Exam 1 Flashcards

Question

"Tie-in"

Answer 1

* External fixation tying into intramedullary pin * Aid in reduction * Control bending * Aid rigidity * Humeral & femoral fxs

Answer 2

Free Form External Fixator o Use Epoxy resin or methyl methacrylate   o Can be used to replace the whole connecting  bar   o Or just replace the clamps   o Cheaper than commercial clamps and connecting bars   o Particularly useful if don’t use ESF very often   o Just need threaded pins for fixation   Hybrid External Skeletal Fixation o Combine linear & circular o Fractures w/ short juxta articular bone segment o Can be used on radius, tibia, humerus, & femur

Answer 3

o Adequate reduction o Rigid fixation o Early active motion & weight bearing

Answer 4

o Biocompatible o Resist corrosion o Same alloy to prevent corrosion when implants are mixed o 316L stainless steel o Never reuse

Answer 5

Steinmann pins * most common in vet med * Range in size from 1/16 to 1⁄4 inch * Used for diaphyseal fractures * Humerus, femur, tibia, metatarsals and metacarpals * Contraindicated for the radius because pin insertion interferes with the carpus and elbow Kirschner wires (K-wires) * range in size from 0.035 to 0.062-inch * can be used as cross pins to stabilize metaphyseal and physeal fractures in young animals

Answer 6

Pros * Resist applied bending loads Cons * Poor resistance to axial & rotational loads * Lack of fixation (don’t interlock w/ bone) * Should be combined w/ something else to negate these cons

Answer 7

Combine with: * Cerclage wire * Plates * External fixators * Cross-pins Pin Size * 70% of diameter of medullary canal if used with cerclage wires * 30-40% of diameter of medullary canal if used with a plate or external fixator

Answer 8

* Medium cheap * Inserted in medullary canal * locked into place using screws or cross-locking bolts placed in the proximal and distal fragments at least 2 cm from the fracture line * Interlocking nails resist all types of forces placed on the fracture. * Humeral, femoral and tibial fractures. * Contraindicated for radial fractures

Answer 9

o Anatomically reconstruct long oblique or spiral fractures. o Length of the fracture line should be two to three times the diameter of the medullary cavity o Max of two fracture lines o The fracture must be anatomically reduced o Cerclage wire is always supplemented by additional implants (IM pins, ex fix, plate)

Answer 10

o Used to neutralize tension when it is the predominant force. o Avulsion fractures (groups of muscle originate or insert on bone) o Tension bands convert the distraction of tensile forces into compressive forces.

Answer 11

* Can stabilize any type of long bone fracture * Fractures of the axial skeleton * Imperative for fractures of the joint surface * Provide postoperative comfort and early limb use. * Used to treat animals with a high, medium and low fracture-assessment score

Answer 12

Plate * Anchor a plate to bone Positional * Hold bone fragments in anatomical position Lag or Compression * Compress 2 bone fragments

Answer 13

Use * Used to compress fragments * Articular fractures  * Oblique fractures  * Spiral fractures Method * Over drill the near cortex -> * Drill the far cortex -> * Screw slides through near cortex -> * Pulls far cortex into compression

Answer 14

* Plate length is designated by the number of screw holes * Plate size is determined by the cortical screw that the plate hole will accept Hole configuration * Round hole (Veterinary Cuttable Plate) * Oblong hole (Dynamic Compression Plate, DCP)

Answer 15

* Select a plate that spans the bone length for diaphyseal fractures. -> * Accurately contour the plate. -> * Place a minimum of three bicortical screws, or secure six cortices above and below the fracture. -> * Use a longer and stronger plate as a bridging plate or augment it with an IM pin

Answer 16

* Screw head locks into the plate * Locking mechanism between the screw and plates provides fracture fixation * Contouring unnecessary * Neutral position, no stress on the bone * Increase construct yield strength

Answer 17

* Locking screws must be perpendicular to the plate. * Reduce the fracture before locking screws are tightened. * Use a longer plate with fewer screws. * Ideally you fill 50% of the plate holes in each fragment

Answer 18

Normal  Long bone afferent nerve  Nutrient artery  Proximal & distal metaphyseal arteries  Periosteal arteries Fracture  Medullary supply disrupted  Metaphyseal vessels enhanced  Extraosseus vasculature comes in to play  Closed reduction will have least amount of disruption  Stable implants allow new medullary circulation

Answer 19

Normal  Centrifugal  Medullary canal to periosteum Fracture  Centripetal  From surrounding soft tissue

Answer 20

o Post operative o 2-8wks post o 10, 12, or 16wks post o 1wk for every month of age up to 6mo

Answer 21

o Change in gap width / total gap width o Decreases w/ increased fracture rigidity o Fracture first bridge by tolerant tissue but becomes less tolerant to strain over time

Answer 22

o Type of direct bone healing o Differentiation of mesenchymal cells into osteoblasts o Can occur with up to 5% strain o Bone is deposited directly on bone away from the fracture site o Combined with indirect bone healing

Answer 23

o Slow healing than anticipated o Progressive signs of bone activity visible on rads Reasons  Immune system  Nature of the trauma  Inappropriate fracture management/repair  Steroids or NSAIDs

Answer 24

o Arrested fracture repair o Requires surgical intervention o Result of failure on part of surgeon o Instability at fracture site is most common cause Vascular  Lucent line through the fracture site on rads  Cartilage, fibrous tissue and ineffective callus formation Hypertrophic  Large amounts of non-bridging callus  Treated w/ debridement, grafting, stabilization Atrophic  Biologically inactive pseudoarthrosis  No evidence of bone reaction  Bone ends appear sclerotic  Treated w/ debridement, grafting, stabilization

Answer 25

o Healed fractures where anatomic bone alignment is not achieved or maintained during healing. o Can have a deleterious affect on function. o Severe malunions can cause arthritis o Treat w/ corrective osteotomy

Answer 26

o Inflammatory condition of bone and medullary canal. Causes  Bacterial or fungal  Most post-traumatic osteomyelitis are due to bacterial infection.  Biofilm on implant protects the bacteria from antimicrobials and host defenses. Clinical Signs  Acute pain, tenderness, swelling, erythema  Chronic drainage Diagnosis  Culture  Periosteal reaction or maybe sequestrum on rads Treatment  Surgical debridement to healthy bleeding bone  Establish drainage  Re-stabilize if necessary  Antibiotics based on culture for 4-6 weeks

Answer 27

 If implants are stable leave in place until the fracture heals  Bone heals in the presence of infection as long as the repair is stable  Infection will not clear until implants are removed

Answer 28

o Clinical union o Radiographic union o Growing animal/open physis o Interference with function o Pain o Unstable or loose Implants o If infection is present once healing has occurred, the implant may need to be removed.

Answer 29

Causes  Neoplasia  Osteomyelitis  Bone cyst  Radiation therapy Rads  Lytic/prolifrative  Periosteal reaction  Soft tissue mass

Answer 30

o Quadriceps contracture or tie-down o Sciatic nerve entrapment o Ankylosis of joints

Answer 31

 Maxillary fractures often heal on their own Tape Muzzle * most common in practice * minimize movement * Minimally displaced * Caudal fractures * Comminuted fractures Dental Bonding * If teeth intact, glue teeth together to hold jaw intact until healed * Minimally invasive * Maintains occlusion * Avoids malocclusion * Caudal fxs * Comminuted fxs Symphyseal wiring * Use two needles * Slide wire through needles * Behind canines * May use heavy PDS in cats instead of wire

Answer 32

Stable extra-articular * Body * No fixation needed Unstable extra-articular * body, neck * Sx recommended for neck fractures Intra-articular * glenoid * Sx recommended for articular fractures

Answer 33

o Usually fractures in 3 places due to box structure Indications for fixation  Weight bearing - acetabulum, ilium body, sacroiliac joint  Articular - acetabulum  Pelvic inlet narrowing  Contralateral injury  Uncontrollable pain (often sacral involvement)

Answer 34

o Non-displaced maxillary fracture o Mandibular symphyseal fractures o Minimally displaced pelvic/scapular fractures o Most metacarpal/metatarsal fractures, unless very large dogs o Tibial or radial fractures in young puppies, especially if the fibula or ulna is intact

Answer 35

Humeral and femoral fx  complex diaphyseal supracondylar fractures  articular fractures  physeal fractures Radial & Tibila Fx  comminuted  articular fractures  physeal fractures  distal radius (especially toy breeds)  geriatric

Answer 36

o Commonly fracture distal radial diaphysis o Higher rate of non-union or delayed union with external coaptation o Shown to have poorer blood supply to the distal 1/3 of the radius compared to larger breed dogs o Rigid surgical fixation gives the best chance of uncomplicated healing o Always recommend surgery for these cases o Only use external coaptation if client declines surgery and note in your records

Answer 37

Physiologic Effects  Aids in pain free exercise (PROM)  +/- decrease need for pain meds  Vasoconstriction  Analgesia  Reduce edema/inflammation  Reduce muscle spasms How To  Use in first 72hrs of injury  Don’t use too much of a barrier  10-20 mins q 2-4hrs in first 24-48hrs Contraindications  Check skin every 5-10 minutes for redness or blanching  Areas of previous frostbite  Areas of nerve impairment  Open wounds or superficial nerves  Areas of decreased to absent sensation  Patients with hypertension (may increase BP)  Very young or very old patients

Answer 38

Physiologic Effects  Vasodilation  Increased soft tissue flexibility  Pain relief  Relaxation of muscles How To  After the acute inflammatory period (>72 hours)  Apply prior to stretching, PROM, massage and exercises  10-20 minutes 3-4 times daily  Greater than 45o C (113 F) -> painful and can cause irreversible damage Contraindications  Pregnancy  Obesity  Impaired circulation  Bleeding  Acute inflammation  Poor thermal regulation  Cardiac insufficiency  Young and old patients  Malignancy  Thrombophlebitis  Pyrexia

Answer 39

AROM  Motion of a joint that may be achieved by active muscle contraction PROM  Motion of a joint that is performed without muscle contraction within the available range of motion How to * Relaxed patient * Gentle * Support bones proximal & distal to joint * 10-20 reps 2-4 times/day Contraindications * Unstable fx * External coaptation

Answer 40

 Additional force applied at the end of the available range of motion  elongate tissues, increase flexibility of normal and abnormal tissues, and help increase joint motion How to * Perform opposite action of target muscle * Two joint muscles require to action stretches * Hold for 10-30secs and repeat * After PROM * May apply heat prior

Answer 41

o Skin: 4d – 1y o SQ: 4d – 5wk o Fascia: 3wk – 2mo o Muscle: few hrs – 6mo o Tendon: 3wk - >1yr o Ligament: 4d – 1yr o Bone: 5wk – 3mo

Answer 42

Front  Down-hill walking  Digging  High Fives/Shake  Sit to Down  Push-ups Hind  Up-hill walking  Stairs  Backward walking  Side-stepping  Sit to stand

Answer 43

How to  Underwater treadmill or swimming  Ideal water temp: 86-92F  Uses buoyancy, hydrostatic P, viscosity, resistance, surface tension Contraindications  Cautious w/ cardiac or resp dysfunction  Skin Infections  Post-operative incisions  Diarrhea

Answer 44

o Penetrates up to 5cm Use  Decreases inflammation and edema,  improve blood flow,  decrease pain,  improve healing Contraindications  Neoplasia  Active bleeding  Epiphyseal plate (Risk vs Benefit)  Eyes  Photosensitization medications  Reproductive organs/Pregnancy

Answer 45

o Penetrates up to 5cm Use  Modality of choice for deep tissue heating  Improves blood flow,  increases tissue flexibility,  decreases pain,  improves healing  Good for contractures, tendinopathies, muscle spasms Contraindications  Directly over the heart in animals with pacemakers  Over areas that have risk of emboli  Over the epiphyseal area of bones  Over the spinal cord in post- laminectomy patients  Pregnancy (over the abdomen)  Plastic and metal implants  Infected areas and neoplasia

Answer 46

NMES (neuromuscular electrical stimulation)  Help prevent muscle atrophy  Help facilitate muscle contraction to retrain muscles TENS (transcutaneous electrical nerve stimulation)  Help with pain- gate theory  stimulate acupuncture points  Reduction of edema Contraindications  Over the heart in patients with pacemaker  Patients with seizure disorders  Over areas of reduced sensation/infection/neoplasia  Over the trunk of patents that are pregnant

Answer 47

o chondromalacia o fibrocartilage o osteophyte development o synovitis o effusion o subchondral sclerosis, microfractures (cancellous)

Answer 48

o Synovitis (Inflammatory mediators) o Microfractures of Subchondral Bone o Osteophytes (Mechanical) o Joint Effusion (joint distention) most painful

Answer 49

o Elbow o Carpus o Hock Why?  Carry 60% weight on front limb  40% weight on hind  Have most stress/strain

Answer 50

o Loss of hyaline cartilage matrix (mechanical) -> o Progressive catabolic process by synoviocytes & chondrocytes -> o Subchondral bone and periarticular changes -> o Pain development focuses origins from subchondral bone; effusion

Answer 51

o Gait analysis o Exam of musculoskeletal system localization o Rads o Ultrasound o CT o MRI o Arthroscopy/arthrotomy o Contralateral leg lift (tries to put down quickly)

Answer 52

Surgical  Corrective osteotomy  Chondroplasty  Excisional arthroplasty  Total joint replacement  Arthrodesis  Amputation Non Surgical  Weight reduction (HUGE for comfort)  Exercise modification  NSAIDs / DMOAs  Fish oil!!!

Answer 53

 OCD of the Medial Side Humeral Condyle  Ununited Anconeal Process (UAP)  Medial coronoid disease (MCD)  “Medial Compartment Disease” (Ulnar-radius incongruency)

Answer 54

Pathogenesis * Hypertrophic cartilage -> * Chondromalacia -> * Incomplete ossification -> * Weight bearing forces -> * Cartilage flap formation Treatment * arthroscopy/arthrotomy to remove flap

Answer 55

Pathogenesis * Overloading of medial coronoid process -> * Fragmentation -> * Chondromalacia/ Osteomalacia -> * Incomplete fissure -> * Erosions -> * OA Treatment * arthroscopy/arthrotomy to remove osteochondral fragment

Answer 56

Pathogenesis * overloading of medial articular compartment -> * cartilage erosions -> * OA * can be concurrent with MCPD Treatment * Arthroscopy * Sliding Humeral Osteotomy * Proximal Ulnar Abduction Osteotomy * Canine Unilateral Elbow

Answer 57

Signalment * Retrievers * Bernese Mountain dogs * Rottweilers * Males > Females * Usually not apparent before 5-8 mos of age Signs * Slight - moderate lameness * worse after exercise & prominent after resting * discomfort on marked elbow flexion/extension * synovial “popping” with flexion/extension * +/- pain with deep palpation over MCL (flexed elbow) * +/- “positive” modified Campbell’s test” * mild joint effusion * externally rotated paw when standing or sitting Diagnosis * CT (best) * Rads

Answer 58

Signalment * Large Breeds with separate centers of ossification of the anconeal process: * German Shepherds * Basset Hounds * St. Bernard * Mastiffy things Signs * Usually not apparent before 7- 8 mos of age * Slight - moderate lameness * Circumducted forelimb gait * Externally rotated paw when standing or sitting * Crepitus * Joint effusion Treatment * high osteotomy of the ulna * excise UAP

Answer 59

 Elbow replacement  Arthrodesis  Amputation

Answer 60

o Very common finding on rads o USUALLY subclinical Causes  Genetics  Nutrition  Laxity of round ligament & joint capsule Clinical Signs  Stiff to rise but warm up  Suddenly stops & sits  Uncomfortable at night  Narrowed pelvic limb stance  Pelvic swing on opposite side  Bunny hop  Pain on hip extension & abduction (or no pain)  +/- positive ortilani maneuver in young Rads  VD  PennHIP, extended/compression/distraction views Non-surgical Treatment  Multi-modal OA treatment (weightloss, NSAIDs, exercise mod)  Physical rehab

Answer 61

 All sx is salvage Juveniles * Triple Pelvic Osteotomy * Double Pelvic Osteotomy * Pubic Symphysiodesis Adult * Femoral Head and Neck Ostectomy * Total Hip Replacement

Answer 62

 Mostly medial but sometimes lateral  Rarely clinical  Clinical are usually obese  Often bilateral

Answer 63

I * Infrequent luxation * self-reducing, * no/rare/infrequent lameness II * Luxation occurs more frequently * patella easily reduces * mild musculoskeletal abnormalities * infrequent/intermittent lameness * aclinical or subclinical III * Patella luxated most of the time * Manual reduction infrequently reduces patella, * frequent lameness * advanced musculoskeletal developmental abnormalities IV * Ectopic patella * severe/persistent lameness * severe musculoskeletal abnormalities

Answer 64

 intermittentor persistent lameness (“acrobatics”)  Non-painful patellar manipulations (usually)  +/- mild crepitus  variable abnormalities of tibia, femoral condyles, “patella alta”  (+) sit test  Walk/run on forelimbs only

Answer 65

 Realign quadriceps tendon and patella to trochlear groove  Stabilize the patella to stay reduced in the trochlear grove during stifle movement Procedures * Imbrication of joint capsule and periarticular tissues * Trochlear chondroplasty * Excisional trochleoplasty * Wedge recession trochleoplasty * Block recession trochleoplasty * Tibial tubercle transposition

Answer 66

Signalment o 5-7mo o Larger breeds o Genetic & nutritional o Bilateral Affected Joints o Shoulder, o elbow, o stifle, o tarsus

Answer 67

Clinical Signs  Unilateral Weight-bearing Lameness worse w/ exercise  Mild muscle atrophy over shoulder/scapular region  Pain/discomfort on flexion or extension of shoulder bilaterally Rads  osteophytes on caudal humeral head, caudal glenoid cavity  focal subchondral bone flattening of caudal humeral head  +/- mineralized OCD flap

Answer 68

Clinical Signs  Elbow pain during flexion w/ medial collateral ligament pressure  Effusion/synovial popping  Joint thickening/Resistance to Flex/Ext  Externally rotated paw Rads  osteophytes  focal subchondral defect medial side of humeral condyle

Answer 69

Clinical Signs  Stifle pain on flexion and extension  Effusion  Thickening Rads  osteophytes  focal subchondral defect: lateral side of medial femoral condyle or medial side of lateral femoral condyle

Answer 70

Clinical Signs  Tarsal pain on flexion and extension  Hyperextended when standing  Marked effusion/thickening medial side of joint Rads  osteophytes  Subchondral defect medial trochlear ridge of talus  Lateral trochlear ridge in Rottweilers

Answer 71

o Arthrotomy or arthroscopy to remove OCD flap o +/- curettage o Conservative management of shoulder if no mineral present Post-op  Restrict to leash walks only for 4 weeks  NSAIDs for 5-7 days  Ice incision for 2-3 days

Answer 72

Direction  Craniodorsal (most)  Caudoventral Diagnosis  Orthogonal view rads

Answer 73

 History of trauma  Non weight bearing lame  pain/discomfort at hip Craniodorsal * stifle externally rotated; limb adducted * loss of “hip triangle” * short limb Caudoventral * stifle internally rotated and limb abducted * increased triangle + decreased greater trochanter * longer limb

Answer 74

Closed reduction: * best of done within 5-7 days * 50% success * Ehmer sling bandage: 10-14 days * restrict activity: 4-6 weeks Open Reduction * performed if femoral head does not stay reduced, > 7 days post trauma, or avulsion fracture * 85%-90% success * restrict activity: 4-6 weeks Failure of Open Reduction * Femoral head & neck osteotomy * Total hip replacement

Answer 75

Directions  Traumatic small breeds – medial  Traumatic large breeds – lateral  Congenital toy breeds - medial Diagnosis  Traumatic - 2 view rads  Congenital - malformation of glenoid and humeral head on 2-view rads

Answer 76

 Altered anatomy between acromion and greater tubercle of humerus  Pain on palpation/manipulation of shoulder joint  Joint instability on palpation (traumatic cases) traumatic: * toe touching * shoulder flexed and non- weight bearing congenital: * weight-bearing +/- intermittent lameness lateral luxation: * thoracic limb foot internally rotated, * greater tubercle lateralized medial luxation: * thoracic limb foot externally rotated; * greater tubercle medialized

Answer 77

Traumatic Closed Reduction o Valpeau sling for 2wks on medial lux o Spica splint 2wks on lateral lux Open Reduction o Used if unstable, can’t reduce, concurrent fractures, or recurrence Congenital * excisional arthroplasty of humeral head * arthrodesis

Answer 78

Cause  Sprain of medial glenohumeral ligament  Strain of subscapularis tendon Signalment  Athletic working dogs Clinical Signs  chronic/persistent weight-bearing lameness  pain on flexion or extension  marked abduction angle  ±“lateral drawer sign”  Often have arthritis on rads Treatment  diagnostic and therapeutic arthroscopy  radiofrequency-based capsular shrinkage if “minor”  open MGHL reconstruction if “major”  restrict 4-6 weeks w/ hobbles

Answer 79

 toe touching lameness/non- weight bearing  antebrachium and foot are abducted, elbow flexed  pain and increased elbow width on palpation  resistance to flexion

Answer 80

Closed reduction (if recent injury) * modified Robert Jones (reinforced) bandage, 5-7 days * restricted leash activity 2+ weeks Open reduction * if not stable post closed reduction (esp. with collateral ligament constraint loss) * cannot reduce (chronic) * associated fractures

Answer 81

Cause  derangement of passive stifle joint stabilizers  collateral ligaments  cruciate ligaments  +/- menisci  usually, joint capsule intact Clinical Signs  weight-bearing to non-weight bearing lame  cranial/caudal drawer  genu valgus and/or varus  +/- crepitus  marked joint swelling  pain on palpation Diagnosis  Orthogonal rads

Answer 82

Small dogs and cats * temporary trans-articular pinning 5-7 weeks * expect reduction of 30- 40 degrees in range of motion * poor function following surgery: arthrodesis Small and large dogs, cats * reconstruction of ligamentous constraints * trans-articular ESF w/ adjustable articulating clamps, 6 weeks * prognosis for lame- free function can be good (rehab required)

Answer 83

Clinical Signs  weight-bearing to non-weight bearing lameness  palmigrade during gait and standing  swelling over carpus  pain on extension of carpus,  +- crepitus  hyperextendable carpus  producible carpal valgus and/or varus Diagnosis  Rads +/- stressed views

Answer 84

1st or 2nd Degree sprains with no instability * splinting/bracing for 3-4 weeks, * leash restraint for 6 weeks * if palmigrade or remains lame, consider arthrodesis Instability or carpal fractures (expected with 3rd degree sprains) * Pancarpal arthrodesis * Coaptation w/ bivalvecast 6-10 weeks

Answer 85

Clinical Signs  swelling of tarsus  malalignment of tarsocrural joint or other areas of tarsus  if shearing injury, exposure of tarsal bones  instability and pain on palpation  may ambulate and stand with a plantigrade position Diagnosis  Rads +/- stressed view

Answer 86

 swelling of tarsus  malalignment of tarsocrural joint or other areas of tarsus  if shearing injury, exposure of tarsal bones  instability and pain on palpation  may ambulate and stand with a plantigrade position Diagnosis  Rads +/- stressed views

Answer 87

1st degree or 2nd degree sprains with no gross instability * coaptation for 3-4 weeks * if unstable after treatment, surgery 3rd degree sprains w/ or w/o shearing injuries w/ instability * Open wound management (shearing injuries) * temporary transarticular ESF * pantarsal arthrodesis (tarsocrural joint) * partial arthrodesis (proximal, distal intertarsal joint, tarsometatarsal joint) * coaptation (bivalve cast) 8-12 weeks

Answer 88

Grade 1: * minor stretch (internal substance disruption) Grade 2: * moderate stretch (major internal substance disruption with external tear of fibers Grade 3: * complete fiber tearing/rupture, avulsion

Answer 89

Locations  tarsus  carpus Signs  Joint effusion  Discomfort over affected area of joint capsule  Non weight bearing  Varus or valgus instability Diagnosis  Stress view rads  May see avulsion

Answer 90

Grade 1 or 2 * Ice 24-72hrs post * Heat >72hrs post * NSAIDs 5-7d * Splint or cast 4-6wks * Restrict activity 6-8wks Grade 3 * Primary repair * Splint/coapt for 4-6wks * Restrict activity 6-8wks * Arthrodesis if severe disruption of supporting ligaments * Delay definitive treatment until soft tissue healed

Answer 91

Grade 1 * stretched Grade 2 * partial rupture Grade 3 * Complete tear/ “rupture”

Answer 92

Pathogenesis  Usually due to degeneration (unknown cause)  Trauma (rare) Signalment  2-3 years old  Labs, rottweilers, Newfoundlands Signs  Acute lameness w/ 1-2 wks recovered  OR  Acute progressive lameness worse w/ activity  Common to have previous rupture on other side  Mild to moderate weight bearing  Enlarged stifle joint  Muscle atrophy due to disuse  Meniscal click or clunk Diagnosis  Positive cranial drawer test  Mild-severe OA, joint effusion, medial buttress on rads

Answer 93

Conservative * No sx needed for cats * Often no sx needed for dogs <15kg * restrict to leash walks only for 6 weeks * NSAIDs for 5-7days * If no improvement by 3weeks -> surgery Surgery * Lateral imbrication * TPLO (best) * TTA Post-op * Restrict activity 8-12wks * 8wk post op rads * Rehab 2wks after sx

Answer 94

Pathogenesis  Often occurs w/ cranial cruciate  Trauma Signs  Lameness more pronounced w/ activity  Caudal drawer sign  Joint effusion Treatment  Most ok w/ conservative management  Athletic dogs may need sx

Answer 95

Pathogenesis  Often occurs w/ chronic cranial cruciate instability  Can happen due to cranial cruciate repair Diagnosis  meniscal click or clunk on flexion or extension  discomfort on medial collateral palpation  direct visualization w/ endoscope  arthroscopy or arthrotomy for definitive Treatment  Partial meniscectomy (or total)

Answer 96

Areas  myofascial (fiber interface)  myotendinous  teno-osseous Signs  Lameness  Heat  Tenderness  Fibrosis (chronic)  Loss of tissue continuity Diagnosis  Rads show avulsion and underlying bone pathology  Pair rads w/ ultrasound

Answer 97

Acute Stage * Cryotherapy 1-3d * NSAIDs 7-10d * Restrict activity * Gentle massage After resolution of swelling * Deep friction massage & stretching * Therapeutic laser or ultrasound (heat) Surgery * Myofascial repair if athletic animal * Myotendinous repair if loss of complete tissue continuity & function

Answer 98

Signalment  Sporting & rescue dogs Signs  Lameness that progresses w/ activity  Discomfort on flexion/extension of shoulder  Discomfort on palpation of biceps Diagnosis  Rads  Ultrasound!

Answer 99

Non-mineralized * NSAIDs * Shock Wave therapy (ESWT) * Platelet rich plasma injections * Restrict activity 6wks * Physical rehab Mineralized * ESWT * Partial tenectomy +/- arthroscopy * Restrict activity 6wks * Physical rehab

Answer 100

Anatomy  Supraglenoid tubercle  Intra-articular Signs  Weight-bearing lameness worse w/ activity  Shifting lameness is bilateral  Shoulder/elbow extension upon pressure to the lesser tubercle Diagnosis  Rads  Loss of fiber detail, sheath enlargement, & increased tendon fluid on ultrasound  Arthroscopy

Answer 101

Tenosynovitis * NSAIDs * Adequan IM * Restrict activity 4-6wks Partial rupture * Arthroscopy * Tendon transection/release * Restrict activity 4wks

Answer 102

Cause  Trauma  Compartment syndrome Signalment  Sporting/hunting breeds Signs  Acute activity related lameness  adducted elbow  paw externally rotated/abducted  circumducted swing phase of gait Treatment  surgical transection of the fibrotic tendon and muscle segment  restrict activity for 2-3 wks

Answer 103

Signalment  Rottweiler, Doberman Pincher, Sheltie, Lab, Chow, Greyhound, (many others!) Signs  Moderate to severe persistent or intermittent lameness  discomfort/pain on internal rotation w/ extension of coxofemoral joint  discomfort/pain on deep palpation ventromedial to ilium (fasciculations, spasticity)  discomfort on deep palpation of lesser trochanter  discomfort/pain on rectal palpation Diagnosis  Rads may be unremarkable or have mineralization at lesser trochanter  Hypoechoic pattern of muscle Treatment  NSAIDs 7-10days  Methocarbamol 7-10days  acupuncture  restricted activity and physical rehab for 4-6wks  myotenectomy for non-responsive cases (very rare)

Answer 104

Tendons Involved  Common calcaneal tendon  Gastrocnemius  Superficial digital flexor Cause  Trauma  Degeneration in labs, dobies, collies  Metabolic dz Signs  lameness,  flexed hock, plantigrade  +/- flexed digits  pain  thickening of tendon Diagnosis  Rads  Ultrasound

Answer 105

Grade 1-2 Acute * brace/splint- 4-6 weeks * rehab Grade 3 Acute * primary repair * staged coaptation – 6 weeks Grade 2-3 Chronic * resect and re-anchor calcaneus * prosthetic materials * autographs, small intestinal submucosa, calcaneal tendon allograph * staged coaptation for 12+ wks

Answer 106

Signalment  Shepherds & Dobies Signs  Distinct lameness  short stride,  medial rotation of paw  external rotation of hock  internal rotation of stifle  pain on palpation  limited range of motion  “slaps” foot down during swing phase Treatment  Surgical resection with medical management not rewarding  redevelopment in 100% of patients

Answer 107

Signalment  Young rapdly growing dogs  German Shepherds  Basset hounds Signs  Shifting leg lameness  Reoccurs  Pain on deep palpation of long bones Diagnosis  Rads Treatment  diet (large-breed puppy food)  NSAIDs, PRN  time