Thoracic Limb Exam 2

Question 1

Incomplete ossification of humeral condyle

Answer 1

Present around middle age, although abnormality occurs during development
Radiograph both sides
DJD and OA are inevitable, intervention will delay onset & pain

Question 2

IOHC pathogenesis

Answer 2

Ossification at 2 weeks
Predilection of spaniel breeds
- presidposes to condyle fracture

Question 3

Treatment of IOHC

Answer 3

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

Question 4

Traumatic elbow luxation

Answer 4

From blunt trauma
Lateral>medial 90% lateal
Luxation - rupture or avulsion of collateral ligaments - healing these ligaments will determine joint stability

Question 5

Diagnosing traumatic elbow lux

Answer 5

NWB, limb carriage, swollen/painful, limited ROM
Orthogonal views, check concurrent injuries

Question 6

Testing integrity of collateral ligaments (campbells test)

Answer 6

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

Question 7

Care for traumatic elbow lux

Answer 7

Spica splint
Controlling activity & rehab

Question 8

Juvenile conditions of shoulder

Answer 8

Osteochondritis dissecans
Congenital lux/glenoid dysplasia
Trauma

Question 9

Adult conditions of the shoulder

Answer 9

Biceps tendinopathy /rupture
Supraspinatus tenidonpathy
Shoulder instability
Traumatic lux
Infraspinatus /supraspinatus contracture
Incomplete ossification of caudal glenoid

Question 10

Biceps and supraspinatus tendinopathy

Answer 10

Common in working athletes
Biceps tendon
- origin Supraglenoid tubercle
- intertubercular groove
- insertion ulna tuberosity & radial tuberosity
Supraspinatus - supraspinatus fossa, greater tubercle

Question 11

Presentation of biceps & supraspinatus

Answer 11

Active, Middle Aged, chronic lameness
Variable degree of WB
Pain on palpation - biceps groove, insertion of biceps, flexion of shoulder, extension of the elbow

Question 12

Biceps test

Answer 12

Flex shoulder & hyperextending elbow
Radiographs - lateral, cranio-caudal, skyline
Ultrasound - loss of architecture, calcification, fluid accumulation

Question 13

Conservative treatment for shoulder lux

Answer 13

Intra articular sheath injections
Methylpredisone & triamconolone
50% Response to 1, 50% more to 2, rest need surgery

Question 14

Surgical therapy for biceps tendinopathy

Answer 14

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

Question 15

Supraspinatus tendinopathy

Answer 15

Conservative rehab, NSAIDs, exercise, shock wave, surgery

Question 16

Shoulder instability and lux

Answer 16

Stabilizers of shoulders
Passive - joint capsule + fluid
Glenohumeral ligaments, labrum
Active support
Surround muscles and tendons, biceps, supraspinatus, infraspinatus, teres minor and subscapularis

Question 17

Medial shoulder instability

Answer 17

Stretching of support in joint structures
Secondary to repetitive trauma
Presents in older dogs, moderate WB, pain

Question 18

Shoulder instability

Answer 18

Abduction test
Extend elbow shoulder, humerus and spine of scuba aligned axially, one hand holds shoulder joint/scapula

Question 19

Should instability diagnosis

Answer 19

Radiographs OA if chronic
Arthroscopy - tearing medial or lateral glenohumeral ligaments or subscapularis tendon
MRI - can assess extra articular structures

Question 20

Surgical treatment for shoulder instability

Answer 20

Arthroscopy, tight rope stabilization, open surgery
Presence of OA

Question 21

Scapulohumeral joint lux - traumatic

Answer 21

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

Question 22

Scapulohumeral joint lux - congenital

Answer 22

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

Question 23

Presentation of scapulohumeral Joint lux - traumatic

Answer 23

Acute, NWB
Elbow in flexion
- externally rotated foot = medial
- internally rotated foot = lateral

Question 24

Presentation of scapulohumeral joint lux - congenital

Answer 24

Young dogs, chronic lameness
Weight beating, variable lameness

Question 25

Treatment of scapulohumeral joint lux

Answer 25

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

Question 26

Shoulder lux surgery - traumatic

Answer 26

Suture augmentation, repair or insert prosthetic ligs
Bicep transposition
Move medial for medial luxation and lateral for lateral lux
Surpraspinatus transposition

Question 27

Shoulder lux surgery - congenital

Answer 27

Persistent painful lameness
Excisional arthroplasty - exercise in glenoid of humeral head
Forms pseudoarthrosis
Arthrodesis
Fusion of joint 105
Spica splint following 10-12 weeks