Investigation and management of the mature lame animal - 1

Question 1

List 4 possible causes of acute lameness in mature animal

Answer 1

sprains
acute cruciate rupture
fractures both pathological and traumatic
cellulitis

Question 2

List 3 possible causes of chronic lameness

Answer 2

osteoarthritits
humeral intracondylar fissure
nerve root tumour

Question 3

List 3 possible causes of intermittent lameness

Answer 3

patella luxation
dislocation of the tendon of origin of the long digital extensor
superficial digital flexor instability

Question 4

List 3 acute on chronic causes of lameness

Answer 4

cruciate rupture
pathological fracture
condylar fracture subsequent to HIF

Question 5

List 6 things to look for on clinical exam when approaching lame animal

Answer 5

reduced/ increased range of movement
instability to joints
pain on manipulation of joints/ long bones
crepitus on manipulation of joint/ long bones
muscle atrophy
neuro deficits

Question 6

What should be your top differential for hindlimb lameness

Answer 6

cruciate disease- until proven otherwise

Question 7

What does the shoulder rely on for stability

Answer 7

soft tissues- muscles, tendons, ligaments

Question 8

what injuries is the shoulder prone to

Answer 8

prone to sprains, particularly the medial glenohumeral ligament and other soft tissue injuries

Question 9

Describe how to diagnose shoulder soft tissue conditions

Answer 9

palpation of shoulder
any pain elicited?
biceps tendon test
manipulation under GA

Question 10

Describe the biceps tendon test

Answer 10

apply pressure to the bicipital groove whilst retracting the shoulder and extending the elbow
- is there pain?

Question 11

what is indicative of biceps tendon rupture on biceps tendon test

Answer 11

If it is possible to extend the elbow greater on one leg compared to other? This is indicative of either biceps tendon rupture or avulsion (tearing of the tendon from its bony origin)

Question 12

Describe the imaging techniques you can use to investigate shoulder soft tissue conditions

Answer 12

radiography- mineralisation of the infra and supraspinatus tendons.
ultrasound- good to examine biceps tendon
CT and MRI
arthroscopy- gold standard

Question 13

Describe infraspinatus contracture

Answer 13

abducts their elbow and are unable to weight bear- not painful

Question 14

Describe how to treat infraspinatus contracture

Answer 14

Managed by sectioning the tendon close to its insertion on the humerus

The prognosis is good

Question 15

what dogs are generally affected by infrasponatus contracture

Answer 15

working breeds such as spinger spaniels

Question 16

Describe the signalment of humeral intracondyalr fissure (HIF)

Answer 16

Spaniels and french bulldogs
young to middle aged

Question 17

list the clinical signs of HIF

Answer 17

Chronic forelimb lameness (can be acute)
Muscle atrophy and elbow swelling
Pain on manipulation of elbow

Minimal trauma can cause condylar fracture in young animals

Question 18

Describe conservative management of HIF

Answer 18

rest
NSIADs
but always at risk of a condylar fracture with significant morbidity

Question 19

Describe surgical management of HIF

Answer 19

Placement of large transcondylar screw - this is prone to significant number of complications

Question 20

what is the most common carpal injury

Answer 20

hyperextension- The palmar ligaments and palmar cartilage are damaged irrevocably

Question 21

how are carpal injuries generally treated

Answer 21

pancarpal arthrodesis (all the joints are fused)- as ligaments will never heal

Question 22

why is a parital arthrodesis rarely used to treat carpal injuries

Answer 22

it results in strain on adjacent joints

Question 23

Describe incomplete ossification of the radiocarpal bone

Answer 23

boxers and springers
Attempts to heal often fail as this is a similar pathology to HIF
Treat with pancarpal arthrodesis as healing of the bone very unlikely

Question 24

Describe the signs seen with Stenosing tenosynovitis of the abductor pollicus longus

Answer 24

Chronic lameness seen in large exuberant dogs

Pain on carpal flexion

Soft tissue swelling medial carpus

Boney exostoses seen over the medial aspect of the radius in chronic cases

Question 25

Describe how to treat Stenosing tenosynovitis of the abductor pollicus longus

Answer 25

steroid injection into tendon sheath freeing or sectioning the tendon

Question 26

Describe what is seen with plantar ligament degeneration

Answer 26

proximal intertarsal subluxation with bilateral changes Degeneration progresses to rupture and plantigrade stance

Question 27

Describe how to treat plantar ligament degeneration

Answer 27

Treat with laterally applied plate and arthrodesis of the calcaneoquartal joint.

Question 28

Which dogs generally affected by gastrocnemus tendinopathy

Answer 28

older Labrador retrievers and Dobermanns

Question 29

what does gastrocnemus tendinopathy cause

Answer 29

hyperflexion of the digits characteristic clawing of foot due to lengthenin of gastrocneum but not the SDF tendon

Question 30

Describe how to treat gastrocnemus tendinopathy

Answer 30

resect tendon and place calcaneal tibial screw or transarticular external fixator to support the repair or a pantarsal arthrodesis

Question 31

When approaching treating open traumatic carpal/ tarsal injuries what should you treat first

Answer 31

soft tissue injury first A temporary external fixator may help in the initial stabilisation of the joint

Question 32

Describe gracilis contracture

Answer 32

mature German shepherd dog characteristic gait progressive with no effective treatment

Question 33

Describe the signs seen with Iliopsoas myopathy

Answer 33

progressive hindlimb lameness pain on extension and rotation of hip

Question 34

describe how to treat Iliopsoas myopathy

Answer 34

Rest and NSAI OR section the muscle at its insertion on the lesser trochanter

Question 35

what is the best way to diagnose humeral intracondylar fissure

Answer 35

CT scan- can't always be seen on x-rays

Question 36

Describe long digital extensor avulsion

Answer 36

joint effusion with a small bone fragment Treat by reattaching the fragment or tendonesis to the proximal tibia

Question 37

Describe long digital extensor tendon luxation

Answer 37

associated with TPLO surgery treat by tendenosis OR securing the ligament to the tendon

Question 38

Describe avulsion of the gastrocenemius

Answer 38

low grade trauma resulting in lameness and slight plantigrade stance Treat by reattaching the gastrocnemius by direct suture or screw

Question 39

Describe superficial flexor luxation

Answer 39

intermittent lameness swelling over tip of calcaneus can suture the torn retinaculum or place a screw