Musculoskeletal Flashcards
Musculoskeletal (100 cards)
1
Q
Rehabilitation impact on tissues (bone)
A
- exercise increases bone metabolism and healing
2
Q
Rehabilitation impact on tissues (cartilage)
A
- rest protects injured cartilage
- rigid immobilization damages articular cartilage
- controlled remobilization enhances cartilage recovery
3
Q
Rehabilitation impact on tissues (ligaments)
A
- protected exercise boosts ligaments recovery rate
4
Q
Rehabilitation impact on tissues (muscle)
A
- exercise strengthens, stretches, increases balance, alleviates pain, increases function, decreases depression
5
Q
10 Parts to Rehabilitation (Why bother…)
A
- Assessing patient more completely
- Protecting Patients (from slipping, falling, etc)
- Assisting Patients (slings, harness)
- Relieving Pain
- Providing nursing care
- Strengthening
- Stretching
- Provide (non-noxious) sensory stimuli
- Training and education (everyone)
- Identifying and managing high-risk patients
6
Q
5 points to decreasing pain during rehab
A
- anti-inflammatory measures
- edema control
- gate control theory
- dec. healing tissue stress
- improving posture and locomotion
7
Q
Candidate for physical rehab? ( 7 points)
A
- non-ambulatory
- potential to become non-ambulatory
- potential to lose joint motion (contracture, etc)
- potential for irreversible changes to musculoskeletal system
- require specific form of protection ( not available to or managable by owner)
- severely overweight
- missing limbs
8
Q
Recovery states of wound healing
A
- hemostasis (~hours)
- inflammatory (~days)
- repair/ proliferation (~weeks)
- remodeling/ maturation ( ~months)
9
Q
Perthe’s Disease
A
- aseptic necrosis of the femoral head
- young small breed dogs
- severe lameness and limb disease
10
Q
Canine Hip Dysplasia
A
- highly prevalent, osteoarthritic disease
- mild to severe pain
- hip laxity leads to clinical signs and progressive hip OA
11
Q
What is the #1 risk factor for developing hip OA later in life
A
- passive hip laxity
12
Q
Functional hip laxity influenced by:
A
- increased volumes of joint fluid
- thickened ligament of head of femur
- pelvic muscle mass
- hormonal
- weight and growth rates
- nutrition ( high Ca, Ph, Vit C)
13
Q
T/F: there is no medical or surgical cure for Canine Hip Dysplasia… only palliative treatment
A
T
14
Q
What is the best method to reduce frequency and severity of CHD?
A
- selective breeding
15
Q
T/F: CHD is expressed on a scale from normal to severely abnormal
A
T
16
Q
T/F: checking the dog at 2 years of age is an effective method to rule out hip OA later in life
A
F, hip OA arises progressively through life on a linear scale so looking at 2 years of age is not very helpful
17
Q
T/F: CHD has a biphasic distribution
A
False
18
Q
When testing for laxity, what does a finding of ‘no laxity’ indicate
A
- simply that you can’t find it on exam
- does not indicate that it is not present in the patient
19
Q
Ortolani Sign
A
- the small click heard when the hip is abducted
- indicates reduction of the joint
20
Q
Barlow Sign
A
- the glide or step felt when the hip is adducted
- indicates sub-luxation
21
Q
How to read the difference between Ortolani and Barlow Signs
A
Barlow - Ortolani = 20-30*
- increased angle is an indicator of worse disease
22
Q
danger of hip extension radiographs for hip OA
A
- has potential to hide laxity
23
Q
Hip Disease (Clinical Signs)
A
- mild-severe lameness
- usuallly chronic and insidious lesions
- stiffness on rising and gait
- Bunny-hopping gait
- exercise intolerance
24
Q
Hip Disease (Physical Exam)
A
- muscle atrophy
- protrusion of greater trochanter dorsal and lateral
- pain on hip extension or hip movement
- decreased hip range of motion
- crepitus
- ortolani signs
25
Hip Disease (medical/ Conservative treatment)
- weight management is the best
- exercise modification programs
- physical rehab
- essential fatty acids
26
Do dietary supplements or stem cells help treat Canine Hip Disease?
- no evidence to support that and they can actually be harmful
27
CHD - Exercise modification program examples
1. cold and heat therapy
2. maintain mobility and circulation
3. inclines
4. hydrotherapy
28
2 surgical options for CHD
1. total hip replacement
| 2. femoral head and neck excision
29
Total Hip Replacement (indications)
- any disability from hip OA
- failure to achieve activity level desired by dog or o
- failure of medical management
- no skin bacterial disease
- no UTI
- no dental fractures
30
Total Hip Replacement (non-cemented adv.)
- no bone cement complications ( infection, immune rxn, breakage, neuropraxia)
- longer life span on implants
31
Total Hip Replacement (cemented adv.)
- less precise measurements preop
- implant stable as soon as cement cures
- technically easier
- no subsidence in straight femures
32
Total Hip Replacement (outcomes)
- can return to n function
- complication at 10-40%
- many mistakes are surgical mistakes or poor owner compliance
33
Femoral Head and Neck Excision
- gait will not be normal
| - very good at removing pain
34
Femoral Head and Neck Excision (indications)
- femoral head and neck fractures
- aseptic necrosis of femoral head
- acetabular fractures
- hip luxations
- failed THR
35
Femoral Head and Neck Excision (Ostectomy)
- hold femur at 90
- cut caudal angle 35-45
- muscle flaps not helpful
36
Femoral Head and Neck Excision (outcome)
- correct ostectomy (no neck left, torchanter left intact)
- rehab. plan per owner
- limb use before surgery
37
Aseptic Necrosis of Femoral Head
- usually unilateral
- small dogs
- Etiology - heritable (toy poodle, terriers)
- Pathogenesis - blood supply is disrupted (circumflex femoral vain)
38
Aseptic Necrosis of Femoral Head (Clinilal presentation, tx, rec)
```
Clinical Presentation:
- mild trauma @ 4-12 months of age
- non-partial weight bearing
Tx and Rec:
- conservative doesn't work
- FHO or THR
```
39
Hip Dysplasia in Cats
- 1.2% were clinical
40
Best preventative for Hip Disease
- don't breed and keep thin
41
T/F: conservative treatment is only effective for less than half of hip disease.
F; conservative is good for ~75%
42
T/F: THR can restore normal function but is technical and has higher rates of complications
T
43
T/F: FHO can be successful but is ideal for smaller and requires rehabilitation
T
44
How to treat a dog with congenital/ traumatic elbow luxation?
- Severe OA? -->
Yes = Salvage via arthrodesis/ amputation
No
--> Avulsion frx? Articular frx? > 48-72hrs?
Yes = open reduction, lig reconstruction, fx repair
No = Closed Reduction
--> Stable
Yes = temp stabilization in extension
No = back to open reduction
45
How long to splint a dog treated for elbow luxation?
5-7 days
46
T/F: congential and traumatic elbox luxation are treated the same way
T
47
Signalment and History for Incomplete Ossification of Humeral Condyle (IOHC)
Signalment: spaniel breeds, 90% bilateral
History: front limb lameness and SH type 4 frx caused by minor/ no trauma
48
4 components of elbow dysplasia
1. Elbow incongruence
2. OCD of medial humeral condyle
3. Fragmented coronoid process
4. Ununited anconeal process
49
Treatment of Elbow Dysplasia (OC/ OCD)
- debridement --> defect will fill w/ fibrocartilage; resurfacing via osteochondral autograph
50
Treatment of Elbow Dysplasia (Elbow Incongruence)
- ulnar osteotomy
| - controlled distraction surgery
51
Treatment of Elbow Dysplasia (Anconeal Process)
minimally displaced fragment --> proximal ulnar osteotomy
old or highly displaced frag --> removal of fragment
52
Treatment of Elbow Dysplasia (Coronoid Process)
fragment removal via arthroscopy
53
3 functions of cranial cruciate
1. prevents cranial translation of tibia
2. prevents medial patellar luxation
3. prevents hyperextension of stifle
54
2 pathognomonic ortho exam findings for confirming CCL
1. Drawer's test
| 2. Tibia compression test (indirect drawer)
55
3 (maybe 4) most common surgery treatment methods for cranial cruciate repair
1. Lateral Sutures (static)
2. Tightrope (static)
3. Tibial Plateau Leveling Osteotomy (TPLO)
4. Tibial Tuberosity Advancement (TTA)
56
Lateral Sutures
- suture around fabella and through a hole in tibia
57
Tightrope
- much stronger suture than lateral, but braided
| - potential for infection d/t braided
58
2 Reasons why medial meniscus more likely to be damaged than lateral meniscus?
1. mid-body of meniscus attached to the MCL
| 2. caudal meniscal tibial ligament holds meniscus in place so no stretch/ less than lateral
59
Function of the meniscus
1. force redistribution
| 2. joint stability
60
Rational behind meniscal release
- for an intact meniscus
- prevent future meniscal injury
- gets rid of hammock function
61
Rational behind meniscectomy
- for a torn meniscus
- remove source of pain
- save as much normal tissue as possible
62
2 radiographic views for CHD needed for surgery
- cross-table cranial-caudal
| - open leg lateral
63
Shoulder OCD (common location, diagnosis, treatment, prognosis)
- inherited condition, usually bilateral
- caudomedial humeral head
Diagnosis: rads, CT, Arthroscopy
Treatment: conservative not helpful if OCD; flap removal and debridement via arthroscopy
Prognosis: good - excellent following surgery
64
Glenoid Dysplasia (signalment, clinical signs, treatment)
- toy breed dogs
- luxation usually medially
Clinical Signs: lameness, atrophy
Treatment:
--> Stabilization surgery doesn't seem to work
--> Salvage procedure has fair prognosis (arthrodesis or excision arthorplasty)
65
Incomplete Ossification of Caudal Glenoid
- usually incidental finding
- may cause pain and lameness but usually d/t other conditions
- may see resolution after removal of fragment
66
Biceps Brachii Tendinopathy (signalment)
- adult, active large breed
67
Biceps Tendon ( origin, insertion)
origin - supraglenoid tubercle
| insertion - prox. radius and ulna
68
Biceps Brachii Tendinopathy ( Diagnosis)
- pain @ biceps tendon
- (+) biceps test -- flex shoulder, extend elbow
- shoulder drawer test
- biceps retraction test
69
Biceps Brachii Tendinopathy ( radiography and US)
- not super useful
| - US only useful on lateral
70
Biceps Brachii Tendinopathy ( Treatment)
- medical for mild lameness ( rest and NSAIDs)
| - surgical: tenodesis or biceps brachii transection
71
Supraspinadus tendinopathy
- mineralization of supraspinatus
- large breeds
- Diagnosis: low grade lameness, pain on palpation
- Treatment: NSAIDs, rest, Surgery for removal of tendon
72
Infraspinadous contracture
- active hunting dogs w/ acute onset distal limb abduction and foot circumduction
- Treatment: transection of tendon
- Prognosis: good - excellent
73
Medial - Joint Instability
```
- tearing of medial glenohumeral ligament, subscapular muscle, joint capsule
Clinical Signs and Diagnosis:
- lameness, pain on abduction
- increased abduction
- atrophy
- measure angle of abduction
```
74
What is the most common cause of shoulder lameness in the young, large dog
OCD
75
T/F: incomplete ossification of the glenoid rarely needs treatment
T
76
T/F: Glenoid Dysplasia can become clinical at any age and requires arthrodesis or glendoid excision arthroplasty
T
77
What is the most common soft tissue injury in dogs?
Biceps Brachii Tendinopathy
78
Tibial Plateau Leveling Osteotomy (TPLO)
- change direction of joiint surfaces to change direction of joint contact force
79
Tibial Tuberosity Advancement (TTA)
- change direction of quadriceps pull to change direction of trans-articular force
80
Panosteitis (risk factors/ signalment)
- young, male, >23kg, during summer and fall
81
Panosteitis ( pathogenesis)
- fat necrosis in bone marrow
- vasc proliferation and local bone formation at nutrient foramen ( increase intraosseous pressure)
- further bone formation from congestion
82
Panosteitis (Clinical Signs and Dx)
- shifting leg lameness
| - Rads: smoke in the chimney ( may look normal / thickened periosteum )
83
Panosteitis ( Tx)
- palliative only, good prognosis
84
Hypertrophic Osteodystrophy (HOD) (signalment)
- young, rapidly growing, male, large breeds
85
HOD ( pathogenesis)
- zone of abnormal trabeculae bone in metaphysis
| - hemorrhage , inflammation, necrosis, and fibrosis
86
HOD ( clinical signs and diagnosis)
- exam = metaphyseal swelling, lameness, systemically ill, fever
- Rads = lucent line metaphysis, excessively enlarged meatphysis
87
HOD ( tx and prognosis)
- supportive only
| - self limiting condition but can cause 2* growth deformities
88
OC (Risk factors)
- young, large - giant, males
- heritable
- overfeeding --> rapid growth
- high Ca and Vit. D
89
OC ( Pathogenesis)
- ischemia to certain location of subchondral bone causing death
90
OC ( Osteochondrosis Lesion)
- fate depends on size, vascularized?, extent of attachments
Reattach: only in animals <25 weeks of age
Detach: flap/ joint mouse --> OCD
91
OC ( Locations)
- Femur = condyle, head
- Humerus = medial condyle, head
- Tarsus = talus
92
OC ( Diagnosis)
- exam for joint effusion, pain on joint manipulation
| - rads, ct, mri
93
OC (treatment)
- medical
- surgical:
- -> Palliative (currettage, abrasion arthoplasty)
- -> Restorative (osteochondral transplants, grafts, implants)
94
OC (prevention)
- selective breeding
| - control of energy and diets while young
95
Retained Ulnar Cartilagenous Core
- core of cartilage from distal metaphysis into diaphysis of ulna
- 3-4 month old, large-giant breed
- dx on rads
- tx not necessary
- prg depends on degree of growth retardation
96
Swimmer Syndrome
- poorly understood
- 1-2 weeks of age
- decreased muscle tone forces sternal recumbency
- causes sternal and limb range of motion changes
- tx supportive
- prognosis good if treated aggressively with PT be <3-4 weeks of age
97
Carpal Laxity Syndrome
- either hypoextension or hyperextension of carpus
- 6-16 weeks in large breed dogs
- pathogenesis unknown
- tx: resolves spontaneously post 2 weeks... do not splint the limb
98
5 Signs of an Aggressive Bone Lesion on rad
1. pattern of osteolysis
2. cortical lysis
3. irregular periosteal reaction
4. long zone of transition
5. quick rate of change
99
Normal coxo-femoral joint
1. 50% coverage of dorsal acetabulum
| 2. parallel subchondral bone margins
100
Radiographic features of DJD
1. increased synovial mass
2. Periarticular new bone formation
3. Decreased joint space
4. Subchondral bone sclerosis
