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Locomotor > Tendon and LIgament Dz > Flashcards

Tendon and LIgament Dz Flashcards

1
Q

How can tendon be damaged? LOOK UP

A 
> trauma
- lacerations
> strains 
- breaking/dehiscnece of fibres 
- mechanically induced or weakening d/t degeneration
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2
Q

How can muscles be damaged?

A

> less commonly specifically dx

- injuries similar to tendon

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3
Q

How can tendon/lig dz present?

A 
> Lameness
- acute with trauma
- chronic
> swelling
- diffuse, painful, oedema if acute
- organised and established in chronic cases 
> specific functional disability
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4
Q

Is laeration always traumatic?

A
  • no can be chronic
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5
Q

Dxx for tendon and liggament dz?

A 
> clinical signs 
- dysfunction 
> radiography
- swelling, gap 
> ultrasound 
- gap, loss of linear orientation of fibres
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6
Q

Outline pathophysiology of tendon injury repair. Which tendons will heal faster? Eg?

A
  • fibroblasts and collage fibres line up along line of actio

- SHEATHED tendons less vascular so hal slower (eg. digital extensors) cf. vascular (eg. common calcaneal Achilles)

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7
Q

Time to heal tendon injuries?

A
  • 6 weeks to regain 50% normal strength (repair must be supported for 6 weeks)
  • 1 year to regain average 80% normal strengt h
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8
Q

Tx tendon injury?

A

> Rest
specific support to protect tendon from loading
- dressings/casts
- trans-articular fixator
1* surgical repair for lacerations
- tendon sutures to manage load
- direc contact of healthy edges (debride if necessary)
- suture of epitendon to promote healing
ultrasound monitoring healing (@6/8 weeks etc.)

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9
Q

How long should ESF be left on for tendon repair?

A
  • 6 weeks

- then bandage for 2 weeks

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10
Q

HOw big a gap will interfere with tendon healing?

A

3mm

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11
Q

What ar ethe 2 most common tendon repair sutures?

A
  • locking loop

- 3 loop pulley

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12
Q

What is a sprain?

A

Ligamentous damage

  • can be mild/moderate/severe
  • 1/2/3* degree (stretch, rupture, total laceration)
  • ^ level of soft tissue damage, swelling, pain and instability
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13
Q

What suture material should be used for TENDON repair?

A
  • non-absorbable eg. Prolene

- sheath simple interrupted absorbable

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14
Q

Presentation of strains ? PE?

A 
- acute and chronic presentation 
> PE: 
- especially ROM 
- palaptoin
> Dxx: 
- radiography + stressed views (to demonstrate strains, pull limbs in direction of strains etc.)
- ultrasound (not very useful fr ligament) 
- manipulation under GA 
> always check for ancillary damage
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15
Q

Tx sprains?

A
  • rest, reduce swelling (drugs, cooling)
  • external coaptation (suppot)
  • ligament repair
  • internal ligament splintage
  • attention to oher structures
  • arthrodesis (salvage)
  • degree of tx depedns on instability, pain and healing potential
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16
Q

LIkely damage associated with ddrop from a height? Tx?

A
  • palmar carpal ligaments sprained

- need arhrodesis, will not heal conservatively

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17
Q

Surgical repair of ligament?

A
  • screws at insertion of the ligament, figure of 8 suture between the 2
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18
Q

How long do ligament injuries take to heal?

A

slow healing ~ 6-8 weeks
- not always acceptable function (reevaluate)
- extra chronic capsular tisue formed
- 2* OA
> may require arthrodesis at a later stage

19
Q

What angle is normal for stress radiographs of the carpus?

A

10*

20
Q

How is an arthrodesis carreid out? Which joints is this always required in (first line ?

A
  • remove articular cartilage
  • bone graft to stimulate bone healing
  • stabilise joint
    > TMT (tarsal luxation??)
    > Carpal ligaments (carpal hyperextension)
21
Q

Is ligament dz common in smallies?

A

NO except for cranial cruciate in dogs!

22
Q

Which direction does cranial and caudal cruciate run?

A 
Cranial = cranial tibia, caudal femur (proximal and lateral to distal and medial) 
Caudal = caudal tibia, cranial femur
23
Q

Pathophysiology of cruciate disease?

A
  • normally related to degeneratin
  • can be acute (trauma/degenerative ligament gicing way)
  • assocated with MPL (medial patella luxation) which is seen in young growing animals so even if only found incidentally in older animals check the cruciates!
  • causes a debilitating cranio-caudal instability in the stifle
  • 60% cases involve medial meniscus
24
Q

Does meniscal injury occour spontaneously in animals?

A

NO rarely, always affected d/t cruciate dz

25
Q

How do human and animal cruciate injuries differ?

A
  • human traumatic

- animals gradual degneration n

26
Q

What is MPL?

A
  • medial patella luxation
27
Q

What caues the clinical signs seen with cruciate dz? LOOK UP

A

> forces

  • as dog ,oves forwards, weight thrust forwards, must resist reactive forces acting caudally
  • stifle is vulnerable to this caudal force (d/t round profile of the femur slipping accross the tibial plataeu)
  • cranial cruciate resists this force so if ruptured, joint becomes unstable when loaded
  • > if femur can move across tibia, mensci can be damaged stuff
28
Q

Presentation and predisposed animals of cruciate rupture?

A
  • middle aged (2-10 yrs)
  • overweight, neutered
  • medium/large breed (lab, rotty, spanial, bull breeds, NOT sighthounds)
    > Hx: insiduous onset pelvic limb lameness
  • may be bilateral
  • acute onset can occour
29
Q

Main Ddx for pelvic limb lamensss seen with cruciate dz?

A
  • hip and LS disease

> cruciate usually more unilateral

30
Q

FIndings on PE with cruciate rupture?

A

> muscle atrophy (quads and hamstrings)
stifle effusion
medial buttress
- soft tissue thicking medial aspect of joint
craniocaudal stifle instability (cranial drawer and tibial thrust)
pain on manipulation
- sit test (sit with leg to the side)

31
Q

When may PE tibial thrust/cranial drawer be unhelpful? How cna these be ID?

A
  • partial degeneration (not complete)
    > Radiograph
  • effusion
  • OA
32
Q

Most common reason for OA In the stifle?

A

> cranial cruciate MOST COMMON

  • paella luxation
  • articular fx
33
Q

Conservative tx of cruciate dz? When is this indicated?

A

> appropriate if:

  • lameness liinal
  • low pain
  • small dogs slow return to function, stimulation of OA change, no control of meniscal damage (so cant tell if recovery slow d/t crusiate or menisci)
34
Q

Advantages of surgical tx? Problems?

A
  • improve joint stability
  • speed up recovery
  • tx meniscal lesions (always necesary)
    > joint still never be 100% stable, DJD sill present though less (residual lameness)
35
Q

Surgical tx options of cranial cruciate repair? LOOK UP

A

> implant in a position analgous to cranial cruciate (CCL)
- temporarily restores joint stability
- allows fibrous tissue to stabilise stifle
changing mechanics of stifle
- negates the need for CCL support
Any surgery should involve inspection and debridement of menisci

36
Q

Outline lateral suture technique. What suture material is used? How long does it need to remain for before brekaing down?

A
  • lateral tibio-fabella suture placed
  • extracapsular but same line as the CCL
  • meniscus inspected via arthrotomy
37
Q

OUtline TPLO

A

= tibial plateau levelling osteotomy

  • changes angle tibia meets the femur, allows articular surfaces to bear more of caudal shear force from tibial thrust
  • will start bearing weight straight after sx
38
Q

Outline TTA

A

= tibial tuberosity advancement

  • line of patella tendon advanced
  • makes it parallel to line of force transfer across joint
  • tension in tendon cancels out compression across the joint
  • prevents caudal movement of the femur
39
Q

Outline CWTO

A

= closed wedge tibial ostectomy

  • similar to TPLO but displacement of tibial tuberosity
  • tendinitis possible d/t strain on patella tendon
  • wedge rather than circular osteotomy to collapse bone
40
Q

Outline TTO

A

= triple tibial osteotomy

  • mixture TTA/CWTO
  • decreases displacmeent
  • tendinitis
  • more complex surgery
  • specialist equipement needed
41
Q

How long do most cruciate surgeries take to heal? Post op care?

A 
> lead walks for 6-8weeks (rest) 
- ^ 5min/2w
> coldp ack 48hrs
> warm packs  and PROM BID/TID
> rads @ 6-8weeks (not lateral suture) 
> NO hydrotherapy initially
42
Q

Rehabilitation after cruciate surgery?

A
  • physio and gradual increase in lead excercise
43
Q

Which tendon is prone to damage? ECHO

A

common calcaneal tendon?? achilles (extends and flexxes the ???

44
Q

Which procedures have the best outcome @ 12 weeks?

A

All have similar!! Despite numerous claims for advantages of new procedures

Locomotor (29 decks)

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