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SAS FINAL > Sx of the shoulder > Flashcards

Sx of the shoulder Flashcards

1
Q

T/F: Immune mediated polyarthritis is an inflammatory arthropathy

A

true

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2
Q

What causes biceps brachii tendinopathy?

A

repetitive strain microtrauma

injury w/ tendon fiber disruption

acute to chronic inflam of tendon and associated synovial tissues

both acute and chronic inflam present histopathologically

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3
Q

Origin of biceps brachii tendiopathy?

Travels in what groove?

Insertion?

A

origin: supraglenoid tubercle (intra-articular)

travels in intertubercular groove

insertion: medial tuberosity of proximal radius and adjacent ulna

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4
Q

The biceps brachii is constrained by the _____

A

transverse retinaculum

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5
Q

Biceps Brachii Tendinopathy presents in what dogs?

A

mature adults

medium and large breeds

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6
Q

Biceps Brachii Tendinopathy clinical signs presentation

A

weight bearing lameness that is:

chronic, intermittent

progressive

lameness worsens w/ exercise

unilateral

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7
Q

Biceps Brachii Tendinopathy physical exam findings

A

muscle atrophy

pain

  • maximally flex shoulder and extend elbow
    • deep palpation over intertubercular groove
    • apply tension to biceps insertion
  • standing exam, under load: tension to biceps
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8
Q

How do we dx Biceps Brachii Tendinopathy?

A

rads (cant see tendons so use to rule out other shit)

US

MRI

arthroscopy**

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9
Q

What is the “skyline” radiographic view also known as?

A

cranioproximal-craniodistal

( not commonly used given modern modalities )

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10
Q

Pros and cons of ultrasound for dx of Biceps Brachii Tendinopathy

A

pros: noninvasive
cons: requires experience

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11
Q

Pros and cons of MRI used for dx Biceps Brachii Tendinopathy

A

Pros: cross-sectional anatomy of all soft tissues, identify concurrent problems

Con: over/underinterpretation possible

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12
Q

Why is arthroscopy the golden standard dx for Biceps Brachii Tendinopathy?

A

diagnostic AND therapeutic

practical considerations: if PE suggestive, often used in lieu of other imaging and lateral/craniocaudal radiographs + arthroscopy

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13
Q

Treatment for acute Biceps Brachii Tendinopathy?

A

confinement for 4-6 weeks

non-steroidal anti-inflam drugs

+/- physical therapy

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14
Q

Treatment options for recurrent/persistent lameness Biceps Brachii Tendinopathy

A

moderate/acute signs

intraarticular/bicipital tendon sheath infiltrated corticosteroid injection

methylprednisolone acetate (depo-medrol)

sample joint for fluid analysis/culture

strict confinement, 4-6weeks

physical therapy

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15
Q

Indications to do surgery for Biceps Brachii Tendinopathy

A

medical therapy not working

ruptured biceps tendon

chronic bicipital tenosynovitis

moderate to severe lameness

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16
Q

Biceps Brachii Tendinopathy surgery with arthroscopy: we must ensure that?

A

must ensure all other supporting structures are intact

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17
Q

T/F: We can go right in and cut the tendon for a Biceps Brachii Tendinopathy case

what is that procedure called?

A

False- make sure other tendons are normal

tenotomy

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18
Q

What is the surgical procedure called that may be used to treat Biceps Brachii Tendinopathy? Describe the procedure briefly

A

Tenodesis

cut biceps tendon and then move it to a lateral or medial location

new location

maintains most of its function but takes away from the area where it is chronically inflammed

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19
Q

T/F: Tenotomy does not change the normal function of the biceps tendon

A

FALSE: it changes the normal function

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20
Q

Prognosis for medical tx of Biceps Tendinopathy?

A

good to poor

lack of confinement

PT improves results

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21
Q

Prognosis for surgical tx of Biceps Tendinopathy?

A

good to excellent

tenotomy- excellent (easy just to cut it)

tenodesis- “classic” tx, good results, arthroscopic assistance 6/6 = excellent

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22
Q

Shoulder instability does what to the range of motion?

A

abnormally increases it

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23
Q

Shoulder instability is _____ in the supporting structures of the shoulder

A

laxity

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24
Q

What are the supporting structures of the shoulder?

A

medial/lateral glenohumeral ligaments

joint capsule

subscapularis tendon (medial)

teres minor, supra- and infraspinatus (lateral)

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25
Q

T/F: repetitive microtrauma can cause shoulder instability

A

true: “overuse” injury

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26
Q

80% of shoulder instabilities are _____ (which side?)

A

medial

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27
Q

Signalment seen commonly with shoulder instability?

A

medium/large breed dogs

adults

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28
Q

What is the usual hx of a P w/ shoulder instability?

A

+/- active dog

variable lameness: usually subtle, intermittent, occasionally severe

poor response to rest and NSAIDs

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29
Q

What signs do we see when doing a physical on a dog with shoulder instability?

A

muscle atrophy

pain on manipulation of joint

medial instability: increased abduction angle, exam requires sedation

30
Q

Describe the normal and abnormal shoulder abduction angles

A

normal: 30
abnormal: 50

many clinical cases fall b/t 30-50

31
Q

What are the variables in shoulder abduction angle?

A

variability b/t breeds and individuals

32
Q

How do we make a diagnosis for shoulder instability using the increased abduction angle?

A

diagnosis: compare with the contralateral limb

33
Q

How do we diagnose shoulder instability?

A

radiographs

MRI

arthroscopy

34
Q

How good are rads at diagnosing shoulder instability?

A

standard views rule out other conditions

normal or nonspecific degenerative changes

35
Q

T/F: MRI may overdiagnose severity of shoulder instability

A

FALSE: underdiagnose

36
Q

What is the best way to evaluate/diagnose shoulder instability?

A

arthroscopy- diagnostic and therapeutic if PE is supportive

37
Q

What is the treatment for mild shoulder instability?

A

rest, PT, hobbles

38
Q

What is the tx for moderate shoulder instability?

A

arthroscopic radiofrequency shrinkage of attenuated ligaments and joint capsule

thermal insult induces repair

weakens tissue before it strengthens

rest, PT, hobbles

39
Q

What is the tx for severe shoulder instability?

A

medial glenohumeral ligament reconstruction

velpeau sling instead of hobbles

40
Q

Hobbles for shoulder instability….

post op rehab is how long?

how long is activity restricted?

retraining begins when?

A

3 w

3-4 m

4-6 m

41
Q

What do we use after surgical repair for more severe shoulder instability?

A

slings

velpeau sling 2-4 weeks postop

42
Q

After shoulder surgery, how long does the animal wear hobbles?

A

3-4 months (after the sling was on for 2-4 weeks)

43
Q

How long is recovery for should instability surgery?

A

4-6 months

44
Q

______: muscle shortening not caused by active contraction

A

contracture

45
Q

What is infraspinatus contracture?

A

acute, traumatic disruption of muscle fibers

46
Q

With infraspinatus contracture, the normal muscle-tendon unit is replaced with?

A

fibrous tissue

47
Q

Fibrosis and contracture are secondary to ____

A

necrosis

48
Q

T/F: there has been no documentation of supraspinatus contracture

A

False: similar lesions have been documented

49
Q

What animals do we see infraspinatus contracture in?

A

active, adult, medium to large breed dogs

hunting breeds: spaniels, pointers, retrievers

50
Q

infraspinatus contracture: acute lameness subsides in ____ days

A

10-14 days

51
Q

infraspinatus contracture: chronic static lameness occurs ____ after acute

A

2-4 weeks later

52
Q

How does an animal present when they have infraspinatus contracture?

A

non-painful, non-weightbearing lameness

53
Q

infraspinatus contracture: _____ rotation of the shoulder and ____ displacement of the elbow

A

external

internal

54
Q

Infraspinatus contracture physical exam findings: the scapulohumeral joint cannot be ____ rotated. What happens when the shoulder is rotated?

A

internally

scapula elevates

55
Q

T/F: on phyical exam for a P with infraspinatus contracture, they have pain on manipulation of the joint

A

False- usually no pain

56
Q

infraspinatus contracture on PE has ____ range of motion

A

limited

57
Q

Treatment options for infraspinatus contracture?

Prognosis?

A

conservative treatment unhelpful

tenectomy of infraspinatus tendon

release other capsular adhesions

physical therapy is ideal

prognosis: excellent

58
Q

Traumatic shoulder luxation signalment and hx

A

any breed or age of dogs, rare in cats

hx of trauma or evidence of injury

acute onset

59
Q

PE traumatic shoulder luxation findings

A

non weight bearing lameness

pain on palpation of shoulder

malpositioning of greater tubercle

60
Q

Traumatic shoulder medial luxation: distal limb _____

Traumatic shoulder lateral luxation: distal limb _____

A

medial: abducted
lateral: adducted

61
Q

What is the most common traumatic shoulder luxation?

A

medial is most common

62
Q

Nomenclature for traumatic shoulder luxation

A

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

63
Q

What are the indicatoins for closed reduction treatment for traumatic shoulder luxaton?

A

recent injury, no fractures

64
Q

What is the closed reduction treatment for traumatic shoulder luxaton?

A

general anesthesia

distract limb, move humerus toward glenoid

stable joint; apply coaptation for 2 weeks- velpeau sling for medial luxation or spica (for lateral, cranial, caudal luxation)

65
Q

Indications for surgical treatment of traumatic shoulder luxation?

A

chronic/recurrent/unstable luxation

accompanying fractures

66
Q

Describe the surgery for traumatic shoulder luxation

A

open reductoin + ligament repair:

simple arthrotomy to evaluate/reduce joint

imbrication (tight closure)/repair of capsule during closure

glenohumeral ligament reconstruction

67
Q

What is the prognosis for traumatic shoulder luxation?

A

good to excellent

68
Q

T/F: Most traumatic shoulder luxations are amenable to closed reduction

A

true

69
Q

T/F: closed reduction for traumatic shoulder luxaton is generally not successful

A

FALSE: generally successful

70
Q

Does closed reduction for traumatic shoulder luxation restore normal joint function?

A

yes

71
Q

Goal of open reduction for traumatic shoulder luxation?

A

to maintain normal joint motion

function is typically good long term

72
Q

Open reduction for traumatic shoulder luxation consists of reconstruction of _____ and _____

A

SAS FINAL (4 decks)

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