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ORTHO, ORAL, NEPHROLOGY > Soft Tissue Disease > Flashcards

Soft Tissue Disease Flashcards

1
Q

Biceps tendon runs through the

A

intertubercular groove

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2
Q

In the shoulder, the greater tubercle is located _____ while the lesser tubercle is located ______

A

greater: lateral

lesser: medial

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3
Q

What is the action of the biceps muscle

A

Flexes elbow
Extends shoulder

to test the flexibility: extend the elbow, flex shoulder

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4
Q

To test the flexibility of the biceps muscle, what should you do

A

Extend elbow
flex shoulder

put pressure onto the intertubular groove

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5
Q

How do you test supraspinatus muscle

A

pain on palpation of insertion on greater tubercle, shoulder flexion while elbow flexed

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6
Q

How do you diagnose shoulder tendinopathies (biceps/ supraspinatus)

A

1) X rays (both)
2) Ultrasound and MRI (both)
3) Arthroscopy (biceps only = intra-articualar)

always take rads to get global idea but might need to do more with specific tendinopathies

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7
Q

If radiograph changes are apparent, how do you distinguish biceps from supraspinatus tendinopathies

A

Biceps: dystrophic mineralization in the groove

Supraspinatus: cranial aspect

might need to do skyline views as mineralization can move down

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8
Q

Why is ultrasound useful for diagnosing biceps and supraspinatus tendinopathies

A

able to detect non-mineralized tendinopathies

fairly simple and inexpensive but operator dependent

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9
Q

Why can you not see Supraspinatus tendinopathies on arthroscopy

A

because it is extra-articular

Biceps is intra-articular and you can do arthroscopy for definitive diagnosis

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10
Q

What gives you the definitive diagnosis for biceps tendinopathy

A

Arthroscopy or MRI

allows evaluation of MGHL/subscapularis/cartilage/biceps

tentative diagnosis given through PE, x-rays, ultrasound

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11
Q

T/F: supraspinatus mineralization might be incidental

A

True

but biceps is not

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12
Q

With shoulder tendinopathies, why might you see radiographic changes

A

in really chronic cases

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13
Q

What is a downside of biceps/supraspinatus ultrasound

A

very user dependent and hard to do
need lots of skills to do

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14
Q

What is a downside of MRI for biceps/supraspinatus tendinopathies

A

Costly
General anesthesia
Not 100%

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15
Q

How might you treat biceps tendinopathy

A

1) PT/Rehab

2) Medical: 5mg Trimacinolone (shorter duration, safer)

3) Surgical (last option)
-Tenodesis (open)
-Tenotomy (scope/ultrasound)

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16
Q

What might you use as medical management for biceps tendinopathy

A

5mg Trimacinolone (shorter duration, safer)

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17
Q

How do you treat supraspinatus tendinopathy

A

1) PT/Rehab

2) Medical:
Shock wave
Stemcells /PRP

3) Surgical (last option)
-Tendon resection
-Release of transverse humeral ligament
-Release incisions in supraspinatus

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18
Q

What are the goals of shockwave (EWST) therapy

A

1) Start/ increase an inflammatory process
2) Facilitate proper fiber alignment
3) Improve extensibility
4) Strengthening
5) Alleviate pain

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19
Q

What are the effects of shockwave (EWST) therapy

A

1) Bimodal analgesia 3-4 days then 3-4 weeks
2) stimulates angiogenesis and tissue matrix remodeling

these generated mechanical forces produce secondary effects through cavitation

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20
Q

What are the goals of platelet rich plasma and mesenchymal stem cells

A

1) enhance tissue architecture
2) Increase collagen fiber density
3) Improve biomechanical strength

tendons never regain full strength, repeat injury is very possible

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21
Q

What is the biggest risk of shockwave therapy

A

bruising
need to be sedated

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22
Q

What are the effects of platelet products and mesenchymal stem cells

A

1) Provide growth factors for healing/ remodeling
2) Differentiation into connective tissue cell lines
3) Reduce inflammation

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23
Q

Surgical indications for biceps/supraspinatus tendinopathy are

A

Mechanical issue
patient doesnt respond to medical management

24
Q

What are the different tendon release techniques for biceps tendinopathy

A

1) Arthroscopic - release/ tenodesis

2) Percutaneous - palpation / US-guided. severing with a needle

25
Why is it not practical to release the biceps tendon, especially in working dogs
1) Losing cranial support of the glenohumeral joint 2) Cant flex the elbow Not ideal in patients - do tenodesis instead (moving the tendon of origin still allows for flexion of the elbow but lose the support
26
How does tenodesis differ from biceps release
you move the tendon of origin of the biceps. still maintains flexion of elbow but lose some of the cranial
27
What can cause medial shoulder instability
pathology of the medial compartment of shoulder -MGHL -Glenoid -Subscapularis -Humeral head
28
How do you diagnose medial shoulder instability (MSI)
Abduction angle! -sedation -full extension -goniometer centered on shoulder joint -along axis of humerus -parallel to scapular spine Correct measurement: 30degrees >35 is abnormal avoid getting a false positive by pushing down on the scapula
29
How do you measure the abduction angle of the shoulder to diagnose medial shoulder instability
-sedation -full extension -goniometer centered on shoulder joint -along axis of humerus -parallel to scapular spine
30
How do you avoid getting a false positive when doing a abduction angle measurement for medial shoulder instability
push down on the scapula
31
You get abduction angle on left shoulder of >39 degrees but the right is 29 degrees. How do you confirm the diagnosis of medial shoulder instability
1) Arthroscopy: intra-articular components of MGHL and subscapularis 2) MRI: all intra- and extraarticular structures (besides cartilage) 3) Ultrasound = technically challenging
32
Grade 1 Medial Shoulder Instability
Mild 30-39 degree abduction angle Arthroscopy findings: Synovitis but no obvious MGHL / subscapularis pathology besides laxity/joint capsule tearing try non-surgical treatment first
33
Grade 2 Medial Shoulder Instability
Moderate 40-55 degrees Arthroscopy findings: Synovitis, fraying to partial disruption of subscapularis tendon and/or MGHL try non-surgical treatment first
34
What can give you a false positive for shoulder abduction angle, that isnt just failure to push on the scapula
muscle atrophy - very important to compare to the opposite leg
35
Grade 3 Medial Shoulder Instability
Severe >55 degrees Arthroscopy findings: Complete tearing of subscapularis and MGHL and subluxation of humeral head / degenerate changes and cartilage damage RF or synthetic ligament??
36
Grade 4 Medial Shoulder Instability
Luxation luxated joint Dx: Radiographic evidence of luxation
37
With medial shoulder instability, what structures fray/tear
Subscapularis tendon and/pr MGHL fraying to partial disruption (Grade 2) complete tearing (Grade 3)
38
What Grade of Medial Shoulder Instability: complete tearing of subscapularis and MGHL and subluxation of humeral head/ degenerative cartilage changes >55 degrees
Grade 3 (severe)
39
T/F: there is no superior treatment method for medial shoulder instability in dogs
True - may be treated with medical or surgical
40
How might you medically treat medial shoulder instability
-Therapetic exercise (strengthen adduction) -Orthotics / supportive devices -PT/Rehab modalities -Analgesia / anti-inflammatories -Biologics -HOBBLES
41
What are the surgical treatment options for medial shoulder instability
1) Radiofrequency shrinkage: controversial due to possible cartilage damage and weakening of tissues 2) Prosthetic ligament reconstruction: better outcome in recent study but technically challenging 3) Tnedon transpoistion (biceps) all require post-op hobbles/ rehab so is it the surgery or rehab??
42
What are the two types of common calcaneal tendinopathy?
1) Acute, traumatic injury = true laceration... treat like other tendon laceration 2) Chronic, degenerative injury -Hunting dogs -Frequently bilateral -Check for underlying disease (endocrine, coagulopathy) -Surgery is recommended like other tendon lacerations
43
What kind of dogs get chronic, degenerative injury of common calcaneal tendinopathy
hunting dogs (labs and dobermans) active dogs middle aged
44
is chronic, degenerative injury of common calcaneal tendinopathy typically unilateral or bilateral **
bilateral
45
What will you see on exam with injury of common calcaneal tendinopathy
CCT palpation: firm thickening at insertion, effusion, swelling Flexibility testing: stifle extended while flexing the tarsus assess standing angle of tarsus (may need to lift contralateral limb to evaluate for acute hyper flexion) PLANTIGRADE STANCE
46
In animals with injury of common calcaneal tendinopathy, what stance will they have
Plantigrade stance 1) And flat paw with stifle in extension = complete rupture of all components of the common calcaneal tendon 2) AND crab-craw like stance SDF is intact Type 2c injury
47
And flat paw with stifle in extension
complete rupture of all components of the common calcaneal tendon
48
How do you do flexibility testing of the common calcaneal tendon
Extend stifle Flex hock you shouldnt be able to flex the hock much when the stifle is extended
49
What is happening when the dog has a crab-craw like stance with increased flexion of tarsus
SDF is intact Type 2c injury can only flex the toes
50
what might you see radiographically sometimes with injury of common calcaneal tendinopathy
dystrophic mineralization
51
How do you surgically fix traumatic achilles tendinopathy
1) Repair each tendon individually if possible via three-loop pulley pattern Prolene suture (2-0) with additional epitenon/paratenon sutures (3 or 4-0 PDS) 2) Maintain hock in extension post op for 6 weeks max via: -Cast vs Ex-Fix -orthosis and gradually increase ROM
52
after achilles tendon repair you need to keep the ______ in _____ for ________
the hock in extension for 6 weeks max
53
What is the problem with achilles tendon debridement and reattachment
unhealthy tendon and resection to normal tendon not feasible in many cases
54
T/F: achilles tendinopathy with complete dropping of hock requires surgical intervention
True
55
What are te non-surgical options for common calcaneal tendinopathy
1) Physical rehabilitation - manual therapy to aid in ROM and therex to strengthen CCT components 2) Intra-lesional injection: PRP, stem cells 3) Extracorporeal shockwave therapy 4) Orthotic *** 5) Conservative management- activity modification, NSAIDS, additional analgesics
56
Orthoses for achilles tendinopathies is used for
1) Early Type 2c- sole treatment 2) Supportive post-op for surgical repair 3) Downstage to sports brace longterm

ORTHO, ORAL, NEPHROLOGY (7 decks)

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