MSK Flashcards
(99 cards)
1
Q
Pathophsyiology of Perthe’s disease
A
Avasucalr necrosis of the femoral head
2
Q
Signalment of Perthe’s disease
A
Toy, small dogs
Inherited in Manchester terriers
Under 6 months
3
Q
Dx of Perthes disease
A
Pain on extension
Crepitus
Radiography: Radiolucent necrosis of femoral head, misshapen, reduced muscle mass
4
Q
Tx of Perthe’s disease
A
Fermoral head and neck excision
Or total hip replacement
5
Q
Metaphyseal osteopathy clinical signs
A
Unable to walk
Painful swelling and pitting oedema at Metaphyseal region
Signs of systemic illness (pyrexia)
Poor prognosis
6
Q
Craniomandibular osteopathy signalment
A
Aka Lion Jaw (painful swelling)
Small terriers particularly the West Highland and Cairn less than 6 months
7
Q
Panosteitis signalment
A
Young German Shepard dogs
8
Q
Panosteitis clinical signs
A
Shifting lameness
Waxing and waning signs
Depress and pyretic
9
Q
Diagnostic consideration in Panosteitis
A
Clinical signs and radiographic signs may not coincide (ask owner to bring dog back couple weeks later)
Usually self limiting
10
Q
Radiographic signs of Panosteitis
A
Subtle
Loss of trabecular pattern in medulla
Common on the humerus
Periosteal reaction around diaphysis
11
Q
Ddx for Rickets
A
Nutritional hyperparathyroidism in animals on all meat diets
12
Q
What is a valgus deformity?
A
Lateral deviation of feet
13
Q
What is a varus deformity
A
Medial deviation of feet
14
Q
Two methods to overcome angular limb deformities:
A
- Young dogs: Prevent growth on side where growth plate is still open
- Mature dogs: Straighten limb with open or closed wedge osteotomy
15
Q
What should be calculated before correcting a limb deformity with an osteotomy
A
Centre of rotation of angulation (CORA)
- Determines the place where definitive correction should be performed
16
Q
What deformity is short ulna syndrome
A
Most common
Valgus (external rotation of paws)
17
Q
What is Osteochondrosis
A
Developmental disorder causing failure of mineralisation of the articular cartilage possibly associated with joint incongruity
18
Q
Most common site for Osteochondrosis
A
Elbow
19
Q
What aspect of the joint is elbow dysplasia seen on
A
The medial compartment
20
Q
The 3 main manifestations of elbow dysplasia
A
- Medial coronoid process disease / fragmentation
- Osteochondrosis (medial humeral condyle)
- Ununited Anconeal Process
21
Q
Elbow dysplasia signalment
A
Labrador, GSD
Young dogs with consequences into adulthood
22
Q
Elbow dysplasia signs
A
Chronic lameness (worse on rising)
Abducted limbs
Externally rotated limbs
Joint effusion
23
Q
Radiographic views for elbow dysplasia
A
Flexed mediolateral + craniocaudal
24
Q
Radiographic findings for elbow dysplasia
A
Signs of degeneration
secondary changes like trochlea notch sclerosis, new bone on the anneal process
UAP = seen on flexed view
MCP = needs CT often
25
Shoulder osteochondrosis signalment and signs
Young lab or border collie
Lame on rising
worse after exercise
pain over shoulder (extension)
26
Radiographic views and findings in Shoulder osteochondrosis
Mediolateral and caudocranial
Thick cartilage, poor ossification
Mineralised cartilage flap ==> remove fragment and debride
27
Ddx for stifle osteochondrosis
Cruicate disease
28
Radiographic views and findings in stifle osteochondrosis
Mediolateral and caudocranial
flattened condyle
Joint effusion
29
View to take if lateral hock osteochondrosis can't be visualised on X-ray?
Flexed ML - move calcaneus
30
Best treatment for shoulder soft tissue disease
Rest
Also steroids intra-articular
31
Signalment of Humeral intracondylar fissure
Spaniels!!! And French bulldogs
Young to middle aged
32
Diagnostic of choice for Humeral intracondylar fissure
CT is best
Radiography requires multiple views
33
Treatment for Humeral intracondylar fissure
Can rest but always prone to fracture...
LARGE Prophylactic transcondylar screw placed for life (lots of complications)
34
Treatment for Carpal hyperextension injuries (traumatic) and tarsal subluxations (often degenerative)
arthrodesis
35
Common bone neoplasia
Osteosarcoma
36
Radiographic signs of Osteosarcoma
Proliferative and destructive
Joint spared (unlike other bone tumours)
All will have mets
37
How to obtain biopsy of osteosarcoma
Jamshidi needle
From centre of lesion
38
Distinctive sign of nerve cell tumour
Unilateral muscle atrophy
39
What is Feline PADS
Patella fracture and dental anomaly syndrome
40
Signs of PADS
Non healing patella fractures
Retained deciduous teeth
41
Ddx for PADS and how to tell difference
Medial patella luxation
MPL = hopping gait
PADS = collapsing gait as they can't fix the stifle
42
What is capital physis separation in cats?
Burmese cats
Fracture of the femoral head and epiphysis remains in acetabulum
43
3 common causes of acute on chronic lameness
Cruciate rupture
Pathological fractures due to osteosarcoma
Condylar fracture due to HIF (Spaniels)
44
Best treatment for hip luxation
Toggle pin
can also do transarticular pin (removed 3 weeks later)
45
Up to multi limb lameness on key points
need to do chest sheets too
46
What joints can arthoplasties be performed in
Hip and Temporomandibular joint
47
What is the biphasic presentation of hip dysplasia
Young: Hip subluxation
Mature: Osteoarthritis
48
Best test for hip dysplasia
Ortolani test for hip laxity
49
Ortolani protocol
Stifle pushed to subluxate hip
Leg/s abducted and if click heard => hips were lunated and femur fell back into acetabulum
50
What is the significance of a positive Ortolani sign
If this test is positive, the dog has hip dysplasia regardless of radiographic findings
51
How is hip dysplasia typically treated
Conservatively
Analgesia, weight reduction, diet and appropriate excercise
52
What procedures can be used in young dogs with hip dysplasia
Under one year = Double or triple pelvic osteotomy
Under 16 weeks = Pubic symphysiodesis
53
What procedures can be used in older dogs with hip dysplasia
Salvage techniques like FHNO or THR
54
What 3 views are taken in the PennHIP scheme
Under GA
Hip extension to show osteoarthritis
+ compression and distraction views to calculate distraction index
55
How does osteochondrosis develop (elbow dysplasia)
Incongruity => failure of articular cartilage ossification => cartilage thickens => separates from underlying bone => synovial fluid contacts bone => inflammation
56
Signs of elbow dysplasia
*Chronic lameness (worse on rising)
*Abducted and externally rotated limbs (relieve pressure on medial comportment)
*Pain on manipulation (esp flexion with UAP)
*Joint effusion
*Muscle atrophy
57
What imaging modality is best for a fragmented corned process
CT
58
Surgery options for FCP (not conservative management) 4
Surgical:
1. Removal of fragment, ulna osteotomy to correct incongruence
2. Off loading the medial comportment to reduce weight bearing (PAUL or sliding medial humeral osteotomy)
3. Arthrodesis (hard to get correct limb length)
4. Elbow replacement
59
Surgery options for OCD
Generally surgical removal of fragment and fixing of deficit
Deficit: OAT (autograft) or SOR (synthetic) joint surface replacement
60
Surgery options for UAP
Reattach fragment with screw
61
WHAT views are taken in the kennel club elbow dysplasia scheme
Two mediolateral views: flexed and neutral
max score = 3 per elbow
62
Signalment for medial and lateral patella luxation
Lateral = Large breeds and flat coat retriever
Medial = more common. Small breeds, labs, EBTs
63
Signs of patella luxation
Skipping/hopping lameness
Stiff, awkward gait
Poorly extending knees
Usually no pain
64
Simple grades of patella luxation
1. Can be luxated
2. Spontaneously luxes alone
3. Can be corrected
4. Can't be corrected
65
Major ddx for patella luxation
Skipping terrier syndrome
Behavioural
66
What are the cons of a sulcoplasty
Expose subchondral bone and initiate joint inflammation
Hyaline cartilage replaced with weaker fibrocartilagenous
67
What other procedure can deepen the groove without a sulcoplasty
Synthetic trochlea buttress (Ridgestop)
68
surgical correction for patella luxation
Tibial tuberosity transposition/translocation = moves the patellar tendon into the trochlear groove
69
What does the cranial cruciate ligament prevent
Forwards movement of the tibia
70
Which meniscus is damaged with a cranial cruciate rupture
Medial meniscus (attached to the tibia so can be damaged by femur movement)
71
Signs of cruciate disease
Rising lameness
Swelling to the medial stifle (medial buttress)
Pain on extension and flexion
Thick joint capsule = thrust and draw test hard to detect as joint more stable!
72
Hand placement for tibial thrust
Finger along patella tendon to tibial tuberosity
Other hand flexes the hock and keeps the stifle extended
73
Hand placement for cranial drawer
*Femur grasped: thumb on lateral fabella and finger on patella
*Tibia grasped: thumb on fibular head and finger on tibial tuberosity
74
Signs of cruciate disease on radiographs
Joint effusion (soft tissue density)
Loss of the sub patella fat pad
Osteoarthritic changes
o periosteal new bone to fabellae (first step)
o new bone on poles of the patella (white arrow)
o steep tibial plateau
o trochlea ridges (green arrow)
75
Which surgical technique stops the cranial drawer
Lateral suture/ DeAngelis suture
76
Purpose of a Tibial plateau levelling osteotomy (TPLO)
Prevents forward movement of the tibia by changing tibia plateau angle
Closing wedge osteotomy can help too
77
Purpose of the Tibial tuberosity advancement
Decreases the angle between the plateau and patella tendon => when the quadriceps contract it forces the tibia back into a normal position
78
Most common cause of multi limb lameness
Immune mediated polyarthritis
79
Signs of IMPA
Generalised lameness
* Poor movement generally with short stride lengths
* Swollen and painful joints
* There may be accompanying muscle pain
* The animal may be systemically unwell with a pyrexia
80
Best test for IMPA
Joint taps - tap at least 4 distal joints
81
Joint tap sign of IMPA
Lots of neutrophils in multiple joints (esp + pyrexia)
82
Joint tap signs of septic joint
High degenerative neutrophils and leucocytes in usually one joint
+/- bacteria
Septic PA, vector borne (Lyme (Borrelia burgdorferi))
83
Joint tap signs of OA
Monocytes
84
What 3 causes of IMPA can be investigated with serology
o RF (rotenoid factor) for rheumatoid arthritis (not diagnostic)
o ANF (anti nuclear factor) for SLE (not diagnostic alone)
o Borrelia (TBF), Ehrlichia too
85
Tubes for joint taps
EDTA for cell count and cytoloy
plain for TP
86
What are the subdivision of immune mediate polyarthrtisi
Non-erosive
- T1 = No underlying disease
- T2 = Infection elsewhere
- T3 = GIT disease
- T4 = Neoplasia
Erosie = rheumatoid arthritis
87
List the common causes of non-erosive polyarthritis
Endocarditis
Vaccine reactions
Systemic lupus erythematosus
Breed associated (Star Pei, Akitas)
88
Name the two erosive forms of poly arthritis (Cats and dogs)
Rheumatoid arthritis
Feline erosive proliferative and non-proliferative polyarthritis
89
Signs of Rheumatoid arthritis
Destruction
Loss of articular srufaces
Collapse of joint space
Sub luxation
Poor prognosis
90
Treatment for IMPA
Treat underlying cause if possible
Immunosupression (prednisalone)
91
Should NSAIDs be given for IMPA?
Avoid if giving steroids as can lead to gastric ulcers
choose other pain relief (paracetamol, opiates, Librela)
92
Signs of septic arthritis in young and old dogs
Young = multiple joints
Older = single joint, typically elbow
93
Common secondary causes of osteoarthritis
Developmental conditions (elbow/hip dysplasia, osteochondrosis, patella luxation)
Degenerative conditions (cruciate disease)
Inflammatory arthropathies (rheumatoid arthritis, systemic lupus)
Trauma
Sepsis
94
What is the pathophysiology of osteoarthritis
Weight bearing areas of the joint => fibrillation (fraying) of the articular cartilage => exposure of the subchondral bone to synovial fluid => inflammatory reaction => scleroses => osteophytes produced => joint re-modelling
also thickening of the joint capsule and reduced movement
95
Which COX receptor is more selective for pain
COX2
96
Which NSAIDs are COX2 selective
Carprofen
Firocoxib
Cimicoxib
Rodenacoxib (Onsior)
97
what other analgesia is available
o Opiates = for severe flare ups
o Amantadine = NDMA antagonist (similar to ketamine). For when NSAIDs aren’t providing adequate analgesia in dogs
o Paracetamol is a useful adjunct with NSAIDs (Dogs ONLY)
o Librela (Dog) or Solensia (Cat) are directed against nerve growth factor
98
Ddx for non healing nail bed infection
neoplasia
Nail Paronychia= bacterial infection. Remove nail to drain + ABS
Nail Onychomycosis = fungal infection. Remove nail to drain + Afs
99
Claw amputation leads to lameness
Lameness results if remove
○ >2 digits
○ Either of central 2 digits: P3 and P4 are the weight bearing digits
