Thoracic Limb Exam 2 Flashcards
Incomplete ossification of humeral condyle
Present around middle age, although abnormality occurs during development
Radiograph both sides
DJD and OA are inevitable, intervention will delay onset & pain
IOHC pathogenesis
Ossification at 2 weeks
Predilection of spaniel breeds
- presidposes to condyle fracture
Treatment of IOHC
High fracture rate, stabilize joint w screw plate or screw anti-rotational pin
Implant failure, infection, seroma, non-healing
Fair to good w high complication rate
Traumatic elbow luxation
From blunt trauma
Lateral>medial 90% lateal
Luxation - rupture or avulsion of collateral ligaments - healing these ligaments will determine joint stability
Diagnosing traumatic elbow lux
NWB, limb carriage, swollen/painful, limited ROM
Orthogonal views, check concurrent injuries
Testing integrity of collateral ligaments (campbells test)
Elbow & carpus @90*
Rotate paw medically - if >70* of medial rotation, lateral collateral torn
Rotate paw laterally - if >45* of lateral rotation, medial collateral torn
Care for traumatic elbow lux
Spica splint
Controlling activity & rehab
Juvenile conditions of shoulder
Osteochondritis dissecans
Congenital lux/glenoid dysplasia
Trauma
Adult conditions of the shoulder
Biceps tendinopathy /rupture
Supraspinatus tenidonpathy
Shoulder instability
Traumatic lux
Infraspinatus /supraspinatus contracture
Incomplete ossification of caudal glenoid
Biceps and supraspinatus tendinopathy
Common in working athletes
Biceps tendon
- origin Supraglenoid tubercle
- intertubercular groove
- insertion ulna tuberosity & radial tuberosity
Supraspinatus - supraspinatus fossa, greater tubercle
Presentation of biceps & supraspinatus
Active, Middle Aged, chronic lameness
Variable degree of WB
Pain on palpation - biceps groove, insertion of biceps, flexion of shoulder, extension of the elbow
Biceps test
Flex shoulder & hyperextending elbow
Radiographs - lateral, cranio-caudal, skyline
Ultrasound - loss of architecture, calcification, fluid accumulation
Conservative treatment for shoulder lux
Intra articular sheath injections
Methylpredisone & triamconolone
50% Response to 1, 50% more to 2, rest need surgery
Surgical therapy for biceps tendinopathy
Tenotomy & tenodesis
Eliminate movement within tendon sheath, release partially torn /avulsed tendon
Reserved for medical management failures and complete ruptures
Concurrent shoulder soft tissue injuries
Supraspinatus tendinopathy
Conservative rehab, NSAIDs, exercise, shock wave, surgery
Shoulder instability and lux
Stabilizers of shoulders
Passive - joint capsule + fluid
Glenohumeral ligaments, labrum
Active support
Surround muscles and tendons, biceps, supraspinatus, infraspinatus, teres minor and subscapularis
Medial shoulder instability
Stretching of support in joint structures
Secondary to repetitive trauma
Presents in older dogs, moderate WB, pain
Shoulder instability
Abduction test
Extend elbow shoulder, humerus and spine of scuba aligned axially, one hand holds shoulder joint/scapula
Should instability diagnosis
Radiographs OA if chronic
Arthroscopy - tearing medial or lateral glenohumeral ligaments or subscapularis tendon
MRI - can assess extra articular structures
Surgical treatment for shoulder instability
Arthroscopy, tight rope stabilization, open surgery
Presence of OA
Scapulohumeral joint lux - traumatic
Lots of soft tissue damage
Any direction results of tearing ligs or joint capsule
Normal development of glenoid cavity
Medial/lateral are common
Cranial and caudal are rare
Scapulohumeral joint lux - congenital
Joint will look confusing on X-ray
Result of a hypo plastic /deformed glenoid or insufficient development of the lig and joint capsule usually medial
Presentation of scapulohumeral Joint lux - traumatic
Acute, NWB
Elbow in flexion
- externally rotated foot = medial
- internally rotated foot = lateral
Presentation of scapulohumeral joint lux - congenital
Young dogs, chronic lameness
Weight beating, variable lameness
Treatment of scapulohumeral joint lux
traumatic
Reduction, splice splint for lateral and velpeau long for medial luxation
Congenital
Mild to moderate lameness, reduction will not stay in place, no good options
Shoulder lux surgery - traumatic
Suture augmentation, repair or insert prosthetic ligs
Bicep transposition
Move medial for medial luxation and lateral for lateral lux
Surpraspinatus transposition
Shoulder lux surgery - congenital
Persistent painful lameness
Excisional arthroplasty - exercise in glenoid of humeral head
Forms pseudoarthrosis
Arthrodesis
Fusion of joint 105
Spica splint following 10-12 weeks
