_____ joins bones with a fibrous joint capsule that is continuous with the periosteum of the joined bones
_____ permits motion while providing stability for load transfer b/t bones
Hips, stifle, elbow and shoulder are examples of _____ joints
Synovial joints are made up of what type of cartilage?
T/F: Hyaline/Articular cartilage is highly vascular
FALSE: relatively avascular
Where do joints get their nutrients?
Is osteoarthritis inflammatory?
No- non inflam degenerative joint disease
What are the three factors of osteoarthritis (non-inflam DJD)?
articular cartilage degeneration
marginal bone hypertrophy, aka osteophytosis
synovial membrane changes4
T/F: Dysplasia, DJD, trauma and neoplasia are examples of inflammatory arthropathy
FLASE- non inflammatory
infectious: bact, viral, rickettsia, fungi, mycoplasms, protozoa, spirochetes
non-infectious: erosive vs nonerosive
Inflammatory non-infectious causes of arthopathy
erosive: rheumatoid, feline chronic progressive polyarthritis
nonerosive: immune-mediated polyarthritis, chronic inflam induced polyarthritis, systemic lupus erythematosus
Diagnosis of osteoarthritis
history and clinical signs: acute vs chronic, dog vs cat
physical exam: muscular asymmetry, joint enlargement, CREPI
What does CREPI stand for?
Crepitus (cracking/crunching when moving joint)
Range of motion
What are the risk factors for osteoarthritis?
Size and growth rate: 45% of OA dogs are large breeds
Breed and genetics: labs & german shepards are predisposed
Advanced age: 50% of OA dogs are 8 to 13 years old
Repeated trauma & mechanical stress
Clinical signs of mild osteoarthritis (OA)
dogs: stiffness, decreased activity, limping
cats: decreased activity
Clinical signs of moderate OA
dogs: pain, muscle atrophy, difficulty rising
cats: reluctance to jump, climb stairs, groom
Clinical signs of severe OA
dogs: loss of range of motion, vocalization, creptius, lethary, inappetence
cats: limping, muscle atrophy, inappropriate elimination
OA radiographic changes for inflammatory/infectious
subchondral bone may be sclerotic or lytic
+/- periarticular bone formation
+/- joint space narrowing
+/- capsule distension and soft tissue swelling
OA radiographic changes for noninfectious- nonerosive
soft tissue swelling and joint capsule w/o bony changes- multiple joints affected
OA radiographic changes for noninfectious- erosive
joint space collapse
subchondral bone proliferation
periosteal new bone production
soft tissue swelling
-multiple joints affected
OA radiographic changes in non inflammatory DJD
soft tissue swelling & intracapsular distension
diminished joint space
subchondral bone plate usually intact but may be sclerotic
OA radiographic changes in non inflammatory- trauma
depends on trauma (fracture luxation)
ultimately leads to DJD
OA radiographic changes in non inflammatory- neoplasia
soft tissue swelling and intracapsular distension
destruction of the subchondral bone plate (often on both sides of the joint) with aggressive bone proliferation
What testing can we use to diagnose osteoarthritis (OA)?
computed tomography (CT) -bony changes
MRI- evaluate soft tissue structure: tendons and ligaments
T/F: bone scintigraphy diagnoses OA
FALSE- it localizes OA
(radioactive isotope specific for inflam w/in a joint)
What can differentiate b/t inflammatory Vs non-inflammatory arthropathies?
Joint tap/Joint fluid analysis
looking at the cellular content
inflam has neutrophils
List some examples of OA medical management
anti-inflam medications and other pain management
What types of nutritional supplements are good for management of OA?
omega 3 fatty acids- anti inflam
chrondroprotectants- glucosamine/chondroitin and ASU (avocado soybean unsaponifiables)
What type of exercise is recommended for P with OA?
low impact activity
leash walks, swimming, hill work
Physical therapy options for OA
range of motion
List some options for pain management of OA
NSAIDs- want to spare the kidneys and stomach (COX-1, COX-2, EP4 blockers)
Corticosteroids NOT recommended with DJD
Osteochondrosis is a disturbance in _____ that leads to _____
What is the issue with increased cartilage thickness?
can result in malnourished, necrotic chondrocytes
Osteochondrosis leads to resultant clefts at the junction of ____ and ____
calcified and non-calcified tissue
clefts are fissues that develop w/in the cartilage
Normal activity with osteochondrosis can create vertical fissures and result in _____
cartilage flap (OCD)
What does the bottom circle show an example of?
What are some risk factors for osteochondrosis?
age, gender, breed (genetics), rapid growth, nutritional excesses (Ca)
The cause of osteochondrosis is multifactoral. What are the two factors?
genetic and nutritional factors
T/F: Females are more likely to develop osteochondrosis
FALSE males more likely
What breed of dogs are mostly presented with osteochondrosis?
When do we usually see clinical signs of osteochondrosis?
usually at 4-8 months but can present later
T/F: osteochondrosis usually presents as a bilateral disease
FALSE: it is a bilateral disease but presents with unilateral lameness
so make sure to evaluate the other side
How can we diagnose osteochondrosis?
physical exam findings dependent on location
When examining a dogs shoulder joint, if they have osteochondrosis they will show pain when?
hyperextension of the shoulder, flexion of the shoulder
Does osteoarthritis have an acute or gradual onset?
gradual onset that is worse after exercise
Osteochondrosis is usually lameness on what limb?
unilateral forelimb lameness
Early signs on shoulder osteochondrosis on a lateral radiograph?
flattening of the subchondral bone of caudal humeral head
Later signs on osteochondrosis on a lateral radiograph?
Saucer shaped radiolucent area
What is the arrow pointing to?
saucer shaped radiolucent area
What are some way to conservatively manage shoulder OCD?
What diet helps in the conservative management of shoulder OCD?
control energy, calcium, vitamin D intake
Surgery is usually the recommened treatment for shoulder OCD. We try conservative treatment first as long as what 3 indications are true?
minimal to no lameness
very young dog (<6 months)
____ is the standard of care for dogs with shoulder OCD treatment
What is preffered with surgical tx of shoulder OCD... arthroscopy or arthrotomy?
What does surgical treatment of shoulder OCD entail?
flap removal and joint lavage
debridement of bone with curette or shaver
defect heals with fibrocartilage
Prognosis of shoulder OCD with surgery
px much better w/ sx than w/o
near-normal function w/ sx
- pet dog- good to excellent
- working dog- fair to good
- assuming sx is done prior to onset of DJD
If surgery is not performed on a OCD shoulder, what can we expect to see?
OCD on the distal humerus is the ____ joint
How does elbow joint OCD present?
unilateral lameness- acute vs chronic, worse after exercise and stiff in the AM
When examining the elbow joint on a P with OCD, you will see pain when doing what to the joint?
pain on elbow extension and lateral rotation of the forearm
What does elbow joint OCD look like on radiographs?
radiolucent concavity of distal aspect of medial humeral condyle
What does this rad show?
OCD of the elbow joint
T/F: early intervention for elbow OCD will prevent DJD
What is the best chance for a good prognosis with elbow OCD?
What tx is worse for elbow OCD... arthroscopy or arthrotomy?
arthrotomy is worse
T/F: short term medical management of elbow OCD has a good prognosis
FALSE- expect long term treatment
How does stifle joint OCD present?
young, large breed dog w/ hindlimb lameness
stifle effusion and crepitus
What does stifle joint OCD look like on radiographs?
radiolucent concavity on medial aspect of lateral femoral condyle (most comon)
medial condyle can also be affected
What does this radiograph show?
OCD of the stifle joint
Tarsus OCD is seen in what dogs?
large breeds- Rotties
How does Tarsus OCD present?
unilateral hindlimb lameness- acute vs chronic- worse after activity or rest
When examining OCD of the tarsus, the P will exhibit pain when?
flexing the hock
Radiographic signs of an OCD tarsus
radiolucent concavity on medial (more frequent)
or lateral trochlear ridge of talus
Tarsus OCD prognosis
gaurded to poor
_____ is ideal for treatment of tarsus OCD
T/F: arthrotomy and fragment removal may be no better than medical management for tarsus OCD
T/F: surgery for tarsus OCD will prevent the development of OA
FALSE: does not prevent
T/F: surgery for tarsus OCD will eliminate the lameness
FALSE: does not eliminate the lameness
surgery improves function somewhat
End stage OCD is also known as?
Prognosis of OCD is dependent on?
when diagnosis was made and level of DJD present
List the joints in order of best prognosis to least for OCD