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SAS FINAL > Sx of the shoulder > Flashcards

Sx of the shoulder Flashcards

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1
Q

T/F: Immune mediated polyarthritis is an inflammatory arthropathy

A

true

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2
Q

What causes biceps brachii tendinopathy?

A

repetitive strain microtrauma

injury w/ tendon fiber disruption

acute to chronic inflam of tendon and associated synovial tissues

both acute and chronic inflam present histopathologically

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3
Q

Origin of biceps brachii tendiopathy?

Travels in what groove?

Insertion?

A

origin: supraglenoid tubercle (intra-articular)

travels in intertubercular groove

insertion: medial tuberosity of proximal radius and adjacent ulna

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4
Q

The biceps brachii is constrained by the _____

A

transverse retinaculum

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5
Q

Biceps Brachii Tendinopathy presents in what dogs?

A

mature adults

medium and large breeds

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6
Q

Biceps Brachii Tendinopathy clinical signs presentation

A

weight bearing lameness that is:

chronic, intermittent

progressive

lameness worsens w/ exercise

unilateral

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7
Q

Biceps Brachii Tendinopathy physical exam findings

A

muscle atrophy

pain

  • maximally flex shoulder and extend elbow
    • deep palpation over intertubercular groove
    • apply tension to biceps insertion
  • standing exam, under load: tension to biceps
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8
Q

How do we dx Biceps Brachii Tendinopathy?

A

rads (cant see tendons so use to rule out other shit)

US

MRI

arthroscopy**

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9
Q

What is the “skyline” radiographic view also known as?

A

cranioproximal-craniodistal

( not commonly used given modern modalities )

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10
Q

Pros and cons of ultrasound for dx of Biceps Brachii Tendinopathy

A

pros: noninvasive
cons: requires experience

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11
Q

Pros and cons of MRI used for dx Biceps Brachii Tendinopathy

A

Pros: cross-sectional anatomy of all soft tissues, identify concurrent problems

Con: over/underinterpretation possible

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12
Q

Why is arthroscopy the golden standard dx for Biceps Brachii Tendinopathy?

A

diagnostic AND therapeutic

practical considerations: if PE suggestive, often used in lieu of other imaging and lateral/craniocaudal radiographs + arthroscopy

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13
Q

Treatment for acute Biceps Brachii Tendinopathy?

A

confinement for 4-6 weeks

non-steroidal anti-inflam drugs

+/- physical therapy

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14
Q

Treatment options for recurrent/persistent lameness Biceps Brachii Tendinopathy

A

moderate/acute signs

intraarticular/bicipital tendon sheath infiltrated corticosteroid injection

methylprednisolone acetate (depo-medrol)

sample joint for fluid analysis/culture

strict confinement, 4-6weeks

physical therapy

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15
Q

Indications to do surgery for Biceps Brachii Tendinopathy

A

medical therapy not working

ruptured biceps tendon

chronic bicipital tenosynovitis

moderate to severe lameness

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16
Q

Biceps Brachii Tendinopathy surgery with arthroscopy: we must ensure that?

A

must ensure all other supporting structures are intact

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17
Q

T/F: We can go right in and cut the tendon for a Biceps Brachii Tendinopathy case

what is that procedure called?

A

False- make sure other tendons are normal

tenotomy

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18
Q

What is the surgical procedure called that may be used to treat Biceps Brachii Tendinopathy? Describe the procedure briefly

A

Tenodesis

cut biceps tendon and then move it to a lateral or medial location

new location

maintains most of its function but takes away from the area where it is chronically inflammed

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19
Q

T/F: Tenotomy does not change the normal function of the biceps tendon

A

FALSE: it changes the normal function

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20
Q

Prognosis for medical tx of Biceps Tendinopathy?

A

good to poor

lack of confinement

PT improves results

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21
Q

Prognosis for surgical tx of Biceps Tendinopathy?

A

good to excellent

tenotomy- excellent (easy just to cut it)

tenodesis- “classic” tx, good results, arthroscopic assistance 6/6 = excellent

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22
Q

Shoulder instability does what to the range of motion?

A

abnormally increases it

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23
Q

Shoulder instability is _____ in the supporting structures of the shoulder

A

laxity

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24
Q

What are the supporting structures of the shoulder?

A

medial/lateral glenohumeral ligaments

joint capsule

subscapularis tendon (medial)

teres minor, supra- and infraspinatus (lateral)

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25
T/F: repetitive microtrauma can cause shoulder instability
true: "overuse" injury
26
80% of shoulder instabilities are _____ (which side?)
medial
27
Signalment seen commonly with shoulder instability?
medium/large breed dogs adults
28
What is the usual hx of a P w/ shoulder instability?
+/- active dog variable lameness: usually subtle, intermittent, occasionally severe poor response to rest and NSAIDs
29
What signs do we see when doing a physical on a dog with shoulder instability?
muscle atrophy pain on manipulation of joint medial instability: increased abduction angle, exam requires sedation
30
Describe the normal and abnormal shoulder abduction angles
normal: 30 abnormal: 50 many clinical cases fall b/t 30-50
31
What are the variables in shoulder abduction angle?
variability b/t breeds and individuals
32
How do we make a diagnosis for shoulder instability using the increased abduction angle?
diagnosis: compare with the contralateral limb
33
How do we diagnose shoulder instability?
radiographs MRI arthroscopy
34
How good are rads at diagnosing shoulder instability?
standard views rule out other conditions normal or nonspecific degenerative changes
35
T/F: MRI may overdiagnose severity of shoulder instability
FALSE: underdiagnose
36
What is the best way to evaluate/diagnose shoulder instability?
arthroscopy- diagnostic and therapeutic if PE is supportive
37
What is the treatment for mild shoulder instability?
rest, PT, hobbles
38
What is the tx for moderate shoulder instability?
arthroscopic radiofrequency shrinkage of attenuated ligaments and joint capsule thermal insult induces repair weakens tissue before it strengthens rest, PT, hobbles
39
What is the tx for severe shoulder instability?
medial glenohumeral ligament reconstruction velpeau sling instead of hobbles
40
Hobbles for shoulder instability.... post op rehab is how long? how long is activity restricted? retraining begins when?
3 w 3-4 m 4-6 m
41
What do we use after surgical repair for more severe shoulder instability?
slings velpeau sling 2-4 weeks postop
42
After shoulder surgery, how long does the animal wear hobbles?
3-4 months (after the sling was on for 2-4 weeks)
43
How long is recovery for should instability surgery?
4-6 months
44
\_\_\_\_\_\_: muscle shortening not caused by active contraction
contracture
45
What is infraspinatus contracture?
acute, traumatic disruption of muscle fibers
46
With infraspinatus contracture, the normal muscle-tendon unit is replaced with?
fibrous tissue
47
Fibrosis and contracture are secondary to \_\_\_\_
necrosis
48
T/F: there has been no documentation of supraspinatus contracture
False: similar lesions have been documented
49
What animals do we see infraspinatus contracture in?
active, adult, medium to large breed dogs hunting breeds: spaniels, pointers, retrievers
50
infraspinatus contracture: acute lameness subsides in ____ days
10-14 days
51
infraspinatus contracture: chronic static lameness occurs ____ after acute
2-4 weeks later
52
How does an animal present when they have infraspinatus contracture?
non-painful, non-weightbearing lameness
53
infraspinatus contracture: _____ rotation of the shoulder and ____ displacement of the elbow
external internal
54
Infraspinatus contracture physical exam findings: the scapulohumeral joint cannot be ____ rotated. What happens when the shoulder is rotated?
internally scapula elevates
55
T/F: on phyical exam for a P with infraspinatus contracture, they have pain on manipulation of the joint
False- usually no pain
56
infraspinatus contracture on PE has ____ range of motion
limited
57
Treatment options for infraspinatus contracture? Prognosis?
conservative treatment unhelpful tenectomy of infraspinatus tendon release other capsular adhesions physical therapy is ideal prognosis: excellent
58
Traumatic shoulder luxation signalment and hx
any breed or age of dogs, rare in cats hx of trauma or evidence of injury acute onset
59
PE traumatic shoulder luxation findings
non weight bearing lameness pain on palpation of shoulder _malpositioning of greater tubercle_
60
Traumatic shoulder medial luxation: distal limb \_\_\_\_\_ Traumatic shoulder lateral luxation: distal limb \_\_\_\_\_
medial: abducted lateral: adducted
61
What is the most common traumatic shoulder luxation?
**medial is most common**
62
Nomenclature for traumatic shoulder luxation
named for the position of the humeral head relative to the glenoid
63
What are the indicatoins for closed reduction treatment for traumatic shoulder luxaton?
recent injury, no fractures
64
What is the closed reduction treatment for traumatic shoulder luxaton?
general anesthesia distract limb, move humerus toward glenoid stable joint; apply coaptation for 2 weeks- velpeau sling for medial luxation or spica (for lateral, cranial, caudal luxation)
65
Indications for surgical treatment of traumatic shoulder luxation?
chronic/recurrent/unstable luxation accompanying fractures
66
Describe the surgery for traumatic shoulder luxation
open reductoin + ligament repair: simple arthrotomy to evaluate/reduce joint imbrication (tight closure)/repair of capsule during closure glenohumeral ligament reconstruction
67
What is the prognosis for traumatic shoulder luxation?
good to excellent
68
T/F: Most traumatic shoulder luxations are amenable to closed reduction
true
69
T/F: closed reduction for traumatic shoulder luxaton is generally not successful
FALSE: generally successful
70
Does closed reduction for traumatic shoulder luxation restore normal joint function?
yes
71
Goal of open reduction for traumatic shoulder luxation?
to maintain normal joint motion function is typically good long term
72
Open reduction for traumatic shoulder luxation consists of reconstruction of _____ and \_\_\_\_\_

SAS FINAL (4 decks)

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