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Musculoskeletal > The shoulder > Flashcards

The shoulder Flashcards

1
Q

On which side is the labrum of the glenoid widest?

A

Lateral. Extends the surface area of the glenoid by 25-30%

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2
Q

What holds the biceps tendon in place in the intertubercular groove?

A

Transverse humeral retinaculum

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3
Q

Is the tendon of the biceps intra or extraarticular?

A

Intraarticular (craniomedial aspect is surrounded by joint capsule)

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4
Q

What shape is the medial glenohumeral (collateral) ligament of the shoulder?

A

Y-shaped

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5
Q

What are the rotator cuff muscles of the shoulders?

A

Supraspinatous, infrapinatous, teres minor (lateral), subscapularis, coracobrachialis (medial). Tendons are blended with the joint capsule

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6
Q

What are normal flexion and extension values of the shoulder in the dog and cat?

A

Dog: 57 degrees flexion, 165 extension
Cat: 32 degrees flexion, 164 extension

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7
Q

What are the passive mechanisms of shoulder joint stabilization?

A

Limited joint volume, adhesion/cohesion mechanisms, concavity compression, capsuloligamentous restraints

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8
Q

What are the active mechanisms of shoulder joint stabilization?

A

Rotator cuff muscles

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9
Q

What soft tissue structures of the shoulder cannot be visualized on CT?

A

Teres minor muscle tendon and coracobrachialis muscle

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10
Q

What shoulder joint angle is ideal following arthrodesis?

A

105-110 degrees

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11
Q

What is the most common location of shoulder OCD?

A

Caudocentral or caudomedial humeral hdead

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12
Q

In what percentage of dogs with shoulder OCD is a non-mineralized cartilage flap trapped in the tendon sheath of the biceps brachii muscle?

A

10%. MRI or arthrography may be required to identify the lesion in these instances.

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13
Q

What is the recommended treatment for glenoid dysplasia?

A

Excision arthroplasty or arthrodesis

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14
Q

What diagnostics should be considered in the work-up for shoulder disorders?

A

Orthopedic examination, arthrocentesis, radiography (+/- arthrography), CT (+/- arthrography), ultrasonography, MRI

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15
Q

What percentage of dogs have mineralization of the periarticular structures of the shoulder without associated thoracic limb lameness?

A

40%

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16
Q

Is ultrasonography useful in analysis of the lateral or medial structures of the shoulder joint?

A

Lateral. Cannot properly visualize medial structures.

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17
Q

What nerve needs to be protected during glenoid excision?

A

Suprascapular nerve

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18
Q

What surgical options are there for shoulder arthrodesis in small and large breed dogs?

A

Small dogs: transarticular screw, diverging K-wires, plates and screws.

Large dogs: plates and screws

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19
Q

True or false? Placement of an additional caudal plate may help to prevent implant failure with shoulder arthrodesis?

A

True

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20
Q

What is the prognosis for patients following shoulder arthrodesis?

A

Typically good. If the arthrodesis angle is greater than 105-110 degrees may have persistent lameness with mild circumduction of the leg.

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21
Q

What percentage of dogs with OCD have bilateral lesions?

A

27-68%.

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22
Q

Are female or male dogs more likely to have shoulder OCD?

A

Large or giant breed male dogs

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23
Q

When debriding an OCD lesion of the shoulder, should the edges of the lesion be bevelled?

A

No - will cause increased risk of fibrillation and erosion of the corresponding surface of the glenoid.

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24
Q

What surgical approaches to the shoulder joint have been described for OCD removal? What are the benefits of each?

A

Caudal: improved weight bearing post-op.
Caudolateral: helps protect the axillary nerve and caudal circumflex humeral artery.
Craniolateral (with tenotomy of the infraspinatus tendon): greater exposure of the caudal aspect of the humeral head. Limits exposure to the caudal compartment.

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25
Q

Is glenoid dysplasia usually unilateral or bilateral?

A

Unilateral. Typically diagnosed in dogs between 3-10 months of age.

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26
Q

What is multiple epiphyseal dysplasia?

A

Genetic condition of a defect in ossification of the epiphysis of long bones, vertebrae, cuboidal bones and apophysis. Euthanasia is generally recommended.

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27
Q

List 5 conditions that can affect the osseous components of the shoulder?

A

OCD, glenoid dysplasia, hypertrophic osteodystrophy, epiphyseal dysplasia, incomplete ossification of the caudal glenoid, chrondrocalcinosis.

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28
Q

Is caudal ossification of the caudal glenoid associated with clinical signs of shoulder pain?

A

Normally asymptomatic, but can display pain. If painful should remove.

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29
Q

What is chrondrocalcinosis?

A

Deposits of hydroxyapatite in the articular cartilage. Typically unilateral but can be bilateral. Clinical relevance is unknown.

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30
Q

List 8 conditions that might affect the soft tissues of the shoulder joint.

A
  1. Biceps brachii tendinopathy.
  2. Medial displacement of the biceps tendon.
  3. Rupture of the biceps tendon.
  4. Calcifying tendinopathy of the biceps tendon.
  5. Supraspinatous tendinopathy.
  6. Medial shoulder instability
  7. Traumatic shoulder luxation
  8. Muscle strain
  9. Teres minor myopathy
  10. Infraspinatous and supraspinatous muscle contracture
  11. Villonodular synovitis
  12. Synovial chrondrometaplasia
  13. Infraspinatous bursal ossification
  14. Calcinosis circumscripta
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31
Q

What are the suspected causes of primary and secondary biceps tendinopathy?

A

Primary: overuse or chronic repetitive injury.

Secondary: in response to intra-articular disease or cartilaginous loose body entrapment.

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32
Q

What is the typical signalment for patients with biceps tendinopathy?

A

Middle aged medium to large breed dogs

33
Q

What orthopedic tests can be performed when testing for biceps tendinopathy?

A

Biceps tendon test, drawer test, biceps retraction test

34
Q

What imaging techniques can be used for diagnosis of biceps tendinopathy?

A

Radiography (include skyline view), ultrasound, MRI

35
Q

What does medical management of biceps tendinopathy typically entail?

A

Strict rest for 4-6 weeks and intra-articular injection of corticosteroids (methylprednisolone or triamcinolone).

36
Q

What are the two surgical options for treatment of biceps brachii tendinopathy?

A

Tenodesis or tenotomy

37
Q

What causes medial displacement of the biceps tendon?

A

Rupture of the transverse humeral retinaculum

38
Q

What are the surgical treatment options for medial displacement of the biceps tendon?

A

Reconstruction of the transverse humeral retinaculum +/- augmentation with screws and PDS sutures, or staples and polypropylene mesh.

39
Q

What is the surgical treatment for rupture of the tendon of origin of the biceps brachii muscle?

A

Tenodesis

40
Q

What is the proposed pathogenesis of mineralization of calcifying tendinopathy of the biceps tendon?

A

Injury to the tendon results in hypoxia, this causes remodeling of tendon collagen into fibrocartilage, followed by chondrocyte mediated osteogenesis.

41
Q

What is the typical signalment of a patient with calcifying tendinopathy of the biceps tendon?

A

Large breed, middle aged and active dogs. Labradors and Rottweilers are overrepresented.

42
Q

What are the treatment options for calcifying tendinopathy of the biceps tendon?

A

Medical and surgical options are the same as for non-calcifying biceps brachii tendinopathy.

43
Q

Which two dog breeds appear predisposed to supraspinatous tendinopathy?

A

Labrador retrievers and Rottweilers

44
Q

What is the surgical treatment for supraspinatous tendinopathy

A

Excision of any calcified tissue within the tendon and associated muscle. Removal of mineralization impinging on the biceps tendon is particularly important.

45
Q

Is medial instability of the shoulder joint considered a congenital condition if large or small breed dogs?

A

Small breed dogs (generally diagnosed between 3-10 months of age). In large dogs it is usually considered an overuse injury. In both cases the bony anatomy is normal.

46
Q

What are the proposed mechanisms of medial joint instability?

A

Loss of concavity compression, disruption of glenohumeral balance (dynamic muscle imbalance, abnormal angulation of the glenoid, disruption of the capsuloligamentous restraints)

47
Q

Is shoulder joint subluxation more common in large or small breed dogs?

A

Large breed, middle-aged, male dogs

48
Q

What percentage of shoulder joint subluxations are medial?

A

80%

49
Q

What are normal shoulder joint abduction angles?

A

30 degrees

50
Q

What diagnostic imaging modalities may be useful in the diagnosis of medial shoulder instability?

A

Stressed radiographs, MRI, arthroscopy

51
Q

What are the surgical options for surgical stabilization of medial shoulder instability?

A

Transposition of the tendon of origin of the biceps or supraspinatous tendon, augmentation of the existing medial collateral ligament, imbrication of the tendon of the subscapularis muscle, radiofrequency induced thermal modification (thermal capsulorrhaphy), excision arthoplasty or arthrodesis.

52
Q

What are the major disadvantages associated with thermal capsulorrhaphy for treatment of medial shoulder instability?

A

Thermal damage to the glenohumeral ligament, axillary neuropathy, Velpeau bandage complications, carpal stiffness, difficulties in applying thermal energy consistently and uniformly, tendency of the collagen to stretch back to its original size, limited number of appropriate candidates (should not have other shoulder pathology).

53
Q

Is traumatic medial or lateral shoulder luxation more common?

A

Medial, although lateral luxation reported frequently in large breed dogs.

54
Q

Should an Velpeau sling be placed following closed reduction of both medial and lateral shoulder luxations?

A

No - only medial. Want to prevent adduction of the limb following lateral luxation, therefore a spica or neutral sling are more appropriate.

55
Q

How is surgical correction of a traumatic shoulder luxation achieved?

A

Typically with reconstruction or augmentation of the glenohumeral ligament and joint capsule. Salvage procedures such as arthrodesis and excision arthroplasty can also be considered.

56
Q

Is the prognosis for traumatic shoulder luxation typically good or bad?

A

Good

57
Q

When muscle is strained to 80% of failure, the strength of the muscle contraction is decreased by how much immediately after injury?

A

30%, then 50% by 24 hours, 25% by 48 hours, returning to 90% by 1 week

58
Q

How does teres minor contracture differ from infraspinatous and supraspinatous contracture?

A

Pain is a major feature

59
Q

What is the treatment for teres minor contracture?

A

Surgical excision of the entire muscle.

60
Q

Does contracture of the supraspinatous or infraspinatous muscle occur more frequently?

A

Infraspinatous

61
Q

What is the typical signalment of patients with infraspinatous muscle contracture?

A

Medium to large breeds (Brittany spaniels, pointers, labradors), active and middle aged with no apparent sex predilection.

62
Q

What is the treatment for infraspinatous muscle contracture?

A

Tenotomy. Restores the gait to near normal.

63
Q

What is the surgical treatment for villonodular synovitis?

A

Excision arthroplasty or arthrodesis. Can attempt medical management prior with NSAIDs.

64
Q

What is the typical signalment of dogs with synovial chondrometaplasia (synovial osteochondromatosis)?

A

Medium to large breed, no sex predilection.

65
Q

What surgical treatment has been reported for synovial chrondrometaplasia?

A

Debridement of nodules, loose body removal, synovial stripping. Excision arthroplasty or arthrodesis may be required in severe cases.

66
Q

In which dog breed has infraspinatus bursal ossification been reported?

A

Labrador retrievers

67
Q

What is the surgical treatment for infraspinatus bursal ossification?

A

Surgical excision of loose bodies, the infraspinatus bursa, and a portion of the tendon of the infraspinatus muscle.

68
Q

According to Phipps 2022 in Vet Surg, what was the outcome of shoulder arthrodesis using 2 locking plates? What was the mean symmetry index post-operative?

A

Outcome was good (11/12 dogs made a full functional recovery). Mean symmetry index was 8% during gait analysis.

69
Q

In a study by Zann 2022 in Vet Surg, what was the decrease in load to the operated limb 12-months following surgical debridement of proximal humeral OCD? Was brachial circumference and the progression of osteoarthritis affected?

A

4%.
Brachial circumference was decreased in the operated limb, and there was progression of OA as determined by radiographs and CT.

70
Q

In a study by Carwardine 2019 in JSAP, what technique was used for repair of both lateral and medial shoulder instability in a feline cadaveric study?

A

Ligament prosthesis using bone tunnels and 3.5 metric polypropylene

71
Q

In a study by Hammer 2021 in JSAP, what surgical technique was used to stabilize instances of canine medial shoulder instability without post-operative external coaptation?

A

An inverted V-shaped extracapsular stabilization technique. All 6 cases had acceptable outcome.

72
Q

What technique described by Livet 2019 in VCOT, may be useful in detecting dogs with medial glenohumeral ligament instability?

A

Stressed radiographic views of the shoulder

73
Q

What approach for minimally invasive treatment of shoulder OCD in dogs was described by Vezzoni 2021 in VCOT?

A

The modified cheli approach

74
Q

Describe the modified cheli approach to the shoulder joint from the study by Vezzoni 2021 in VCOT.

A
75
Q

What technique was described by Llido 2023 in VCOT in canine cadavers for treatment of medial glenohumeral instability?

A

Arthroscopically guided prosthetic ligament. Abduction angles after repair were not significant different from intact.

76
Q

What structures of the shoulder are delineated in the image from Holman 2024 in VCOT? What percentage of these structures could be seen via a lateral arthroscopic approach?

A

Medial glenohumeral ligament: 58%
Subscapularis tendon: 20%

77
Q

What structure of the shoulder is delineated in the image from Holman 2024 in VCOT? What percentage of this structure could be seen via a lateral arthroscopic approach?

A

Biceps tendon: 48% at a standing angle, 63% when flexed.

78
Q

In a study by Gemignani 2022 in VRU, was ultrasound able to successfully identify transection of the medial glenohumeral ligament in cadavers? What finding was discriminatory to transection of the medial glenohumeral ligament?

A

No - ultrasound was not able to identify transection of the ligament.

An articular space wider than 8.2mm was discriminatory for transection.

Musculoskeletal (30 decks)

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