Exam 3: Lecture 14: Surgery of the shoulder Flashcards
(116 cards)
1
Q
Define Scapulohumeral joint luxation
A
when loss of damage of supporting structures of joint cause seperation of the humerus from scapula
May be defined as
- dislocated shoulder
- Shoulder luxation
2
Q
What is the etiology of scapulohumeral luxations
A
trauma or congenital
3
Q
The main support of the scapulohumeral joint includes the joint capsule, glenohumeral ligament and surrounding tendonds. what are the muscles surrounding this joint which aid in support?
A
- supraspinatus
- infraspinatus
- teres minor
- subscapularis
4
Q
What are the two significant structures that when are torn or deficient may lead to humeral head luxation
A
- biceps tendon
- medial and lateral glenohumeral ligaments
5
Q
Which types of humeral head luxations are common
A
medial or lateral deviations
6
Q
Which type of humeral head luxations are rare
A
cranial or caudal luxations
7
Q
What type of luxation occurs after lateral glenohumeral ligament + infraspinatus tendon rupture
A
lateral humeral luxation
8
Q
What type of luxation occurs from tearing of medial glenohumeral ligaments and subscapular tendon
A
Medial humeral luxations
9
Q
Concurrent thoracic trauma is common from scapulohumeral luxations, which include?
A
- pneumothorax
- hemothorax
- pulmonary contusions
- fractured ribs
10
Q
Congenital or developmental laxity of capsule + ligaments cause medial displacement and ______ _____ of humeral head
A
medial luxation
11
Q
Which structure of sufficiently deformed or hypoplastic
- prevents reduction of humeral head
- often bilateral in affected animals
A
Glenoid cavity
12
Q
Which type of luxation is from congenital or developmental laxity of capsule and ligaments
A
medial luxation
13
Q
How can you diagnose scapulohumeral luxations
A
Clinical presentation
- signalment
- history
14
Q
Would the following fit traumatic or congenital clinical presentation in animals with scapulohumeral luxations
- Any age or breed of dog
- rare in cats
A
traumatic
15
Q
Would the following fit traumatic or congenital clinical presentation in animals with scapulohumeral luxations
- occurs in small + minature dog breeds
- toy poodles + shetland sheepdogs
- lameness usually appears when animal is young
A
Congenital: Medial luxation
16
Q
What is the normal history in animals with Traumatic luxation of the scapulohumeral luxations
A
history or evidence of trauma
17
Q
What is the normal history in animals with congenital luxation of the scapulohumeral luxations
A
chronic forelimb lameness evident at a young age + without history or trauma
18
Q
During a PE how would animals present with traumatic luxation
A
- animals NWB
- limb carried in flexed position
19
Q
During a PE how would animals present with lateral scapulohumeral luxations
A
Foot is rotated internally
- greater tubercle palpable lateral to normal position
20
Q
During a PE how would animals present with medial scapulohumeral luxations
A
Foot is rotated enternally
- greater tubercle palpated medial to normal position
- pain and crepitations evident with shoulder manipulation
21
Q
During a PE how would animals with chronic-congenital medial luxation present
A
- dogs often lame
- joint is easily luxated + reduced
- manipulation does not usually cause pain
22
Q
IF the glenoid cavity is deformed with scapulohumeral luxations how would you describe reduction of the humeral head
A
reduction of humeral head may be impossible
- some small dogs with chronic medial luxations show only mild intermittent lameness and minimal DJD
23
Q
When taking DI for scapulohumeral luxations lateral and ventrodorsal radiographs of the shoulder may be needed to confirm diagnosis. If you have a traumatic luxation what should be done?
A
special attention to identifying concurrent scapular fractures or thoracic injuries
24
Q
What does A show?
A
Congenital medial luxation of the humeral head in animals with scapulohumeral luxations
25
What does B show?
Traumatic medial luxation of the humeral head in animals with scapulohumeral luxations
26
What lab findings would be present in animals with scapulohumeral luxations
No specific abnormalities
- with traumatic or congenital luxations
Traumatized animals undergoing surgery
- full blood work to determine optimum anesthestic regimen
Analysis of synovial fluid
- may reflet associated inflammation + DJD
27
Differential diagnosis of scapulohumeral luxations include?
- DJD
- humeral osteosarcoma
- contracture of infraspinatus or supraspinatus tendons
(PE findings or DI)
28
What would the medical management be in dogs with chronic medial luxation (only mild intermittent lameness + minimal DJD)
- managed with exercise restriction and antiflammatory medications during acute exacerbations
29
What type of luxation is presented soon after injury
- closed reduction attempted (if not humeral or scapular fractures)
- general anesthesia required
Traumatic luxation
30
What type of luxation is described as
- reduced with leg held in extension
- medial pressure applies to humeral head
- lateral pressure is applied to medial surface of scapula
- humeral head should remain in place when moved through normal ROM
Lateral luxation
31
If stable what type of splint can be applied for 10-14 days if you have a lateral luxation in scapulohumeral luxations
Lateral spica splint
32
What type of splint is this?
Spica splint
33
What does the image show?
Lateral luxation
34
Medial luxation is generall caused by?
trauma
35
How would you immobilize the limb in animals with medial luxation (caused by trauma)
Velpeau Sling
36
What type of fixation is shown in this image and what is it for?
Velpeau Sling
- used for medial luxation
37
scapulohumeral luxations surgical treatment
- if traumatic luxation is unstable after closed reduction what can occur?
re-luxation occurs or luxation is chronic
38
For scapulohumeral luxations surgical treatment when would you use open reduction and stabilization
- capsulorrphy/prosthetic ligament reconstruction
- or biceps tendon transpoisitioned required
39
For scapulohumeral luxations surgical treatment in animals with congenital luxations with severe or persistent lameness what would you recomment
surgery is warranted
40
What is number 1
Biceps brachii tendon
41
What is number 2
Suture anchors or bone tunnels
42
What is number 3
Monofilament nylon
43
Position of bone anchors in this image is for stabilization of ______ glenohumeral luxation
Medial
44
The image shows what type of surgical treatment used for Scapulohumeral luxations
Capsulorrhaphy / prosthetic ligament reconstruction
45
What type of surgical treatment is shown in the image for a scapulohumeral luxations
Biceps tendon transposition
46
What type of surgical treatment for scapulohumeral luxations is done through incision through the transverse humeral ligament.
- Make an incision in joint capsule to free it and **move the tendon MEDIALLY**.
- Secure it to the humerus with a bone screw and spiked washer
Biceps tendon transposition
47
In animals with Scapulohumeral luxations cases with **severe** joint dysplasia or DJD
- open reduction + stabilization are unsuccessful
What type of Salvage procedures are performed?
Arthodesis or glenoid excision
48
What does this image show?
Arthrodesis and glenoid excision
49
For a lateral luxation the limb is supported using ?
spica splint
- 10-14 days
50
For a medial luxation how is the limb supported?
Velpeau sling
- around the 10-14 days
51
Postoperative care and assessment of Scapulohumeral luxations include?
- postop radiographs (document position of humeral head and any implants used)
- owners cautioned to limite activity + protect bandage
- Rehabilitation exercise begin after removal
- Uncontrolled activity limited for additional 6 to 12 weeks
52
What is the major complication with Scapulohumeral luxations
reluxation
53
Complications of Scapulohumeral luxations include?
The major complication is reluxation
- with traumatic luxation most dogs regain normal limb use
- DJD may occur and require periodic treatment with analgesics
54
What is the prognosis of animals with Scapulohumeral luxations after closed reduction when the forelimb is manipulated and stays in place
good for return of limb function
55
What is the prognosis in animals with Scapulohumeral luxations after a closed reduction if the joint is unstable
- open reduction and joint stabilization considered
Guarded
56
What is the prognosis in animals with Scapulohumeral luxations after closed reduction when the issue is due to congenital or developmental medial luxations
guarded
57
In animals with Scapulohumeral luxations when its not possible to maintain reduction of shoulder joint, what should be indicated
slavage procedure (arthodesis)
58
Define shoulder instability
AKA:
- shoulder subluxation
- Glenohumeral instability
Characterized by pathological increase of ROM of joint
59
What is the most common type of shoulder instability
mediolateral plane
60
General considerations for shoulder instability should be?
clinically relevant pathophysiology
61
Shoulder instability is due to ______ or _____ of medial or lateral supportive strucutres of shoulder joint
tearing or stretching
62
Shoulder instability from a low grade chronic traume or acute blunt trauma result in?
instability and subluxation of joint with complete luxation
63
Damaged structures from injury (low grade chronic trauma or acute blunt trauma) to cause Shoulder instability includes?
Medial or lateral glenohumeral ligaments + subscapularis tendon
- damage to biceps tendon may also occur
64
Dogs with Shoulder instability may also have varying degree of which disease
OA
65
Clinical presentation of animals with Shoulder instability include?
dogs of any size affected
66
Normal history in animals with Shoulder instability includes?
- occurs mostly in active dogs
- may be diagnosed in older animals after years of exercise and activity
- typically - history of moderate chronic lameness
- less commonly acute onset of lameness and history of mild trauma
67
During a PE in animals with Shoulder instability what can be noted during a gait analysis
moderate WB lameness is observed
68
During a PE on animals with Shoulder instability what may show up during an orthopedic exam
- may revel moderate muscle atrophy of affected limb
- palpation of limb may show increased angles of abduction
(medial shoulder instability)
- most dogs have pain on manipulation of shoulder joint
69
What does this image show?
Abduction palpation of shoulder joint to evaluate medial instability
70
What would Diagnosit imaging look like in animals with Shoulder instability
- radiographs are usually normal
- some cases may have changed compatile with OA
- dogs with concurrent bicipital tendionpathy
71
A dog with Shoulder instability gets radiographs done and it shows concurrent bicipital tendiopathy. What does that mean?
Osteopytosis + Sclerosis of bicipital groove on skyline views
72
How is a definitive diagnosis made in animals with Shoulder instability
Arthoscopy
- see damage inside the shoulder joint
73
Arthoscopic findings in animals with Shoulder instability include?
- tearing or laxity of medial glenohumeral ligament, lateral glenohumeral ligament or subscapularis tendon
- Tearing or inflammation of biceps tendon may also occur
74
Lab findings in animals with Shoulder instability include?
- specific abnormalities not seen
- arthocentesis shows chnages compatible with OA
75
Shoulder instability differential diagnosis include?
- OCD
- Biceps disease
- OA
- Other trauma
- Neoplasia
76
Medical management of Shoulder instability includes rest and physical therapy. Why is this recommenede in mild cases
Shoulder stabilization orthoics
- prevents limb abduction + shoulder extension / flexion
(reported to be effective)
77
for Shoulder instability why are Rehabilitation programs recommended
Desigened to maintain ROM while strengthening muscles
- minimize instability
Physcial rehabilitation aimed at strengthening periarticular structures + improving comfortable active ROM
78
How does body weight management effect Shoulder instability
aids in decreasing loads on joint and limiting signs of OA
79
How would you surgically treat Shoulder instability
- Performed with **arthoscopic or open surgery**
- neither method shown superior
- arthoscopic-assisted techniques
- open surgery
80
Arthoscopic-assisted Shoulder instability surgical treatment includes with 3 techniques
- arthroscopic-assisted anchor and suture technique
- Tighrope (TR) stabilization of medial shoulder instability
- radiofrequency shrinkage of ligaments + joint capsule
81
Which type of arthroscopic-assisted technique is no longer recommended due to serious complications for Shoulder instability
- Historic use
- Well documented in human medicine
Radiofrequency shrinkage
82
How would you perform open surgery to treat Shoulder instability
involves placement of suture anchors at sites of origin + insertion of medial glenohumeral ligament
83
What does this image show?
Arthoscopic view of medial aspect of shoulder showing tearing
- subscapularis tendon
- medial glenohumeral ligament
84
What does this image show?
(A) craniocaudal + (B) lateral medial postop radiographs
**following tightrope stabilization** of medial shoulder instability
85
For Shoulder instability TR stabilization includes
- **use hobbles for 6 to 12 weeks**
(doggleggs theraptuc + rehavilitive products)
- activity restricted to leash walking for a minimum of **8 weeks**
- Passive ROM, swimming, and other muscle building activits
- **PT management** highly recommended
- Reevaluate pt
(includes lameness evaluation joint palpation for stability every 4 weeks)
(return to full athletic function at 16 weeks post-op when stability is achieved)
86
When doing open surgery for Shoulder instability Place the limb in **_______ ______** for 1-2 weeks
Velpeau sling
87
Significant complications of Velpeau Sling in animals with Shoulder instability include?
- **contracture of the caprus**
- extreme care + observation must be used
- PT highly recommended
- Reevaluation of pt includes **lameness evaluation + joint palpation for stability q2 to 4 weeks**
88
What is the prognosis for animals with Shoulder instability
Variable
- depending on severity of soft tissue injuries and OA
- reports of both open + arthoscopic techniques suggest favorable results with each
89
What did Dr. Gilley suggest we call Bicipital tenosynovitis and why?
Tendiopathy
- because not much signs of inflammation
90
What is the common cause of shoulder lamness in dogs
Bicipital Tendon Disease
91
What is the primary cause of Bicipital Tendon disease
overuse or chronic repetitive
- inflmmation ?? prob not
92
What is the secondary cause of Bicipital Tendon disease
- response to other articular disease
- loose fragment
- acute trauma
93
What is the exact pathophysiology of Bicipital Tendon disease
unknown
94
How can you diagnose Bicipital Tendon disease
- History
- clinical signs
- physcial and orthopedic exam
95
History of animals with Bicipital Tendon disease include?
- middle to older ages
- medium to large breed dogs
- no breed or gender predilection
96
Clinical signs of animals with Bicipital Tendon disease are?
Chronic intermittent or progressive lameness
97
What can be noted on an PE and orthopedic exam in animals with Bicipital Tendon disease
- shoulder pain on joint manipulation
- direct palpation of biceps tendon of origin
98
Which technique is mostly used nw to diagnose Bicipital Tendon disease
Ultrasonography
99
What does this image show?
Bicipital Tendinopathy
Radiographic image (may be subtle)
- skyline view helps visualize irregularities and mineralization
100
What type of treatment for Bicipital Tendinopathy should be tried first?
Medical treatment
101
Describe the medical treatment for Bicipital Tendinopathy
- Oral NSAIDs tried but typically ineffective
- 1-2 intra-articular injection of long acting corticosteriod
(methylprenisolone acetate = Depo-Medrol)
(Trimcinolon)
- strict cage rest 4-6 weeks with gradual resturn to activate
(cortiosteriod reduced inflammation but rest is critical)
102
_____% of animals with Bicipital Tendinopathy respond to medical management
- if lameness returns after 2 attempts surgery is indicated
50%
103
Define a Tenodesis surgery in animals with Bicipital Tendinopathy
- traditional open approach
- secure tendon of origin to proximal humerus
- generally good results
- arthoscopy (less complications)
104
Define Tenotomy surgery in animals with Bicipital Tendinopathy
- Arthroscopy
- cut tendon at origin
- tendon drops down in sheath
- Popular method
105
What type of surgery is shown in the image and what would it be used for?
Tenodesis
used in animals with Bicipital Tendinopathy
106
Supraspinatus tendinopathy may cause Dystrophic calcification of the the tendon. Can this be foud is asymptomatic dogs?
yes
107
What is the etiology for Supraspinatus tendinopathy
unknown
- disease is not common
108
Signalment for Supraspinatus tendinopathy includes?
- Middle aged large breed dogs
- rottweilers and Labador retrievers predisposed
109
how can you diagnose Supraspinatus tendinopathy
history
PE and orthopedic exam
DI
110
Animals with Supraspinatus tendinopathy may have a history of?
chronic intermittent or progressive lameness
111
On PE and orthopedic exams, animals with Supraspinatus tendinopathy may show?
- shoulder pain on joint manipulation
- pain increased with calcification of tendon
112
DI may be taken on animals with Supraspinatus tendinopathy. What can be seen?
- may revel mineralization bilaterally
- clinicals signs can still be unilateral
113
Additional imaging may be needed for animals with Supraspinatus tendinopathy, why?
- to see if Calcification present
- **differentiate supraspinatus tendon vs biceps tendon**
114
Supraspinatus tendinopathy may cause impingement of which tendon?
- Requires MRI
- Clinical signs related to both condition
biceps tendon
115
Medical Treatment for Supraspinatus tendinopathy includes?
- strict rest and NSAIDs
- extracorporeal shock wave therapy
116
Surgical treatment for Supraspinatus tendinopathy includes?
- **surgical excision of calcified tissue in tendon
- excise disease tissue if impingment on biceps tendon**
- rehabilitation exercise after surgery to speed recovery
