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Preeti: SA Surgery > Sx Diseases of the Shoulder Objectives > Flashcards

Sx Diseases of the Shoulder Objectives Flashcards

1
Q

Describe the typical presentation for OCD of the shoulder in the dog

A

Young, male, large/giant breed dog

Either 4-8 months or middle-age to old

Forelimb lameness (head bob-down on the sound), muscle atrophy

Pain on hyperextension and flexion of shoulder

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2
Q

Why might a dog with bilateral OCD only appear lame on one side?

A

One side could be worse, and it is disguising the other side

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3
Q

How do you diagnose OCD of the shoulder?

A

Radiographs- will see flattening of the caudal humeral head

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4
Q

When is conservative management appropriate for OCD of the shoulder?

A

If animal is young, defect is small, and there is no/minimal lameness

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5
Q

What are the typical recommendations (medical vs. surgical) for

OCD of the shoulder?

A

Medical: rest, diet control, NSAIDs

Surgical: The STANDARD OF CARE!

Flap removal and joint lavage with bone debridement

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6
Q

What is the prognosis for OCD of the shoulder?

A

Pet dog: Good to excellent

Working dog: Fair to Good

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7
Q

What is the typical pathogenesis of biceps brachii tendinopathy in the dog?

A

Repetitive strain microtrauma→

injury with tendon fiber disruption→

Acute AND chronic inflammation of tendon and synovial tissues

Typically UNILATERAL

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8
Q

What is the typical presentation of biceps brachii tendinopathy in the dog?

A

Older adult dog, Medium or large breed

Weightbearing lameness that is chronic, intermittent, and progressive

Lameness worsens with exercise and is unilateral

Muscle atrophy

Pain when shoulder is maximally flexed and elbow is extended

Pain when standing under load due to tension to biceps

Pain with palpation of proximal medial radius (insertion of tendon)

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9
Q

Why is pain elicited when shoulder is maximally flexed and elbow is extended in a dog with biceps brachii tendonopathy?

A

This results in deep palpation over the intertubercular groove,

which is where the tendon runs,

as well as tension to the biceps insertion on the proximal medial radius

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10
Q

What is the value of “standard” craniocaudal and lateral radiographic views

in relation to diagnosis of Biceps Brachii Tendonopathy?

A

These standard views rule out other diagnoses (like osteosarcoma)

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11
Q

What is the value of using Ultrasound in diagnosis of

Biceps Brachii Tendonopathy?

A

It is non-invasive,

but requires experience and is less accessible

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12
Q

What is the value of using MRI in diagnosis of

Biceps Brachii Tendonopathy?

A

It provides the cross-sectional anatomy of all soft tissues, so it can

identify any concurrent problems

But over/underinterpretation is possible

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13
Q

What is the value of using Arthroscopy in diagnosis of

Biceps Brachii Tendonopathy?

A

Arthroscopy is both DIAGNOSTIC AND THERAPEUTIC!

Best method, when used in conjunction with standard rads

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14
Q

How would you treat ACUTE Biceps Brachii Tendonopathy?

A

Confinement for 4 - 6 weeks

NSAIDs

Physical therapy

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15
Q

How would you treat PERSISTENT/RECURRENT

Biceps Brachii Tendonopathy lameness non-surgically?

A

Intraarticular corticosteroid injection (Methylprenisolone acetate)

Strict confinement (4 - 6 weeks)

Physical therapy

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16
Q

What are the indications for surgical treatment of

Biceps Brachii Tendonopathy?

A

Refractory to medical tx

Radiographic changes seen

Mechanical deficits are present

Moderate to severe lameness present

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17
Q

How is Biceps Brachii Tendonopathy treated surgically when indicated?

A

Tenotomy (cut) or

Tenodesis (fix)

of the bicipital tendon

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18
Q

What is the prognosis for Biceps Brachii Tendonopathy

and how does prognosis relate to treatment?

A

Medical tx: Good to poor

Surgical tx: Good to excellent

Prognosis for Tenotomy vs. Tenodesis: Both have similar success rates!

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19
Q

What is the definition and etiopathogenesis of shoulder instability?

A

Definition: Abnormally increased ROM of the shoulder

Pathogenesis: Repetitive microtrauma (overuse injury)

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20
Q

What are the support structures of the shoulder?

A

Glenohumeral ligaments (medial and lateral)

Joint capsule

Subscapularis tendon (medial)

Teres minor (lateral)

Supraspinatus and Infraspinatus (lateral)

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21
Q

What is the most common direction of shoulder instability?

A

MEDIAL

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22
Q

What is the typical signalment and history of a dog with shoulder instability?

A

Medium/Large breed adult dog

Active with variable lameness (subtle, intermittent)

and poor response to rest and NSAIDs!

23
Q

What are the tests that may be used during orthopedic exam to detect shoulder instability?

A

Awake exam: Palpation and manipulation = pain

Sedated exam: Medial instability = increased abduction angle!

24
Q

How is the sedated exam interpreted for a dog with

shoulder instability?

A

For medial instability, abduction angle:

Normal = 30 degrees

Abnormal = 50 degrees

Must compare to contralateral limb

25
Q

What imaging techniques are used to diagnose shoulder

instability?

A

Radiographs (to rule out other conditions)

Arthroscopy (BEST for evaluating joint, therapeutic AND diagnostic!)

26
Q

which modality is best for evaluating joints for shoulder instability?

A

ARTHROSCOPY

27
Q

How is MILD shoulder instability treated?

A

Rest, PT, and Hobbles

28
Q

How is MODERATE shoulder instability treated?

A

Arthroscopic thermal capsulorrhapy +

Rest, PT, and Hobbles

29
Q

How is SEVERE shoulder instability treated?

A

Medial Glenohumeral Ligament Reconstruction (MGHL) +

Rest, PT, and VELPEAU sling (not hobbles!)

30
Q

What is the definition of muscle contracture?

A

Abnormal muscle shortening not caused by active contraction

31
Q

What is the pathogenesis of infraspinatus contracture?

A

Acute traumatic disruption of muscle fibers

leads to

fibrosis and contracture secondary to necrosis

32
Q

Describe the pathognomonic stance of a dog with infraspinatus contracture

A

Elbow tucked close to body with the arm (antebrachium)

held up and away from body (abducted)

33
Q

An active adult hunting dog presents to you

with a history of acute lameness that lasted about 2 weeks and then subsided for about a month before it presented again.

On physical exam, dog has nonpainful nonweightbearing lameness

and looks like he can’t put his paw or arm down.

What is your primary differential?

A

Infraspinatus contracture!

34
Q

Is conservative treatment helpful in cases of infraspinatus contracture?

A

NO! Surgery is the ONLY option!

35
Q

What surgical treatment is indicated for

Infraspinatus contracture?

A

Tenectomy of the infraspinatus tendon

Physical therapy post-surgery is essential

36
Q

What is the prognosis following surgery for infraspinatus contracture?

A

Excellent!

37
Q

Describe the palpation findings in a dog with

traumatic shoulder luxation

A

Non weightbearing lameness with pain upon shoulder palpation

Palpation reveals malpositioning of the greater tubercle

38
Q

What limb position would you see in a dog with

medial traumatic shoulder luxation?

A

Distal limb is ABducted (held out and away)

39
Q

What limb position would you see in a dog with

lateral traumatic shoulder luxation?

A

Distal limb is ADDucted

and greater tubercle is more prominent

40
Q

Describe the nomenclature of traumatic shoulder luxation

A

Named for the position of the humeral head relative to the glenoid

41
Q

What is the most common direction of traumatic shoulder luxation?

A

MEDIAL

42
Q

What are the indications for closed reduction of traumatic shoulder luxation?

A

A recent injury with NO fractures and joint is STABLE

43
Q

Which form of coaptation is required after closed reduction of a

medial shoulder luxation? Why?

A

Velpeau Sling

Takes tension off the medial aspect of the joint and holds it in place

44
Q

Which form of coaptation is required after closed reduction of a

lateral shoulder luxation?

A

Splica Splint

Maintains limb in standing position

45
Q

Which form of coaptation is required after closed reduction of a

cranial or caudal shoulder luxation?

A

Splica Splint

46
Q

What are the indications for surgical reduction of a

traumatic shoulder luxation?

A

If luxation is chronic, recurrent, or unstable

If there are accompanying fractures

47
Q

What is involved in surgical reduction of a traumatic shoulder luxation?

A

Open Reduction + Glenohumeral Ligament Repair

  1. Simple arthrotomy
  2. Imbrication/repair of capsule
  3. Glenohumeral ligament reconstruction (GHL)

Medial GHL repaired for medial luxation

Lateral GHL repaired for lateral luxation

48
Q

What is the expected functional outcome following shoulder luxation

A

Good to excellent for open and closed!

49
Q

What is the most common direction of congenital shoulder luxation?

A

MEDIAL

50
Q

What is the signalment and history of the

typical dog with congenital shoulder luxation?

A

SMALL and TOY BREEDS! (YOUNG!)

3 - 10 months old

Also: Shetland Sheepdog, Collie, Elkhound

History: minimal or no trauma reported, chronic lameness beginning at early age, and lameness may be intermittent

51
Q

How is does congenital luxation present differently from

traumatic luxation on PE?

A

Both: Greater tubercle is medial to glenoid in medial luxation and lateral in lateral luxation

Traumatic- PAIN present on manipulation

Congenital- Pain minimal or not present at all on manipulation

52
Q

What is glenoid dysplasia and how does it relate to

congenital shoulder luxation?

A

Glenoid Dysplasia refers to an abnormality in the development of the glenoid portion of the scapula (the socket bone of the shoulder joint).

53
Q

What are your treatment options for congenital shoulder luxation

if there is glenoid dysplasia?

A

Can only do a SALVAGE procedure:

Arthrodesis (fusion of joint with tons of screws)

or

Glenoid excision (removing glenoid) *best*

Outcomes similar, but excision less challenging

54
Q

How is congenital shoulder luxation treated surgically

if the glenoid cavity is normal?

A

Similar to traumatic luxation:

Open reduction/capsulorrhapy

Glenohumeral ligament reconstruction

Preeti: SA Surgery (10 decks)

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