Pelvic Limb Flashcards
1
Q
What cause intrinsic/ passive stability of the lumbar spine?
A
Ligaments
Facets
Discs
2
Q
What cause extrinsic/ active stability of the lumbar spine?
A
Core muscles
3
Q
What is spinal arthritis and what can occur secondary to this?
A
Degenerative joint disease of articular facets
- Cause bony and soft tissue proliferation
- Can result in spinal cord compression and pain
- ROM decreases
- Can cause muscle spasms
- Decreases performance in working dogs
4
Q
What does spondylosis occur?
A
- New bone is laid down when hypermobility occurs in a joint
5
Q
What type of IVDD occurs with lumbosacral instability?
A
Type II
6
Q
What is the pathway of force transfer from the hind limb to the lower back
A
Limb –> sacrum –> L7
7
Q
What is the weight-bearing axis of the pelvis?
A
Acetabulum
Ilial body
SI joint
Sacrum
8
Q
In what direction do sacroiliac luxations occur? When is surgical correction indicated?
A
Craniodorsal
When significant displacement or neuro deficits are noted
9
Q
What is an uncommon sequelae to femur fractures in young dogs?
A
Quadriceps contracture
Occurs when blood supply to fracture increases, surrounding quadriceps mm becomes enveloped in callous and fibrous tissue
Usually occurs secondary to long-term coaptation or soft tissue trauma
10
Q
What parts of the leg are affected by quadriceps contracture? Is this extended or flexed?
A
Rigid extension of stifle and tarsus
Leg cannot be flexed due to muscles becoming fibrotic and contracted
11
Q
What surgical treatment options are used for quadriceps contracture?
A
Z-plasy - lengthens quadriceps tendon
12
Q
What is the long-term prognosis with QC
A
- Guarded
- Early intervention is best option for good prognosis
13
Q
What is a muscle strain?
A
Contraction of the muscle when it is elongated
14
Q
What is a grade 1 muscle strain
A
Few fibers are disrupted
- E.G hematoma
15
Q
What is a grade 3 muscle strain?
A
Muscle is completely ruptured
16
Q
Why do you not want scar tissue to form with muscle strains?
A
- Predisposition to future injury (scar tissue is weak)
- Muscle strength decreases ~ 50 %
17
Q
What is the difference between strain and sprain?
A
- Strain occurs with muscles and tendons
- Sprains occur with ligaments
18
Q
What soft tissue structures are most at risk of injury?
A
- Those crossing multiple joints
- Occurs at myotendinous junction
- Most common are hip flexors, adductors, and hamstrings
19
Q
What types of treatments/ rehab are needed for muscle injury?
A
- Rest and immobilization for 3-5 days, include ice and NSAIDs
- Controlled remobilization for 4-6 weeks
- Reduce scar tissue with manual therapy
20
Q
What is a common cause of iliopsoas strain?
A
Secondary to sporting injury
21
Q
What muscles are involved with fibrotic myopathy?
A
Gracilis and semitendinous
22
Q
What is the common presentation for fibrotic myopathy?
A
- GSD/ Belgian Shepherds
- ~5 YO
- 80 % male
- 25 % bilateral
23
Q
What is the appearance of the gait with fibrotic myopathy?
A
- Shortened stride
24
Q
How is the hind limb positioned with fibrotic myopathy?
A
- Rapid, elastic internal rotation of paw
- Extenral rotation of tuber calcani
- Internal rotation of stilfe during middle and late swing phase
- Best visualized behind dog
25
What region of the muscle is painful on palpation with fibrotic myopathy?
Insertion
26
What are the stabilizers of the tarsus?
Joint congruity
Collateral ligaments
Plantar fibrocartilage
27
Where is osteochondrosis dissecans commonly seen in the hock?
Medial aspect of the talus
Palpates as firm swelling of the calcaneus
28
What muscles make up the Achilles tendon
```
Gastrocnemius
Biceps femoris
Semitendinosis
Gracillis
Superficial digital flexor
```
29
What is the function of the common calcanean tendon
Tarsal extension and stifle flexion
Also used in cranial tibial thrust
30
What breeds are most commonly affected with gastroc avulsion?
Labs and dobermans
31
What PE findings are noted with partial Achilles ruptures?
Extended stifle
Flexed hock
Flexed digits (secondary to stretch of the superficial digital flexor tendons)
32
How are partial Achilles Tendon tears diagnosed? Treated
Dx: U/S
Tr: ESWT
- Coaptation
33
What PE findings are noted with complete tear of Achilles tendon?
Plantigrade stance
- Needs to be surgically corrected
34
What is the role of rehab in the cancer patient
- Complimentary to therapy
| - Exercise helps with cancer fatigue and functional activity/ immune function in people
35
What are some cancers of the nervous system?
Brachial plexus
Nerve root
Spinal tumours
Brain tumors
36
What are the stabilizers of the coxofemoral joint?
- Ligament of femoral head
- Acetabular rim
- Joint capsule
- Gluteal muscle and pectineus mm
- Rotators and flexors
37
What is coxa-vara and what conditions are typically seen with this?
- Bow-legged
- Decreased transverse plane
- Seen with medial patellar luxation
38
What is coxa-valga and what conditions are typically seen with this?
- Increased transverse plane
| - Seen with hip dysplasia
39
What is hip dysplasia?
- Abnormal growth/ development of hip joint
- Usually bilateral
- Laxity leads to malformation of femoral head and acetabulum and eventually DJD
40
What is the signalment for hip dysplasia
- Castrated male dogs
| - Typically bimodal
41
What clinical signs are seen with hip dysplasia early in the disease? Later in the disease?
- Early: 2-12 months: joint laxity
| - Later: 1-4 YO DJD
42
What is degenerative joint disease?
- Degradation of articular cartilage adn subchondral bone
| - Usually secondary to another underlying condition
43
What clinical signs are noted with early stages of hip dysplasia?
- Acute onset
- Diminished activity
- Sore hind quarters
- Reluctance to rise
- Bunny hopping gait
- Small pelvic muscles
- Positive Ortolani sign
44
What clinical signs are noted with late stages of hip dysplasia?
- Chronic onset
- Waddling gait
- Decreased ROM and crepitus
- Slow to rise
- Increased chest musculature, decreased pelvic muscle
- Usually Ortolani negative
45
What important factors can reduce the severity of hip dysplasia?
- Slowing growth rate
| - Weight control
46
What other orthopedic condition can be mistaken for hip dysplasia?
- Cranial cruciate ligament rupture
47
What is the age cut-off for juvenile pubic synphysiodesis
- Performed under 20 weeks old
- Closes pubic growth plate --> leads to increased acetabular coverage of femoral heads
- Good for mild-moderate laxity
48
What structures are cut for a triple pelvic osterotomy?
- Pubis, ischium, and ilium
| - Appkly pre-bent plates to cuts
49
What is the recommended age for a triple pelvic osterotomy?
- 5-8 months
| - Perform before DJD sets in
50
What is the complication rate of total hip replacements?
- 5-30%
| - e.g infection, luxation, loosening, shaft fractures
51
What must be removed for an FHO?
Must remove bone-on-bone contact --> removes pain
- Must completely remove femoral head and neck
- Needs rehab ASAP due to joint becoming muscular rather than bone
52
What PE signs are noted with coxofemoral luxations?
- Non-weight bearing
- Hock and foot adducted
- Stifle externally rotated
53
When is a closed reduction of a coxofemoral luxation indicated?
- No hip dysplasia
- Occurred < 5 days ago
- Keep in Ehmer sling for 10 days
54
When is are surgical treatments of a coxofemoral luxation for a non-dysplastic hip? Dysplastic hip?
Non-dysplastic: open reduction + toggle pin or iliofemoral suture
Dysplastic: FHO or THR
55
What is a common presentation of Legg-Calve-Perthes dz?
- Small breed dogs, 5-8 months, chronic progressive lameness
56
What clinical signs are noted with Legg-Calve-Perthes dz?
- Decreased ROM
- Crepitus
- Muscle atrophy
57
How do you diagnose and treat LCP dz?
- Rads
| - Treat with FHO or THR
58
What are the active stabilizers of the stifle? Passive?
Active: Muscles
Passive: cruciate ligaments, joint capsule, collateral ligaments, menisci
59
What condition can be seen with dogs with medial patellar luxation?
- 40% have CrCL tears
60
What PE findings are noted with dogs with MPL?
- Occ hopping, skipping, reluctance to jump
61
What condition can be seen concurrently with lateral patellar luxation?
- Hip osteoarthritis
62
What is the treatment recommendation for patellar luxations?
- Grade I and II can be treated with rehab early on
| - Grade III and IV should be surgically corrected
63
What types of osteotomies can be used to treat patellar luxations?
- Trochleoplasty (wedge, block recession)
- Tibial tuberosity transposition
- Distal femoral ostectomy
64
What soft tissue surgeries can be performed for patellar luxations?
- Lateral/ medial imbrications
- Lateral/ medial release
- Anti-rotational suture
65
What are the functions of the Cr Cruc Lig?
- Limit cranial drawer
- Limit hyperextension
- Limit internal rotation
66
What are the two bands of the cranial cruciate ligament? When is tension/ tightness felt on these bands?
- Craniomedial band (smaller): tight in flexion and extension
- Caudolateral band (larger): loose in flexion, tight in extension
67
What band are partial tears noted in? When can you notice this?
- Craniomedial band
| - Cranial drawer noted only in flexion and non-weight bearing
68
What are the functions of the meniscus?
Load transmission and shock absorption
69
What is a normal tibial plateau angle? Abnormal?
Normal: 25 degrees
Abnormal: >35 degrees
Larger angles associated with cranial cruciate tear
70
What are the passive stabilizers of the stifle?
- CrCL
- Mensici
- Collateral ligaments
71
What are the active/ dynamic stabilizers of the stifle?
- Hamstrings
- Quadriceps
- Gastroc
72
What test can you perform to assess for stability of the cranial cruciate ligament?
- Cranial drawer: test in flexion and extension - Tests for passive stabilizers (CCL)
- Tibial thrust: test in normal standing angle - mimics the forces dogs will be and experiencing when standing and active stabilizers
- Internal rotation
73
What percentage of Cr CL is bilateral?
50%
74
What is the causes of cranial cruciate ligament rupture?
Unknown
- Developmental/ genetic
- Immune-mediated
- Metabolic (fat metabolism vs nutrient deficiency)
- Hormonal: early spay/ neuter, thyroid function,
- Obesity
75
What physical exam findings are noted with cruciate rupture?
- During walking - weightbearing lameness, (
- During standing eval: hip and stifle flexion, hock extension
- On palpation: pain on extension, +/- meniscal click
76
What clinical signs are eliminated with extra-capsular suture?
- Eliminates cranial drawer, tibial thrust, internal rotation
77
What clinical signs are reduced with osteotomies? What are still present?
- Eliminates cranial tibial subluxation
| - Cranial drawer still present
78
Why do TPLO/ TTA work so quick?
- Passive stability immediately improved
| -
79
What region of the meniscus is damaged during a cruciate ligament tear?
Caudal pole of medial meniscus
80
What are pros and cons of meniscal release?
- Pros: decreases subsequent injury,
| - Cons: eliminates function (shock absorption), develops OA, does not eliminate future injury
81
What are side-effects to stifle procedures?
- Decreased weight-bearing secondary to quadriceps inhibition
- Decreased ROM
- Lumbar muscle and iliopsoas discomfort
- Compensation to other limbs
82
Where the cranial cruciate ligament originate and insert?
Originates at caudal aspect of lateral condyle
Inserts at cranial aspect of tibia
83
Where does the medial mensicus attach? Lateral mensicus?
- Medial attaches to proximal tibia - More likely to be crushed under femoral condyle
- Lateral attaches to femur (meniscofemoral ligament)
- Poor healing due to poor blood supply
84
What are the landmarks for cranial drawer test
Proximal femur: patella with thumb on fabella
| Distal hand: fibular head and tibial tuberosity
