinopathies

A

middle-aged, medium/large breed athletic dogs

History: progressive lameness (Nonweight bearing with partial acute avulsion), exacerbated with exercise

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53
Q

What are your differentials for dogs with biceps/ supraspinatus tendinopathies

A

ED/DJD - take rads +/- CT for adult onset

OA- take rads of the proximal humerus to rule out osteosarcoma

Neuro (including brachial plexus tumor)- check reflexes, CP, anisocoria

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54
Q

When a dog has biceps/supraspinatus tendinopathies, how do you rule out neurological disease

A

Check reflexes
Central proprioception
Lack of Anisocoria

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55
Q

How do you test a dog with biceps/supraspinatus tendinopathies

A

Palpation

Biceps: Pain when extend elbow, flex shoulder

Supraspinatus: Pain on palpation of insertion on greater tubercle, shoulder flexion while elbow flexed

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56
Q

You notice pain when extending the elbow and shoulder, what do you do next

A

Isolated hyperextension of the elbow, if still painful then it is likely the elbow

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57
Q

How do you test for supraspinatus tendinopathy

A

1) Painful palpation of insertion of greater tubercle
2) Pain when shoulder flexed, elbow flexed

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58
Q

How do you test for biceps tendinopathy

A

Painful when extend elbow, flex shoulder

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59
Q

How do you confirm diagnosis of a dog with biceps/supraspinatus tendinopathies

A

Radiographs (both)- only for calcifying tendinopathies

US, MRI (both)

Arthrogram (biceps only)

Arthroscopy (Biceps intra-articular)

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60
Q

On radiographs, how do you distinguish biceps from supraspinatus tendinopathies

A

Supraspinatus: fragments along the greater tubercle (more cranial)

Biceps brachii: fragment along the groove

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61
Q

Tendionpathies are only distinguishable on radiograph if

A

they are calcified

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62
Q

Arthrograms can only distinguish biceps or supraspinatus tendinopathies

A

Biceps - the only one that is in the joint

Supraspinatus is extra-articular

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63
Q

What is the big question when finding calcification of the biceps or supraspinatus tendons

A

it could be incidental or a reason for the lameness

do joint blocks for intra-articular disease (may help)

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64
Q

What radiograph views are helpful in identifying calcifying biceps/ supraspinatus tendinopathies

A

1) Lateral view
2) Craniocaudal view
3) Skyline view (intertibercular groove)

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65
Q

T/F: Ultrasound can only pick up calcifying biceps/ supraspinatus tendinopathies

A

False- can detect calcified or non-calcified tendinopathies

Dynamic - can detect adhesions of the tendon (MRI and Rads cant do this)

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66
Q

How do you treat Biceps tendinopathies in dogs

A

1) PT/Rehab

2) Medical: 5mg Triamaicnolone (shorter duration and safer than Depo) because it is intra-articular

3) Surgical (not really needed): Tenodesis (open), Tenotomy (Scope/Ultrasound)

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67
Q

What shoulder tendon is intra-articular

A

Biceps

that is why you can treat Biceps tendinopathies with 5mg Triamaicnolone

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68
Q

Tenodesis for biceps tendinopathy treatment

A

cutting tendon at origin and then release at inch and then reattach it at proximal humerus

this is different from tenotomy, where it is just cut and reattaches by itself

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69
Q

T/F: biceps tendinopathy is best treated with surgical management

A

False- it is not really done, patients respond well to PT/Rehab

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70
Q

How do you treat Supraspinatus tendinopathy

A

1) PT/Rehab

2) Medical: shock wave, PRP

3) Surgical: tendon resection, release of transverse humeral ligament, release incisions in supraspinatus

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71
Q

Biceps/Supraspinatus diagnosis and treatment (broad)

A

Diagnose with PE, X-rays, Ultrasound

Targeted treatment: Rehab/ ESWT/ TA/PRP

If no significant improvement: Scope, MRI to reach definitive diagnose and release/excision sx

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72
Q

What structures are important to evaluate the positioning of hip radiographs

A

Ilial wing
Obturator foramen

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73
Q

T/F: OCD lesions can be seen in the hip joint

A

False- OCD lesions do not exist in the hip

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74
Q

What is seen well in a lateral pelvic radiograph

A

the lumbosacral joint (L7-S1)

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75
Q

What is a good radiograph view to see the lumbosacral joint

A

lateral projection

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76
Q

Unlike the elbow, the hip joint is an unstable joint. What are the stabilizers of the hip joint?

A

1) Normal congruency (femoral head and acetabulum)
2) Joint capsule and joint fluid (hydrostatic pressure)
3) Round ligament
4) Surrounding musculature
-Gluteals/Pectineus/ Adductor
Small pelvic association (mm. obturator internus, gemelli, obturator externus, and quadratus femoris)

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77
Q

Why do you not want to tap a joint if there might be instability

A

because you are introducing air and getting rid of the hydrostatic pressure, making it less stable

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78
Q

What is the function of the gluteal muscles?

A

-Hip extension
-Hip abduction
-Medial rotation of hip joint
-Hip stability

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79
Q

What is the origin and insertion of the pectineus muscles

A

O: ilio-pubic eminence
I: Distal femur

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80
Q

What is the function of the pectineus muscles

A

-Adduction of thigh (together with adductor)
-Hip stability

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81
Q

What muscles provide stabilizing to the hip joint

A

Gluteals
Pectineus
Adductor

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82
Q

The gluteal muscles (superficial, middle, and deep) all go from

A

ilium or tuber sacrale (superficial) to the greater trochanter or 3rd trochanter (superficial)

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83
Q

Origin and insertion of Gluteus medius and Deep

A

O: lateral ilium

I: greater trochanter

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84
Q

Origin and insertion of the gluteus superficalis

A

O: tuber sacrale

I: 3rd trochanter

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85
Q

Why does rehab work well for dogs with hip dysplasia

A

increasing the musculature around the hips is really important in providing stability to the joint

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86
Q

How do the gluteal and pectineus/adductor work together to co-contraction and stabilize the hip joint

A

Gluteals: Extend hip, abduct, and internally rotate

while the

Pectineus/Adductor: Extend hip, adducts, and externally rotates

reduces hip laxity

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87
Q

Contraction of what muscles subluxates the hip joint during the swing phase

A

Iliopsoas, rectus femoris, sartorius

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88
Q

Why do dogs with hip dysplasia have a shorter swing phase

A

because the shorter you make the swing phase, the less change of subluxation occurs

this is done by the iliopsoas, rectus femoris, and sartorius

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89
Q

What causes hip dysplasia in dogs

A

Genetically Predisposed animals
+
Environmental factors leading to enhanced expression of genetic weakness (e.g obesity)

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90
Q

What three characteristics make hip dysplasia definition

A

Hip laxity that results in hip subluxation that results in hip arthritis

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91
Q

What breeds are predisposed to hip dysplasia

A

-Golden retrievers
-German shephards
-Saint bernards
-Labradors
-Rottweilers

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92
Q

T/F: hip dysplasia commonly leads to animals being really unilateral lame

A

False

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93
Q

Are radiographs helpful in diagnosing hip dysplasia?

A

Not necessarily good for early stages but good at picking up arthritis

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94
Q

Palpation tests for hip dysplasia

A

Ortolani
Full pelvic limb extension

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95
Q

T/F: OFA is good at detecting hip dysplasia

A

False

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96
Q

Hip dysplasia has linear biphasic progression, what does this mean?

A

Juvenille: severe lameness and joint laxity then the joint tightens up w fibrosis but then you have adult dogs becoming lame from joint inflammation and periarticular fibrosis

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97
Q

What does the gait of a dog with hip dysplasia look like

A

short strided gait, not swing through with their limbs, tight skirt gait

In severe cases, you can see subluxation of the femoral head

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98
Q

What are the differential diagnoses for dogs with pain on hip extension

A

1) Hip dysplasia
2) CCLD
3) Neuro
4) Flexor muscle disease (stretching flexor muscles- could be iliopsoas)

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99
Q

If you notice a dog with pain on hip extension, what should you do next

A

Hip abduction and flexion

if yes- hip dysplasia

if no- then likely
1) Pain on lumbosacral palpation (neurologic)
2) Pain on stifle hyperextension (CCLD)
3) Flexor muscle pain (stretching individual muscles- ie iliopsoas myopathy)

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100
Q

What is painful in dogs with hip dysplasia

A

Hip extension
Hip abduction
Hip Flexion

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101
Q

T/F: dogs with hip dysplasia are painful in both hip flexion and extension

A

Tru e

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102
Q

You have a dog with pain on hip extension and lumbosacral palpation but no
no pain on abduction or lfexion.
what could be happening

A

Lumbosacral disease

perform further palpation and diagnostics of L4-S2 neurologic disease

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103
Q

T/F: dogs with CCLD are painful on hip extension

A

True- also extending the stifle

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104
Q

a test where the dog is in dorsal or lateral recumbency
one hand stabilizing pelvis
one hand pushing femur to subluxate hip via abduct

A

Ortolani

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105
Q

What indicates a positive ortolani test

A

Reduction and subluxation

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106
Q

What does a dog that is bunny hopping up the stairs indicate

A

Hip dysplasia or bilateral cruciate disease

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107
Q

Why do dogs with CCLD have their hind legs spread out when sitting

A

they do not want to flex their stifles

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108
Q

If they have a positive sit test what should you think

A

Cruciate disease
possibly hip dysplasia

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109
Q

How to take a OFA-like radiograph

A

Dog in dorsal
Hip joints extended
patella pointing straight up at ceiling

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110
Q

The femoral head should be covered by

A

> 50% of the acetabulum

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111
Q

How do you tell the pelvis is rotated when taking radiographs

A

look at the iliac wings

rotation makes the thinner winged side look better than the other side

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112
Q

Why is the femoral head thickened with hip dysplasia

A

joint capsule inflammed and pulled, ostephytes created, thickening the head

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113
Q

If the left hip is raised up from the table, what will the ilial body look like

A

it will be thinner

the femoral head will artificially appear further in the acetabulum

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114
Q

Thin is

A

up and in

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115
Q

How old does the dog need to be for OFA radiographs

A

> 2years of age

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116
Q

OFA is rad scored based on

A

consensus of 3 radiologist (OA, subluxation)
seven point ordinal grading system (excellent, good, fair, borderline, mild dysplasia, moderate dysplasia, severe dysplasai)

Bias as self-submission

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117
Q

What is the issue with OFA-like radiographs

A

when you extend the hips you create wind-up which makes the joint capsule tighter, making the hips look better

sometimes hip dysplasia is so bad you dont need other views

PENN HIP radiographs are better

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118
Q

T/F: OFA-like radiographs are a good start but not always diagnostic

A

True

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119
Q

What does the PennHip radiographs do

A

appartus that is put between the legs,
push in, trying to subluxate femur

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120
Q

What are the 3 radiograph views in PENNHIP radiographs

A

1) Compression view
2) Distraction view
3) OFA view

Measures “passive” not function laxity and places it into a distraction index that is breed specific
<0.3: no OA
>0.7: OA
0.3-0.7: greyzone

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121
Q

What does distraction index correlate with

A

DJD probability at >2 years

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122
Q

T/F: PennHIP radiographs is a mandatory submission

A

True

after submission you get OA risk category and breed average DI
Central 90% range of breed DI’s

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123
Q

If you get + ortolani, can you say it is positive if they arent sedated

A

YES

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123
Q

When does juvenile hip dysplasia occur

A

less than 5 months of age

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124
Q

If you get a - ortolani, can you say it is negative if they arent sedated

A

No- you must sedate muscle mass might be messing this up

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125
Q

Immature hip dysplasia occurs in dogs that are _________ old

A

5-14 months old

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126
Q

T/F: juvenille hip dysplasia abnormalities is hard to detect

A

True

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127
Q

Immature hip dysplasia diagnostics

A

owners usually notice abnormality
Ortolani-specify how it palpates
Radiographs: OFA-like frequent sufficient
PENN HIP only needed if no obvious subluxation

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128
Q

Adult hip dysplasia diagnostics

A

> 14 months old
abnormal gait
ortolani not present
radiographs- OFA-like alwyas sufficient
PennHIP not needed

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129
Q

When is the PennHIP not needed

A

when adult hip dysplasia
OFA-like always sufficient

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130
Q

Which is the most appropriate diagnostic tool to screen for hip arthritis in a 2-year-old dog?

A

OFA-like radiographs

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131
Q

What are the next step(s) for a 4-month-old puppy that presents to you with signs of hip dysplasia (short strided gait, pain on hip extension, flexion, and abduction), yet OFA-like radiographs are not showing evidence of HD? Please note that this owner wants you to only examine the area where you believe the problem is located.

A

PennHIP
Ortolani

dont do ortolani first before PENNHIP

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132
Q

What should you do first
-Ortolani
-PennHIP

A

PennHIP

ortolani can create gas bubbles

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133
Q

JPS can only be done in dogs that are

A

less than 5 months

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134
Q

What is the process of the juvenile pubic symphysiodesis sx

A

1) Cauterize pubic symphysis
2) Pubic symphysis growth halted
3) Remainder of pelvis grows normally
4) Increased coverage of femoral head

only for dogs less than 5 months

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135
Q

procedure to cauterize pubic growth plate leading to halted pubic symphysis growth, causing the plevis to grow normally and increased coverage of femoral head

A

juvenile pubic symphysiodesis

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136
Q

What might be able to be done for dogs with hip dysplasia that are 5-14 months old

A

Triple Pelvic osteotomy

may not be recommended

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137
Q

procedures that involve ilial osteotomy to increase the coverage of the femoral head

A

Triple Pelvic Osteotomy
Double Pelvic Osteotomy

only for dogs 6-12 months old

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138
Q

What are the indications for dogs to get Triple Pelvic Osteotomy

A

1) 6-12 months old
2) Clinical symptoms
3) No significant DJD
4) Adequate dorsal acetbaular rim (DAR)

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139
Q

What needs to be done if owners consider TPO sx

A

PennHIP
DAR view

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140
Q

What needs to be done if owners do not consider TPO sx

A

Medical management
Total Hip replacement when needed

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141
Q

What are the benefits of JPS over TPO

A

JRS: both hips, less (no complications), less invasive, cheaper, easier

only benefit of TPO is that it can be done from 6-12 months

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142
Q

What are the treatment options for hip dysplasia in adult dogs

A

1) Medical management: Omega-3 fatty acids, weight loss, Glucosamine Cs/UC-II, Exercise modification, NSAIDS, and other pain meds
2) Total hip replacement
3) Femoral head and neck “ex”

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143
Q

What are the two most important components of hip dysplasia medical management in adult dogs

A

Omega-3-fatty acids
Weight loss/control

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144
Q

What are the total hip replacement options

A

Cemeted: aspeptic loosening

Cementless: last longer-

Hybrid: combined cemented stem/cup with cementless cup/stem

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145
Q

Is cemented or cementless hip replacement more prome to aspectic loosening

A

Cemented

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146
Q

what are the 3 complications of total hip replacement

A

1) Femur fracture- older dogs with thinner cortices
2) Luxation- more common in cemented THR
3) Infection

long term: aspectic loosening or implant failure

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147
Q

a surgery to eliminate the bony contact (source of pain) between the acetabulum and femoral head
creates fibrous pseudoarthrosis
variable results

A

Femoral head and neck ostectomy/excision

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148
Q

Femoral head and neck ostectomy/excision is better in smaller or bigger dogs

A

smaller

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149
Q

Why is Femoral head and neck ostectomy/excision not advised in juvenile patients

A

-Increased risk of bone regrowth
-Can always FHO
-Can not total hip repacement after femoral head ostectomy

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150
Q

What do you do if you have a dog with femoral head or acetabular fracture

A

FHO
-need to be very aggressive with rehab and ROM exercise
-long term painmeds

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151
Q

Best treatment for 4 MONTHS OLD DOG WITH HD

A

JPS

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152
Q

Best treatment for 8 MONTHS OLD DOG WITH HD

A

TPO

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153
Q

Best treatment for 2 YEAR OLD DOG WITH HD

A

THR

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154
Q

Best treatment for 2 YEAR OLD DOG WITH CCLD

A

TPLO

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155
Q

What causes a true hip luxation

A

1) HBC
2) Non-traumatic (watch for these = different treatment)

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156
Q

Is hip luxation more common in dogs or cats

A

Dogs

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157
Q

What gait will you see with craniodorsal hip luxation

A

Adducted with externally rotated stifle
looks like limb length discrepancy

limb length discrepancy

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158
Q

What is the most common type of hip luxation

A

craniodorsal

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159
Q

What are the different types of hip luxations

A

1) craniodorsal (most common)
2) Caudo-dorsal
3)Caudo-ventral

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160
Q

What should you do if you are unsure if the hip is luxated

A

take a 2nd view

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161
Q

When a dog’s hip is caudo-ventral luxated, where will the head of the femur be on radiograph

A

in the obturator foramen area

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162
Q

What do you evaluate in a dog with hip luxation

A

Are there any fractures?

Does the dog have good hip conformation

these change treatment

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163
Q

closed reduction tx for hip luxation

A

when you pop the head of the femur back into its place to fix hip luxation

not an option if the dog has arthritic hips (instead do FHO or THR)

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164
Q

What do you do if the dog has hip luxation with arthritis hips

A

you cant do closed reduction

do FHO or THR

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165
Q

What should you do for patients with hip luxation

A

Treat the patient first
-At least chest rads, 50% incidence of other issues (abdominal, thoracic, orthopedic)

ASAP closed reduction but prior to sedation, evaluate the patienr, do if no arthritis

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166
Q

What do you do after doing closed reduction of dorsal hip luxation treatment?

A

If closed reduction is succuessful, keep on Ehmer sling for no longer than 10-14 days

DogLegg’s less soft tissue swelling

Follow-up
-Recheck after 2-3 days and confirm hip reduced via rads
-Exercise restriction
-Aggressive PT once hip stable
-Arthritis management

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167
Q

Ehmer sling

A

a sling used to externally rotate and abduct the dog’s leg

Only For dorsal luxations

keeps the dog’s hip more likely to stay in place after closed reduction

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168
Q

What do you do after doing closed reduction of ventral hip luxation treatment?

A

Hobbles for 14 days to prevent abduction

Follow-up
-Recheck after 2-3 days and confirm hip reduced via rads
-Exercise restriction
-Aggressive PT once hip stable
-Arthritis management

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169
Q

How do you manage closed reduction of dorsal hip luxation vs ventral hip luxation

A

Dorsal: Ehmer sling to externally rotate and abduct leg (10-14)

Ventral: Hobbles (10-14) to prevent abduction

Both: -Recheck after 2-3 days and confirm hip reduced via rads
-Exercise restriction
-Aggressive PT once hip stable
-Arthritis management

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170
Q

What do you do if closed reduction of hip luxation is unsuccessful

A

1) Open reduction and stabilization: only if good hip conformation, best chance for normal hip

2) FHO: salvage procedure esp for smaller dogs and cats or if financial restrictions prevent THR

3) THR: if poor hip conformation, especially in larger dogs, very expensive

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171
Q

Open reduction

A

Approach to hip
-Trochanteric osteotomy (better exposure)
-Craniolateral approach (less complication)

Surgical stabilization
-Capsulorrhapy: suture/tighten joint capsule
-Capsule augmentation- can support with bone anchors dorsally
-Toggle pin or tightrope- replaces round ligament

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172
Q

non-inflammatory, aspectic necrosis of the femoral head

A

legg calve perthes disease

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173
Q

what breeds is legg calve perthes disease common in

A

toy and terrier breeds

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174
Q

What is the typical singalment of legg calve perthes disease

A

toy and terrier breeds
3-13 months (usually 5-8 months)

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175
Q

T/F: legg calve perthes disease is always unilateral

A

false bilateral involvment 15% of time

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176
Q

How do you treat legg calve perthes disease

A

FHO
they do well

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177
Q

What happens concurrently to legg calve perthes disease

A

medial patellar luxation

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178
Q

Diffuse periosteal reaction around distal bones associated with thoracic/abdominal mass

A

hypertrophic osteopathy

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179
Q

What are other names for hypertrophic osteopathy

A

-pulmonary osteoarthropathy
-hypertrophic pulmonary osteoarthropathy
-hypertrophic pulmonary osteopathy

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180
Q

What is the typical signalment of hypertrophic osteopathy

A

age- any, related to underlying disease (neoplasia = usually older)

Breed- any

gender: either

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181
Q

What are the clinical signs of hypertrophic osteopathy

A

lethargy, anorexia, unwillingness to move and unspecific signs more common than lameness

swollen, painful distal extremities

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182
Q

How do you diagnose hypertrophic osteopathy

A

careful general exam (abdominal palpaition)

ultrasound, thoracic and abdominal radiographs

limb radiographs

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183
Q

What does hypertrophic osteopathy look like on radiograph

A

‘Pallisade formation’
-Bilaterally symmetric periosteal reaction
-Smooth/regular or rough/aggressive
-Soft tissue swelling

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184
Q

What causes hypertrophic osteopathy

A

Paraneoplastic or associated with other disease
1) Commonly Pulmonary neoplasia (primary or metastatic)
2) Any mass can induce it
-Thoracic (esophageal granuloma, embryonal rhabdomyosarcoma)
-Abdominal (liver neoplasia, pregnancy, etc)

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185
Q

What is the pathophysiologic of hypertrophic osteopathy

A

1) Irritation of afferent nerves by primary mass
2) Neurally (vagus) mediated reflex
3) Increase peripheral blood flow
4) Connective tissue/periosteum congestion
5) New periosteal bone deposition

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186
Q

How do you treat hypertrophic osteopathy

A

1) Remove/treat primary lesion - bone lesions regress within weeks as periosteal new bone remodels
pain resolves within weeks

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187
Q

What is the prognosis of hypertrophic osteopathy?

A

depends on the primary lesion
recurrence of tumor or metastatic disease

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188
Q

What is the difference between congenital and developmental diseases

A

Congenital= born with (birth defects) that can be inherited or caused by chemicals or injury during pregnancy

Developmental:
caused by disturbances in the development and maturation of the musculoskeletal system, in particular the articular and metaphyseal cartilage

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189
Q

caused by disturbances in the development and maturation of the musculoskeletal system, in particular the articular and metaphyseal cartilage

A

developmental disorder

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190
Q

born with (birth defects) that can be inherited or caused by chemicals or injury during pregnancy

A

congenital defects

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191
Q

disruption of endochondral ossification due to rapid growth
can be osteochondral (with subchondral bone) or cartilaginous flap (without bone)
causes pain, effusion, lameness and osteoarthritis long term

A

osteochondrosis dissecans

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192
Q

What happens when osteochondrosis dissecans fragment is removed

A

fibrocartilage fills the gap,

193
Q

In dogs, what 4 joints does OCD occur in *

A

1) Shoulder
2) Elbow
3) Tarsus
4) Stifle

194
Q

In dogs, what joints does OCD not occur in *

A

1) Hip
2) Carpus

195
Q

How do you diagnose shoulder OCD in dogs

A

rads are frequently sufficient

196
Q

In dogs, OCD in the ________ joint has the best prognosis

A

shoulder, especially for caudal lesions

the elbow/tarsus/stifle have questionable benefit of surgery/fair-poor

197
Q

How do you need to diagnose elbow, tarsus, and stifle OCD?

A

often times CT is frequently needed

198
Q

What does OCD in the shoulder of dogs look like radiographically

A

flattenining of the caudal humeral head

CT is generally not required if rads are obvious

199
Q

How do you treat OCD in dogs

A

-Flap removal: simple + cheap, fibrocartilage fills in

-Focal procedure: OATS, synthetic OATS

-Regenerative Medicine: Stem cells, PRP

200
Q

What is another name for hypertrophic osteodystrophy

A

Metaphyseal osteopathy

201
Q

disruption of the metaphyseal trabeculae in long bones of young, rapidly growing dogs

A

hypertrophic osteodystrophy

202
Q

What kind of dogs does hypertrophic osteodystrophy typically occur in?

A

young, rapidly growing dogs
3-6 months (early as 2 mo)
males are more common than females
may involve several or all littermates

203
Q

Are male of female puppies more likely to get hypertrophic osteodystrophy

A

males, esp giant/large breed dogs 3-6 months

204
Q

What are the clinical signs of hypertrophic osteodystrophy

A

-slight limp to non-weight bearing to recumbent
-swollen, hot, painful, Metaphysis, (usually bilateral)
-Episodic signs
-Sick systemic signs: fever, depression, anorexia, diarrhea, weight loss

205
Q

In hypertrophic osteodystrophy, puppies will be swollen, hot, and painful at the

A

metaphysis (usually bilateral)

206
Q

What do you see on clin path in a dog with hypertrophic osteodystrophy

A

usually normal
-leukocytosis
-mild anemia
-bacteremia (rare)

207
Q

What do you see radiographically in dogs with hypertrophic osteodystrophy

A

1) *a double physeal line
2) Endosteal density with layers of lucency
3) Irregular periosteal proliferations at the metaphyseal level

Later stages:
1) Retained cartilage cores
2) Premature physeal closures
3) Diaphyseal lesions

208
Q

You see a 4month old puppy that presented with bilateral swelling, upon radiographic signs you see a double physeal line and endosteal denstiy with layers of lucency
and irregular periosteal proliferations at the metaphyseal level.
What is the diagnosis

A

hypertrophic osteodystrophy

209
Q

What radiographic changes do you in late hypertrophic osteodystrophy

A

1) retained cartilage cores
2) premature physeal closures (leading to ALD)
3) diaphyseal lesions

hard to differentiate from HOA- specifically fungal lesion in the chest

210
Q

What radiogrpahic changes do you see in early hypertrophic osteodystrophy

A

1) *a double physeal line
2) Endosteal density with layers of lucency
3) Irregular periosteal proliferations at the metaphyseal level

211
Q

What causes hypertrophic osteodystrophy

A

unknown etiology
-canine distemper virus
-Previous vaccination
-Hereditary causes
-Auto-immune disorder

212
Q

What are common differentials when considering hypertrophic osteodystrophy

A

septic arthritis
Panosteitis

213
Q

What are common locations for hypertrophic osteodystrophy

A

radius, ulna, and tibia
(also mandible)

214
Q

What is the pathogenesis of hypertrophic osteodystrophy

A

1) Disturbance in metaphyseal blood supply
2) Delay/failure in ossification of the physeal hypertrophic zone (delayed endochondral ossification)
3) Retained cartilage, extends into the metaphyseal trabeculae
4) Trabeculae fractures, leading to hemorrhage and inflammation
5) Trabecular fractures causes lifting of the periosteum and new bone production (Codmans triangle)

215
Q

How do you treat mild cases of hypertrophic osteodystrophy

A

Supportive care: analgesia with NSAIDs, GI protectants, and rest

prognosis: good to excellent, relapses may occur
NEED regular rechecks as angular limb deformities are possible

216
Q

Why do you need to recheck hypertrophic osteodystrophy mild cases frequently

A

can lead to angular limb deformities

217
Q

How do you treat severe cases of hypertrophic osteodystrophy

A

more advanced supportive care: enteral nutrition, antibiotics

prognosis: guarded to poor, long-term support needed, angular limb deformities are common

218
Q

What is the typical signalment of panosteitis

A

7-16 months (teenagers)

reported to occur up to several years of age
-rapidly growing larger and giant breeds (german shepherds)
80% males

219
Q

Panosteitis typically occurs in males or females

A

Males 80%

220
Q

Panosteitis typically occurs in what kind of dogs?

A

rapidly growing larger and giant breed dogs
German shephards

221
Q

What causes panosteitis

A

1) Idiopathic
2) Osseous compartment syndrome due to protein rich diet
-Genetic
-Autoimmune reaction
-Viral osteomyelitis (CDV) or vaccine response
-Bacterial osteomyelitis

222
Q

What kind of lameness is seen with panosteitis

A

acute shifting limb lameness
pain wuth direct pressure over the affected diaphyseal region

223
Q

Dogs with panosteitis have pain with direct pressure over the

A

affected diaphyseal region

224
Q

Where in the bone does panosteitis typically occur

A

diaphysis

frequently forelimb (radius/ulna) first then humerus, femur, tibia

225
Q

What are the clinical signs of dogs with panosteitis

A

-Acute shifting limb lameness
-Pain with direct pressure over affected diaphyseal region
-Intermittent mild fever, lethargy, anorexia

Bloodwork WNL

226
Q

How do you diagnose panosteitis

A

Radiographs, nuclear scintigraphy, CT

Radiographs:
-Increased radiolucency at the nutrient foramen
-Unifocal increased intramedullary density
-Multiple, coalescing foci of increased radiolucencies
-Indistinct endosteal surfaces
-Mild periosteal reaction

radiograph findings lag at leasy 7 days behind clinical symptoms

227
Q

What are the radiographic findings of panosteitis

A

1) Increased radiolucency at the nutrient foramen
2) Unifocal increased intramedullary density
3) Multiple, coalescing foci of increased radiolucencies
4) Indistinct endosteal surfaces
5) Mild periosteal reaction

228
Q

At what age do dogs typically get panosteitis

A

7-16 months old (can occur up to several years of age)

229
Q

How do you treat dogs with panosteitis

A

-Typically self limiting
-Check diet
-NSAIDs/pain meds

prognosis: excellent but multiple bouts happen frequently
best prognosis amongst juvenille diseases

230
Q

a rare congenital bone abnormality that affects the soft tissue and bones of a dog’s thoracic limbs. It’s also known as split-hand deformity

A

ectrodactyly

231
Q

Very young animals
can be very sick
double physis
supportive care
prognosis depends on severity of case

A

hypertrophic osteodystrophy

232
Q

teenager to adult dogs
shifting lameness with no systemic signs
Increased opacities
Pain meds and rest
excellent prognosis

A

Panosteitis

233
Q

older animals
swollen limbs, ADR
pallisading lesions
remove mass
prognosis depends on underlying disease

A

hypertrophic osteopathy

234
Q

What is the highmovement joint of the dog tarsus

A

Tarsocrural

235
Q

T/F: Tarsal OCD is rare

A

True

236
Q

Varus/Valgus can place stress on the _____ of the carpus

A

collateral ligaments

237
Q

How do you test the collateral ligaments of the carpus

A

varus/valgus stress

-short branch: flexed

238
Q

If you take a DMPLO of the dogs tarsus, what is it highlighting

A

Dorsolateral and medial palmar

239
Q

What are the 4 standard radiographic views you take of the hock/tarsus

A

1) Lateral
2) DP
3) DMPLO
4) DLPMO

if collateral rupture: stress views

240
Q

Tarsal OCD affects the

A

talus (often bilateral)

medial ridge (60-80%) > lateral risge > both ridges

241
Q

What site of the dog’s tarsus is the most common site of OCD

A

medial ridge of the talus

242
Q

What is the signalment of dogs with tarsal OCD

A

developmental = young, large breed dogs Male > female

adult dogs with arthritis (secondary changes)

243
Q

What are the radiographic findings of tarsal OCD

A

1) Frequently have tarsal hyperextension
2) + Sit test (DD: CCLD)
3) Joint effusion * (severe) /periarticular swelling
4) Painful ROM (especially flexion)
5) Rear limb lameness (unilateral or bilateral)
6) Acute onset or slow insidious, chronci progressive
7) Stiff, slow lame after cool down

244
Q

Dogs with tarsal OCD are painful when the tarsus is

A

flexed - dogs with tarsal OCD typically have tarsal hyperextension

245
Q

What are the radiographic findings of dogs with Tarsal OCD

A

Medial and lateral ridges of talus
if lesion is not detected, does not rule out OCD
DP skyline is useful

CT allows accurate localization required for surgery

246
Q

How do you treat OCD of the tarsus surgically

A

1) Removal and debridement of fragment
2) unloading osteotomy: that moves load onto the lateral compartment

arthrodesis (end-stage)
Total ankle replacement

247
Q

What causes carpal hyperextension

A

traumatic disruption of palmar fibrocartilage

248
Q

When taking goniometry measurements, always measure on the

A

flexion surface

249
Q

carpal hyperextension can occur due to carpal injury at what levels

A

1) Antebrachiocarpal
2) Middle carpal
3) Carpometacarpal

250
Q

Is splinting more likely to be successful for antebrachiocarpal or carpometacarpal hyperextension injuries

A

Antebrachiocarpal

251
Q

traumatic disruption of palmar fibrocartilage of the carpus
most common injury of the carpus
fibrocartilage does not heal

A

carpal hyperextension

252
Q

The treatment of carpal hyperextension depends on

A

Severity

Mild cases (not dropped) are amenable to coaptation

Severe cases (palmigrade): require arthodesis

253
Q

How do you treat mild cases of carpal hyperextension (not dropped)

A

amendable to coaptation

254
Q

How do you treat severe cases of carpal hyperextension (palmigrade)

A

Arthrodesis is requires

Pancarpal= all carpal joints
Partial= distal carpal joints (all except antebrachial-carpal joint)

255
Q

How do you diagnose collateral ligament injury

A

visual instability/ abnormal stance
palpable instability

256
Q

How do you treat first degree (stretch) / mild tarsal ligament injuries

A

Rest, ice, compression, elevation
NSAIDs
+/- soft padded bandage

257
Q

How do you treat second degree (partial) / moderate tarsal ligament injuries

A

external coaptation

258
Q

How do you treat third degree (complete)/ severe tarsal ligament injuries

A

Surgery vs support

Ligament repair / augmentation
-Anchors
-Bone tunnels
via locking loop

Support: Splint vs hinged orthotic or trans-articular fixator (lots of fibrosis and less ROM)

259
Q

What suture pattern is best for collateral ligament repair

A

locking loop

260
Q

Which locations are feasible for primary (suture) repair?

A) Carpal hyperextension (inter carpal ligaments

B) Achilles mechanism (common calcanean tendon, gastrocnemius, SDF)

C) Cranial cruciate ligament

D) Tarsal medial collateral ligament

A

B) Achilles mechanism (common calcanean tendon, gastrocnemius, SDF)

D) Tarsal medial collateral ligament

carpal has too many
CCL will fail

261
Q

surgical procedure to fuse a joint

A

arthrodesis

262
Q

you can do partial arthrodesis on what carpal and tarsal joints

A

any of the distal low motion joints
-less morbidity / complications
-ensure high motion joint is not involved
-some partial carpal may breakdown -> PanCA

263
Q

Pan-Arthrodesis

A

full fusion of all joints
-injuries that involve high motion joint
-last resort (salvage)

264
Q

T/F: you can reverse arthrodesis

A

False

265
Q

What are the principles of arthrodesis

A

1) Remove all cartilage, forage bone
2) Use bone graft (from proximal tibia, ilium, humerus) to encourage fusion of the bone
3) Fix at a standing angle
4) Provide stable fixation (bone plates) +/- splint

high rate of complications

266
Q

Where should you get bone graft from

A

proximal tibia
proximal humerus
ilium

267
Q

What are the high motion joints of the carpus and tarsus

A

Antebrachiocarpal
Tarsocrural joint

(90% of joint motion)

268
Q

What are complications of arthrodesis

A

highly technical sx
-plate fixation in most cases
ESF if infection/wounds

monitor for complications (10%)
-implant failure / delayed union
-wounds

269
Q

How should you manage dogs after arthrodesis

A

1) splint/cast bandage care
2) monitor for complications (10%)
-implant failure/delayed union
-wounds
3) Encourage controlled weight bearing
4) Slow bone healing (radiographs at 6 + 12 weeks)
5) Good function with extremity joints once healed

270
Q

T/F: tarsal OCD in dogs has a good prognosis *

A

False - therefore aggressive/novel intervention is needed

271
Q

What is the common signalment and history of dogs with Cranial Cruciate ligament tear

A

middle aged
medium to large breed
normal activity “weekend warrior”

272
Q

How does CCL tear differ from in dogs from humans

A

dogs have a higher tibial plateau angle (TPA): 25-30 degrees

ligament degeneration vs acute injury

273
Q

What is the normal tibial plateau angle of dogs?

A

25-30 degrees

274
Q

What is the typical signalment for dogs w CrCL acute avulsion injury

A

young (skeletally immature) athletic dogs

subchondral bone is weaker

275
Q

What is a risk factor for early CrCL ligament rupture in dogs

A

1) Early neutered (growth plates stay open longer)
2) Straight legged conformation

leads to higher TAP and risk factor for early rupture

276
Q

early neutering leads to

A

growth plates staying open longer and orthopedic diseases

277
Q

How do small dog breeds present with Cranial Cruciate ligament disease

A

Older, overweight
acute complete rupture

may be secondary to MPL (due to internal stifle rotation)

278
Q

Small dog breeds might have acute complete CrCL rupture due to

A

1) may be secondary to MPL- internal stifle rotation and increased mechanical stress
2) Older, overweight

279
Q

How would CrCL partial tear present

A

lameness may be prolonged, intermittent and mild

280
Q

How would CrCL complete tear present

A

acute and severe

281
Q

How would a secondary meniscal injury present

A

lameness may partually improve then becomes and stays severe

282
Q

CrCL tear is worse _________ and improves with

A

after strenuous exercise
after prolonged rest

improves with rest/ activity exercise restriction
improves with NSAIDs

283
Q

How will a dog move with CrCL disease

A

significant lameness in the hindlimb
-shifting weight away from the leg
-hip moves up
-may plant good leg closer to midline forcefully

284
Q

What are the two diseases that would lead to a positive sit test

A

1) Cruciate disease
2) Tarsal OCD

285
Q

What muscle becomes atrophied with CrCL disease

A

quadriceps muscles

286
Q

What are signs of CrCL disease on stifle manipulation

A

Pain on ROM
Cepitus/clicks
instability

287
Q

With a sit test, how do you lateralize a lesion

A

shifts weight away from the lame leg

288
Q

How do dogs with bilateral CrCL disease move

A

lower head movement
weight shifting forward or doesnt want to sit when sitting

289
Q

______% of dogs that present for unilateral CCLD, present with lameness on the contralateral limb within 2 years

A

50%

290
Q

Dogs with CrCL disease have pain on

A

full flexion and extension

291
Q

Where do you assess for stifle effusion in a dog

A

on either side of the patellar tendon

if chronic: periarticular tendon

effusion makes patellar tendon less distinct

292
Q

For cranial drawer motion, how do you position your proximal hand

A

thumb: lateral fabella
index: patella

shift the distal side while stabilizing the proximal side

293
Q

thickening of fibrous tissue along the medial aspect of the stifle joint

A

medial buttress

seen with chronicity of cruciate disease

294
Q

When is medial buttress felt

A

seen with chronicity of cruciate disease

295
Q

For cranial drawer motion, how do you position your distal hand

A

thumb: fibula head
index: tibial tuberosity

shift the distal side while stabilizing the proximal side

296
Q

With caudal cruciate ligament tear, how does the drawer motion feel

A

caudal cruciate drawer motion, stifle doesnt stop when moved caudally

297
Q

In tibial compression test, what prevents the tibia from moving forward

A

intact cranial cruciate ligament

298
Q

Why is tibial compression test more valuable than cranial drawer test

A

1) More tolerable by the patient, instability can be determined
2) Can be done in standing exam
3) Caudal CL tears do not have cranial tibial crust

299
Q

T/F: many dogs with significant CrCL disease will not have much instability to cranial drawer or tibial thrust

A

True- look for other signs

300
Q

What radiographic view is best for CCLD diagnostics

A

lateral projection is most useful
assess
1) effusion
2) osteoarthritis (OA)

301
Q

What are the radiographic findings of dogs with a partial CCL tear

A

1) fluid/soft tissue density displacing the fat pad
2) stifle is outpouched by effusion
3) ostephytes can form (trochlear ridge, distal patella, around fabella, tibial plateau)

302
Q

In dogs with CCL tear, where are common sites to see osteophytes

A

1) trochlear ridge
2) Distal patella
3) Fabella
4) Tibial plateau

303
Q

When taking a stifle radiograph for CCLD, what do you do if the patient is too big to focus on both the stifle and tibia

A

take two radiographs and superimpose them onto each other

304
Q

How do you measure tibial plateau angle

A

Functional axis: intercondylar eminence to middle of weight bearing surface

measure line across the tibial line

angle between the perpendicular to the functional axis and the tibial slope

305
Q

tibial plataeu angle

A

angle between the perpendicular to the functional axis and the tibial slope

306
Q

What is an excessive TPA

A

> 35 degrees

307
Q

Patients that have a higher TPA (>30) are poor candidates for

A

Poor candidates for
1) Conservative management
2) ExCap- suture under stress
3) TTA- further you have to advance tuberosity

Best treated with TPLO

308
Q

Patients with a TPA >30 are best treated with

A

TPLO

309
Q

Dogs with caudal CL tear do not have

A

tibial thrust

310
Q

What are the radiographic findings of a dog with a complete cranial cruciate ligament tear

A

1) Cranial tibial subluxation

Nx: Eminence should sit under the ball of the femoral condyle

Complete tear: you see the eminence be more cranial to the femoral condyle

311
Q

crescent and wedge shaped fibrocartilages important in load bearing and load distribution of the stifle

A

Meniscus

312
Q

What meniscus is most prone to injury after CrCLD

A

caudal pole of the medial meniscus

-femoral condyle roles onto it

313
Q

Why is the caudal pole of the medial meniscus most prone to injury after CrCLD

A

tagged down to tibia via ligament while the lateral meniscus is tapped down to femur

the repetitive caudal pole ramming damages the caudal pole of the medial meniscus

314
Q

With CrCL injury how often does meniscal injury occur

A

50-90% of the time

315
Q

T/F: isolated meniscal tear to lateral meniscus is common

A

false

316
Q

caudal pole of the medial meniscus

A

commonly tears after CrCl tear

317
Q

what are the different types of meniscal tears

A

Radial: 2mm tear

Complex: multidirectional tears and crushing of tissues

Vertical Longitudinal: non displaced, involving the whole caudal pole

Displaced Vertical Longitudinal (non-reducible bucket handle)- crushed

Flap: transected bucket handle

318
Q

How do you treat radial meniscal tears

A

no treatment

319
Q

How do you treat complex meniscal tears (multidirectional tears and crushing of tissues)

A

all of the caudal pole (hemi-meniscectomy)

320
Q

How do you treat longitudinal meniscal tears?

A

partial meniscectomy

321
Q

How do you assess for meniscal injury with CrCL disease

A

must insepct via arthrotomy or arthroscopy

probing increases diagnostic accuracy by 8 times

322
Q

When is conservative management for CrCL disease indicated

A

dogs <15kgs with acceptable limb function

smaller and less athletic dogs

reported success rates of 84-90%

323
Q

For CrCL disease, what are the goals with surgery management

A

1) Address an concurrent meniscal injury
2) Reestablish joint stability
3) Mitigate secondary osteoarthritis

324
Q

At what weight is CrCL conservative management considered acceptable recovery

A

80% reach acceptable recovery if <15kg

325
Q

What improves the results of CrCL conservative management in small dogs

A

weight loss

326
Q

What are the cons of CrCL Extraarticular Stabilization (ExCAP)

A

1) Fails to maintain stability
2) Progressive OA
3) Does not prevent late meniscal damage
4) No perfectly isometric suture (hard to anchor and doesnt last long)
5) Not good for high performance

327
Q

a procedure where suture of nylon leater line is used to anchor the cranial tibia to the caudal femur in CrCL

A

CrCL Extraarticular Stabilization (ExCAP)

328
Q

What are procedures that function to decrease the tibial plateau angle

A

1) Cranial tibial closing wedge osteotomy (CTWO)
2) Tibial Plateau Leveling Osteotomy (TPLO)
3) Combined CTWO and TPLO
4) Proximal intraarticular osteotomy
5) Chevron Wedge Osteomy

329
Q

What procedure functions to alter the alignment of the patella tendon for CrCL tears

A

Tibial Tuberosity Advancement (TTA)

330
Q

What procedure functions to both decrease the tibial plateau angle and alter the alignment of the patella tendon

A

Triple Tibial Osteomy (TTO)

331
Q

What TPA is the goal of TPLO

A

6 degrees

332
Q

A procedure used for a CrCL deficient stifle where the joint reaction force is parallel to longitudinal axis of tibia and tibial plateu
thrust elmininated
used to change the angle via semicircle cut and rotation of the caudal proximal tibial bone

A

TPLO

333
Q

a procedure to CrCLD where a cut in the tibia is made to make a 90 degree between tibial plateu and patellar tendon

A

Tibial Tuberosity Advancement (TTA)

334
Q

Why is the Tibial Tuberosity Advancement (TTA) a lot less reliable

A

relationshop of tibial plateu and patellar tendon being 90 degrees is changed due to positioning of the stifle and quadriceps/hamstrings balance

doesnt always provide good stabilization

335
Q

With a Tibial Tuberosity Advancement (TTA), what should be perpendicular to each other

A

patellar tendon and tibial plateau

336
Q

What are considerations when deciding to do ExCap vs TPLO vs TTA

A

-Owners goals, financial constraints
-Patient signalment, activity
-Degree of instability
-Tibial plateau angle and conformation
-Concurrent patella luxation

337
Q

What CrCL treatment has the fastest return to comfortable function

A

TTA

TTA > TPLO > ExCap > Conservative

338
Q

What procedure should you do if a patient has an excessive TTA (ex 60 degrees), where in TPLO you cant rotate the tibia that much

A

Modified cranial closing wedge osteotomy

339
Q

What is the CrCL prognosis after surgical intervention

A

all surgical techniques quote 80-90% return to normal function

340
Q

With CrCL disease, you often see _____ contralateral CrCL rupture within ________

A

50% contralateral CrCL rupture within 12-18 months

341
Q

What is the pathogenesis of patella luxation *

A

Primary malalignment of extensor mechanism
1) Shallow trochlear groove (never forms)
2) Malpositioning of tibial tuberosity
3) Distal femoral varus
4) Excessive laxity and fibrosis of soft tissues

342
Q

what patella luxation is most common

A

Medial patella luxation is most common in all breeds, especially small breeds

343
Q

What is the most common patella luxation in small breeds

A

Medial patella luxation

344
Q

What is the most common patella luxation in large dogs

A

medial patella luxation

345
Q

Lateral patella luxation is usually in

A

larger breed dogs, but it is still more common for large dogs to get medial

346
Q

a patella that subluxates with digital pressure but spontaneously reduces

rare spontaneous luxation and lameness

A

Grade I Patella Luxation

347
Q

What causes patella luxation

A

Primary malalignment of extensor mechanism
1) Shallow trochlear groove (never forms)
2) Malpositioning of tibial tuberosity
3) Distal femoral varus
4) Excessive laxity and fibrosis of soft tissues

348
Q

What are the 4 primary ways a dog might get patella luxation

A

1) Shallow trochlear groove (never forms)
2) Malpositioning of tibial tuberosity
3) Distal femoral varus
4) Excessive laxity and fibrosis of soft tissues

349
Q

T/F: grade 1 patella luxation is normal in cats

A

true- possible. cats have a very mobile patella

350
Q

a patella that luxates manually and spontaneously

can be manually reduced or spontaneously reduces but spends most of its time in the groove

may have intermittent lameness of skipping lamness

A

Grade II Patella Luxation

351
Q

What lameness is seen with Grade II Patella luxation

A

may have intermittent lameness of skipping lameness

352
Q

What lameness is seen with Grade I Patella luxation

A

rare spontaneous luxation and lameness

353
Q

patella is luxated, but can be manually reduced

may walk crouched with stifle semi-flexed

patella spends more time out than in
constant lameness out and internally rotated stifle

A

Grade III Patella luxation

354
Q

patella is permanently luxation and cannot be reduced
may carry limb or walk crouched
severe gait changes (hand-stands)

A

Grade IV Patella Luxation

355
Q

What are the different grades of patella luxated

A

1) Subluxated with digital pressure but spontaneously reduces, rare spontaneous luxation and lameness, normal in cats

2) Luxates manually and spontaneously, can be manually reduced or spontaneously reduces, spends most of its time in the groove, intermittent lameness or skipping lameness

3) Patella is luxated but can be manually reduced, may walk crouched with stifle semi-flexed, patella spends more time out than in

4) Permanently luxated and cannot be reduced, may carry limb or walk crouched, severe gait changes (hand-stands)

356
Q

How do you assess for patella luxation in a dog

A

lameness varies with grade
-standing exam most useful
-slighting extend and internally rotate the stifle

357
Q

What are MPL surgical considerations

A

-How clinically affected is the patient
-Frequency and severity of lameness
-Performance goals
-Grade of MPL

358
Q

Do you recommend sx for grade I and II patella luxations

A

only indicated if clinically significant

359
Q

When is sx for MPL indicated

A

Grade 1-2 (if clinically significant)

Grade 2-3: recommended to minimize arthritis and may avoid cranial cruciate disease

Grade 4: severe bony and ligamentous deformities may not be repairable if not corrected early

360
Q

Why is surgery of grade II to III MPL indicated

A

recommended to minimize arthritis and may avoid cranial cruciate disease

361
Q

Grade 4 MPL surgery

A

severe bony and ligamentous deformities may not be repairable if not corrected early

362
Q

how do you fix the primary malalignment of extensor mechanism caused by a shallow trochlear groove

A

Trochleopasty

363
Q

How do you fix the primary malalignment of extensor mechanism caused by malpositioning of tibial tuberosity

A

Tibial Tuberosity Transposition (TTT)

364
Q

How do you fix the primary malalignment of extensor mechanism caused by distal femoral varus

A

Distal femoral osteotomy (DFO)

365
Q

How do you fix the primary malalignment of extensor mechanism caused by excessive laxity and fibrosis of soft tissues

A

-Fascia imbrication and/or release
-Anti-rotation suture (ex: ExCap)

366
Q

What are the complications of MPL sx

A

-reluxation or overcorrection (MPL -> LPL)
-owners should be forewarned of potential for second surgery

guarded prognosis for grade IV

367
Q

How do you tell good positioning of a stifle radiograph

A

you want superimposition of the femoral condyles

368
Q

A dog presents to you for suspected medial patella luxation. The owner reports seeing an intermittent “skipping” right hind limb lameness around 2-3 times a week that lasts for only 5 to 10 mins. When you palpate the dog’s right stifle the patella luxates medially with gentle medial pressure and internal rotation of the stifle, but was in the correct position to begin and returns to a normal position after you release pressure on the stifle. What grade of MPL is this most consistent with?

A

Grade 2/4 MPLs are in the normal position the majority of the time, but can spontaneously luxate.

369
Q

What 3 joints make up the canine elbow

A

1) Humeroradial - weight bearing function
2) Hueroulnar - restruicts motion to sagittal plane
3) Proximal radioulnar - transverse plane pronation/rotation

370
Q

what joint of the elbow is important for weight bearing function

A

humeroradial

371
Q

what joint of the elbow is important for transverse plane pronation/rotation

A

proximal radioulnar

372
Q

what joint of the elbow is important for restricting motion to the sagittal plane

A

humeroulnar

373
Q

what is the lateral componet of the humerus that articulates with the radial head

A

capitulum

374
Q

what is the medial component of the humerus that articulates with the medial portion of the ulnar coronoid process

A

trochlea

375
Q

How do you diagnose coronoid disease (MCD)

A

1) CT
2) Scope

Rads can give supportive information but never a definitive dx

376
Q

How do you diagnose ununited anconeal process

A

flexed lateral radiograph

377
Q

How do you rule out elbow incongruity

A

1) CT
2) Scope

Rads are only to rule out large incongruity

378
Q

How do you diagnose OCD of the canine elbow

A

CT

Rads will not pick up much

379
Q

What plays an important role in MCD and UAP

A

elbow incongruity

if there is humeral-radial incongruity there will be more load on the coronoid

380
Q

where the elbow joint surfaces dont match. can occur in 3 joints
-humeroulnar
-proximal radioulnar
-humeroradial

A

incongruity

381
Q

What is humeroulnar incongruity called

A

notch incongruity “C shape”

382
Q

What occurs when the radius is too short

A

1) pressure on coronoid process
2) medial coronoid disease
3) Radioulnar incongruency

383
Q

What occurs when the ulna is too short

A

1) Pressure on anconeal process
2) UAP
3) Radioulnar incongruency

384
Q

Short ulna leads to

A

UAP

385
Q

Short radius leads to

A

MCD

386
Q

What procedure is done for a long ulna (short radius) = MCD

A

Ulna ostectomy- allows shortening of ulna

387
Q

What procedure us done for a short ulna = UAP

A

Ulna osteotomy- triceps pull restores elbow congruity by pulling ulna proximally dynammically
proximal- above interosseus ligament (adult)
distal- below interosseous ligament (growing)

388
Q

Ulna osteotomy is for ________

Ulna ostectomy is for ________

A

osteotomy for short ulna (UAP)

ostectomy is for short radius (MCD)

389
Q

pathology of the medial aspect of coronoid process (ulna)

A

Fragmented coronoid process (FCP) / Coronoid or medial compartment disease

390
Q

What causes coronoid disease

A

unknown pathogenesis
-genetic component proven
-incongruity (static or dynamic or temporary)
-not limited to fragment itself
-very diverse disease

391
Q

How do you diagnose coronoid disease

A

1) PE
2) Rads (50-70% accurate)
3) CT- good for osseous evaluation and incongruity
4) Arthroscopy- good for cartilage evaluation and incongruity

392
Q

What is the typical signalment of dogs with coronoid disease

A

large breed dogs (Labs, GSD, rotties, goldens, etc)
usually 6-18 months

history:
variable lameness, worse after exercise
stiff gait after rising
lazy but will still play
often bilateral so difficult to notice

393
Q

How old are dogs with coronoid disease typically

A

6-18 months

394
Q

Is cornoid typically bilateral or unilateral

A

bilateral

395
Q

What do you notice on your physical exam in dogs with coronoid disease

A

-abnormal stance
-pain on palpation (hyperflexion, extension, and medial compartment pressure/palpation
-crepitus, reduced ROM, and swelling in older arthritic patient
-Campbells test

396
Q

Test for dogs that assesses the collateral ligaments in the dog’s elbow. To perform the test, the dog’s elbow and carpus are positioned at 90° flexion, and the dog’s paw is then externally rotated. The amount of external rotation the dog’s paw can achieve indicates the condition of the collateral ligaments. The average amount of pronation for a dog’s elbow is 30°, and the average amount of supination is 50°.

A

campbells test

397
Q

What do we look for on radiographs in dogs with coronoid disease

A

1) Discontinuity of coronoid process
2) Osteophytes on anceoneal process and cranial aspect of the proximal portion of the radial head
3) ulnar sclerosis
4) fragment occasionally on A/P view

398
Q

In coronoid disease, fragments are best seen on the

A

A/P view

399
Q

What CT view is used to assess elbow incongruity

A

sagittal

400
Q

What CT view is used to assess cornoid fragments

A

transverse

401
Q

How do you treat coronoid disease?

A

-Arthroscopic debridement? - remove

-Subtotal coronoidectomy- removing base of coronoid to prevent future fragments from breaking off

-Ulnar ostectomy for incongruity (ie long ulna/short radius)

-Arthritis management

402
Q

removing base of coronoid to prevent future fragments from breaking off

A

Subtotal coronoidectomy

403
Q

What is the prognosis of dogs with developmental MCD

A

depends on the severity of DJD
surgery recommended to slow down arthritis progression and decrease lameness

not a cure

everything should be done to preserve a joint because otherwise it will not look good

404
Q

In developmental coronoid disease how does the diagnosis differ between puppies and adult dogs

A

Puppies: severe ED but little DJD- may need CT for diagnosis

Adult dog with moderate ED but severe DJD- rads are adequate for diagnosis

405
Q

Adult onset form of coronoid disease

A

rare but any mid-older aged dog with minimal radiographic changes
traumatic in origin
developmental but not clinically
-need CT or arthroscopy for diagnosis

406
Q

In the dog, where do they get OCD in their elbow joint

A

Medial humeral condyle

407
Q

How do you diagnose humeral OCD?

A

CT/arthroscopy

408
Q

How do your treat elbow OCD in dogs

A

-excision of cartilage flap
-curettage and microfracture/picking of the subchondral bone
-OATS

409
Q

What is the prognosis of humeral OCD in the dog

A

DJD inevitable
medical OA

410
Q

Humeral OCD is often accompanied by

A

coronoid fragment on ulna

411
Q

UAP is an anconeal process that doesnt unite by

A

week 20

412
Q

Anconeal process that doesnt united by week 20

A

ununited anconeal process

413
Q

What is the typical signalment of UAP

A

young, large/giant breed dogs (GSD, Berner)
Male:female = 2:1

414
Q

T/F: UAP is bilateral disease

A

about 20-35% of the time

415
Q

What is the pathogenesis of UAP

A

1) Nutrition, genetic, trauma, OCD
2) Incongruity (elbow dysplasia) - short ulna
3) Incongruity (traumatic)- premature closure of distal ulnar physis
4) Concomitant disease: MCD ~15%

416
Q

What are the exam findings of UAP

A

-Mild to moderation lameness
-Pain on hyperextension
-joint effusion *

417
Q

Dogs with UAP will have pain on elbow

A

hyperextension

418
Q

What radiograph view is best to diagnose UAP

A

flexed view- to eliminate superimposition of humerus

419
Q

How do you diagnose UAP

A

1) flexed view radiograph- to eliminate superimposition of humerus
2) CT/ arthroscopy to evaluate MCD and incongruity

420
Q

How do you treat UAP

A

1) Removal of UAP- leads to elbow instability or DJD

2) Ulna osteotomy: morbidity associated with osteotomy or failure of fusion/DJD

3) Lag-screw fixation (with or without osteotomy)- implant associated morbidity or failure of fusion/DJD/ additional surgeries

421
Q

What are possible negative outcomes of removal of UAP

A

1) Elbow instability
2) DJD

422
Q

What are possible negative outcomes of ulna osteotomy for UAP

A

morbidity associated with osteotomy or failure of fusion/DJD

423
Q

What are possible negative outcomes of lag-screw fixation (with or without osteotomy)

A

implant associated morbidity or failure of fusion/DJD/ additional surgeries

424
Q

How common is OA in small animals

A

Really common
20% of dogs over 1 year
35% of all dogs clinically affected by OA
>60% of adult cats diagnosed

425
Q

T/F: OA is curable

A

False- incurable

426
Q

cushioning support that allows support of the joint and doesnt have a direct blood supply and relies on diffusion for nutritional support

A

Articular cartilage

427
Q

produces and filters synovial fluid

A

joint capsule

428
Q

what are the two layers of the joint capsule

A

Stratum fibrosum
Stratum synovium

429
Q

produced by joint capsule and bathes articular cartilage

A

synovial fluid

430
Q

What are the components of articular (hyaline) cartilage

A

Cellular component: chondrocytes and chondroblasts

Extracellular matrix:
collagen (mostly type II)
proteogylcans (mostly aggrecan which contains negatively charged GAGs chondroitin and keratin sulfate)
Water

431
Q

What gives cartilage the ability to resist compressive forces and support the cells

A

osmotic swelling pressure

432
Q

What pumps waste and nutrients in and out of the cartilage

A

compressive forces

433
Q

What causes osteoarthritis in small animals

A

1) Idiopathic (primary)

2) Secondary: to dysplasia- extracellular matrix is destroyed

434
Q

What factors predispose dogs to osteoarthritis

A

1) Genetics
2) Age
3) Systemic factors (ie obesity)

435
Q

in OA, what breaks down components of the ECM

A

enzymes (MMPs, aggrecanases, collagenases)

436
Q

pathogenesis of OA in dogs

A

1) enzymes (MMPs, aggrecanases, collagenases) breakdown components of ECM
2) Pro-inflammatory mediators (ie IL-1b, TNFa) - increased vascular permeability, increased white blood cells and proteins in synovial fluid
3) Pain signaling proteins (NGF)- decrease pain threshold, central sensation

437
Q

In OA, what do pro-inflammatory mediators (ie IL-1b, TNFa) do

A

increased vascular permeability, increased white blood cells and proteins in synovial fluid

438
Q

In OA, what do Pain signaling proteins (NGF) do?

A

decrease pain threshold, central sensation

439
Q

What are the clinical findings of dogs with OA

A

Crepitus: osteophytes and subchondral bone sclerosis

Range of Motion: synovitis and capsular fibrosis, pain, and stiffness

Effusion: Increased vascular permeability, infiltration of inflammatory mediators, ECM degration

Pain: central nervous system changes (pain sensitization), inflammation

Instability: frequently inciting cause

440
Q

With bilateral hindlimb lameness, what should you include on your neuro examination

A

Withdrawal reflex
Patellar reflex
Placing Responses

441
Q

What is multimodal OA approach in dogs

A

1) Prevention
2) Client education
3) Surgery
4) Weight
5) Pharmacologics
6) Nutraceuticals/disease modifying agents
7) Physical rehabilitation
8) Joint injections

442
Q

How do you prevent OA in dogs

A

1) Breeding: heritability of pre-disposing conditions (elbow and hip dysplasia)

2) Nutrition: calcium (puppy food) and calories (too many calories, will grow too fast)

3) Spay/neuter: castration correlated with increased risk of orthopedic disease (hip dysplasia, CCLD)

443
Q

Surgery for OA management in dogs

A

1) treat underlying disease (ie arthroscopy for shoulder OCD)
2) treat instability (ie TPLO)
3)treat clinical signs (ie arthrodesis, joint replacement)

444
Q

in treating canine OA, what lifestyle adjustments need to be made

A

-moderated activity
-daily routine and environment
-consider: harness, booties, slings, rugs/yoga mats, elevated food bowls, ramps/stairs

445
Q

What BCS should be maintained to prevent OA

A

Ideal (4-5)

increase in median lifespan by almost 2 years

446
Q

What are the benefits of limited food consumption in dogs with OA

A

-Delayed onset of OA and other degenerative diseases
-Decreased incidence of multi-joint OA at 8 years
-Substantially increased lifespan

447
Q

Each point over 5 means the dog is ________ overweight

A

10-15% overweight

448
Q

How do you calculate ideal BW

A

current body weight / 100% + %overweight
(%overweight = 10-15% for every point over 5)

calculate RER based on IBW
kcal/day = 70 x IBW ^0.75

449
Q

What are important dietary considerations

A

1) <10% of total caloric intake dedicated to treats
2) Consider prescription weight loss diet
3) Reducing calorie consumption more important than exercise
4) Aim for 1-2% weight loss per weight

450
Q

Is reducing calorie consumption or exercise more important in managing OA

A

reducing calorie consumption

451
Q

an anti-inflammatory that is a prostaglandin receptor antagonist

A

Galliprant

452
Q

an adjunctive agent for chronic and neuropathic pain

A

gabapentin

453
Q

an opioid receptor agonist that doesnt do anything for OA

A

tramadol

454
Q

an NMDA receptor antagonist for chronic pain

A

Amantadine

455
Q

a tricyclic antidepressant for chronic pain

A

Amitriptyline

456
Q

What NSAID is safe for cats with stable CKD

A

low dose meloxicam (0.02mg/kg/d)

457
Q

Different phamacologics for OA in dogs

A

NSAIDS
Galliprant
Gabapentin
Tramadol (not good)
Amantadine
Amitriptyline
Acetominophin +/- codeine (not for cats)

458
Q

dietary supplement intended to provide health benefits beyond prevention of deficiencies in essential nutrients

A

Nutraceuticals

459
Q

T/F: FDA functions to regulate nutraceuticals

A

False- there is no regulatory body for animal supplements
it arbitrarily falls under FDA-CVM

460
Q

What are three nutraceuticals with good efficacy

A

1) Omega 3 fatty acids
2) Undenatured collagen type II
3) PSGAGs

make sure they have NSAC approval

461
Q

What is the mechanism of omega-3 fatty acids in OA

A

anti-inflammatory
-competes with arachidonic acid as substrates for COX and LOX enzymes
-may also reduce MMP

462
Q

What is the nutraceutical with the most evidence for OA management

A

omega-3 fatty acids

463
Q

What is the recommeneded does of EPA +DHA for canine osteoarthritis

A

310 x IBW (kg) ^0.75

464
Q

What are the dose dependent adverse outcomes of omega-3 fatty acids in dogs

A

diarrhea and adverse effects on platelet function

465
Q

What should you consider when supplementing a dog with omega-3 fatty acids

A

the calories
120kcal/tbsp

466
Q

What is the mechanism of action of undenatured collagen type II

A

induction of oral tolerance
Treg cells target type II collagen to release of anti-inflammatory mediators in joint cartilage (TGFb, IL-4, IL-10)

467
Q

What nutraceutical is not bioavailable when taken orally

A

glucosamine/chondroitin

468
Q

What is mechanism of action of PSGAGs

A

catabolic enzyme inhibitor (MMPs)
enhances anabolic activity of chondrocytes and synoviocytes
-HA
-Collagen
-PGs
binds to cartilage to prevent further degradation
labeled IM but can be administered SQ

469
Q

catabolic enzyme inhibitor (MMPs)
enhances anabolic activity of chondrocytes and synoviocytes
-HA
-Collagen
-PGs
binds to cartilage to prevent further degradation
labeled IM but can be administered SQ

A

PSGAGs (adequan)

470
Q

What is the tradename of PSGAGs

A

Adequan

471
Q

What are goals of physical rehabilitation

A

strengthen periarticular core and postural muscles
maintain soft tissue flexibility and joint ROM
alleviate compensatory muscle tension and pain
improve balance and proprioception

472
Q

What exericse is important for OA

A

regular, low impact exericse
-leash walks (grass >pavement)
-hydrotherapy

473
Q

advanced rehabilitation

A

target affected joints/muscles
strengthen periarticular muscles
-improve muscular shock absorption
-minimize fatigue related injury
alleviate compensatory muscle tension, pain, and myofacial trigger points
-improve comfort
-improve joint ROM

474
Q

What steroid is typically used in dogs for joint injections

A

triamcinolone hexacetonide - local anti-inflammatory effect

typically mixed with hyaluronic acid

475
Q

a joint injection used in small animals to increase joint viscosity, lubricatio/shock absorption; anti-inflammatory and anabolic effects

A

hyaluronic acid

476
Q

joint injection to increase IL-Ra (anti-inflammatory)

A

cytokine therapy (IRAP)

477
Q

joint injection where platelts granules rich in Gfs and are anti-inflammatory

A

Platelet rich plasma

478
Q

Dog Joint Cytology Analysis : TNCC
Normal:
IMPA:
Infection:

A

Normal: 2,000
IMPA: 30,000
Infection: 80,000

479
Q

Meniscal tear rate

A

50% at presentation with unstable CCL

Orthopedic Medicine (8 decks)

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