Lecture 15: Sx of the Elbow 2 (Exam 3) Flashcards
1
Q
Definition
Denotes a joint but has also been defined as a degenerative disease of a joint
A
Arthrosis
2
Q
Definition
Inflammation affecting several joints
A
Polyarthritis
3
Q
Definition
Noninflammatory degenerative joint disease (DJD) characterized by articular cartilage degeneration, marginal bone hypertrophy (osteophytosis), & synovial membrane changes
A
osteoarthritis (osteoarthrosis)
4
Q
Definition
Result of DJD or inflammatory diseases
A
Ankylosis (joint is fused after new bone production)
5
Q
Definition
Joints lined with synovial membrane (allow relatively free movement)
A
synovial joint
6
Q
What joints are connected with fibrous tissue allowing for little/no movement
A
Fibrous joints
7
Q
What joints are connected with cartilage allowing for little/no movements
A
Cartilaginous joints
8
Q
Definition
Use of endoscope to examine/treat joints
A
arthroscopy
9
Q
Definition
Surgical exposure of a joint
A
arthrotomy
10
Q
Definition
Revision of a joint structure
A
arthroplasty
11
Q
Definition
surgical treatment for joint effusion
A
arthrodesis
12
Q
Definition
Abnormal development of tissue, organs, or cells
A
dysplasia
13
Q
What is the leading cause of forelimb lameness in dogs
A
canine elbow dysplasia
14
Q
Is there a genetic influence on canine elbow dysplasia
A
yes (a polygenic trait with both hereditary and environmental influences)
15
Q
Is canine elbow dysplasia hereditary
A
YES (do not breed dogs with this condition)
16
Q
Elbow dysplasia includes what 4 conditions
A
- OCD
- fragmented coronoid process(FCP)
- medial compartment (MCD)
- ununited anconeal process
17
Q
What is a disease that causes similar clinical signs to elbow dysplasia or lead to fracture of humeral condyle
A
incomplete ossification of humeral
18
Q
What is a major indicator of elbow dysplasia
A
- loss of elbow ROM
- evidence of DJD in immature dogs
19
Q
Is radiographic positioning essential for elbow dysplasia
A
yes (subtle lesions)
20
Q
Should you radiograph just the lame limb
A
NO radiograph both limbs
21
Q
What can improve limb function in patients with elbow dysplasia
A
surgical removal of bone and cartilage pieces
22
Q
Separation of small portion of medial coronoid process of ulna resulting in DJD and lameness
A
Fragmented coronoid process
23
Q
Fill in the ?s
Fragmented coronoid process may occur as ? of coronoid or ? with in medial coronoid
A
- osteonecrosis
- Fissure
24
Q
These are all synonyms for what condition?
- unsuited coronoid process
- elbow dysplasia
- jump-down syndrome
A
Fractured coronoid process
25
What is the Signalment for fractured coronoid process
* large dogs (labrador retrievers, rottweilers, bernese mountain dogs, newfoundlands, golden retrievers, german shepherd, and chows)
* immature (disease starts)
* 5-7 months old (may present at any age with associated OA)
26
What is the History and PE findings for a patients affected by fractured coronoid process
* forelimb lameness (stiff in morning or after rest, worsens with exercise)
* shortened step due to stiff leg
* symmetrical/asymmetrical atrophy
* JOINT EFFUSION AND PERIARTICULAR SOFT TISSUE SWELLING (most easily felt with dog standing)
* SHOULDER NOT FLEXED OR EXTENDED DURING ELBOW MANIPULATION (prevents mistaking elbow pain for shoulder)
* CREPITATION
* DECREASED ROM
* PAIN ON HYPEREXTENSION.(may be earliest sign)
27
Diagnosis of Fracture of coronoid process is based on radiographic signs of DJD: what views should you take
* craniocaudal
* lateral
* flexed lateral
* oblique craniocaudal
28
# **Fill in the ?s**
When positioning a patient for a craniocaudal radiograph to determine if the patient has fractured coronoid process the patient should be in **?** with the elbow **?** and slightly rotated **?**
* sternal recumbency
* flexed 30 degrees
* medially
29
When taing lateral views of a patients limb should the leg desired to be seen be against the table/cassette ( ex: right lateral to see right limb)
yes
30
What are the two earliest radiograph sign of a fractured coronoid process
* sclerosis of distal aspect of trochlear notch (loss of fine trabecular pattern and increased opacity)
* blunting of the medial coronoid process
31
T/F is is common to see visible fragments on radiographs with a fractured coronoid process
False (osteophytes with coronoid and anconeal processes seen later in the process)
32
Diagnosis of fractured coronoid process is made by
osteoarthritis (radiographs may have very subtle changes - occult elbow dysplasia even in presence of arthrosis- consult with radiologist or ortho surgeon)
33
Is joint congruence a reliable method to diagnose fractured anconeal process?
NO (high rate of false positives and negatives
34
What is more accurate in diagnosing Fractured coronoid process than radiographs?
computed tomograph (cannot diagnose fissuring and microcracks)
35
What diagnostic method can diagnose incomplete fragmentation of medial coronoid (does not reach cartilage surface)
Computed tomography
36
What is affecting this patient?
* Fractured coronoid process (DJD)
* second image is the same dog 8 years later after surgical removal)
37
What is this Ct image showing
in situ osteomalacia of medial coronoid process associated with fracture coronoid process
38
What is the most valuable tool for diagnosing fractured coronoid process
Arthroscopy
39
What is seen here on this arthroscopy image
osteochondral fragment of MCP (fractured coronoid process)
40
What should you always make the client aware of with elbow dysplasia
**HEREDITARY**
41
When radiographing a patient with elbow dysplasia should you radiograph both elbows?
**ALWAYS**
42
What may improve function of limb with elbow dysplasia
surgical removal of bone and cartilage pieces
43
Does surgical treatment of elbow dysplasia decrease progression of DJD
NO
44
If an elbow is incongruent way may you have to do after surgery?
medical therapy
45
What are candidates for surgery to correct fractured coronoid process
* young dogs (intermittent or chronic lameness)
* animals with advanced osteoarthritis (medial compartment disease)
46
# **Fill in the ?s**
Basis of treatment for Fractured coronoid process includes fragment removal by **?** or **?**
arthroscopy or open arthrotomy
47
**Which method of treatment for FCP is:**
* less invasive
* has lower post operative morbidity
* provides greater opportunity for topical treatment of osteoarthritis lesions
* provides superior visualization and magnification of joint
Arthroscopic treatment of FCP
48
If arthroscopy or arthrotomy fails to demonstrate a fragment
subtotal coronoidectomy
49
What surgical method for FCP that may decrease transarticular forces between distal medial humeral condyle and medial coronoid process
release of biceps insertion on ulna
50
1?
Osteotomy Line
51
2?
Fracture of coronoid process
52
What are 3 techniques to expose of medial coronoid process
* tenotomy of pronator teres m. and incising medial collateral ligament
* muscle splitting (limits exposure)
* osteotomy of medial epicondyle (requires implementation of lag screw or wire)
53
What technique of open surgery of FCP is this
transection of pronator teres muscle
54
What open surgery technique for FCP
muscle splitting approach
55
Elevation of coronoid above level of radial head due to asynchronous growth between radius and ulna
Radial ulnar incongruence
56
What is a suggested cause of fragmentation of MCP and medial compartment disease
radial ulnar incronguence
57
# **Fill in the ?s**
Radial ulnar incongruence increases forces across the **?** of the elbow joint which leads to bone fragmentation and cartilage
medial compartment
58
What is the signalment for radial ulnar incongruence
* large dogs(labrador retrievers, rottweilers, bernese mountain dogs, newfoundlands, golden retrievers, german shepherd, and chows)
* immature (disease starts)
* 5-7 months old (may present at any age with associated OA)
59
The history and physical examination of patients with radial ulnar incongruency is identical to which other issue?
fractured coronoid process
60
Incongruency of joints is investigated with what
plain film radiography
61
WHat will appear proximal to the radial head in diagnostic imaging of radial ulnar incongruency
medial coronoid process
62
Is routine medial lateral radiography accurate or diagnosis of mild incongruity
NO (FLEXED LATERAL more accurate)
63
What is a more accurate in evaluating radial ulnar incongruence radiographs, CT, Arthroscopy?
Arthroscopy (CT more accurate than radiography)
64
How do we surgically restore nomral congruency between proximal articular surfaces of radius and ulna in patients with radial ulnar incongruence?
shortening ulna or lengthening radius
65
What are the surgical treatment s for radial ulnar incongruence
proximal and distal ulnar segmental osteotomy (distal has limitations due to interosseus ligament)
66
# **Fill in the ?s**
Proximal ulnar segmental osteotomy: segmental osteotomy in proximal **?** of ulna removing approximately **?** of bine
* 1/3
* 1/2 cm
67
What is the angle of a proximal ulnar segmental osteotomy
caudoproximal to craniodistal (and craniolateral to caudomedial)
68
# **Fill in the ?**
In a distal ulnar segmental osteotomy, 3 m incision is made over **?** of ulna
lateral distal 1/3 of the ulna
69
In a distal ulnar segmental osteotomy you should dissect between tendon of lateral digital extensor muscle & tendon of ulnaris lateralis muscle to expose what? isolate the ulna with what instrument?
* diaphysis
* Hohmann retractors
70
How large of a section of the ulna should be removed in a distal ulnar segmental osteotomy
5 mm
71
When doing a proximal or distal segmental osteotomy you should close the periosteum and deep fascia with what pattern? How long should it be bandaged?
* Simple continuous
* For 3 to 5 D
72
In distal ulnar segmental osteotomy what can you do to aid in distal migration of ulna? What can this lead to?
* elevation of interosseus ligament off ulna
* MAY LEAD TO SIGNIFICANT HEMORRHAGE
73
This is radiographs for what procedure
proximal ulnar osteotomy
74
# **Definition**
moderate to severe cartilage erosion limited to medial aspect of the canine elbow joint
medial compartment disease (MCD)
75
What are the 3 regions commonly affected by medial compartment disease
* medial portion of coronoid process
* medial distal aspect of humeral condyle
* medial most portion of radial head
76
Etiology of Medial Compartment Disease compartment disease is unknown but what is most likely the cause
mechanical overload of incongruity of elbow joint
77
How is the severity of medial compartment disease graded
modified Outerbridge scale
78
# **What # is this on the Modified outerbridge scale?**
Eburnated cartilage
V
79
# **What # is this on the Modified outerbridge scale?**
Full thickness fissuring
III
80
# **What # is this on the Modified outerbridge scale?**
chondromalacia
I
81
# **What # is this on the Modified outerbridge scale?**
Full thickness cartilage loss
IV
82
# **What # is this on the Modified outerbridge scale?**
Partial thickness fibrillation & fissuring
II
83
What is the Signalment for Medial compartment disease
* large breeds (can be any size though)
* young as 6 months to several years of age
84
What is the History and Physical exam findings in patients with medial compartment disease
* forelimb lameness (worsens with exercise)
* stiff in the morning or after rest
* bilateral lameness
* shortened steps
* symmetrical or asymmetrical muscle atrophy
* joint effusion and periarticular soft tissue swelling (felt with dog standing)
* decreased ROM
* painful
85
# **Fill in the ?s**
Diagnosis of Medial compartment disease suspected on basis of **?**
radiographic signs of DJD (severe cartilage damage may be present with minimal radiographic changes)
86
Most definitive tool for diagnosing Medial compartment disease
Arthroscopy (direct visualization and assessment of cartilage surface)
87
Which is superior for diagnosis of Medial compartment disease: arthroscopy or open surgery
arthroscopy (less invasive)
88
Grade this arthroscopic view of a patient affected with medial compartment disease:
* full thickness cartilage
* damage 4
89
Is it beneficial to remove fragments from a patient affected by MCD and FCP?
questionable pain remains
90
What surgery technique of medial compartment disease may aid in recruiting stem cells and create channels for revascularization of arthritic lesion from bone marrow
Microfracture and abrasion arthroplasty
**(LIMITED BENEFIT- MECHANICAL FORCES THAT LED TO CARTILAGE EROSION ALSO PREVENT HEALING OF CARTILAGE LESION)**
91
Surgical treatment of Medial compartment disease that decreases trans articular loads
segmental ulnar osteotomy (radial osteotomy, sliding humeral osteotomy)
92
How can you decrease pain and joint inflammation surgically in medial compartment disease patients
decreasing stimulation of nerve endings in subchondral bones
93
What procedure was used to correct medial compartment disease
sliding humeral osteotomy
94
# **Fill in the ?s**
Release of **?** on ulna can decrease proximal forces on radius and ulna
release of biceps insertion on ulna (decrease
95
What may aid in healing of microcracks in coronoids and decrease risk of MCD
release of bicep insertion on ulna
