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Flashcards in Sx of the shoulder Deck (72):
1

T/F: Immune mediated polyarthritis is an inflammatory arthropathy

true

2

What causes biceps brachii tendinopathy?

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

3

Origin of biceps brachii tendiopathy?

Travels in what groove?

Insertion?

origin: supraglenoid tubercle (intra-articular)

travels in intertubercular groove

insertion: medial tuberosity of proximal radius and adjacent ulna

A image thumb
4

The biceps brachii is constrained by the _____

transverse retinaculum

5

Biceps Brachii Tendinopathy presents in what dogs?

mature adults

medium and large breeds

6

Biceps Brachii Tendinopathy clinical signs presentation

weight bearing lameness that is:

chronic, intermittent

progressive

lameness worsens w/ exercise

unilateral

7

Biceps Brachii Tendinopathy physical exam findings

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

 

A image thumb
8

How do we dx Biceps Brachii Tendinopathy?

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

US

MRI

arthroscopy**

9

What is the "skyline" radiographic view also known as?

cranioproximal-craniodistal

( not commonly used given modern modalities )

10

Pros and cons of ultrasound for dx of Biceps Brachii Tendinopathy

pros: noninvasive

cons: requires experience

11

Pros and cons of MRI used for dx Biceps Brachii Tendinopathy

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

Con: over/underinterpretation possible

12

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

diagnostic AND therapeutic

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

13

Treatment for acute Biceps Brachii Tendinopathy?

confinement for 4-6 weeks

non-steroidal anti-inflam drugs

+/- physical therapy

 

14

Treatment options for recurrent/persistent lameness Biceps Brachii Tendinopathy

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

15

Indications to do surgery for Biceps Brachii Tendinopathy

medical therapy not working

ruptured biceps tendon

chronic bicipital tenosynovitis

moderate to severe lameness

16

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

must ensure all other supporting structures are intact

17

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

what is that procedure called?

False- make sure other tendons are normal

tenotomy

18

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

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

19

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

FALSE: it changes the normal function

20

Prognosis for medical tx of Biceps Tendinopathy?

good to poor

lack of confinement

PT improves results

21

Prognosis for surgical tx of Biceps Tendinopathy?

good to excellent

tenotomy- excellent (easy just to cut it)

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

22

Shoulder instability does what to the range of motion?

abnormally increases it

23

Shoulder instability is _____ in the supporting structures of the shoulder

laxity

24

What are the supporting structures of the shoulder?

medial/lateral glenohumeral ligaments

joint capsule

subscapularis tendon (medial)

teres minor, supra- and infraspinatus (lateral)

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 _____