Surgical Disorders of the Shoulder Flashcards
Fact Frog: If something is a developmental joint dz, it’s probably…
Bilateral with biphasic age grouping
What is the typical signalment of osteochondritis dissecans?
Large and giant breed males
4-8 months (cartilage injury) or middle age to older (secondary DJD)
What are 4 clinical signs on PE of osteochondritis dissecans in the shoulder?
Forelimb lameness
Atrophy
Pain on hyperextension and flexion of shoulder
Unilateral lameness (even with bilateral dz)
What would you expect to see on RADs of osteochondritis dissecans in the shoulder?
Flattened caudal humeral head
What is conservative treatment for osteochondritis dissecans in the shoulder?
Rest
Reduced calorin intake
NSAIDs
What is the recommended treatment for osteochondritis dissecans in the shoulder?
Surgical intervention
How do you treat osteochondritis dissecans of the shoulder surgically?
Remove flap, lavage joint, debride bone to allow defect to heal with fibrocartilage
What is the preferred surgical approach for osteochondritis dissecans of the shoulder?
Arthroscopy preferred over arthrotomy
What is the prognosis of osteochondritis dissecans in the shoulder?
Near normal to normal fxn with surgery
Pet dog = good to excellent prognosis
Working dog = fair to good (juts because they are expected to do more)
What is the cause of biceps brachii tendinopathy?
Injury with tendon fiber disruption and acute to chronic inflammation of the tendon and associated synovial tissues
Fact Frog: If the etiology is repeptitive trauma or overuse…
Probably see unilaterally in adult dogs
What is the presentation of biceps brachii tendinopathy?
Middle-aged, medium and large breed dogs with weight-bearing lameness
What are 4 descriptions of the weight-bearing lameness of biceps brachii tendinopathy?
Chronic, intermittent
Progressive
Lameness worsens with exercise
Unilateral
What will you find on exam on a dog with biceps brachii tendinopathy?
Muscle atrophy
Pain when shoulder is maximally flexed and elbow is extended
What 4 diagnostics could you use with biceps brachii tendinopathy?
RADs (to r/o other issues)
US
MRI (more for research)
Arthroscopy (diagnostic and therapeutic)
Why is arthroscopy the best way to diagnose biceps brachii tendinopathy?
Because it’s diagnostic and therapeutic
What is the treatment for acute biceps brachii tendinopathy? 3 things
4-6 weeks confinement
NSAIDs
Physical therapy
What is the treatment for recurrent/persistent biceps brachii tendinopathy?
Intraarticular corticosteroid injection
Strict confinement for 4-6 weeks
Physical therapy
Do we risk tendon rupture when treating biceps brachii tendinopathy with corticosteroids?
It can be a risk because steroids are catabolic, but it’s not really something you see clinically
What are 4 indications for surgery on biceps brachii tendinopathy?
Refreactory to medical therapy
Radiographic changes
Mechanical deficits
Moderate to severe lameness
What are the 2 surgical procedures you can do on biceps brachii tendinopathy?
Arthroscopic evaluation and then…
Tenotomy of biceps tendon (cutting the tendon)
Tenodesis of bicipital tendon (cut the tendon and fix it in place lower down on the humerus)
What is the prognosis of biceps brachii tendinopathy with medical treatment?
Good to poor
NOTE: Physical therapy improves results
NOTE: Doesn’t limit surgical treatment if you try this first
What is the prognosis of biceps brachii tendinopathy with surgical treatment?
Good to excellent
Tenotomy = excellent results Tenodesis = "classic treatment"
What is shoulder instability?
Abnormally increased range of motion due to laxity in the support structures of the shoulder
What ligaments are responsible for shoulder stability normally?
Medial and lateral glenohumeral ligaments
How does shoulder instability happen?
repetitive microtrauma
What is the most common type of shoulder instability?
~80% is medial shoulder instability
