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Joint Diseases of the Forelimb > Shoulder Joint Part 2 > Flashcards

Shoulder Joint Part 2 Flashcards

1
Q

Where does the biceps brachii m originate and run?

A

The biceps brachii muscle originates from the supraglenoid tubercle of the scapula and runs distally within the intertubercular groove of the humerus

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2
Q

The A) part of the biceps tendon invaginates the joint capsule so that it forms a B) around the tendon.

A

A) intra-articular
B) sheath

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3
Q

Biceps muscle during standing/weight bearing in locomotion has what effects on:
A) Elbow?
S) Shoulder?

A

A) Flexes
B) Extends/stabilise

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4
Q

What is Bicipital tenosynovitis?

A

An inflammation of the tendon and its surrounding sheath.

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5
Q

What is the aetiology of Bicipital tenosynovitis?

A

The underlying aetiology is unknown, however, chronic trauma to the shoulder joint causing minor injuries of the muscle and/or tendon which fail to heal appropriately.

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6
Q

Biceps tendinopathy:
A) Breed?
B) Age?

A

A) Medium-large
B) Middle- older

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7
Q

What can be seen on xrays with biceps tendinopathy? (3)

A

Sclerosis and/or osteophytosis of the intertubercular groove
Mineralisation of the biceps tendon

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8
Q

What may synovial fluid analysis of biceps tendinopathy show?

A

increased numbers of monocytes, macrophages, and vacuolated phagocytes which suggests degenerative joint disease

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9
Q

What would a biopsy of biceps tendinopathy show?

A

proliferative tenosynovitis and lymphocytic-plasmacytic infiltration.

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10
Q

What may atrophy as biceps tendinopathy becomes chronic? (2)

A

infraspinatus and supraspinatus muscles

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11
Q

Clinical signs of biceps tendinopathy?

A

Lameness - aggravated by exercise.

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12
Q

What is found on clinical exam with biceps tendinopathy?

A

Palpation of the tendon within the intertubercular groove typically results in pain, particularly with hyperextension of the shoulder or flexion of the shoulder and extension of the elbow (positive “biceps tendon test”) or while pushing the humerus cranially while holding the scapula steady with the other hand (positive “shoulder drawer test”).

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13
Q

What is the biceps tendon test?

A

hyperextension of the shoulder or flexion of the shoulder and extension of the elbow

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14
Q

What is the shoulder drawer test?

A

pushing the humerus cranially while holding the scapula steady with the other hand

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15
Q

How is biceps tendinopathy diagnosed?

A

Radiographic changes usually only become evident in chronic cases and perhaps in as few as one-third of patients with chronic biceps tendinopathy. However, nearly all dogs with biceps tenosynovitis will have non-specific degenerative changes on shoulder radiographs

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16
Q

D/Dx for biceps tendinopathy? (5)

A

Supraspinatus tendinopathy;
Shoulder instability;
OCD;
Cervical disc disease;
Neoplasia (brachial plexus neurofibroma, osteosarcoma).

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17
Q

How successful is medical management if there is no chronic change with biceps tendinopathy?

A

50-75%

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18
Q

How is biceps tendinopathy medically managed? (7)

A
  • Confinement for 4-6 weeks
  • weight reduction
  • NSAID
  • Physio
  • Hydry treadmill
  • Regen medicine
  • Shockwave
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19
Q

IF there is advanced stages of biceps tendinopathy - what can be used? Can it be repeated?
What if this fails?

A

Injection of long-acting corticosteroids (e.g. methylprednisolone acetate (10 to 40 mg) into the scapulohumeral joint is recommended in advanced stages. If there is no improvement in two weeks, the injection may be repeated. If no improvement is seen after one or two injections, surgery should be considered.

20
Q

Why should steroid NOT be injected into a tendon?

A

Predispose to rupture

21
Q

Is the following sentence true or false for biceps tendinopathy?

Surgical management is recommended if changes are chronic or if patients have not responded to conservative treatment.

A

True

22
Q

Is the following sentence true or false? For biceps tendinopathy

Recovery to full function may take up to 2 to 3 months and mild, residual lameness may persist in some cases.

A

True

23
Q

Surgical treatment for biceps tendinopathy? (2)

A

Tenotomy
Tenodesis

24
Q

What is done during a tenopathy?

A

The tendon is simply cut free of its origin. Recovery time is much shorter and affected dogs seem to have more rapid relief of their discomfort. Open or arthroscopic biceps tendon tenotomy is considered a safe and reliable technique, which yields favorable short and long-term clinical results and it therefore has replaced the technique of tenodesis in most cases.

25
Q

How is a tenodesis performed with biceps tendinopathy?

A

Tenodesis involves cutting the biceps tendon free of its origin on the supraglenoid tubercle and reattaching it to the proximal humerus, thereby getting it out of the shoulder joint and taking the stretch of shoulder flexion of it.

26
Q

What is the success rate of tenodesis for biceps tendinopathy?

A

80%

27
Q

Steps to a Biceps Tenotomy via Open surgical Approach?

A
  • Position in lateral recumbency
  • An open approach to the cranial region of the shoulder joint is performed
  • Identify and incise the transverse humeral ligament and joint capsule to expose the biceps tendon and the intertubercular groove.
  • Transect the tendon at the level of the identified lesion near to the supraglenoid tubercle.
  • Flex the elbow joint to test and allow slight retraction into its tendon sheet.
  • If required reattach the tendon to the humerus distal to the intertubercular groove.
  • Close muscle layers, deep and superficial fascia, and skin in separate layers.
28
Q

What can rupture of the biceps tendon be a sequelae of?

A

-Traumatic shoulder joint luxation
-Of avulsion from the supraglenoid tubercule or a mid-substance tear

29
Q

Clinical sings of rupture biceps tendon? (4)

A

Lameness;
Swelling;
Pain;
Joint instability.

30
Q

Rupture of the Biceps Tendon or its Tendon Sheath
A biceps tendon test is usually…

A

+Ve

31
Q

Rupture of the Biceps Tendon or its Tendon Sheath; radiographic changes (3)

A

-Calcification of the intertubercular groove,
- Enthesiophytes in close proximity to the supraglenoid tubercle
-Degenerative changes in the caudal glenoid rim.

32
Q

Rupture of the Biceps Tendon or its Tendon Sheath; contrast arthrography.

A

Filling defect

33
Q

Rupture of the Biceps Tendon or its Tendon Sheath; ; ultrasound exam

A

Hyperechoic areas in the origin of the tendon.

34
Q

Rupture of the biceps tendon sheath has been reported in two Labrador Retrievers. Both dogs were moderately lame and mildly painful. Intra-articular steroids failed to significantly improve the clinical signs. Tenodesis further improved clinical signs, however, a mild degree of A) persisted

A

Lameness

35
Q

Medial displacement of the biceps tendon usually occurs after rupture of the…

A

transverse humeral

36
Q

Medial displacement of the biceps tendon breeds (4)

A

Greyhounds
GSD
Border collie
Afghan hound

37
Q

Medial displacement of the biceps tendon causes (2)

A

acute or chronic repetitive trauma
Retinacular hypoplasia

38
Q

Medial displacement of the biceps tendon; orthopaedic exam (3)

A

Muscle atrophy,
Pain on flexion/extension
Popping sound with range of motion.

39
Q

Medial displacement of the biceps tendon; radiographs/ultrasound

A

Unremarkable

40
Q

Medial displacement of the biceps tendon:
A) Surgical aim?
B) Prognosis?

A

Surgery aims in replacement of augmentation of the transverse humeral retinaculum.

The prognosis for full functional recovery is generally excellent.

41
Q

How common in Supraspinatus tendinopathy? Which breeds are affected (2)

A

Rare
- Rottweiler
- Labrador

42
Q

Which “type” of dog has been shown to have general Supraspinatus tendinopathy changes?

A

Agility

43
Q

Clinical exam of Supraspinatus tendinopathy (1)

A

Pain on palpation is more prominent in patients showing calcifications in the region of the supraspinatus tendon

44
Q

Why are xrays/ ultrasound/ CT or MRI advised for Supraspinatus tendinopathy?

A

to differentiate calcifications of the supraspinatus tendon from those affecting the biceps brachii tendon.

45
Q

Mineralisation of which aspect of the Supraspinatus tendinopathy appears to be more clinically significant?

A

Medial aspect

46
Q

Supraspinatus tendinopathy treatment?

A

Medical management includes NSAIDs and rest

Surgical excision of calcified tissue within the tendon can be recommended in cases not responding to medical management. Physical rehabilitation will significantly contribute to a speedy recovery.

Joint Diseases of the Forelimb (10 decks)

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