Osteoarthritis and osteochrondritis dissecans Flashcards Preview

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Flashcards in Osteoarthritis and osteochrondritis dissecans Deck (81):
1

_____ joins bones with a fibrous joint capsule that is continuous with the periosteum of the joined bones

synovial joint

2

_____ permits motion while providing stability for load transfer b/t bones

synovial joints

3

Hips, stifle, elbow and shoulder are examples of _____ joints

synovial

4

Synovial joints are made up of what type of cartilage?

hyaline/articular cartilage

5

T/F: Hyaline/Articular cartilage is highly vascular

FALSE:  relatively avascular

6

Where do joints get their nutrients?

synovial fluid

7

Is osteoarthritis inflammatory?

No- non inflam degenerative joint disease

8

What are the three factors of osteoarthritis (non-inflam DJD)?

 

articular cartilage degeneration

marginal bone hypertrophy, aka osteophytosis

synovial membrane changes4

A image thumb
9

T/F: Dysplasia, DJD, trauma and neoplasia are examples of inflammatory arthropathy

FLASE- non inflammatory

 

10

Inflammatory causes

infectious: bact, viral, rickettsia, fungi, mycoplasms, protozoa, spirochetes

 non-infectious: erosive vs nonerosive

11

Inflammatory non-infectious causes of arthopathy

erosive: rheumatoid, feline chronic progressive polyarthritis

nonerosive: immune-mediated polyarthritis, chronic inflam induced polyarthritis, systemic lupus erythematosus

12

Diagnosis of osteoarthritis

history and clinical signs: acute vs chronic, dog vs cat

physical exam: muscular asymmetry, joint enlargement, CREPI

13

What does CREPI stand for?

Crepitus (cracking/crunching when moving joint)

Range of motion

Effusion

Pain

Instability 

14

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

Obesity

Repeated trauma & mechanical stress

15

Clinical signs of mild osteoarthritis (OA)

dogs: stiffness, decreased activity, limping

cats: decreased activity

16

Clinical signs of moderate OA

dogs: pain, muscle atrophy, difficulty rising

cats: reluctance to jump, climb stairs, groom 

17

Clinical signs of severe OA

dogs: loss of range of motion, vocalization, creptius, lethary, inappetence

cats: limping, muscle atrophy, inappropriate elimination

18

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

19

OA radiographic changes for noninfectious- nonerosive

soft tissue swelling and joint capsule w/o bony changes- multiple joints affected

20

OA radiographic changes for noninfectious- erosive

joint space collapse

subchondral bone proliferation

periosteal new bone production

soft tissue swelling

-multiple joints affected

21

OA radiographic changes in non inflammatory DJD

soft tissue swelling & intracapsular distension

diminished joint space

periarticular osteophytosis

subchondral bone plate usually intact but may be sclerotic

22

OA radiographic changes in non inflammatory- trauma

depends on trauma (fracture luxation)

ultimately leads to DJD

23

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

24

What testing can we use to diagnose osteoarthritis (OA)?

computed tomography (CT) -bony changes

MRI- evaluate soft tissue structure: tendons and ligaments

ultrasound

bone scintigraphy

25

T/F: bone scintigraphy diagnoses OA

FALSE- it localizes OA

(radioactive isotope specific for inflam w/in a joint)

26

What can differentiate b/t inflammatory Vs non-inflammatory arthropathies?

Joint tap/Joint fluid analysis

looking at the cellular content

inflam has neutrophils

27

List some examples of OA medical management

weight management

nutritional supplements

exercise moderation

physical rehabilitation

anti-inflam medications and other pain management

28

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)

29

What type of exercise is recommended for P with OA?

low impact activity

leash walks, swimming, hill work

30

Physical therapy options for OA

stregth

endurance

range of motion

laser therapy

31

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

PSGAGs

Acupuncture

32

Osteochondrosis is a disturbance in _____ that leads to _____

endochondral ossification

cartilage retention/thickening

33

What is the issue with increased cartilage thickness?

can result in malnourished, necrotic chondrocytes 

34

Osteochondrosis leads to resultant clefts at the junction of ____ and ____

calcified and non-calcified tissue

clefts are fissues that develop w/in the cartilage

35

Normal activity with osteochondrosis can create vertical fissures and result in _____

cartilage flap (OCD) 

36

What does the bottom circle show an example of?

Q image thumb

osteochondosis- clefts

37

What are some risk factors for osteochondrosis?

age, gender, breed (genetics), rapid growth, nutritional excesses (Ca)

38

The cause of osteochondrosis is multifactoral. What are the two factors?

genetic and nutritional factors

39

T/F: Females are more likely to develop osteochondrosis

FALSE males more likely

40

What breed of dogs are mostly presented with osteochondrosis?

large/giant breeds

41

When do we usually see clinical signs of osteochondrosis?

usually at 4-8 months but can present later

42

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

43

How can we diagnose osteochondrosis?

physical exam findings dependent on location

radiographs

CT/MRI

arthroscopy

44

When examining a dogs shoulder joint, if they have osteochondrosis they will show pain when?

hyperextension of the shoulder, flexion of the shoulder

45

Does osteoarthritis have an acute or gradual onset?

gradual onset that is worse after exercise

46

Osteochondrosis is usually lameness on what limb?

unilateral forelimb lameness

47

Early signs on shoulder osteochondrosis on a lateral radiograph?

flattening of the subchondral bone of caudal humeral head 

48

Later signs on osteochondrosis on a lateral radiograph?

Saucer shaped radiolucent area 

49

What is the arrow pointing to?

Q image thumb

saucer shaped radiolucent area

osteochondrosis 

50

What are some way to conservatively manage shoulder OCD?

rest

diet

NSAIDs

 

51

What diet helps in the conservative management of shoulder OCD?

control energy, calcium, vitamin D intake

52

Surgery is usually the recommened treatment for shoulder OCD. We try conservative treatment first as long as what 3 indications are true?

small defect

minimal to no lameness

very young dog (<6 months)

53

____ is the standard of care for dogs with shoulder OCD treatment

surgical treatment

54

What is preffered with surgical tx of shoulder OCD... arthroscopy or arthrotomy?

arthroscopy

55

What does surgical treatment of shoulder OCD entail?

flap removal and joint lavage

debridement of bone with curette or shaver

defect heals with fibrocartilage

56

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

 

57

If surgery is not performed on a OCD shoulder, what can we expect to see?

DJD

58

OCD on the distal humerus is the ____ joint

elbow

59

How does elbow joint OCD present?

unilateral lameness- acute vs chronic, worse after exercise and stiff in the AM

60

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

61

What does elbow joint OCD look like on radiographs?

radiolucent concavity of distal aspect of medial humeral condyle

62

What does this rad show?

Q image thumb

OCD of the elbow joint

63

T/F: early intervention for elbow OCD will prevent DJD

FALSE

 

64

What is the best chance for a good prognosis with elbow OCD?

early intervention

65

What tx is worse for elbow OCD... arthroscopy or arthrotomy?

arthrotomy is worse

66

T/F: short term medical management of elbow OCD has a good prognosis

FALSE- expect long term treatment

67

How does stifle joint OCD present?

young, large breed dog w/ hindlimb lameness

stifle effusion and crepitus

68

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

69

What does this radiograph show?

Q image thumb

OCD of the stifle joint

70

Tarsus OCD is seen in what dogs?

large breeds- Rotties

71

How does Tarsus OCD present?

unilateral hindlimb lameness- acute vs chronic- worse after activity or rest

72

When examining OCD of the tarsus, the P will exhibit pain when?

flexing the hock

73

Radiographic signs of an OCD tarsus

radiolucent concavity on medial (more frequent) 

or lateral trochlear ridge of talus

74

Tarsus OCD prognosis

gaurded to poor

75

_____ is ideal for treatment of tarsus OCD

arthroscopy

76

T/F: arthrotomy and fragment removal may be no better than medical management for tarsus OCD

TRUE

77

T/F: surgery for tarsus OCD will prevent the development of OA

FALSE: does not prevent

78

T/F: surgery for tarsus OCD will eliminate the lameness

FALSE: does not eliminate the lameness

surgery improves function somewhat

79

End stage OCD is also known as?

DJD

80

Prognosis of OCD is dependent on?

when diagnosis was made and level of DJD present

 

81

List the joints in order of best prognosis to least for OCD

shoulder

stifle

elbow

tarsus