Thoracic Limb Exam 1

Question 1

Surgical anatomy of carpus

Answer 1

Hinge joint, radiocarpal, ulna carpal, numbered carpal bones
Short intercarpal ligaments, palmar fibrocartilage, collateral ligaments

Question 2

Carpal hyperextension structural involvement

Answer 2

Trauma - injury to palmar soft tissue structures
- radiocarpal + ulnarcarpal ligaments
- palmar carpal fibrocartilage
- ligaments associated w accessory carpal bone
(Cushings, IMPA)

Question 3

Signalment & clin presentation of elbow dysplasia

Answer 3

Any size
Variable lameness, soft tissue swelling, joint effusion, hyperextended stance (bi or unilateral)

Question 4

Diagnosing hyperextension injury

Answer 4

Radiographs of carpi, orthogonal and stressed views
Medial & lateral stressed for concurrent collateral damage

Question 5

Traumatic hyperextension injury

Answer 5

Conservative management - unrewarding
Splint, rest, analgesics

Question 6

Surgery for hyperextension injury

Answer 6

Arthrodesis - permanent fusion of a joint, can be partial or full

Question 7

Partial carpal Arthrodesis

Answer 7

Need a normal radiocarpal joint - trauma needs to be confined to intercarpal or carpometacarpal joints
Fuses the intercarpal and carpometacarpal joints
- normally very little motion in these joints
Preserves motion of the carpus

Question 8

Pancarpal Arthrodesis

Answer 8

Fusion of all joint that make up carpus
80% achieve excellent limb function
Can have secondary complications from surgery

Question 9

Principles of Arthrodesis

Answer 9

Complete removal of cartilage
Rigid fixation
Bone graft
Anatomic alignment (10-12th extension)

Question 10

After care of hyperextension injury

Answer 10

NSAID
Palmar splint - 6-8 weeks, change every 1-2 woks
Strict confinement - reduce catastrophic damage
Radiographs @8 wks

Question 11

Potential complications of hyperextension

Answer 11

Screw loosening
Implant breakage
Metacarpal fracture
Non healing
Infection
Physiologic tourniquet
Bandaging complications

Question 12

Juvenile conditions of elbow

Answer 12

Elbow dysplasia
Fragmented medial coronoid process
Osteochondrosis /chondritis dissecans
Ununited anconeal process
Incongruity
United medial epicondyle
Congenital luxation

Question 13

Adult conditions of the elbow

Answer 13

Incomplete ossification of the humeral condyle
Flexor tendon enthesopathy
Traumatic luxation
Fracture
Neoplasia (joint or long bone)

Question 14

Anatomy of elbow

Answer 14

Joints - humero radial, humeroulnar, proximal radioulnar
Collateral ligs
Radial, ulna, median nerve
Important landmarks - medial coronoid process & anconeal process

Question 15

Elbow dysplasia - clin pres

Answer 15

Large fast growing breeds
5-7 months onset of lameness - or in mature dogs w OA
Variable degrees of lameness, worse w prolonged rest & exercise
Elbow effusion
Pain of hyperextension & flexion
Decreased ROM, crepitis palpable thickening

Question 16

Elbow dysplasia - diagnostic

Answer 16

Radiographs - lateral and craniocaudal, flexed lateral
Ct scan - more sensitive
MRI & ultrasound

Question 17

Components of elbow dysplasia

Answer 17

Fragmented medial coronoid process
Osteochondritis dissecans
Ununited anconeal process
Incongruence
-
Medial compartment disease/DJD
Flexor tendon enthesopathy
Ununited epicondyle

Question 18

FMCP

Answer 18

Fissure
Osteochondrosis dessicans
Asynchronous growth
Osteoporosis (vascular abnormalities)
Trauma

Question 19

Diagnosing FMCP

Answer 19

Radiographs - earliest signs sclerosis of distal aspect of trochlear notch

Question 20

Management of FMCP

Answer 20

Treat as OA
Remove fragment, subtotal coronoidectomy

Question 21

OCD

Answer 21

Medial humeral condyle (trochlea)
Failure of endochondral ossification - cartilage defect
Use radiographs, radiolucent subchondral defect
Flap removal - remove, debridement, perpendicular

Question 22

UAP

Answer 22

Ununited anconeal process
Separated center of ossification
Starts young 11-12 weeks, complete by 16-20 weeks
20-25% bilateral incidence
Easy radiograph diagnosis (over 6 months old)

Question 23

UAP

Answer 23

Unstable fragment will accelerate progression of OA
Can remove fragment, caudolateral approach, v ROM
Ulnar osteotomy - screw

Question 24

Radial ulna incongruence

Answer 24

Elevation of coronoid above level or radial head
(Radius too short radius too long)
Caused by coronoid disease, medial compartment, ununited anconeal process, OCD
Radiographs

Question 25

RUI

Answer 25

Due to asynchronous growth of radius and ulna
Ulna - premature closure of distal physis, radius too long, pressure on anconeal process
Radius - premature closure of either physis, radius too short, pressure on coronoid

Question 26

Treatment plan for RUI

Answer 26

Aggressively !!!
Could be non healing
Implant breakage
Premature fusion
Infection

Question 27

Medial compartment disease

Answer 27

Mod to severe cartilage erosion
Secondary to elbow dysplasia
Radiographs

Question 28

MCD modified outer bridge scale

Answer 28

Chrondromalaica
Partial thickness fibrillation & fissuring
Full thickness fissuring
Full thickness cartilage loss

Question 29

Treating MCD

Answer 29

Assess cartilage
Remove fragments
Decrease trans articular loads
Resurfacing, partial and total elbow replacement

Question 30

Elbow arthroscopy complications

Answer 30

Post op lameness 5%
Swelling 2%
Infection 0.2%
Pain 2.8%
Nerupraxia 0.2%
^^ long term lameness 7%

Question 31

Prognosis of elbow dysplasia

Answer 31

Depends on the case and severity