Final: OA/ OCD, Shoulder, Elbow Flashcards by Sarah Sabler

When would you use a DCP (dynamic compression plate) on a carpal injury?

When you want to perform a pancarpal arthodesis because the antebrahiocarpal joint is abnormal and all 3 joints need to be fused (do in conjunction w/removal of all cartilage and cancellous bone graft)

Place on dorsal surface

BEST TREATMENT FOR CARPAL LUXATIONS, antebrachial carpal injuries

More commonly done tha partial carpal arthodesis

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What are the indications for surgical treatment of a shoulder luxation?

Chronic/recurrent/unstable luxation

Accompanying fractures (e.g. HBC injuries)

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What is the most mobile joint in the carpus? Tarsus?

Antebrachiocarpal joint

Tibiotarsal/Talocrural joint

I.e. these are least likely to be affected by luxations

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What is the recommended treatment for collateral injury of the tarsus/carpus?

Surgical mgmt- reconstruction/replacement of the ligamenets

Splint + rest not helpful alone, ESF can help joint stay stable while soft tissue trauma is healing

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What are the 3 steps to surgically repairing a shoulder luxation?

Arthrotomy (to evaluate/reduce joint)
Glenohumeral ligament (MGHL) repair
Imbrication/repair of capsule (during closure)

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What are the 5 risk factors for OA?

Advanced age

Size and growth rate (large breed dogs)

Obesity

Repeated trauma and mechanical stress

Breed/genetics

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Which of the following are medial and which are lateral on the tarsus?

Trochlea of the talus

Calcaneous

Metatarsal bone I

Metatarsal bone V

Central tarsal bone

_Medial:_Trochlea, MT I, central tarsal bone

Lateral: Calcaneous, MT V

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T/F: Excess weight will accelerate the expression of OA/DJD.

True

No such thing as too thin for any dog w/OA

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Why are corticosteroids not recommended with DJD?

Steroids depress chrondrocyte metabolism and alter the matrix and can affect collagen formation, so they have long term deleterious effects

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What is the typical signalment for congenital shoulder luxation?

Small or Toy breed dog

3-10 months of age

Shetland sheepdog, Collie, Elkhound too

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What can you do to treat pain due to end-stage OCD in the tarsocrural joint?

Tarsocrural arthodensis

Fuse in standing angle, remove articular cartilage, pack w/bone graft, rigid fixation

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What does it indicate if a dog is chewing at his toes that are peaking out of the bottom of a bandage?

Bandage too tight

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What is the purpose of curettaging in OCD surgery?

To stimulate fibrocartilage

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What type of disease (infectious, non-infectious nonerosive, non-infectious erosive, non-inflammatory) shows the following radiographic signs:

Joint space collapse

Multiple joints affected

No bony changes

Noninfectious Nonerosive

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What breeds are predisposed to infraspinatus contracture?

Hunting breeds

(Spaniels, Pointers, Retreivers)

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GSD are particularly predisposed to what form of elbow displasia?

UAP

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How many tarsal bones are there?

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Which portion of the tarsal collateral ligament is taut only in extension? Which is taut in both flexion and extension?

Long- Extension only

Short- Extension and flexion

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What type of incongruity is associated with UAP? FCP?

UAP- short ulna + long radius

FCP- short radius + long ulna

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What diagnostic can you use to definitively establish whether joint disease is inflammatory or not?

Arthrocentesis

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Shoulder instability will cause medial instability and an increased ______ angle. Normal is ___ degrees, abnormal is over ___ degrees. Many clinical causes fall between these values.

Abduction

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What surgical treatment is indicated for shoulder OCD?

Via arthroscopy:

First remove flap and lavage joint

Then debride bone with curette/shaver

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What are 3 options for post-op immobilization after a calcanean tendon repair?

External fixator

Splint

Giant lag screw (from calcaneous to tibia)

Often combo of these

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What stess laterally deviates the limb? Medially?

VaLgus= Lateral

Vargus = Medial

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What supporting structure(s) is/are most commonly affected with shoulder instability?

**Medial structures:** Medial glenohumeral ligament, Suprascapularis tendon

Where do OCD lesions on the tarsus occur?

Talus

What joint condition is this posture associated with? Describe the posture in terms of what is adducted and what is externally rotated.

MCD (medial compartment disease) "Toed out" posture Elbow adducted Toes/rest of limb abducted *Taking strain of medial compartment*

Is osteoarthritis/osteoarthosis inflammatory or not?

Non-inflammatory DJD

What surgery is this? When is it indicated? Describe what's going on.

Partial carpal arthodesis When antebrachiocarpal joint is healthy Middle and carpometacarpal joints are fused using a T-Plate (or pins)

If IOHC (incomplete ossification of the humeral condyle) presents to you with no displacement or fractures, how do you treat?

Single lag screw through condyles

T/F: End-stage DJD is OCD.

False, end stage OCD = DJD

What motions elicit pain in a dog with OCD of the shoulder? What radiographic view is diagnostic

Hyperextension Flexion Lateral view *(early on will see flattening of humeral head, eventually a saucer-shaped divit/flap forms)*

OCD is a bilateral disease. Does it usualy present with bilateral lameness?

No, unilateral

Which ligaments need to be 'replaced' during collateral ligament replacement surgery on the carpus? Tarsus?

Carpus= **short** ligaments (medial = straight and 2 oblique ligs, lateral= straight only) Tarsus= short and long ligaments ***T**arsus = **T**wo*; *car**Pus** = pus(sy cats) are short*

What nutritional supplements help to with inflammation? Which one prevent further damage?

Anti-inflammatory = Omega 3 FAs Chrondroprotectants = Glucosamine/Chondroiten, Avocado Soybean Unsaponifiables (ASU)

What is the most stable option for primary tendon repair after a calcanean rupture?

3-loop pulley

What constrains mediolateral motion of the elbow in flexion? Extension?

Collateral ligaments Olecranon

Does early intervention prevent elbow DJD?

No ## Footnote *Prognosis is better w/small flap and small duration of CS but will need to medically manage DJD longterm*

What type of disease (infectious, non-infectious nonerosive, non-infectious erosive, non-inflammatory) shows the following radiographic signs: Soft tissue swelling Dimished joint space Bony changes (e.g. periarticular osteophytosis, subchondral bone plate possibly sclerotic)

Non-inflammatory (specifically DJD)

What are your treatment options for a traumatic elbow luxation without joint disease where closed reduction was successful?

Split Modified ESF (Open reduction and ligament reconstruction if these fail)

What is the common signalment for biceps brachii tendinopathy? How does it typically present?

_Sig:_ Mature adult medium or large breed dog _CS:_ Chronic, intemittent progressive **WEIGHT BARING** lameness that worsens with exercise and is unilateral

What procedure is required for definitive treatment of hyperextension injuries? What if the antebrachiocarpal joint is involved?

Arthodensis of affected joint and joinst distal to it Panarthrodesis (antebrachiocarpal joint)

What conditions are involved in elbow displasia? Which are included in the component of "Medial compartment disease"?

UAP (ununited anconeal process) Incongruity OCD (osteochondritis dissecans, of the medial humeral condyle) FCP (fragmented medial coronoid process, of the ulna) MCD= FCP+OCD+Incongruity

Elbow displasia is a collection of separate but related diagnoses. What is the typical presentation and progression?

Biphasic distribution (age) Large/Giant dog breeds Often bilateral Chronic, progressive lameness (often worse w/exercise) Natural progression to osteoarthritis

Does surgical intervention with tarsus OCD prevent the development of OA? Is it always better than medical management?

No No, medical management might be as good as an arthotomy and fragment removal *Tarsus is not a very forgiving joint*

What is expected if you do not surgically treat shoulder OCD?

DJD

How do you assess the collateral ligaments of the elbow?

**Campbell's test** Elbow and carpus at 90deg, supination to assess lateral ligament, pronation for medial ligament Compare to contralateral limb

What stance does complete rupture of the common calcanean tendon cause? Which tendon is usually affected with a partial rupture? What does this look like?

Plantigrade SDF- partial hyperextension of hock, flexion of digits

What type of disease (infectious, non-infectious nonerosive, non-infectious erosive, non-inflammatory) shows the following radiographic signs: Sclerotic or lytic subchondral bone Bony changes (e.g. periarticular done formation) Joint space changes (e.g. narrowing, capsule distension) Soft tissue swelling

Inflammatory (infectious)

When is fusion of the humeral condyle normally complete? What breed is prediposed to IOHC?

12 weeks Spaniel breeds (Males)

What are your treatment options for a traumatic elbow luxation in conjunction with severe joint disease?

Total elbow replacement Arthrodesis

What does acute NWB lameness in a dog with IOHC indicate?

Pathologic fracture

What is the treatment for congenital shoulder luxation with a normal glenoid?

Open reduction/capsulorrhaphy Glenohumeral ligament reconstruction

T/F: IOHC is usually bilateral.

True | (90% have bilateral lesions)

What is the best diagnostic modality for asssessing shoulder instability?

Arthroscopy

What is muscle shortening not caused by active contraction?

Contracture

What is the purpose of exercise modulation for OA?

Maintain muscle mass

What rad view is required to diagnose UAP?

Flexed lateral

After preforming a closed reduction of a shoulder luxation, what spint would you use if the luxation had been medial? What is it was lateral? Cranial? Caudal?

Medial = Velpeau Lateral, Cranial, Caudal = Spica

When manipulating the joint of a dog with elbow displasia, pain is felt on ______ with UAP, and ______ as well as ______ with MCD. _______ indicates osteoarthritis.

Extension (*anconeal pressure*) Flexion and supination Crepitus

What is the recommened procedure for infraspinatus contracture?

**Tenectomy** of infraspinatus tendon | (Also release other capsular adhesions)

When is an intraarticular corticosteorid injection indicated for biceps brachii tendinopathy? What should you do in conjunction with (before) this?

When there is recurrent or persistent lameness Sample joint fluid for analysis/culture

Hyaline/Articular cartilage is 10% _____ and 90% \_\_\_\_\_\_.

Chrondrocytes Extracellular matrix

What type of disease (infectious, non-infectious nonerosive, non-infectious erosive, non-inflammatory) shows the following radiographic signs: Joinst space collapse Bony changes (e.g. subchondral bone proliferation, new bone formation) Soft tissue swelling Multiple joints affected

Noninfectious erosive (e.g. Rheumatoid arthritis)

What is the source of pain in young dogs with elbow displasia? Old dogs?

Young- defect in joint surface (friction) Old- OA

What do you do to look for a pain response in a dog with suspected biceps brachii tendinopathy?

Maximally flex shoulder and extend eblow Deeply palpate over intertubercular groove Apply tension to biceps insertion (If standing then apply tension to biceps insertion) **Stretch in biceps tendon elicits pain**

In terms of prognosis, how would you order the following joints from best to worst? Stifle,Shoulder, Elbow, Tarsus

Shoulder \> Stifle \> Elbow \> Tarsus

What is generally more successful, open or closed reduction of shoulder luxation?

Closed

What are the 2 options for surgical treatment of UAP? Which is more appropriate for a dog with OA?

Fragment excision - better for dog with OA (Ulnar lengthening) Osteotomy + Fixation

What is true about the centers of ossification in the ulna of dogs with UAP?

Have a **separate ossification center** on the anconeal process

What procedure is indicated if the PE is highly suggestive of a bicept tendinopathy?

Arthroscopy | (+ Lateral/craniocadual rads)

What is CREPI?

Crepitus Rage of Motion Effusion Pain Instability

Is arthroscopy or arthrotomy better for medical management of elbow displasia?

Arthroscopy ## Footnote *OA progresses despite treatment*

What are the 3 salvage procedures for the shoulder?

Arthodensis (joint fusion) Glenoid incision Amputation

\_\_\_ is used to evaluate bone while ____ is beter for evaluating tendons and ligaments.

CT MRI

Hyperextension injury of the carpus/tarsus causes damage to which ligaments?

Palmar/Plantar support ligaments

What type of injury do these stress views of the carpus indicate?

Medial collateral injury (Valgus stess opens the joint medially because MCL is deficient but vargus pressure does not open the joint because the LCL is fine)

What is the gold standard for diagnosing FCP and OCD?

Arthroscopy

Does osteochondrosis occur in young or old dogs?

Young

What are the 2 surgical procedures for biceps tendinopathy? Give a basic description of each.

Tenotomy: cutting tendon **(*much easier and good results)*** Tendoesis: cutting tendon and moving it to another position ***(better results)***

What are the 2 options to keep the leg in extension after reduction of elbow luxation?

Spica splint for stable, closed reduction (q2-3 weeks) **-** *shoulder joint must be immobilized* Flexible ESF for open/unstable reduction (q 3-4weeks)

With a medial traumatic shoulder luxation the distal limb is \_\_\_\_\_, with a lateral luxation the distal limb is \_\_\_\_\_. Medial is most common.

Abducted Adducted

When you manipulate the shoulder, will a dog with infraspinatus contracture be painful?

No Non-painful, NWB lameness

When infraspinatus contracture occurs, the elbow is ______ and the antebrachium is \_\_\_\_\_\_\_.

Adducted Abducted

What type of injury does this stance indicate?

Hyperextension injury of the carpus

What can you use to prevent a dog from abduction his shoulder? What more rigid thing do you need to use for severe shoulder instability, post-op?

Hobbles Velpeau sling (q2-4 weeks, followed by hobbles q3-4mo)

Which of the following are medial and which are lateral on the carpus? Ulnar carpal bone Metacarpal bone I Sesamoid bones Metacarpal bone V Short radial collateral ligaments Short ulnar collateral ligaments

_Medial:_ MC I, Sesamoids, Short radial collateral ligaments _Lateral:_ MC V, Ulnar carpal bone, Short ulnarcollateral ligaments

Excess of what nutrient can lead to OCD?

Calcium

What would make it impossible to reduce a congenital shoulder luxation?

Glenoid dysplasia

What are the 3 salvage procedures for the elbow?

Canine Unicompartmental Elbow (CUE) Total Elbow Replacement (TER) Arthrodesis