Tarsus/Carpus - Duerr

Question 1

Carpal hyperextension

Answer 1

(Traumatic) disruption of palmar fibrocartilage - fibrocartilage does not heal!

This is the most common carpal injury!

Tx: Arthrodesis (fusion)

• pan(-carpal) = all carpal jts
• partial = all carpal jts besides radiocarpal joint

Question 2

In carpal hyperextension… its a soft tissue injury (damage to fibrocartilage) so why do we have to fuse the joints (arthrodesis)?

Answer 2

The fibrocartilage takes FOREVER to heal –> its very unstable! So arthrodesis provides the stability

Question 3

How do you pick partial or pan-carpal arthrodesis?

Answer 3

If performing partial… the radiocarpal jt must be INTACT

Question 4

IMPA - Carpal

Answer 4

Erosive:
- rad dx

Non-erosive:
- jt taps

+ internal med work up (its immune-mediated!)

Question 5

Jt fluid analysis:

DJD

Septic

IMPA

Neoplasia

Answer 5

DJD
- mononuclear cells

Septic
- degenerative neutrophils

IMPA
- non-degen neuts

Neoplasia
- unusual cells

Question 6

OCD - Signalment and Hx

Answer 6

Signalment:

• congenital = young, lg breeds, male > female
• adult = (2ndary changes)

Hx:

• rear limb lameness (uni- or bilateral)
• acute onset or slow insidious, chronic progression
• stiff, slow, lame after “cool down”

Question 7

OCD - PE Findings

Answer 7

• often have tarsal hyperextension
• may have + sit test
• jt effusion/periarticular swelling
• painful ROM (esp flexion!)

Question 8

Dx and Tx of OCD

Answer 8

Hard to dx on rads! CT is best

Tx is controversial - many cons
- but will all, do long-term OA tx

Question 9

Pantarsal arthrodesis is a _____ _____. Partial is ____ ____

Answer 9

LAST RESORT - very high complication rate

(usually) well-tolerated

Question 10

Carpal hyperextension injuries are generally due to ____ and while it is a soft tissue injury, ____ is the tx of choice

When considering arthrodesis as the tx for tarsal or carpal injuries the choice between a ____ and a _____ arthrodesis depends upon the ____ that are involved

OCD can happen in the _____ and has a _______ prognosis and hence ____ is very important regardless of whether sx is performed

Answer 10

Trauma

Arthrodesis

Partial

Panarthrodesis

Structure

Tarsus, elbow, shoulder, and stifle

Poor

OA medical management